Is it possible to recommend safe drinking levels without increasing per capita consumption? Another aspect of the prevention paradox

Associations between alcohol intake and hospital contacts due to alcohol and unintentional injuries in 71,025 Danish adolescents - a prospective cohort study

Background

Alcohol is a leading risk factor to adolescent health. However, it is unclear how associations between alcohol intake and injuries are shaped. We investigated the dose-response relationship between alcohol intake and risk of hospital contacts due to alcohol and unintentional injuries in adolescents.

Methods

We conducted a prospective cohort study including 71,025 Danish students aged 15-24 years, followed up for five years from 2014 to 2019. The main outcome measures were hospital contacts due to alcohol and unintentional injuries (all injuries and head injuries), obtained from hospital registers.

Findings

Approximately 90% of males and females reported drinking alcohol, and the median intake among those was 11 drinks/week in males and 8 drinks/week in females. During five years of follow-up, 1.3% had an alcohol-attributable hospital contact, the majority of which were due to acute intoxication (70%). Alcohol-attributable hospital contacts were equally frequent in males and females and between age groups (15-17-year-olds vs 18-24-year-olds). Compared with never drinking, the adjusted incidence rate ratios for weekly intake of <7, 7-13, 14-20, 21-27, and >27 drinks/week were 1.70 (95% confidence interval 1.23-2.34), 1.77 (1.27-2.46), 1.91 (1.35-2.70), 2.34 (1.59-3.46), and 3.25 (2.27-4.64) for having an alcohol-attributable hospital contact within five years of follow-up. Restricting follow-up to one year more than doubled risk estimates. During the five years of follow-up, 27% incurred an unintentional injury. The most frequent types of injury were to the wrist or hand (27.6%), ankle or foot (25.2%), or head (12.4%). Injuries were more frequent among males (first-time incidence rate 110 per 1000 person-years) compared to females (82 per 1000 person-years), with no differences between age groups. Compared with never drinking, the adjusted incidence rate ratios for weekly intake of <7, 7-13, 14-20, 21-27, and >27 drinks were 1.09 (1.03-1.15), 1.14 (1.07-1.20), 1.25 (1.17-1.33), 1.38 (1.28-1.49), and 1.58 (1.47-1.69) for having a hospital contact for any type of unintentional injury within five years of follow-up. Results for the one-year follow-up period were comparable. Separate analysis for head injuries showed similar results as the analysis on all injuries. Results were generally similar in males and females.

Interpretation

Adolescents' drinking is associated with a higher risk of acute harm in terms of hospital contacts due to alcohol and unintentional injuries in a dose-response relationship. Thus, increased risk was apparent in those with low alcohol intake, suggesting a need for awareness of and initiatives to prevent youth drinking. Furthermore, initiatives should include a strengthened focus on people younger than 18 years.

Funding

This study was funded by the Tryg Foundation (ID: 153539) and The Helse Foundation (21-B-0359).

Immediate effects on adult drinkers of exposure to alcohol harm reduction advertisements with and without drinking guideline messages: experimental study

AIMS

To compare the immediate effects on drinkers of television advertisements focusing upon short- versus long-term harms with and without low-risk drinking guidelines.

DESIGN

Between-participants on-line experiment, with random assignment to view: (a) alcohol product advertisements (ALC control); (b) advertisements unrelated to alcohol (NON-ALC control); (c) advertisements featuring short-term harms (STH) of alcohol; (d) advertisements featuring STH plus a STH guideline (STH+G); (e) advertisements featuring long-term harms (LTH); or (f) advertisements featuring LTH plus a LTH guideline (LTH+G).

SETTING

Australia, 2016.

PARTICIPANTS

A total of 3718 drinkers aged 18-64 years (48.5% male).

MEASUREMENTS

Post-exposure likelihood that participants provided a correct estimate of drinking levels associated with short- and long-term harms; post-exposure intentions to avoid alcohol or reduce consumption.

FINDINGS

After exposure to STH+G or LTH+G advertisements, participants were more likely to estimate correctly rather than overestimate drinking levels associated with harm, compared with those exposed to STH (P < 0.001) and LTH advertisements without guidelines, respectively (P = 0.019) and ALC control (STH+G, P < 0.001; LTH+G, P < 0.001) and NON-ALC control conditions (STH+G, P < 0.001; LTH+G, P = 0.011). Drinkers exposed to STH conditions were more likely to intend to reduce next-week alcohol consumption than those exposed to ALC control (both P < 0.001) and NON-ALC control conditions (STH, P = 0.001; STH+G, P < 0.001); a similar pattern was observed for intentions to avoid alcohol. Drinkers exposed to LTH conditions were also more likely than drinkers exposed to ALC or NON-ALC controls to intend to avoid and reduce alcohol in the next week. Additionally, drinkers exposed to LTH+G were more likely to intend to reduce drinking than those exposed to LTH advertisements without guidelines (P = 0.022). Response patterns for low- and high-risk drinkers by condition were similar.

CONCLUSIONS

Alcohol harm television advertisements increase intentions to reduce alcohol consumption among both low- and high-risk drinkers. The addition of low-risk drinking guidelines can enhance these effects for advertisements featuring long-term harms and improve estimates of both short- and long-term harmful drinking levels.

Alcohol use during pregnancy: considerations for Australian policy

Although there is an extensive recorded history of concerns related to alcohol exposed pregnancies and possible outcomes of fetal alcohol spectrum disorder in recent scientific literature, Australia has only recently begun to accurately or systematically diagnose and record these conditions, or to provide comprehensive, coordinated, policy-guided funding, prevention, and treatment. This article discusses some considerations that can guide policy development within the Australian context including the social context and determinates of alcohol consumption during pregnancy and the need to consider the issue as one that goes beyond the decision making of individual women. The article also identifies the contribution of research to guide evidence-based policy development, including emerging evidence of epigenetics, and systematic reviews for prevention. Other policy considerations include costs, and the possibility of the prevention paradox applying to this field, with its associated impact on costs and focus of prevention.

Perceptions of low-risk drinking levels among Australians during a period of change in the official drinking guidelines

INTRODUCTION AND AIMS

In 2009, the National Health and Medical Research Council released a revision of Australia's official low-risk alcohol guidelines, specifying low-risk consumption levels for both short- and long-term consumption. This study aims to assess how the general population's assessment of low-risk drinking levels compares to these guidelines and to examine whether the changes to the official guidelines corresponded with changes in perceptions of low-risk drinking levels in the population.

DESIGN AND METHODS

The study uses two waves of a large, general population survey which was run in 2007 (n = 19 818) and 2010 (n = 26 648), providing before and after measures of respondents' estimates of low-risk drinking levels.

RESULTS

In the 2010 survey, less than 5% of respondents estimated low-risk drinking levels that matched those in the 2009 guidelines. Generally speaking, younger respondents and heavier drinkers provided higher estimates of low-risk drinking thresholds. There was little change in estimates between 2007 and 2010, although there was some evidence that the changes to the guidelines had influenced perceptions of safe drinking.

CONCLUSIONS

There is very little knowledge of the official drinking guidelines among the general Australian population. If drinking guidelines are to have any effect on levels of consumption, a more concerted effort to publicise them is necessary.

Lying down with the lion: co-operating with the alcohol industry? The 1991 Leonard Ball Oration

The author examines the extent to which the alcohol industry, while purporting to be a responsible industry sensitive to the potential harm associated with alcohol, has attempted to subvert the efforts of those seeking to reduce that harm. Reference is made to recent attempts to circumvent the advertising code, exaggerate the beneficial health effects of alcohol, co-opt the NH & MRC guidelines regarding responsible drinking and minimize community support for control measures. Notwithstanding these manifestations of the industry's duplicity, it will be argued that the lion and the sheep will need at some stage to lie down together if the alcohol industry is not to suffer the same fate as the tobacco industry. It will be suggested that among the issues on which both sides might co-operate are the advertising and promotion of alcohol, the responsible serving of alcohol and the design of the licensed drinking environment. It will, moreover, be argued that such co-operation is in the long-term interest of the alcohol industry, which like any other must be responsive to community concerns.

Health beliefs relating to alcohol and other drug use in the Australian population

This study uses data from a nationally representative population survey conducted in March and April 1993 to examine alcohol and other drug-related health beliefs within the Australian population. The results show widespread ignorance about the causes of drug-related mortality, with 43 percent of respondents believing that alcohol is the major cause of drug-related premature death. Only 32 percent of the respondents mentioned tobacco as the major cause of death. Those who identified tobacco as the drug causing the greatest number of deaths were more likely to be male, young, Australian or British-born, and better educated. Women were more accurate in their assessment of the risk levels associated with alcohol consumption than men, as were the young and the better educated. There is widespread public knowledge about the risks that are associated with passive smoking. Overall, the results point to the need to focus health promotion and awareness campaigns on the groups that have so far proved most immune to health messages, namely, heavy drinkers and smokers.

DSM-IV alcohol dependence and drinking in the U.S. population: a risk analysis

PURPOSE

This paper examines the relationship between alcohol dependence according to the criteria found in the 4th edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association and drinking in the U.S. general population.

METHODS

The data set under analysis is the 1988 National Health Interview Survey, which interviewed a probability sample of 22,102 adult drinkers in the U.S. household population. The response rate was 86%.

RESULTS

Results indicate that there is a linear relationship between DSM-IV dependence and the mean number of drinks consumed per day, or the number of days drinking five or more glasses of alcohol in the past 12 months. Respondents who reported consuming five or more drinks in a day have about six times more chances of being dependent than respondents who did not report such pattern of drinking. Older drinkers are less at risk than younger drinkers.

CONCLUSIONS

There is a risk of alcohol dependence at relatively low volumes of consumption. The risk increases gradually with the volume of consumption. An added and higher risk exists when drinkers engage in a pattern of consumption involving the ingestion of five or more drinks per day.

Risk functions for alcohol-related problems in a 1988 US national sample

To assess the relationship of alcohol use and three types of alcohol-related problems (ICD-10 dependence syndrome, work problems and drunk driving), risk curves were developed for average number of drinks per day during last year (volume) and number of days drinking five or more drinks during one day (5+). Using data from the 1988 National Health Interview Alcohol Supplement, risk curves were derived from data on 22,102 current drinkers who consumed at least 12 drinks in the last year. The emphasis in this analysis was on the proportion of drinkers at lower levels reporting different types of problems. The results indicate that even at lower levels of drinking (volume averaging one or fewer drinks/day) there is considerable risk for drunk driving and less risk for work problems and alcohol dependence. The risk for all types of problems at lower and moderate levels of drinking was significantly higher for respondents who had five or more drinks during one day in the last year. These findings underscore the importance of examining risk (physical and social) at lower levels of drinking and for using both overall volume and heavier quantity per occasion drinking measures when assessing risk for any alcohol-related problem.

Alcohol consumption across the lifecycle in Australia, 1985-1988

National studies show an overall decline in alcohol consumption across a range of developed countries. Using national population survey data collected in 1985 and 1988 in Australia indicate a decline in alcohol consumption with a differential impact upon particular age and sex groups. In particular, the results support Ledermann's prediction that as consumption declines, heavy drinkers will decline disproportionately. This trend is particularly notable among women. While overall levels of alcohol consumption have remained stable among the young, the pattern for women is for a uniform decrease in consumption, for men, a decrease in the older age groups. Various possible explanations for these trends are discussed.