Association between concurrent alcohol and tobacco use and poverty

Polysubstance use in South Asia

PURPOSE OF REVIEW

Polysubstance use is very common in the world, but there has been limited research in this area. South Asia is sandwiched between two of the world's largest heroin producing areas: the Golden Crescent and the Golden Triangle. The burden and prevalence of polysubstance use have not been estimated in this region of the world. We review the research findings on polysubstance use in different South Asian countries. The review also comments on the gaps in knowledge regarding polysubstance use in this region of the world.

RECENT FINDINGS

The available literature on polysubstance use from South Asia suggests its widespread presence in the region, ranging from 20 to 90%, more commonly among illicit opioid drug users and injection drug users. Most of the available data is from epidemiological studies. There are few studies on the adverse effects of polysubstance use, but the limited data clearly suggests an elevated risk of comorbid psychopathology and health problems.

SUMMARY

Polysubstance use still lacks a consensus definition. There is a need of more research on its prevalence, effects on health, and prevention and treatment.

Trends in concurrent tobacco use and heavy drinking among individuals 15 years and older in Mongolia

The study aimed to evaluate trends in the prevalence and correlates of current tobacco use only (= CT), current heavy drinking only (= CHD), and current tobacco use and current heavy drinking (= CTHD) in people 15 years and older from 2009 to 2019 in Mongolia. Cross-sectional data were analyzed from 5,438 individuals (15-64 years) of the Mongolia STEPS 2009 survey, 6,013 (15-69 years) of the Mongolia STEPS 2013 survey, and 6,654 persons (15-69 years) of the Mongolia STEPS 2019 survey and responded to questions about substance use, other health risk behaviours and physical measurements. Trend analysis shows that the prevalence of CT increased from 14.4% in 2009 to 15.3% in 2019, and the prevalence of CHD significantly decreased from 13.3% in 2009 to 10.3% in 2019, and the prevalence of CTHD significantly decreased from 14.2% in 2009 to 9.4% in 2019. Middle and older age, male sex (13 times higher for CT, 3.4 times higher for CHD, and 28 times higher for CTHD) and high physical activity significantly increased the odds of CT, CHD and CTHD. Higher education decreased the odds of CT but increased the odds of CHD. Urban residence was positively associated with CT, and among women with CTHD. Underweight decreased the odds of CT, CHD, and CTHD, and obesity decreased the odds of CT and CTHD and increased the odds of CHD. Hypertension was positively associated with CHD and CTHD, while sedentary behaviour was positively associated with CT and CTHD. Being Khalkh by ethnicity increased the odds of CT and inadequate fruit and vegetable intake increased the odds of CHD. More than one in six persons 15 years and older engaged in CT and more than one in ten engaged in CHD and CTHD. Several sociodemographic factors, such as male sex and middle and/or older age, and health variables, such as obesity and hypertension for CHD, were identified associated with CT, CHD, and CTHD that can help in guiding public interventions.

Tobacco Use Disorder

Tobacco use disorder is highly prevalent; more than a billion individuals use tobacco worldwide. Popular views on the addictive potential of tobacco often underestimate the complex neural adaptations that underpin continued use. Although sometimes trivialized as a minor substance, effects of nicotine on behavior lead to profound morbidity over a lifetime of exposure. Innovations in processing have led to potent forms of tobacco and delivery devices. Proactive treatment strategies focus on pharmacotherapeutic interventions. Innovations on the horizon hold promise to help clinicians address this problem in a phenotypically tailored manner. Efforts are needed to prevent tobacco use for future generations.

Factors associated with alcohol use and abuse in Brazilian primary health care settings

The main goal of this study was to identify the prevalence of alcohol use and associations with selected variables among clients in a primary healthcare setting. A quantitative, cross-sectional study was carried out using structured questionnaires to measure the pattern of alcohol consumption, quality of life and common mental disorders. The results showed that men, people between 18 and 40 years old, with income between $300.00 and 1200.00 and smokers were at a higher risk of problematic alcohol use. Healthcare professionals should include alcohol screening questions to identify the hazardous consumption of alcohol at an early stage and prevent negative consequences.

Analysis of factors affecting alcohol and tobacco concurrent use by bivariate probit model in Turkey

Alcohol and tobacco use are risky factors that are associated with one another. High alcohol and tobacco use are significant public health problems with social and economic costs and one of the leading causes of preventable death and disease. The aim of this study was to determine the sociodemographic and economic factors on alcohol and tobacco concurrent use. In this study, a bivariate probit model was employed to determine the factors affecting alcohol and tobacco concurrent use among individuals aged 15 and above who were living in Turkey. The data used in this study was obtained from the Turkey Health Survey conducted in 2010, 2012, 2014, and 2016 by the Turkish Statistical Institute. The data were gathered from a total of 77,327 individuals. Empirical findings suggest that factors affecting alcohol and tobacco use were simultaneous. Also, the results revealed that several key variables such as age, gender, educational status, marital status, household monthly income level, and survey year were significant determinants of alcohol and tobacco concurrent use. Psychosocial support is significant for only tobacco use. In the last decade, a number of restrictions aimed to combat alcohol and tobacco use have been associated with reducing the usage habits of individuals. This is the first study that simultaneously compared both alcohol use and tobacco use using a Turkish sample.

Independent and Combined Effects of Nicotine or Chronic Tobacco Smoking and HIV on the Brain: A Review of Preclinical and Clinical Studies

Tobacco smoking is highly prevalent among HIV-infected individuals. Chronic smokers with HIV showed greater cognitive deficits and impulsivity, and had more psychopathological symptoms and greater neuroinflammation than HIV non-smokers or smokers without HIV infection. However, preclinical studies that evaluated the combined effects of HIV-infection and tobacco smoking are scare. The preclinical models typically used cell cultures or animal models that involved specific HIV viral proteins or the administration of nicotine to rodents. These preclinical models consistently demonstrated that nicotine had neuroprotective and anti-inflammatory effects, leading to cognitive enhancement. Although the major addictive ingredient in tobacco smoking is nicotine, chronic smoking does not lead to improved cognitive function in humans. Therefore, preclinical studies designed to unravel the interactive effects of chronic tobacco smoking and HIV infection are needed. In this review, we summarized the preclinical studies that demonstrated the neuroprotective effects of nicotine, the neurotoxic effects of the HIV viral proteins, and the scant literature on nicotine or tobacco smoke in HIV transgenic rat models. We also reviewed the clinical studies that evaluated the neurotoxic effects of tobacco smoking, HIV infection and their combined effects on the brain, including studies that evaluated the cognitive and behavioral assessments, as well as neuroimaging measures. Lastly, we compared the different approaches between preclinical and clinical studies, identified some gaps and proposed some future directions. Graphical abstract Independent and combined effects of HIV and tobacco/nicotine. Left top and bottom panels: Both clinical studies of HIV infected persons and preclinical studies using viral proteins in vitro or in vivo in animal models showed that HIV infection could lead to neurotoxicity and neuroinflammation. Right top and bottom panels: While clinical studies of tobacco smoking consistently showed deleterious effects of smoking, clinical and preclinical studies that used nicotine show mild cognitive enhancement, neuroprotective and possibly anti-inflammatory effects. In the developing brain, however, nicotine is neurotoxic. Middle overlapping panels: Clinical studies of persons with HIV who were smokers typically showed additive deleterious effects of HIV and tobacco smoking. However, in the preclinical studies, when nicotine was administered to the HIV-1 Tg rats, the neurotoxic effects of HIV were attenuated, but tobacco smoke worsened the inflammatory cascade.

Association between alcohol consumption/alcohol use disorders and patient complexity: a cross-sectional study

OBJECTIVES

The objective was to clarify the relationship between alcohol consumption/alcohol use disorders and patient complexity.

DESIGN

Cross-sectional study.

SETTING

A clinic located on a remote island in Okinawa, Japan, providing general outpatient practices and round-the-clock emergency services.

PARTICIPANTS

Patients who lived on the island, visited Tarama Clinic from 1 April 2018 to 30 June 2018, were aged ≥20 years and had decision-making capacity were judged to be eligible for this study.

MAIN OUTCOME MEASURES

Alcohol consumption/alcohol use disorders as measured by the Alcohol Use Disorders Identification Test (AUDIT) and patient complexity as scored by the Patient Centered Assessment Method (PCAM).

RESULTS

During the 3-month study period, 355 patients (163 women and 192 men) with mean (SD) age of 66.4 (13.6) years were included. Multiple regression analysis of PCAM scores showed that, after adjusting for age, sex, education, occupation, physical activity, smoking, annual medical expenses and number of family members living with the patient, AUDIT scores classified as 'dependence likely' were associated with PCAM scores (p value=0.040).

CONCLUSIONS

Alcohol consumption and alcohol use disorders classified as dependence likely are associated with patient complexity.

Factors Associated with Single-Use and Co-Use of Tobacco and Alcohol: A Multinomial Modeling Approach

Tobacco smoking and alcohol consumption are among the most important public health concerns not only in South Korea but also globally. This study identified the factors associated with single-use and co-use of tobacco and alcohol in Korean adults and provided more accurate estimates using a multinomial modeling approach. This study used the Korea Community Health Survey Data 2017, of which 205,336 respondents were selected as the sample for a multinomial logistic regression analysis. For the group that identified as only drinking monthly compared to the reference group, we found that the direction of the following factors was opposite to that of the results of the only currently smoking group: Age, marital status, educational level, monthly household income, occupation, obesity, self-rated health, hypertension, and hyperlipidemia. For the currently smoking and drinking monthly group relative to the reference group, the overall direction was a mix of the results of only currently smoking and only drinking monthly. These findings support the development of policies that consider the risk of smoking tobacco and consuming alcohol simultaneously.

Community perspectives of second-generation alcohol misuse and HIV risk in rural Kenya: A gendered syndemic lens

Sub-Saharan Africa is at the intersection of the HIV epidemic and the highest burden of alcohol-related disease and injury. Alcohol consumption is associated with an increased likelihood of HIV infection, high rates of intimate partner violence and is considered both a cause and a contributor of economic stress and poverty. Our study integrates the syndemic and socio-ecological system theoretical frameworks to qualitatively explore the effect of second-generation alcohol consumption on sexual risk behaviours, alcohol misuse, violence and economic stress (SAVE) factors and HIV infection risk. We recruited 80 people from rural Kenya to participate in 12 focus groups. Consistent with the literature, we found evidence of syndemic associations of second-generation alcohol consumption with SAVE factors, including HIV infection risk. Structural-level factors including availability of cheap second-generation alcohol and widespread unemployment are the biggest risk factors for alcohol misuse. Because of the psychological effect of women's increasing economic independence on men, gendered syndemic programming - that includes both men and women - and addresses the complex web of risk factors for second-generation alcohol misuse can interrupt the vicious cycle of poverty, violence, sexual risk behaviours and mitigate HIV infection risk in rural Kenya.

EXPERIENCING SYNDEMIC: DISENTANGLING THE BIOSOCIAL COMPLEXITY OF TUBERCULOSIS THROUGH QUALITATIVE RESEARCH

Tuberculosis (TB) remains a major global public health problem that has become a crisis fuelled by HIV and the increasing occurrence of antimicrobial resistance. What has been termed the biosocial nature of TB challenges effective control of the disease. Yet, biosocial interactions involved in the persistence of TB in diverse settings are difficult to systematically account for. The recently developed framework of syndemics provides a way to capture how complex health problems result from the interactions between diseases such as HIV and TB, and harmful social conditions such as unemployment, malnutrition and substance abuse. This article advances the syndemics scholarship by examining health conditions that cluster together with TB in the Russian Federation, by eliciting a set of social processes that precipitate this clustering and exacerbate health outcomes, and by analysing interactions between these health conditions and social processes. To provide an account of this complexity, the article takes a qualitative approach and draws on the perspectives and experiences of people with TB. The results demonstrate emergence of a syndemic of stress, substance abuse, TB and HIV that is sustained by poverty, occupational insecurity, marginalization and isolation. Frictions between the narrow focus of the health care system on TB and the wider syndemic processes in which the lives of many persons with TB are embedded, contribute to poorer health outcomes and increase the risks of developing drug resistance. Finally, the article argues that the large-scale and impersonal forces become embodied as individual pathology through the crucial interface of the ways in which persons experience and make sense of these forces and pathologies. Qualitative research is needed for the adequate analysis of this biosocial complexity in order to provide a solid basis for responses to TB-centred syndemics in various settings.

Economic costs of alcohol use in Sri Lanka

Aim

Alcohol related disease conditions are responsible for a significant proportion of morbidity and mortality in Sri Lanka. This study quantified the economic cost of selected alcohol related disease conditions in Sri Lanka in 2015.

Methods

This study uses the prevalence-based cost of illness methodology specified by the World Health Organization, and uses the gross costing approach. The direct costs includes the costs of curative care (inpatient and outpatient care borne by the state and out of pocket expenditure borne by patients) for alcohol related diseases, weighted by the respective population attributable fractions. Indirect costs consist of lost earnings due to absenteeism of the patient and carers due to seeking care and recuperation, and the loss of income due to mortality.

Data form the Ministry of Health, Registrar General’s Department, Department of Census and Statistics and the National Cancer Registry was used. Systemic and house costs and population attributable fractions were obtained from research studies. Economists, Public Health Experts, Medical Administrators and Clinical Specialists were iteratively consulted during the estimation and validation of the costs and the results.

Results

The estimated present value of current and future economic cost of the alcohol-related conditions for Sri Lanka in 2015 was USD 885.86 million, 1.07% of the GDP of that year. The direct cost of alcohol related disease conditions was USD 388.35 million, which was 44% of the total cost, while the indirect cost was USD 497.50 million, which was 66% of the total cost. Road Injury cost was the highest cost category among the conditions studied.

Conclusion

Addressing alcohol use and its harms through effective implementation of evidence-based polices and interventions is urgently required to address the economic costs of alcohol use in Sri Lanka as it imposes a significant burden to the country.

Alcohol use in a rural district in Uganda: findings from community-based and facility-based cross-sectional studies

Background

Uganda has one of the highest per capita alcohol consumption rates in sub-Saharan Africa. However, the prevalence of alcohol use disorders (AUD) remains unknown in many areas, especially in rural districts. This study aimed to estimate the prevalence of alcohol consumption and of alcohol use disorder among men, and to describe the distribution of drinking intensity, among men in in Kamuli District, Uganda.

Methods

Men attending primary care clinics in Kamuli District were consecutively interviewed in a facility-based cross-sectional study, and a separate group of men were interviewed in a population-based cross-sectional study. In both studies the men were administered a structured questionnaire, which included the alcohol use disorder identification test (AUDIT) to screen for AUD, as well as sections about demographic characteristics, depression screening, internalized stigma for alcohol problems and treatment-seeking.

Results

Among the 351 men enrolled in the Community study, 21.8% consumed alcohol in the past 12 months, compared to 39.6% of 778 men in the Facility Survey. The proportion of men who screened positive for AUD was 4.1% in the community study and 5.8% in the facility study. AUDIT scores were higher among older men, men with paid/self-employment status and higher PHQ-9 score (P < 0.05). Nearly half (47.5%) of the men with AUDIT-positive scores reported that alcohol use problems had ruined their lives. A majority (55.0%) of men with AUDIT-positive scores did not seek treatment because they did not think AUD was a problem that could be treated.

Conclusions

Internalized stigma beliefs among AUDIT-positive men impede treatment-seeking. As part of any efforts to increase detection and treatment services for alcohol use problems, routine screening and brief interventions for internalized stigma must be incorporated within the normal clinical routine of primary health care.

Electronic supplementary material

The online version of this article (10.1186/s13033-018-0191-5) contains supplementary material, which is available to authorized users.

Household Expenditure on Tobacco Consumption in a Poverty-Stricken Rural District in Sri Lanka

Tobacco is a determinant of poverty and a barrier for development. Monaragala, a rural, agricultural district, reports the highest poverty-related indicators in southern Sri Lanka. A cross-sectional study was used to describe the household expenditure on tobacco and its association with food- and education-related expenditures at household level. This study used a 4-stage cluster sampling method to recruit a representative sample of 1160 households. Response rate was 98.6%. Median monthly household income was LKR 20 000 (interquartile range [IQR] = LKR 12 000-30 000). The median monthly expenditure on tobacco was LKR 1000 (IQR = LKR 400-2000) with the highest spending tertile reporting a median of LKR 2700 (IQR = LKR 2000-3600).The proportionate expenditure from the monthly income ranged from 0.0% to 50% with a median of 5.0% (IQR = 2.0-10.0) and a mean of 7.4% (7.6). The poorest reported the highest mean proportionate expenditure (9.8%, SD = 10) from the household income. Household expenditure on tobacco negatively associated with expenditure on education.

Conjoint moderate or high-risk alcohol and tobacco use among male out-patients in Thailand

Objective

To better understand conjoint alcohol and tobacco use among male hospital out-patients, the purposes of this study were: (1) to assess the prevalence of conjoint use and (2) to determine the factors associated with the conjoint alcohol use and tobacco use.

Methods

In a cross-sectional survey, consecutive male out-patients from four district hospitals in Nakhon Pathom province in Thailand were assessed with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Hospital Anxiety and Depression Scale (HADS), self-reported chronic conditions and health-seeking behaviour. The sample included 2208 study participants, with a mean age of 36.2 years (SD = 11.7) and an age range of 18–60 years.

Results

Overall, 34.5% of the male hospital out-patients were conjoint moderate or high-risk alcohol and tobacco users, and 31.1% were moderate or high-risk alcohol or tobacco users. In multivariate analysis, younger age, having primary or less education, being separated, divorced or widowed, not having diabetes and not being obese were associated with conjoint moderate or high-risk alcohol and tobacco use.

Conclusion

High prevalence and several risk factors of conjoint alcohol and tobacco use were found among hospital male out-patients. The findings of this study call for dual-intervention approaches for both alcohol and tobacco.

Effect of Al-Anon attendance on family function and quality of life in women in Mashhad, Iran

BACKGROUND

Al-Anon self-help group is the sole source of assistance for families whose members suffer from alcohol abuse problems in Iran.

OBJECTIVES

To assess the effects of Al-Anon meeting attendance on family function and quality of life of women living with husbands with alcohol use disorders.

METHODS

The study was conducted among two groups of women first time participants in Al-Anon (n = 40) and participants who had attended Al-Anon for at least six months (n = 40) in Mashhad, Iran. Participants were administered the Quality of Life Short Form (QOL SF-36) and Family Assessment Device (FAD).

RESULTS

There was a significant group difference in the QOL SF-36 total as well as in the sub-scores of role limitations due to physical problems, role limitations due to emotional problems, vitality, pain, and social functioning sub-scores. No significant group differences were observed in FAD sub-scores, except for the subscale of problem solving.

CONCLUSION

These findings suggest Al-Anon, when other structured therapeutic interventions are not available, may be of particular benefit for quality of life issues in women attendees.

The prevalence and correlates of alcohol use and alcohol use disorders: a population based study in Colombo, Sri Lanka

BACKGROUND

Alcohol use is increasing in non-Western countries. However, the effects of this increase on the prevalence of alcohol use disorders (AUD) remains unknown, particularly in South Asia. This study aimed to estimate the prevalence of alcohol use and AUD in the Colombo District, Sri Lanka. Environmental risk factors and psychiatric correlates were also examined.

METHODS

The Composite International Diagnostic Interview was used to assess alcohol use and psychiatric disorders in a population based sample of 6014 twins and singletons in the Colombo region of Sri Lanka.

RESULTS

Lifetime alcohol use on 12 or more occasions was estimated at 63.1 % (95 % CI: 61.3-64.9) in men and 3.7 % (95 % CI: 3.0-4.3) in women. Prevalence of lifetime alcohol abuse and alcohol dependence in men was 6.2 % (95 % CI: 5.3-7.1) and 4.0 % (95 % CI: 3.3-4.7) respectively. Lower standard of living was independently associated with alcohol use and dependence but not abuse. Significant associations between lifetime AUD and other psychiatric disorders were observed.

CONCLUSIONS

Lower prevalence of alcohol use and AUD was observed compared to Western countries. Prevalence of alcohol use and AUD were higher than previous reports. Socio-demographic and environmental risk factors appear to be similar across cultures as were associations between AUD and other psychiatric disorders.

Mental health status of Sri Lanka Navy personnel three years after end of combat operations: a follow up study

The main aim of this study was to assess the mental health status of the Navy Special Forces and regular forces three and a half years after the end of combat operations in mid 2009, and compare it with the findings in 2009. This cross sectional study was carried out in the Sri Lanka Navy (SLN), three and a half years after the end of combat operations. Representative samples of SLN Special Forces and regular forces deployed in combat areas were selected using simple random sampling. Only personnel who had served continuously in combat areas during the one year period prior to the end of combat operations were included in the study. The sample consisted of 220 Special Forces and 275 regular forces personnel. Compared to regular forces a significantly higher number of Special Forces personnel had experienced potentially traumatic events. Compared to the period immediately after end of combat operations, in the Special Forces, prevalence of psychological distress and fatigue showed a marginal increase while hazardous drinking and multiple physical symptoms showed a marginal decrease. In the regular forces, the prevalence of psychological distress, fatigue and multiple somatic symptoms declined and prevalence of hazardous drinking increased from 16.5% to 25.7%. During the same period prevalence of smoking doubled in both Special Forces and regular forces. Prevalence of PTSD reduced from 1.9% in Special Forces to 0.9% and in the regular forces from 2.07% to 1.1%. Three and a half years after the end of combat operations mental health problems have declined among SLN regular forces while there was no significant change among Special Forces. Hazardous drinking among regular forces and smoking among both Special Forces and regular forces have increased.

Implementing tobacco dependence treatment during clinical consultations: a qualitative study of clinicians' experiences, perceptions and behaviours in a South African primary health care setting

Background

Evidence suggests that healthcare providers (HCPs) in South Africa do not consistently offer tobacco dependence treatment (TDT) during clinical consultations. In order to understand and explain this behaviour in a South African context, we conducted a qualitative exploration of HCPs’ experiences, perceptions and behaviours regarding TDT.

Methods

Individual qualitative interviews were conducted with physicians and nurses who were purposively selected. Themes were identified from interview transcripts using content analysis. Findings were triangulated and peer-reviewed, and were also verified by the participants.

Results

Fifteen physicians and four nurses were interviewed, none of whom used tobacco. These participants perceived TDT as an important task, but could not consistently implement it during clinical consultations due to health systems constraints (time-constraints because of patient-overload, the unavailability of cessation medications and a lack of support for referrals), misperceptions and misconceptions (negative outcome expectations about the effectiveness and feasibility of TDT), socio-cultural barriers (counselling older persons was perceived as challenging) and personal limitations (perceived low self-efficacy, poor knowledge and skills on implementing any evidence-based TDT framework). Patients are therefore selectively screened based on clinical relevance and offered only prescriptive brief advice. Participants recommended several systems changes, including academic detailing of tobacco status, training HCPs and incorporating tobacco cessation medications in the Essential Drug List.

Conclusion

The reported selective screening and limited TDT interventions offered by HCPs are related to interactions between health systems constraints, personal limitations, and misperceptions and misconceptions about the effectiveness and feasibility of TDT during clinical consultation. Implementing the recommended systems changes has the potential to improve the implementation of TDT in South African primary health care (PHC).

Antipsychotic medication and tobacco use among outpatients with schizophrenia: a cross-sectional study

BACKGROUND

Many studies have shown that the prevalence of smoking in schizophrenia is higher than in the general population. Biological, psychological and social factors influence smoking in patients with schizophrenia.

METHODS

The study was carried out in psychiatry outpatient clinics in a tertiary care hospital in Sri Lanka. Every third patient was selected using systematic sampling from patients diagnosed with schizophrenia according to ICD-10 clinical criteria. Smoking behaviours were assessed using self-reports. Severity of illness was assessed using Brief Psychiatric Rating Scale (BPRS). Fagerstrom Test for Nicotine Dependence assessed level of dependence. Readiness to Change Questionnaire assessed motivation to change smoking behaviour.

RESULTS

The sample consisted of 306 patients with schizophrenia. Mean age was 38.93 years (SD 10.98). There were 148 males (48.4%). Mean duration of illness was 12.63 years (SD 8.38). Current medication was oral atypical antipsychotics 103, clozapine 136, oral typicals 29 and depot typicals 38. Prevalence of tobacco use among males was 30.41% (95% CI 22.91 to 37.90) and among females 1.90% (95% CI -0.25 to 4.05). Prevalence of current smoking among males was 20.27% (95% CI 13.72 to 26.82). None of the females smoked. Prevalence of smokeless tobacco use among males was 10.14 (95% CI 5.22 to 15.05) and among females 1.90 (95% CI -0.03 to 4.05). When patients treated with clozapine were excluded from the analysis, prevalence of tobacco use was 41.6% among males and 3.2% among females and prevalence of smoking was 29.9% among males. Prevalence of tobacco use was lowest in patients treated with clozapine 18.31 (95% CI 9.09 to 27.53) and highest in those treated with depot antipsychotics 47.83 (95% CI 25.74 to 69.91).

CONCLUSIONS

Prevalence of smoking was less than in many countries. This is influenced by prevalence in the general population and low affordability. Risk of tobacco use was significantly less among patients treated with clozapine.

Prevalence, patterns and predictors of alcohol consumption in a mountainous district of Bhutan

INTRODUCTION AND AIMS

South Asian countries, with their diverse cultures, have varying prevalences of alcohol consumption. Little is known about Bhutan, a Himalayan country. The objectives of this study are to estimate the prevalence of alcohol consumption among the residents of a rural community in Bhutan and determine their patterns of and factors associated with drinking.

DESIGN AND METHODS

A cross-sectional household survey using a multistage systematic sampling technique was conducted in eight sub-districts of Tashiyangtse. A total of 442 subjects of 270 households were surveyed in 17 villages using the Alcohol Use Disorders Identification Test (AUDIT), with the tri-level method and face-to-face interviews.

RESULTS

The drinking prevalence (at least one standard drink in the past year) was 38.5% (52% in men and 30% in women). The prevalence of low-, moderate- and high-risk drinking based on the AUDIT was 22.4%, 13.6% and 2.5%, respectively. Annual per capita alcohol consumption was 5442 and 2566 g in men and women, respectively, while the corresponding values of home-made alcohol consumption were 3768 and 2127 g, respectively. Among drinkers, 30.3% of men and 25.9% of women reported encountering financial consequences. The home was almost the exclusive drinking venue (92.4%). Belief in the medicinal use of alcohol was 34.8% in men and 58% in women as the reason to start drinking. This belief was a strong independent predictor for current drinking after adjustment for age and sex.

DISCUSSION AND CONCLUSIONS

Home-made alcohol and home drinking with a belief of medicinal effects were the major cause of drinking and its consequences in the study area.

Association between frequency of heavy episodic drinking and self-reported consequences: a cross-sectional study in a Swedish population

AIMS

To describe perceived negative consequences (PNCs) of alcohol consumption related to the frequency of heavy episodic drinking (HED) in a Swedish population attending primary health care (PHC).

METHODS

Data from a computer-based assessment, including questions about alcohol consumption and PNC, were collected from 28 PHC centres in Sweden. The analysis included 4559 responders. Risk ratios concerning PNC for different frequencies of HED were calculated.

RESULTS

Engaging in HED once a month for women and two to three times a month for men significantly raised the proportion of individuals reporting PNC, compared with engaging in HED less than once a month. The men reported PNC of alcohol consumption to a higher degree than the women, and in general, the proportion of individuals reporting PNC was associated with the frequency of HED.

CONCLUSION

Engaging in HED once a month for women and two to three times a month for men are critical levels regarding PNC of alcohol consumption. To identify a cut-off value for categorizing individuals as hazardous alcohol consumers due to the frequency of HED, further studies are needed.

Smoking among troops deployed in combat areas and its association with combat exposure among navy personnel in Sri Lanka

Background

Among military personnel alcohol consumption and binge-drinking have increased but cigarette smoking has declined in the recent past. Although there is a strong association between smoking and PTSD the association between combat exposure and smoking is not clear.

Methods

This cross sectional study was carried out among representative samples of SLN Special Forces and regular forces deployed in combat areas. Both Special Forces and regular forces were selected using simple random sampling. Only personnel who had served continuously in combat areas during the one year period prior to end of combat operations were included in the study. Females were not included in the sample. The study assessed several mental health outcomes as well as alcohol use, smoking and cannabis use. Sample was classified according to smoking habits as never smokers, past smokers (those who had smoked in the past but not within the past year) and current smokers (those smoking at least one cigarette within the past 12 months).

Results

Sample consisted of 259 Special Forces and 412 regular navy personnel. Prevalence of current smoking was 17.9% (95% CI 14.9-20.8). Of the sample 58.4% had never smoked and 23.7% were past smokers. Prevalence of current smoking was significantly higher among Special Forces personnel compared to regular forces. (OR 1.90 (95% CI 1.20-3.02). Personnel aged ≥35 years had the lowest prevalence of smoking (14.0%). Commissioned officers had a lower prevalence (12.1%) than non commissioned officers or other ranks. After adjustment for demographic variables and service type there was significant association between smoking and combat experiences of seeing dead or wounded [OR 1.79 (95%CI 1.08-2.9)], handling dead bodies [OR 2.47(95%CI 1.6-3.81)], coming under small arms fire [OR 2.01(95%CI 1.28-3.15)] and coming under mortar, missile and artillery fire [OR 2.02(95%CI 1.29-3.17)]. There was significant association between the number of risk events and current smoking [OR 1.22 (95%CI1.11-1.35)].

Conclusions

There was significant association between current smoking and combat experiences. Current smoking was strongly associated with current alcohol use. Prevalence of current smoking was less among military personnel than in the general population. Prevalence of smoking was significantly higher among Special Forces personnel.

Alcohol use in a military population deployed in combat areas: a cross sectional study

Background

Alcohol misuse is more prevalent among military populations. Association between PTSD and heavy drinking have been reported in many studies. Most of the studies on alcohol use among military personnel are from US and UK. Aim of this study is to describe alcohol consumption patterns among military personnel in Sri Lanka, a country where the alcohol consumption among the general population are very different to that in US and UK.

Methods

Cross sectional study consisting of representative samples of Sri Lanka Navy Special Forces and regular forces deployed in combat areas continuously during a one year period was carried out. Data was collected using a self report questionnaire. Alcohol Use Disorder Identification Test (AUDIT) was used to assess alcohol consumption.

Results

Sample consisted of 259 Special Forces and 412 regular navy personnel. The median AUDIT score was 2.0 (interquartile range 6.0). Prevalence of current drinking was 71.2 %. Of the current users 54.81 % were infrequent users (frequency ≤ once a month) while 37.87 % of users consumed 2–4 times a month. Prevalence of hazardous drinking (AUDIT ≥ 8) was 16.69 % and binge drinking 14.01 %. Five (0.75 %) had AUDIT total ≥20. There was no significant difference between Special Forces and regular forces in hazardous drinking or binge drinking. Total AUDIT score ≥16 were associated with difficulty performing work.

Conclusions

High rates of hazardous drinking and binge drinking described among military personnel in US and UK were not seen among SLN personnel deployed in combat areas. This finding contrasts with previously reported association between combat exposure and hazardous alcohol use among military personnel. Alcohol use among military personnel may be significantly influenced by alcohol consumption patterns among the general population, access to alcohol and attitudes about alcohol use. Similar to findings from other countries, heavy alcohol use was associated with poorer psychological health and functional impairment.