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Lac A. Drinking to Cope With the COVID-19 Pandemic Mediates Pathways From COVID-19 Anxiety to Alcohol Use and Alcohol Myopia Consequences. J Dual Diagn 2024:1-13. [PMID: 38742669 DOI: 10.1080/15504263.2024.2343372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE People may consume alcohol to cope with the stressors and anxieties of the COVID-19 pandemic. The present study applied the self-medication hypothesis, tension reduction hypothesis, and alcohol myopia theory to understand COVID-19 alcohol coping as a mediator of the pathways from COVID-19 anxiety to alcohol use and alcohol consequences. METHODS Participants (N = 477) were undergraduate college students. The mean age was 22.14 (SD = 5.66) years. Gender distribution included 73% females, 26% males, and 1% transgender. Racial categories included 70% White, 11% Latino, 5% Black, 5% Asian, and 9% multiracial. They completed the Coronavirus Anxiety Scale, the COVID-19 Alcohol Coping Scale developed and validated in the present study, measures of drinking frequency and drinking quantity, and the Alcohol Myopia Scale to assess alcohol consequences. RESULTS First, confirmatory factor analysis supported the measurement structure of the COVID-19 Alcohol Coping Scale. Second, a general structural equation model containing only latent factors provided evidence for the following pathways: COVID-19 anxiety to COVID-19 alcohol coping to overall alcohol use to alcohol myopia consequences. Third, a specific structural equation model separated the overall alcohol use factor into two measures of drinking frequency and drinking quantity. Results found that COVID-19 alcohol coping uniquely explained drinking frequency (but not drinking quantity), indicating that the pursuit of alcohol to cope with the pandemic was related to more frequent days of alcohol use but not more concentrated use on drinking days. Tests of indirect effects corroborated the mediational pathways in the explanatory models. CONCLUSIONS The research offers insights into understanding that the risk connections from COVID-19 anxiety to alcohol behavioral outcomes are mediated by alcohol use to cope with the pandemic.
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Affiliation(s)
- Andrew Lac
- Department of Psychology, University of Colorado, Colorado Springs, Colorado, USA
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Bertholet N, Schmutz E, Studer J, Adam A, Gmel G, Cunningham JA, McNeely J, Daeppen JB. Effect of a smartphone intervention as a secondary prevention for use among university students with unhealthy alcohol use: randomised controlled trial. BMJ 2023; 382:e073713. [PMID: 37586742 PMCID: PMC10428135 DOI: 10.1136/bmj-2022-073713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To estimate the effects of providing access to an alcohol intervention based on a smartphone. DESIGN Randomised controlled trial.. SETTING Four higher education institutions in Switzerland. PARTICIPANTS 1770 students (≥18 years) who screened positive for unhealthy alcohol use (ie, a score on the alcohol use disorders identification test-consumption (AUDIT-C) of ≥4 for men and ≥3 for women) were randomly assigned by 1:1 allocation ratio in blocks of 10. INTERVENTION Providing access to a brief, smartphone based alcohol intervention. OUTCOME MEASURES The primary outcome studied was number of standard drinks per week at six months and the secondary outcome was number of heavy drinking days (past 30 days). Additional outcomes were maximum number of drinks consumed on one occasion, alcohol related consequences, and academic performance. Follow-up assessments occurred at months three, six, and 12. Data were analysed by intention to treat and by using generalised linear mixed models with random intercepts for the recruitment site and participants nested within the recruitment site, and with intervention (v control), time (three months v six months; 12 months v six months), and baseline outcome values as fixed effects. RESULTS Between 26 April 26 2021 and 30 May 2022, 1770 participants (intervention group (n=884); control group (n=886)) were included. Mean age was 22.4 years (standard deviation 3.07); 958 (54.1%) were women; and 1169 (66.0%) were undergraduate students, 533 (30.1%) were studying for a master's degree, 43 (2.4%) were studying for a doctorate, and 25 (1.4%) were students of other higher education programme. The baseline mean number of standard drinks per week was 8.59 (standard deviation 8.18); the baseline number of heavy drinking days was 3.53 (4.02). Of 1770 participants, follow-up rates were 1706 (96.4%) at three months, 1697 (95.9%) at six months, and 1660 (93.8%) at 12 months. Of 884 students randomly assigned to the intervention group, 738 (83.5%) downloaded the smartphone application. The intervention had a significant overall effect on the number of standard drinks per week (incidence rate ratio 0.90 (95% confidence interval 0.85 to 0.96)), heavy drinking days (0.89 (0.83 to 0.96)), and the maximum number of drinks consumed on one occasion (0.96 (0.93 to 1.00), P=0.029), indicating significantly lower drinking outcomes in the intervention group than in the control group during the follow-up period. The intervention did not affect alcohol related consequences or academic performance. CONCLUSIONS Providing access to the smartphone application throughout the 12 month follow-up was effective at limiting the average drinking volume of university students who had self-reported unhealthy alcohol use at baseline. TRIAL REGISTRATION ISRCTN 10007691.
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Affiliation(s)
- Nicolas Bertholet
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Elodie Schmutz
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joseph Studer
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Service of Adult Psychiatry North-West, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Angéline Adam
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John A Cunningham
- National Addiction Centre, King's College, London, UK
- Center for Addiction and Mental Health, Toronto, ON, Canada
| | - Jennifer McNeely
- New York University Grossman School of Medicine, New York, NY, USA
| | - Jean-Bernard Daeppen
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Greenfield TK, Lui CK, Cook WK, Karriker-Jaffe KJ, Li L, Wilsnack SC, Bloomfield K, Room R, Laslett AM, Bond J, Korcha R. High Intensity Drinking (HID) Assessed by Maximum Quantity Consumed Is an Important Pattern Measure Adding Predictive Value in Higher and Lower Income Societies for Modeling Alcohol-Related Problems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3748. [PMID: 36834453 PMCID: PMC9958696 DOI: 10.3390/ijerph20043748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 05/28/2023]
Abstract
Adjusting for demographics and standard drinking measures, High Intensity Drinking (HID), indexed by the maximum quantity consumed in a single day in the past 12 months, may be valuable in predicting alcohol dependence other harms across high and low income societies. The data consisted of 17 surveys of adult (15,460 current drinkers; 71% of total surveyed) in Europe (3), the Americas (8), Africa (2), and Asia/Australia (4). Gender-disaggregated country analyses used Poison regression to investigate whether HID (8-11, 12-23, 24+ drinks) was incrementally influential, beyond log drinking volume and HED (Heavy Episodic Drinking, or 5+ days), in predicting drinking problems, adjusting for age and marital status. In adjusted models predicting AUDIT-5 for men, adding HID improved the overall model fit for 11 of 15 countries. For women, 12 of 14 countries with available data showed an improved fit with HID included. The results for the five Life-Area Harms were similar for men. Considering the results by gender, each country showing improvements in model fit by adding HID had larger values of the average difference between high intensity and usual consumption, implying variations in amounts consumed on any given day. The amount consumed/day often greatly exceeded HED levels. In many societies of varying income levels, as hypothesized, HID provided important added information on drinking patterns for predicting harms, beyond the standard volume and binging indicators.
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Affiliation(s)
- Thomas K. Greenfield
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Camillia K. Lui
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Won K. Cook
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Katherine J. Karriker-Jaffe
- Community Health & Implementation Research Program, Research Triangle Institute, Berkeley Office, CA 94704, USA
| | - Libo Li
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Sharon C. Wilsnack
- Department of Psychiatry and Behavioral Science, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 94704, USA
| | - Kim Bloomfield
- Centre for Alcohol and Drug Research, School of Business and Social Sciences, Aarhus University, 2400 Copenhagen, Denmark
| | - Robin Room
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University (Melbourne Campus), Bundoora, VIC 3086, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, 106 91 Stockholm, Sweden
| | - Anne-Marie Laslett
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University (Melbourne Campus), Bundoora, VIC 3086, Australia
| | - Jason Bond
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Rachael Korcha
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
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Mazurenko E, Rymar O, Rerikh V, Khrapova Y, Direev A, Shcherbakova L, Malyutina S. Risk Factors for Chronic Non-Communicable Diseases and Osteoporotic Fractures in a Middle and Elderly-Aged Population. J Pers Med 2022; 12:jpm12091475. [PMID: 36143260 PMCID: PMC9503074 DOI: 10.3390/jpm12091475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Aim. To study the associations of risk factors for chronic non-communicable diseases (CNCDs) and osteoporotic fractures (OFs) in a population sampling over 50 years. Materials and Methods. The data of a cross-sectional population-based study obtained in the Russian part of the international project HAPIEE (Novosibirsk) are analyzed. The present analysis comprised 7363 men and women aged 50–69 years old. We have assessed the frequency of OFs for the last 12 months and risk factors of CNCDs. Cross-sectional associations between OF history and potential determinants were analyzed using multivariable-adjusted logistic regression. Results. The frequency of OFs in the last 12 months was 3.6% (3.2% in men and 4.0% in women, p = 0.074). In men, the probability of OFs increased with an elevation of blood pressure (BP), high-density lipoprotein cholesterol (HDL-C), ethanol consumption, and reduced with increased body mass index (BMI). In women, the probability of a fracture increased with current smoking and an increased duration of post-menopause and reduced with an increase in triglycerides (TG) levels, independently of other factors. Conclusions. A syndemia of risk factors, both generally recognized for OFs (BMI, tobacco smoking, alcohol consumption, postmenopausal duration) and new factors associated with CNCDs (BP, HDL, TG), have been defined.
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Affiliation(s)
- Elena Mazurenko
- Research Institute of Internal and Preventive Medicine—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630089 Novosibirsk, Russia
- Novosibirsk Research Institute of Traumatology and Orthopedics Named after Ya. L. Tsivyan, 630112 Novosibirsk, Russia
- Correspondence: ; Tel.: +7-(952)-945–72-11
| | - Oksana Rymar
- Research Institute of Internal and Preventive Medicine—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630089 Novosibirsk, Russia
| | - Victor Rerikh
- Novosibirsk Research Institute of Traumatology and Orthopedics Named after Ya. L. Tsivyan, 630112 Novosibirsk, Russia
| | - Yuliya Khrapova
- Novosibirsk Research Institute of Traumatology and Orthopedics Named after Ya. L. Tsivyan, 630112 Novosibirsk, Russia
| | - Artem Direev
- Research Institute of Internal and Preventive Medicine—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630089 Novosibirsk, Russia
| | - Liliya Shcherbakova
- Research Institute of Internal and Preventive Medicine—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630089 Novosibirsk, Russia
| | - Sofia Malyutina
- Research Institute of Internal and Preventive Medicine—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630089 Novosibirsk, Russia
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Åsberg K, Blomqvist J, Lundgren O, Henriksson H, Henriksson P, Bendtsen P, Löf M, Bendtsen M. Digital multiple health behaviour change intervention targeting online help seekers: protocol for the COACH randomised factorial trial. BMJ Open 2022; 12:e061024. [PMID: 35882466 PMCID: PMC9330315 DOI: 10.1136/bmjopen-2022-061024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Unhealthy lifestyle behaviours continue to be highly prevalent, including alcohol consumption, unhealthy diets, insufficient physical activity and smoking. There is a lack of effective interventions which have a large enough reach into the community to improve public health. Additionally, the common co-occurrence of multiple unhealthy behaviours demands investigation of efforts which address more than single behaviours. METHODS AND ANALYSIS The effects of six components of a novel digital multiple health behaviour change intervention on alcohol consumption, diet, physical activity and smoking (coprimary outcomes) will be estimated in a factorial randomised trial. The components are designed to facilitate behaviour change, for example, through goal setting or increasing motivation, and are either present or absent depending on allocation (ie, six factors with two levels each). The study population will be those seeking help online, recruited through search engines, social media and lifestyle-related websites. Included will be those who are at least 18 years of age and have at least one unhealthy behaviour. An adaptive design will be used to periodically make decisions to continue or stop recruitment, with simulations suggesting a final sample size between 1500 and 2500 participants. Multilevel regression models will be used to analyse behavioural outcomes collected at 2 months and 4 months postrandomisation. ETHICS AND DISSEMINATION Approved by the Swedish Ethical Review Authority on 2021-08-11 (Dnr 2021-02855). Since participation is likely motivated by gaining access to novel support, the main concern is demotivation and opportunity cost if the intervention is found to only exert small effects. Recruitment began on 19 October 2021, with an anticipated recruitment period of 12 months. TRIAL REGISTRATION NUMBER ISRCTN16420548.
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Affiliation(s)
- Katarina Åsberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jenny Blomqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Oskar Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hanna Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Medical Specialist, Motala Hospital, Motala, Sweden
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Di Fabio C, Lindell AK, Callinan S. Contextual cues prompt greater improvements in alcohol consumption recall for people with higher working memory capacities. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1080/00049530.2022.2089052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Claudia Di Fabio
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Annukka K. Lindell
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Sarah Callinan
- Centre for Alcohol Policy Research (CAPR), La Trobe University, Melbourne, Australia
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Bendtsen M, Åsberg K, McCambridge J. Effectiveness of a digital intervention versus alcohol information for online help-seekers in Sweden: a randomised controlled trial. BMC Med 2022; 20:176. [PMID: 35578276 PMCID: PMC9112593 DOI: 10.1186/s12916-022-02374-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/12/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The ubiquity of Internet connectivity, and widespread unmet needs, requires investigations of digital interventions for people seeking help with their drinking. The objective of this study was to test the effectiveness of a digital alcohol intervention compared to existing online resources for help seekers. METHODS This parallel randomised controlled trial included 2129 risky drinkers with access to a mobile phone and aged 18 years or older. Randomised sub-studies investigated consent procedures and control group design. Simple computerised randomisation was used. Participants were aware of allocation after randomisation; research personnel were not. The digital intervention was designed around weekly monitoring of alcohol consumption followed by feedback and tools for behaviour change. Primary outcomes were total weekly consumption (TWC) and frequency of heavy episodic drinking (HED), measured 2 and 4 months post-randomisation. RESULTS Between 25/04/2019 and 26/11/2020, 2129 participants were randomised (intervention: 1063, control: 1066). Negative binomial regression was used to contrast groups, with both Bayesian and maximum likelihood inference. The posterior median incidence rate ratio (IRR) of TWC was 0.89 (95% CI = 0.81;0.99, 98.2% probability of effect, P-value = 0.033) at 2 months among 1557 participants and 0.77 (95% CI = 0.69;0.86, > 99.9% probability of effect, P-value < 0.001) at 4 months among 1429 participants. For HED, the IRR was 0.83 (95% CI = 0.75;0.93, > 99.9% probability of effect, P-value = 0.0009) at 2 months among 1548 participants and 0.71 (95% CI = 0.63;0.79, probability of effect > 99.9%, P-value < 0.0001) at 4 months among 1424 participants. Analyses with imputed data were not markedly different. CONCLUSIONS A digital alcohol intervention produced self-reported behaviour change among online help seekers in the general population. The internal and external validity of this trial is strong, subject to carefully considered study limitations arguably inherent to trials of this nature. Limitations include higher than anticipated attrition to follow-up and lack of blinding. TRIAL REGISTRATION The trial was prospectively registered ( ISRCTN48317451 ).
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Affiliation(s)
- Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83, Linköping, Sweden.
| | - Katarina Åsberg
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83, Linköping, Sweden
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, England
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Dutey-Magni P, Brown J, Holmes J, Sinclair J. Concurrent validity of an estimator of weekly alcohol consumption (EWAC) based on the extended AUDIT. Addiction 2022; 117:580-589. [PMID: 34374144 DOI: 10.1111/add.15662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0-12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption. DESIGN Cross-sectional diagnostic study based on a nationally-representative survey. SETTINGS Community dwelling households in England. PARTICIPANTS A total of 22 404 household residents aged ≥16 years reporting drinking alcohol at least occasionally. MEASUREMENTS Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the 'Extended AUDIT') and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units. FINDINGS EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was ±11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and ±2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]). CONCLUSIONS A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions.
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Affiliation(s)
- Peter Dutey-Magni
- Institute of Health Informatics, University College London, London, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jamie Brown
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK
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Tevik K, Bergh S, Selbæk G, Johannessen A, Helvik AS. A systematic review of self-report measures used in epidemiological studies to assess alcohol consumption among older adults. PLoS One 2021; 16:e0261292. [PMID: 34914759 PMCID: PMC8675766 DOI: 10.1371/journal.pone.0261292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background There is a lack of standardization regarding how to assess and categorize alcohol intake in older adults. The aim of this study was to systematically review methods used in epidemiological studies to define drinking patterns and measure alcohol consumption among older adults. Methods A systematic search was conducted in the MEDLINE, PubMed, PsycINFO, EMBASE, and CINAHL databases for studies published from January 2009 to April 2021. Studies were included if they were observational studies with a quantitative design; the mean age of the participants was ≥ 65 years; questionnaires, screening tools, or diagnostic tools were used to define alcohol consumption; and alcohol consumption was self-reported. Results Of 492 studies considered, 105 were included. Among the 105 studies, we detected 19 different drinking patterns, and each drinking pattern had a wide range of definitions. The drinking patterns abstaining from alcohol, current drinking, and risk drinking had seven, 12 and 21 diverse definitions, respectively. The most used questionnaire and screening tools were the quantity-frequency questionnaire, with a recall period of 12 months, and the full and short versions of the Alcohol Use Disorders Identification Test, respectively. Conclusion No consensus was found regarding methods used to assess, define, and measure alcohol consumption in older adults. Identical assessments and definitions must be developed to make valid comparisons of alcohol consumption in older adults. We recommend that alcohol surveys for older adults define the following drinking patterns: lifetime abstainers, former drinkers, current drinkers, risk drinking, and heavy episodic drinking. Standardized and valid definitions of risk drinking, and heavy episodic drinking should be developed. The expanded quantity-frequency questionnaire including three questions focused on drinking frequency, drinking volume, and heavy episodic drinking, with a recall period of 12 months, could be used.
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Affiliation(s)
- Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- * E-mail:
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aud Johannessen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Vestfold, Norway
| | - Anne-S. Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Åsberg K, Lundgren O, Henriksson H, Henriksson P, Bendtsen P, Löf M, Bendtsen M. Multiple lifestyle behaviour mHealth intervention targeting Swedish college and university students: protocol for the Buddy randomised factorial trial. BMJ Open 2021. [PMCID: PMC8719203 DOI: 10.1136/bmjopen-2021-051044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Introduction The time during which many attend college or university is an important period for developing health behaviours, with potentially major implications for future health. Therefore, it is concerning that many Swedish students excessively consume alcohol, have unhealthy diets, are not physical active and smoke. The potential of digital interventions which integrate support for change of all of these behaviours is largely unexplored, as are the dismantled effects of the individual components that make up digital lifestyle behaviour interventions. Methods and analysis A factorial randomised trial (six factors with two levels each) will be employed to estimate the effects of the components of a novel mHealth multiple lifestyle intervention on alcohol consumption, diet, physical activity and smoking among Swedish college and university students. A Bayesian group sequential design will be employed to periodically make decisions to continue or stop recruitment, with simulations suggesting that between 1500 and 2500 participants will be required. Multilevel regression models will be used to analyse behavioural outcomes collected at 2 and 4 months postrandomisation. Ethics and dissemination The study was approved by the Swedish Ethical Review Authority on 2020-12-15 (Dnr 2020-05496). The main concern is the opportunity cost if the intervention is found to only have small effects. However, considering the lack of a generally available evidence-based multiple lifestyle behaviour support to university and college students, this risk was deemed acceptable given the potential benefits from the study. Recruitment will begin in March 2021, and it is expected that recruitment will last no more than 24 months. A final data set will, therefore, be available in July 2023, and findings will be reported no later than December 2023. Trial registration number ISRCTN23310640; Pre-results.
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Affiliation(s)
- Katarina Åsberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Oskar Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hanna Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Medical Specialist, Motala Hospital, Motala, Sweden
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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11
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Isaacs JY, Mackinnon SP, Joyce KM, Stewart SH. Reactivity to Daily Self-Monitoring of Cannabis Use in Biological Females. CANNABIS (RESEARCH SOCIETY ON MARIJUANA) 2021; 4:17-30. [PMID: 37287532 PMCID: PMC10212272 DOI: 10.26828/cannabis/2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Assessment reactivity involves changes to behaviours from self-monitoring those behaviours (Nelson & Hayes, 1981). In the substance use field, reactivity has been identified both as a potential confound in daily diary research (Cohn et al., 2015) and as a possible intervention tool in clinical practice (Cohn et al., 2018). Reactivity to daily self-monitoring of alcohol and tobacco use has been inconsistent in prior research. Reactivity to daily self-monitoring of cannabis use quantity has received far less study. This study involved secondary analyses of data from N = 88 females who self-monitored their cannabis use for 32 days. We examined objective reactivity of cannabis use to daily self-monitoring by assessing changes in daily cannabis use over 32 days. We also explored participants' perceptions of the impact daily self-monitoring had on their cannabis use at study completion (i.e., subjective reactivity). In hurdle models testing objective reactivity, neither probability of cannabis use, nor quantity of cannabis use, changed significantly over the study period. Many respondents (45%) reported no subjective reactivity, though a slight majority (55%) reported some subjective reactivity. Subjective reactivity did not moderate objective reactivity over time; however, higher subjective reactivity was significantly associated with increased variability (interquartile range [IQR]) in cannabis use across the self-monitoring period. Overall, reactivity appears unlikely to confound research utilizing daily diary cannabis measures, and daily self-monitoring of cannabis use may be unlikely to serve as a useful stand-alone intervention for reducing cannabis use in non-treatment-seeking individuals. Potential clinical implications of the novel finding of a link between subjective reactivity and objective cannabis use variability are discussed.
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Affiliation(s)
- Jason Y. Isaacs
- Department of Psychology & Neuroscience, Dalhousie University
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12
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Longitudinal predictors of problematic alcohol use in adolescence: A 2-year follow-up study. Addict Behav 2021; 120:106952. [PMID: 33895660 DOI: 10.1016/j.addbeh.2021.106952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022]
Abstract
Alcohol consumption in adolescence is widespread. Several studies have investigated alcohol use in minors and its consequences in adulthood, but prospective findings on psychosocial predictors for problematic alcohol use (PAU) already in youth are still limited. Next to genetic aspects, psychosocial predictors appear to be particularly relevant. The objective of the present longitudinal survey was to explore psychosocial influences on PAU in adolescence. At baseline, 1,444 adolescents (52.1% girls, average age: 14.65 years) were surveyed. Two years later (at follow-up), we were able to re-assess 515 adolescents (mean age: 16.60 years). Both times, a standardized questionnaire was applied to explore PAU and various psychosocial aspects. We conducted multiple imputation, created 100 datasets with a Markov Chain Monte Carlo algorithm and calculated regression analyses to identify predictors for PAU. In a multivariable analysis, we found that female gender (protective factor), school-type 'Gymnasium' (highest level of school education, protective factor), PAU, more conduct problems and lower psychological well-being (all at baseline) predicted adolescent PAU at follow-up. In supplementary analyses for frequent alcohol use (regardless of quantity) and high alcohol consumption quantity (regardless of frequency), these predictors could only partially be found again. According to the findings of the present study, psychosocial aspects are relevant for PAU in adolescence, and particularly psychological well-being should be given more attention in primary prevention measures and treatment approaches.
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13
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Bendtsen M, Seiterö A, Bendtsen P, Henriksson H, Henriksson P, Thomas K, Löf M, Müssener U. mHealth intervention for multiple lifestyle behaviour change among high school students in Sweden (LIFE4YOUth): protocol for a randomised controlled trial. BMC Public Health 2021; 21:1406. [PMID: 34271882 PMCID: PMC8283383 DOI: 10.1186/s12889-021-11446-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background National surveys in Sweden demonstrate that the majority of young people do not engage in health promoting behaviours at levels recommended by the Public Health Agency of Sweden. The objective of this study is to estimate the effectiveness of a novel mHealth intervention named LIFE4YOUth, which targets multiple lifestyle behaviours (alcohol, diet, physical activity, and smoking) among high school students in Sweden. Methods A 2-arm parallel groups single blind randomised controlled trial (1:1) will be employed to estimate the effectiveness of the novel mHealth intervention. Students will be recruited at high schools throughout Sweden, and will be included if they fulfil one of six criteria relating to unhealthy behaviours with respect to alcohol, diet, physical activity and smoking. Eligible participants will be randomised to either receive the novel intervention immediately, or to be placed on a waiting list for 4 months. The intervention consists of a combination of recurring screening, text messages, and an interactive platform which is adaptable to individual preferences. Outcome measures with respect to alcohol, diet, physical activity and smoking will be assessed through questionnaires at 2 and 4 months post randomisation. Discussion The findings of this trial could be generalised to a diverse high-school student population as our recruitment encompass a large proportion of schools throughout Sweden with various educational profiles. Furthermore, if effective, the mHealth intervention has good potential to be able to be scaled up and disseminated at high schools nationally. Trial registration Registered prospectively on 2020-05-20 in ISRCTN (ISRCTN34468623). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11446-9.
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Affiliation(s)
- Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Anna Seiterö
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Preben Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Medical Specialist, Motala, Sweden
| | - Hanna Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Müssener
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
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14
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Stewart D, Hewitt C, McCambridge J. Exploratory Validation Study of the Individual AUDIT-C Items among Older People. Alcohol Alcohol 2021; 56:258-265. [PMID: 32860051 DOI: 10.1093/alcalc/agaa080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/01/2020] [Accepted: 07/19/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The AUDIT-C is a brief and commonly used alcohol screening tool, with few data available on the relative validity of the three individual items in older adult populations. The aim of this study was to explore the validity of the AUDIT-C items in identifying unhealthy drinking among older people, with a view to developing a single-item screener. METHODS A sample of 143 older adults (mean age = 71) were recruited from non-clinical settings in the UK. AUDIT-C scores were compared to an unhealthy drinking reference category of consuming more than the UK recommended weekly units of alcohol. Standard analyses were conducted for men and women, and for those prescribed medications for long term conditions. RESULTS The AUDIT-C items performed well in identifying unhealthy drinking in this sample of older people, with generally high sensitivity, specificity and area under the ROC curve. No significant differences were found in the validity of the three items, though the combined sensitivity and specificity scores and ROC values for item 3 were consistently slightly lower than for items 1 and 2. The findings were similar for men and women, and for participants prescribed medications for long-term conditions. CONCLUSIONS AUDIT-C items 1 and 2 performed as well as item 3 in identifying unhealthy drinking among older people in this study. Both are reasonable single-item screener candidates, especially given relative ease of administration, with further validation study needed to examine psychometrics and how alcohol screening for older people can best be implemented in clinical settings.
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Affiliation(s)
- Duncan Stewart
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Catherine Hewitt
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Jim McCambridge
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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15
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Vichitkunakorn P, Conigrave KM, Geater AF, Assanangkornchai S. A Context-Specific Instrument to Record Drinking Behaviour: A Pilot Study on Implications of Identifying the Context of Risky Drinking. Community Ment Health J 2021; 57:167-177. [PMID: 32399600 DOI: 10.1007/s10597-020-00629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/05/2020] [Indexed: 11/26/2022]
Abstract
A context-specific quantity-frequency (CSQF) questionnaire has been developed to accurately measure alcohol consumption using probing questions on drinking context. The study aimed to describe the drinking context associated with different drinking intensities in a community of southern Thailand using the CSQF. A cross-sectional survey was conducted among adults aged > 15 years in Songkhla Province, Thailand. Among 804 participants, there were 183 current drinkers with 412 drinking events (215 low-, 79 medium-, and 118 high-intensity). More than half of these events occurred in special situations (i.e., holiday, party, and cultural drinking). About half of the drinking events occurred outside the drinker's house and most drinking events occurred among friends. Higher drinking intensity was associated with higher level of education [adjusted odds ratio (aOR) 4.74 for medium- and aOR 5.23 for high-intensity] and with a special drinking situation (aOR 2.46 for medium- and aOR 2.78 for high-intensity).
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Affiliation(s)
- Polathep Vichitkunakorn
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Katherine M Conigrave
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Alan F Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
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16
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Shimoshikiryo I, Ibusuki R, Shimatani K, Nishimoto D, Takezaki T, Nishida Y, Shimanoe C, Hishida A, Tamura T, Okada R, Kubo Y, Ozaki E, Matsui D, Suzuki S, Nakagawa-Senda H, Kuriki K, Kita Y, Takashima N, Arisawa K, Uemura H, Ikezaki H, Furusyo N, Oze I, Koyanagi YN, Mikami H, Nakamura Y, Naito M, Wakai K. Association between alcohol intake pattern and metabolic syndrome components and simulated change by alcohol intake reduction: A cross-sectional study from the Japan Multi-Institutional Collaborative Cohort Study. Alcohol 2020; 89:129-138. [PMID: 32991979 DOI: 10.1016/j.alcohol.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/31/2020] [Accepted: 09/15/2020] [Indexed: 01/26/2023]
Abstract
To investigate the association between alcohol intake pattern in amount and frequency and metabolic syndrome (Mets) components, we simulated the change in the prevalence of Mets components by intake reduction. In order to manage Mets, alcohol intake reduction with moderation of intake pattern is required. However, evidence investigating the comparative impact of alcohol intake reduction in amount and frequency for Mets components is limited. We conducted a large-scale cross-sectional study in the general Japanese population. The study subjects included 37,371 non-drinkers and current drinkers recruited in the Japan Multi-Institutional Collaborative Cohort Study. Odds ratios (ORs) for Mets components according to alcohol intake amount and frequency were estimated using a multiple logistic regression model. The prevalence of Mets components was estimated after assumed alcohol intake reduction of a) none, b) 10 g/day (men) or 5 g/day (women), c) 20 g/day (men) or 10 g/day (women), d) less than 20 g/day (men) or 10 g/day (women) for moderate-to-heavy drinkers, e) 1-2 times/week, and f) 3-4 times/week. The ORs with alcohol intake amount and frequency increased with high blood pressure while decreasing with dyslipidemia. A J-shaped association was observed between intake amount and Mets. The estimated prevalence (%) of high blood pressure and dyslipidemia in men were a) 45.2, b) 43.0, c) 41.4, d) 40.4, e) 42.9, and f) 42.0; and a) 50.3, b) 51.8, c) 52.9, d) 50.2, e) 52.7, and f) 53.4 in women. The estimated prevalence of high blood pressure in women did not evidently decrease. Simulated alcohol intake reduction showed decreased prevalence for high blood pressure and increased prevalence for dyslipidemia in men after reduced intake amount and frequency. The largest decreased prevalence for high blood pressure was observed in men when all moderate-to-heavy drinkers reduced their alcohol intake amount to less than 20 g/day.
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17
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Stewart D, van Dongen A, Watson M, Mandefield L, Atkin K, Dhital R, Foster B, Gough B, Hewitt C, Madden M, Morris S, O'Carroll R, Ogden M, Parrott S, Watson J, White S, Whittlesea C, McCambridge J. A pilot cluster randomised trial of the medicines and alcohol consultation (MAC): an intervention to discuss alcohol use in community pharmacy medicine review services. BMC Health Serv Res 2020; 20:943. [PMID: 33046094 PMCID: PMC7552554 DOI: 10.1186/s12913-020-05797-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/02/2020] [Indexed: 01/24/2023] Open
Abstract
Background Alcohol interventions are important to the developing public health role of community pharmacies. The Medicines and Alcohol Consultation (MAC) is a new intervention, co-produced with community pharmacists (CPs) and patients, which involves a CP practice development programme designed to integrate discussion of alcohol within existing NHS medicine review services. We conducted a pilot trial of the MAC and its delivery to investigate all study procedures to inform progression to a definitive trial. Methods This cluster pilot RCT was conducted in 10 community pharmacies in Yorkshire, UK, with a CP from each who regularly conducted Medicine Use Review (MUR) and New Medicine Service (NMS) consultations. Randomisation was conducted using a secure remote randomisation service. Intervention CPs (n = 5) were trained to deliver the MAC in MUR/NMS consultations. Control CPs (n = 5) provided these services as usual. Consecutive MUR/NMS patients were asked by CPs to participate, screened for eligibility (consumption of alcohol at least twice per week), and baseline data collected for those eligible. A two-month follow-up telephone interview was conducted. Blinding of CPs was not possible, but patients were blinded to the alcohol focus of the trial. Primary outcomes were total weekly UK units (8 g of ethanol per unit) of alcohol consumption in the week prior to follow-up, and confidence in medications management. Trial procedures were assessed by recruitment, attrition, and follow-up rates. Results 260 patients were approached by CPs to take part in the trial, 68% (n = 178) were assessed for eligibility and 30% (n = 54) of these patients were eligible. Almost all eligible patients (n = 51; 94%) consented to participate, of whom 92% (n = 47) were followed-up at 2 months; alcohol consumption was lower in the intervention arm and confidence in medication management reduced slightly for both groups. Exploration of recall issues at follow-up showed a high level of agreement between a two-item quantity/frequency measure and 7-day guided recall of alcohol consumption. Conclusions The pilot trial demonstrates the feasibility of implementing the MAC in community pharmacy and trial recruitment and data collection procedures. However, decommissioning of MURs means that it is not possible to conduct a definitive trial of the intervention in this service. Trial registration ISRCTN57447996
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Affiliation(s)
- Duncan Stewart
- Department of Health Sciences, University of York, York, UK.
| | | | | | | | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Ranjita Dhital
- Department of Pharmacy, University of Reading, Reading, UK
| | | | - Brendan Gough
- School of Social Sciences, Leeds Beckett University, Leeds, UK
| | | | - Mary Madden
- Department of Health Sciences, University of York, York, UK
| | | | | | - Margaret Ogden
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Judith Watson
- Department of Health Sciences, University of York, York, UK
| | - Sue White
- North of England Commissioning Support (NECS), Newcastle, UK
| | - Cate Whittlesea
- UCL School of Pharmacy, University College London, London, UK
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18
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Malyutina SK, Mazdorova EV, Shapkina MY, Avdeeva EM, Maslacov NA, Simonova GI, Bobak M, Nikitin YP, Ryabikov AN. [The profile of drug treatment in subjects aged over 50 years with hypertension in an urban russian population]. ACTA ACUST UNITED AC 2020; 60:21-29. [PMID: 32375612 DOI: 10.18087/cardio.2020.3.n948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
Objective To analyze a profile of hypotensive drug therapy in patients with arterial hypertension (АH) aged 55-84 in a sample of urban population at a current period of time (2015-2017).Materials and Methods AH is a leader among risk factors of cardiovascular diseases (CVD) due to its high prevalence and serious prognosis. Despite the availability of effective hypotensive drugs and guidelines on AH treatment, 50% of patients do not achieve blood pressure (BP) goals. Knowledge about drug correction of AH in the Russian population is limited to clinical studies. Taking into account changing approaches in management of patients with AH, the population-based evaluation of hypotensive treatment if relevant. A random population sample of males and females aged 55-84 (n=3.898) was evaluated in Novosibirsk in 2015-2017 (international project, Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE)). AH was diagnosed in presence of systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg and/or treatment with hypotensive drugs within the recent two weeks. Regular intake of medication for 12 months was evaluated with coding according to the Anatomic Therapeutic Chemical Classification System (АТХ / АТС).Results In the population sample aged 55-84, AH prevalence was 80.9 %, and 21.1 % of persons with AH did not receive drug therapy. Hypotensive medicines included (total/as a part of combination therapy) angiotensin-converting enzyme (ACE) inhibitors (42.3 % / 25.3 %), angiotensin II receptor blockers (ARBs) (30.3 % / 18.9 %), diuretics (22.6 % / 20.4 %), calcium channel blockers (20.2 % / 16.1 %), and beta-blockers (34.7 % / 27.6 %). 45.7 % of people with AH received a combination therapy. Effective BP control was achieved in 23.4 % of AH patients and in 29.6 % of patients receiving a hypotensive therapy. In the group of ineffective BP control, the proportion of females was lower, AH duration was longer, and blood glucose was higher than in the group of effective control.Conclusion In the sample of urban population aged 55-84 in 2015-2017, each fourth participant with AH and each third participant using hypotensive drugs achieved effective BP control. The therapy profile in AH patients included recommended drug classes. However, combination therapy was used insufficiently (50% of AH patients). By frequency of use, ACE inhibitors were on the first place, beta-blockers were on the second place, ARBs were on the third place, diuretics were on the fourth place, and calcium channel blockers were on the fifth place, which differed from the guidelines (the difference from the recommended priority ranking is that the drugs taking the first places in the guidelines were in fact on the 3rd and 4th places in their actual frequency of use). 20% of persons with AH did not receive hypotensive therapy, which significantly contributed to the insufficient BP control in the population.
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Affiliation(s)
- S K Malyutina
- Research Institute of Internal and Preventive Medicine, Branch, Federal Research Center, Institute of Cytology and Genetics, Siberian Branch, Russian Academy of Sciences
| | - E V Mazdorova
- Research Institute of Internal and Preventive Medicine, Branch, Federal Research Center, Institute of Cytology and Genetics, Siberian Branch, Russian Academy of Sciences
| | - M Y Shapkina
- Research Institute of Internal and Preventive Medicine, Branch, Federal Research Center, Institute of Cytology and Genetics, Siberian Branch, Russian Academy of Sciences
| | - E M Avdeeva
- Research Institute of Internal and Preventive Medicine, Branch, Federal Research Center, Institute of Cytology and Genetics, Siberian Branch, Russian Academy of Sciences
| | - N A Maslacov
- Research Institute of Internal and Preventive Medicine, Branch, Federal Research Center, Institute of Cytology and Genetics, Siberian Branch, Russian Academy of Sciences
| | - G I Simonova
- Research Institute of Internal and Preventive Medicine, Branch, Federal Research Center, Institute of Cytology and Genetics, Siberian Branch, Russian Academy of Sciences
| | - M Bobak
- University College London, Department of Epidemiology & Public Health
| | - Yu P Nikitin
- Research Institute of Internal and Preventive Medicine, Branch, Federal Research Center, Institute of Cytology and Genetics, Siberian Branch, Russian Academy of Sciences
| | - A N Ryabikov
- Research Institute of Internal and Preventive Medicine, Branch, Federal Research Center, Institute of Cytology and Genetics, Siberian Branch, Russian Academy of Sciences
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19
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Bertholet N, Schmutz E, Grazioli VS, Faouzi M, McNeely J, Gmel G, Daeppen JB, Cunningham JA. Smartphone-based secondary prevention intervention for university students with unhealthy alcohol use identified by screening: study protocol of a parallel group randomized controlled trial. Trials 2020; 21:191. [PMID: 32066490 PMCID: PMC7027100 DOI: 10.1186/s13063-020-4145-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Unhealthy alcohol use is a leading cause of morbidity and mortality among young people, including university students. Delivering secondary prevention interventions against unhealthy alcohol use is challenging. Information technology has the potential to reach large parts of the general population. The present study is proposed to test a proactive secondary prevention smartphone-based intervention against unhealthy alcohol use. METHODS This is a parallel-group, randomized controlled trial (1:1 allocation ratio) among 1696 university students with unhealthy alcohol use, identified by screening and followed up at 3, 6, and 12 months. Participants will be randomized to receive access to a smartphone-based intervention or to a no intervention control condition. The primary outcome will be self-reported volume of alcohol drunk over the past 30 days, reported as the mean number of standard drinks per week over the past 30 days, measured at 6 months. Secondary outcomes will be number of heavy drinking days over the past 30 days, at 6 months. Additional outcomes will be maximum number of drinks on any day over the past 30 days, alcohol-related consequences (measured using the Short Inventory of Problems (SIP-2R), and academic performance. DISCUSSION The aim of this trial is to close the evidence gap on the efficacy of smartphone-based secondary prevention interventions. If proven effective, smartphone-based interventions have the potential to reach a large portion of the population, completing what is available on the Internet. TRIAL REGISTRATION ISRCTN, 10007691. Registered on 2 December 2019. Recruitment will start in April 2020.
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Affiliation(s)
- Nicolas Bertholet
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Elodie Schmutz
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Véronique S Grazioli
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Mohamed Faouzi
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jennifer McNeely
- Department of Population Health, Section on Tobacco, Alcohol and Drug Use, New York University (NYU) Grossman School of Medicine, New York, NY, 10016, USA
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John A Cunningham
- Center for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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20
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Brennan SE, McDonald S, Page MJ, Reid J, Ward S, Forbes AB, McKenzie JE. Long-term effects of alcohol consumption on cognitive function: a systematic review and dose-response analysis of evidence published between 2007 and 2018. Syst Rev 2020; 9:33. [PMID: 32054517 PMCID: PMC7020517 DOI: 10.1186/s13643-019-1220-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/04/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Understanding the long-term health effects of low to moderate alcohol consumption is important for establishing thresholds for minimising the lifetime risk of harm. Recent research has elucidated the dose-response relationship between alcohol and cardiovascular outcomes, showing an increased risk of harm at levels of intake previously thought to be protective. The primary objective of this review was to examine (1) whether there is a dose-response relationship between levels of alcohol consumption and long-term cognitive effects, and (2) what the effects are of different levels of consumption. METHODS The review was conducted according to a pre-specified protocol. Eligible studies were those published 2007 onwards that compared cognitive function among people with different levels of alcohol consumption (measured ≥ 6 months prior to first follow-up of cognition). Major cognitive impairment was excluded. Searches were limited to MEDLINE, Embase and PsycINFO (January 2007 to April 2018). Screening, data extraction, and risk of bias assessment (ROBINS-I) were piloted by three authors, then completed by a single author and checked by a second. Analyses were undertaken to identify and characterise dose-response relationships between levels of alcohol consumption and cognition. Certainty of evidence was assessed using GRADE. RESULTS We included 27 cohort studies (from 4786 citations). Eighteen studies examined the effects of alcohol consumption at different levels (risk of bias 16 serious, 2 critical). Ten studies provided data for dose-response analysis. The pooled dose-response relationship showed a maximum standardised mean difference (SMD) indicating slightly better cognition among women with moderate alcohol consumption compared to current non-drinkers (SMD 0.18, 95%CI 0.02 to 0.34, at 14.4 grams/day; 5 studies, very low certainty evidence), and a trivial difference for men (SMD 0.05, 95% CI 0.00 to 0.10, at 19.4 grams/day; 6 studies, very low certainty evidence). CONCLUSIONS Major limitations in the design and reporting of included studies made it impossible to discern if the effects of 'lower' levels of alcohol intake are due to bias. Further review of the evidence is unlikely to resolve this issue without meta-analysis of individual patient data from cohort studies that address biases in the selection of participants and classification of alcohol consumption.
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Affiliation(s)
- Sue E. Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Steve McDonald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew J. Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephanie Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew B. Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E. McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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21
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Bertholet N, Cunningham JA, Adam A, McNeely J, Daeppen JB. Electronic screening and brief intervention for unhealthy alcohol use in primary care waiting rooms - A pilot project. Subst Abus 2019; 41:347-355. [PMID: 31364948 DOI: 10.1080/08897077.2019.1635963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: In primary care, electronic self-administered screening and brief interventions for unhealthy alcohol may overcome some of the implementation barriers of face-to-face intervention. We developed an anonymous electronic self-administered screening brief intervention device for unhealthy alcohol use and assessed its feasibility and acceptability in primary care practice waiting rooms. Two modes of delivery were compared: with or without the presence of a research assistant (RA) to make patients aware of the device's presence and help users. Using the device was optional. Methods: The devices were placed in 10 participating primary care practices waiting rooms for 6 weeks, and were accessible on a voluntary basis. Number of appointments by each practice during the course of the study was recorded. Access to the electronic brief intervention was voluntary among those who screened positive. Screening and brief intervention rates and characteristics of users were compared across the modes of delivery. Results: During the study, there were 7270 appointments and 1511 individuals used the device (20.8%). Mean age of users was 45.3 (19.5), and 57.9% screened positive for unhealthy alcohol use. Of them, 53.8% accessed the brief intervention content. The presence of the RA had a major impact on the device's usage (59.6% vs 17.4% when absent). When the RA was present, participants were less likely to screen positive (49.4% vs 60.7%, P = 0.0003) but more likely to access the intervention (62.7% vs 51.4%, P = 0.009). Results from the satisfaction survey indicated that users found the device easy to use (93.5%), questions useful (89-95%) and 77.2% reported that their friends would be willing to use it. Conclusions: This pilot project indicates that the implementation of an electronic screening and brief intervention device for unhealthy alcohol is feasible and acceptable in primary care practices but that, without human support, its use is rather limited.
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Affiliation(s)
- Nicolas Bertholet
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John A Cunningham
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Angéline Adam
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Jennifer McNeely
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Bendtsen M, McCambridge J. Reducing Alcohol Consumption Among Risky Drinkers in the General Population of Sweden Using an Interactive Mobile Health Intervention: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13119. [PMID: 30998221 PMCID: PMC6495288 DOI: 10.2196/13119] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/28/2019] [Accepted: 03/03/2019] [Indexed: 12/25/2022] Open
Abstract
Background Harmful use of alcohol continues to be a leading contributor to premature deaths globally. Not only does harmful drinking have consequences for the individuals consuming at increased levels, but it may also result in a range of negative consequences for their family members and friends. Interventions delivered via mobile phones (mobile health [mHealth] interventions) could potentially support risky drinkers seeking help to reduce their alcohol consumption. Objective This protocol describes a randomized controlled trial that aims to validly estimate the effect of a novel mHealth intervention targeting risky drinkers in the general population of Sweden. Nested within the trial are 3 substudies that focus on methodological and user satisfaction research questions. Methods A 2-arm parallel group randomized controlled trial will be employed to estimate the effect of the novel intervention. Participants will be recruited through Web advertisements and social media. The inclusion criteria are as follows: 18 years or older, ownership of a mobile phone, and being classified as a risky drinker according to Swedish guidelines. Participants allocated to the intervention group will receive a novel mHealth intervention. The intervention consists of weekly screening, personalized feedback on current consumption, functions allowing for planning of future consumption, as well as a series of messages delivered throughout the week. Participants allocated to the control group will receive a short message regarding negative consequences of alcohol consumption and a hyperlink that offers more information. Following 2 and 4 months after randomization, both groups will be asked to complete follow-up questionnaires (2-month interval being primary). Primary outcomes are weekly alcohol consumption and heavy episodic drinking. Participants in the control group will be given access to the novel intervention after completing the 4-month follow-up. The trial includes 3 substudies: We will explore whether the mode of presenting information before participants giving informed consent affects participation rates and recall of trial parameters, investigate if the content of the short message received by the control group affects study outcomes and requests for more information, and explore user satisfaction with the intervention and reactions of the control group. Results Participant recruitment is planned to begin in April 2019 and to last for a maximum of 24 months. The first dataset will be available approximately 2 months after the final participant has been recruited, and the final dataset will be available approximately 2 months later. No participants had been recruited at the time of submitting this protocol. Conclusions If found effective, the intervention has the potential to reduce negative consequences of alcohol consumption for individuals. The technology has been designed to have potential for extensive reach among those who may benefit. Trial Registration ISRCTN Registry ISRCTN48317451; http://www.isrctn.com/ISRCTN48317451 (Archived by WebCite at http://www.webcitation.org/779tKLsu3) International Registered Report Identifier (IRRID) PRR1-10.2196/13119
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Affiliation(s)
- Marcus Bendtsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, United Kingdom
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Trangenstein PJ, Morojele NK, Lombard C, Jernigan DH, Parry CDH. Heavy drinking and contextual risk factors among adults in South Africa: findings from the International Alcohol Control study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2018; 13:43. [PMID: 30518429 PMCID: PMC6280515 DOI: 10.1186/s13011-018-0182-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/20/2018] [Indexed: 02/06/2023]
Abstract
Background There is limited information about the potential individual-level and contextual drivers of heavy drinking in South Africa. This study aimed to identify risk factors for heavy drinking in Tshwane, South Africa. Methods A household survey using a multi-stage stratified cluster random sampling design. Complete consumption and income data were available on 713 adults. Heavy drinking was defined as consuming ≥120 ml (96 g) of absolute alcohol (AA) for men and ≥ 90 ml (72 g) AA for women at any location at least monthly. Results 53% of the sample were heavy drinkers. Bivariate analyses revealed that heavy drinking differed by marital status, primary drinking location, and container size. Using simple logistic regression, only cider consumption was found to lower the odds of heavy drinking. Persons who primarily drank in someone else’s home, nightclubs, and sports clubs had increased odds of heavy drinking. Using multiple logistic regression and adjusting for marital status and primary container size, single persons were found to have substantially higher odds of heavy drinking. Persons who drank their primary beverage from above average-sized containers at their primary location had 7.9 times the odds of heavy drinking as compared to persons who drank from average-sized containers. Some significant associations between heavy drinking and age, race, and income were found for certain beverages. Conclusion Rates of heavy drinking were higher than expected giving impetus to various alcohol policy reforms under consideration in South Africa. Better labeling of the alcohol content of different containers is needed together with limiting production, marketing and serving of alcohol in large containers.
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Affiliation(s)
- Pamela J Trangenstein
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA, 94608, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - Neo K Morojele
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, 1 Soutpansberg Rd, Prinshof 349-Jr, Pretoria, 0084, South Africa.,School of Public Health, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Falmouth Rd, Observatory, Cape Town, 7925, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - David H Jernigan
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - Charles D H Parry
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Box 19070, Tygerberg, PO, 7505, South Africa. .,Department of Psychiatry, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.
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Søgaard AJ, Ranhoff AH, Meyer HE, Omsland TK, Nystad W, Tell GS, Holvik K. The association between alcohol consumption and risk of hip fracture differs by age and gender in Cohort of Norway: a NOREPOS study. Osteoporos Int 2018; 29:2457-2467. [PMID: 30006884 DOI: 10.1007/s00198-018-4627-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/28/2018] [Indexed: 01/23/2023]
Abstract
UNLABELLED The association between alcohol consumption and hip fracture differed by gender: Men aged 30-59 years drinking frequently or 14+ gl/week had higher risk than moderate drinkers. No significant association was seen in older men. Women not drinking alcohol had higher risk than those drinking moderately both regarding frequency and amount. INTRODUCTION We aimed to examine alcohol consumption and risk of hip fracture according to age and gender in the population-based Cohort of Norway (1994-2003). METHODS Socio-demographics, lifestyle, and health were self-reported and weight and height were measured in 70,568 men and 71,357 women ≥ 30 years. Information on subsequent hip fractures was retrieved from hospitals' electronic patient registries during 1994-2013. Frequency of alcohol consumption was categorized: never/seldom, moderate (≤ 2-3 times/week), or frequent (≥ 4 times/week), and amount as number of glasses per week: 0, 1-6, 7-13, 14-27, and 28+. Type of alcohol (wine vs. beer/hard liquor) was also examined. Cox's proportional hazards regression was used to estimate hazard ratios (HRs) stratified on gender and baseline age < 60 and ≥ 60 years. RESULTS During median 15-year follow-up, 1558 men and 2511 women suffered a hip fracture. Using moderate drinkers as reference, men < 60 years drinking frequently had multivariable adjusted HR = 1.73 (CI 1.02-2.96) for hip fracture and more than 2.5 times higher risk if they consumed 14+ glasses compared to 1-6 glasses per week. In other groups of age and gender, no statistically significant increased risk was found in those consuming the highest levels of alcohol. Compared to women with moderate or frequent alcohol use, never/seldom-drinking women had the highest fracture risk. In women, use of wine was associated with lower fracture risk than other types of alcohol. CONCLUSIONS Risk of hip fracture was highest in men < 60 years with the highest frequency and amount of alcohol consumption and in non-drinking women.
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Affiliation(s)
- A J Søgaard
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway.
| | - A H Ranhoff
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - H E Meyer
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - T K Omsland
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - W Nystad
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway
| | - G S Tell
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - K Holvik
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 4404, 0403, Oslo, Norway
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Effect of electronic screening and brief intervention on hazardous or harmful drinking among adults in the hospital outpatient setting: A randomized, double-blind, controlled trial. Drug Alcohol Depend 2018; 191:78-85. [PMID: 30096637 DOI: 10.1016/j.drugalcdep.2018.06.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/22/2018] [Accepted: 06/26/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Most trials of electronic alcohol screening and brief intervention (e-SBI) have been conducted in young people. The aim of this study was to evaluate the effect of e-SBI in adults with hazardous or harmful drinking. METHODS This individually randomized, parallel, two-group, double-blind controlled trial was conducted in the outpatient department of a large public hospital in Australia. Consenting adults who scored 5-9 on the AUDIT-C (837/3225; 26%) were randomized in a 1:1 ratio by computer to screening alone (442/837; 53%) or to 10 min of assessment and personalized feedback on their alcohol consumption (comparisons with medical guidelines and age and sex-specific norms), peak blood alcohol concentration, expenditure on alcohol, and risk of alcohol dependence (395/837; 47%). The two primary outcomes, assessed six months after randomization, were the number of standard drinks (10 g ethanol) consumed by participants in the last seven days and their AUDIT score. RESULTS 693/837 (83%) and 635/837 (76%) participants were followed-up at 6 and 12 months, respectively. There was no statistically significant difference between the groups in the median number of standard drinks consumed in the last seven days (intervention: 12; control: 10.5; rate ratio, 1.12 [95% confidence interval, 0.96-1.31]; P = .17) or in their median AUDIT score (intervention: 7; control: 7; mean difference, 0.28 [-0.42 to 0.98]; P = .44). CONCLUSION These results do not support the implementation of an e-SBI program comprising personalized feedback and normative feedback for adults with hazardous or harmful drinking in the hospital outpatient setting.
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Vichitkunakorn P, Balthip K, Geater A, Assanangkornchai S. Comparisons between context-specific and beverage-specific quantity frequency instruments to assess alcohol consumption indices: Individual and sample level analysis. PLoS One 2018; 13:e0202756. [PMID: 30118509 PMCID: PMC6097696 DOI: 10.1371/journal.pone.0202756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/08/2018] [Indexed: 11/18/2022] Open
Abstract
There are many survey instruments to determine drinking patterns and alcohol consumption levels in the general population. This study aims to compare the context-specific quantity-frequency (CSQF) and beverage-specific quantity-frequency (BSQF) methods to estimate alcohol consumption indices at individual and sample levels. A community-based cross-sectional study was conducted among a population aged 15 years and older in Songkhla Province, Thailand. The BSQF and CSQF questionnaires with a 3-month retrospective time frame and in random order were applied to each participant. The CSQF was developed to ask more about the drinking contexts. The questions elicited information on location, partner, beverage, quantity, and frequency for five common drinking situations. Among 804 participants, 183 drank alcohol in the last three months. At the individual level, total alcohol consumption of almost all types of beverage by the CSQF was higher than the BSQF in approximately 50% of current drinkers and was mainly accounted for by the higher report of average quantity. At the sample level, there were no significant differences in the average daily intake, 3-month intake per drinker or per capita consumption between instruments. The interview duration and burden of answering the questions by the participants for the CSQF were not significantly higher than those for the BSQF. In summary, the fuller picture of drinking behaviors from the CSQF has several valuable methodological advantages and provides information allowing alcohol policies to be more directly specific to certain target populations or situations. The CSQF is a prototype questionnaire and forms the basis for a contextual approach. However, additional methodological studies need to be explored.
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Affiliation(s)
- Polathep Vichitkunakorn
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | | | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Bertholet N, Studer J, Cunningham JA, Gmel G, Burnand B, Daeppen JB. Four-year follow-up of an internet-based brief intervention for unhealthy alcohol use in young men. Addiction 2018; 113:1517-1521. [PMID: 29396897 DOI: 10.1111/add.14179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/29/2017] [Accepted: 01/31/2018] [Indexed: 11/27/2022]
Abstract
AIM To estimate the long-term efficacy of an internet-based brief intervention (IBI) in decreasing alcohol use among men on (1) number of drinks/week and (2) monthly or more binge drinking prevalence. In addition, overall changes in alcohol use were assessed. DESIGN Participants in a cohort study were recruited in a two parallel-group randomized controlled trial of an IBI versus no-intervention control condition, showing a positive intervention effect at 6 months. As part of the regular cohort assessments, participants were re-assessed 47 months after the initial trial, offering an opportunity to determine long-term efficacy. SETTING Young Swiss men from the general population. PARTICIPANTS Of 737 randomized trial participants with unhealthy alcohol use (> 14 drinks/week or ≥ 6 drinks/occasion at least monthly, or Alcohol Use Disorders Identification Test (AUDIT) ≥ 8), 626 completed a cohort assessment at mean ± standard deviation (SD) = 47.4 ± 2.6) months after their randomized trial baseline assessment. INTERVENTION IBI included normative and personalized feedback on alcohol use, risk indicators, information about alcohol and health and recommendations; controls: assessment only. MEASUREMENTS Self-reported number of drinks/week and monthly or more binge drinking prevalence. FINDINGS Comparisons at follow-up were adjusted for baseline drinking. Missing values were replaced with the last observation carried forward. There was no evidence of differences between the IBI and control group on either the number of drinks/week [IBI: 10.8 (14.2); control: 10.7 (14.1), P = 0.8] or monthly or more binge drinking prevalence (IBI: 65.1%; control: 63.5%, P = 0.5). Although there was no evidence of overall change from baseline in number of drinks/week [9.8 (7.9) at baseline, 10.8 (14.1) at 47 months, P = 0.051], there was evidence that monthly or more binge drinking prevalence had decreased during the follow-up time (84.9% at baseline, 64.3% at 47 months, P < 0.001). CONCLUSIONS An internet-based brief intervention directed at unhealthy alcohol use among young men does not appear to reduce drinking over the long-term.
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Affiliation(s)
- Nicolas Bertholet
- Alcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Joseph Studer
- Alcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland
| | - John A Cunningham
- Center for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Ontario, Canada
| | - Gerhard Gmel
- Alcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Assessment of alcohol intake: Retrospective measures versus a smartphone application. Addict Behav 2018; 83:35-41. [PMID: 29128148 DOI: 10.1016/j.addbeh.2017.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Research investigating problem drinking often relies on retrospective measures to assess alcohol consumption behaviour. Limitations associated with such instruments can, however, distort actual consumption levels and patterns. We developed the smartphone application (app), CNLab-A, to assess alcohol intake behaviour in real-time. METHODS Healthy individuals (N=671, M age 23.12) completed demographic questions plus the Alcohol Use Questionnaire and a 21-day Timeline Followback before using CNLab-A for 21days. The app asked participants to record alcohol consumption details in real time. We compared data reported via retrospective measures with that captured using CNLab-A. RESULTS On average, participants submitted data on 20.27days using CNLab-A. Compared to Timeline Followback, a significantly greater percentage of drinking days (24.79% vs. 26.44%) and significantly higher total intake (20.30 vs. 24.26 standard drinks) was recorded via the app. CNLab-A captured a substantially greater number of high intake occasions at all levels from 8 or more drinks than Timeline Followback. Additionally, relative to the Alcohol Use Questionnaire, a significantly faster rate of consumption was recorded via the app. CONCLUSIONS CNLab-A provided more nuanced information regarding quantity and pattern of alcohol intake than the retrospective measures. In particular, it revealed higher levels of drinking than retrospective reporting. This will have implications for how particular at-risk alcohol consumption patterns are identified in future and might enable a more sophisticated exploration of the causes and consequences of drinking behaviour.
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Guillot CR, Blumenthal H, Zvolensky MJ, Schmidt NB. Anxiety sensitivity components in relation to alcohol and cannabis use, motives, and problems in treatment-seeking cigarette smokers. Addict Behav 2018; 82:166-173. [PMID: 29544169 DOI: 10.1016/j.addbeh.2018.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/06/2018] [Accepted: 03/06/2018] [Indexed: 12/14/2022]
Abstract
Anxiety sensitivity (AS)- fear of anxiety symptoms and their potential negative consequences-has been implicated in the development of substance use problems and motivation to use substances for coping with distress, though the AS components (physical, cognitive, and social concerns) have not been studied extensively in relation to alcohol- and cannabis-related variables. In a cross-sectional design, self-report measures of AS and alcohol and cannabis use, motives, and problems were administered to 364 treatment-seeking cigarette smokers with a history of alcohol and cannabis use. In both adjusted and unadjusted analyses, linear regression models indicated that AS cognitive concerns are related to cannabis-use conformity motives, alcohol-use coping motives, and alcohol problems; AS physical and cognitive concerns are related to greater cannabis problems specifically in males; and AS social concerns are associated with greater social, coping, enhancement, and conformity drinking motives. AS cognitive and physical concerns were also related to greater alcohol and cannabis problems, respectively, in subsamples limited to 214 current alcohol users and 170 current cannabis users. Together with prior work, current findings suggest that it may be beneficial to focus more on addressing AS cognitive concerns in individuals with tobacco-alcohol problem comorbidity, whereas it may be beneficial to focus on addressing both AS physical and cognitive concerns in males with tobacco-cannabis problem comorbidity. In addition, cigarette smokers high in AS social concerns may benefit from relaxation training to lessen their social anxiety as well as behavioral activation to enhance their positive affect.
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Abstract
This article is an overview of different approaches to measuring alcohol consumption: self-reports and objective measures such as blood alcohol concentration (BAC) and aggregate level measures. These approaches are evaluated as regards their ability to capture quantity, frequency, volume and variability of drinking. This review focuses on self-report measures and on the current knowledge of undercoverage error when compared with sales data. In the comparative evaluation of measures, two analytical aims are examined: a) description and testing of differences across groups for which ordinal information is sufficient and b) establishment of cutoff points and risk relationships for which unbiased interval scale level is required. First, minimal differences were found between self-report measures when the recall period was sufficiently long enough. Second, prospective diaries appear to be stronger measures than retrospective recalls. However, prospective diaries commonly cover only short reporting periods and should be combined with simple retrospective measures to capture rare and infrequent drinking episodes. In regard to undercoverage, the discrepancy cannot be fully explained by non-response or concealment of consumption by drinkers. It is argued that undercoverage of sales data may be more related to sample frame defects–-e.g., the non-inclusion of particular subpopulations such as the homeless or institutionalized.
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Johnson NA, Kypri K, Latter J, Dunlop A, Brown A, Saitz R, Saunders JB, Attia J, Wolfenden L, Doran C, McCambridge J. Effect of electronic brief intervention on uptake of specialty treatment in hospital outpatients with likely alcohol dependence: Pilot randomized trial and qualitative interviews. Drug Alcohol Depend 2018; 183:253-260. [PMID: 29306817 DOI: 10.1016/j.drugalcdep.2017.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/25/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A large proportion of hospital outpatients are alcohol dependent (AD) but few are engaged in treatment for their drinking. Brief intervention, designed to raise patients' awareness of their drinking, might encourage uptake of referral to specialty treatment. We assessed the feasibility of conducting a randomized trial evaluating the effectiveness of electronic brief intervention on the uptake of specialty treatment in hospital outpatients with likely AD. METHODS This study was conducted in the outpatient department of a large public hospital in Newcastle, Australia. We randomly assigned adults who scored ≥10 on the AUDIT-C and were not currently receiving treatment for their drinking to electronic brief intervention (comprising an assessment of their drinking and personalized feedback) and referral (n = 59), or to referral alone (n = 64). We pre-specified two co-primary outcomes as the proportions of patients who (1) accepted and (2) attended a Drug and Alcohol outpatient clinic appointment. We interviewed 15 study participants to investigate why they had declined the appointment and what sort of help they might prefer to receive. RESULTS Ten patients (five in each group) accepted an appointment, and one patient (control) attended. Most interviewees' did not see their drinking as a problem or were confident they could manage it by themselves. Those who identified a preferred source of help expressed a preference for treatment by a GP. CONCLUSION Uptake of specialty treatment in hospital outpatients with likely AD was low regardless of whether they received brief intervention. Accordingly, a large randomized trial does not appear to be feasible.
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Affiliation(s)
- Natalie A Johnson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Kypros Kypri
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Joanna Latter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Drug and Alcohol Clinical Services, Newcastle, NSW, 2300, Australia
| | - Amanda Brown
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Drug and Alcohol Clinical Services, Newcastle, NSW, 2300, Australia
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and the Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - John B Saunders
- Centre for Youth Substance Abuse Research, University of Queensland, Herston, 4006, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Department of General Medicine, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter New England Local Health District Population Health, Wallsend, NSW, 2287, Australia
| | - Christopher Doran
- Centre for Indigenous Health Equity Research, Central Queensland University, Brisbane, 4000, Australia
| | - Jim McCambridge
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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Tillmann T, Pikhart H, Peasey A, Kubinova R, Pajak A, Tamosiunas A, Malyutina S, Steptoe A, Kivimäki M, Marmot M, Bobak M. Psychosocial and socioeconomic determinants of cardiovascular mortality in Eastern Europe: A multicentre prospective cohort study. PLoS Med 2017; 14:e1002459. [PMID: 29211726 PMCID: PMC5718419 DOI: 10.1371/journal.pmed.1002459] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 10/23/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Eastern European countries have some of the highest rates of cardiovascular disease (CVD) mortality, much of which cannot be adequately accounted for by conventional CVD risk factors. Psychosocial and socioeconomic factors may affect risk of CVD, but relatively few studies on this issue have been undertaken in Eastern Europe. We investigated whether various psychosocial factors are associated with CVD mortality independently from each other and whether they can help explain differences in CVD mortality between Eastern European populations. METHODS Participants were from the Health, Alcohol and Psychological factors in Eastern Europe (HAPIEE) cohort study in Russia, Poland and the Czech Republic, including a total of 20,867 men and women aged 43-74 years and free of CVD at baseline examination during 2002-2005. Participants were followed-up for CVD mortality after linkage to national mortality registries for a median of 7.2 years. RESULTS During the follow-up, 556 participants died from CVD. After mutual adjustment, six psychosocial and socioeconomic factors were associated with increased risk of CVD death: unemployment, low material amenities, depression, being single, infrequent contacts with friends or relatives. The hazard ratios [HRs] for these six factors ranged between 1.26 [95% confidence interval 1.14-1.40] and 1.81 [95% confidence interval 1.24-2.64], fully adjusted for each other, and conventional cardiovascular risk factors. Population-attributable fractions ranged from 8% [4%-13%] to 22% [11%-31%] for each factor, when measured on average across the three cohorts. However, the prevalence of psychosocial and socioeconomic risk factors and their HRs were similar between the three countries. Altogether, these factors could not explain why participants from Russia had higher CVD mortality when compared to participants from Poland/Czech Republic. Limitations of this study include measurement error that could lead to residual confounding; and the possibilities for reverse causation and/or unmeasured confounding from observational studies to lead to associations that are not causal in nature. CONCLUSIONS Six psychosocial and socioeconomic factors were associated with cardiovascular mortality, independent of each other. Differences in mortality between cohorts from Russia versus Poland or Check Republic remained unexplained.
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Affiliation(s)
- Taavi Tillmann
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
- * E-mail:
| | - Hynek Pikhart
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Anne Peasey
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Ruzena Kubinova
- Centre for Environmental Health Monitoring, National Institute of Public Health, Prague, Czech Republic
| | - Andrzej Pajak
- Chair of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sofia Malyutina
- Research Institute of Internal and Preventive Medicine, Branch of the Institute of Cytology and Genetics, SB RAS, Novosibirsk, Russia
- Novosibirsk State Medical University, Novosibirsk, Russia
| | - Andrew Steptoe
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Mika Kivimäki
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Michael Marmot
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Martin Bobak
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
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Black N, Mullan B, Sharpe L. Predicting heavy episodic drinking using an extended temporal self-regulation theory. Addict Behav 2017; 73:111-118. [PMID: 28501675 DOI: 10.1016/j.addbeh.2017.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 03/04/2017] [Accepted: 04/27/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Alcohol consumption contributes significantly to the global burden from disease and injury, and specific patterns of heavy episodic drinking contribute uniquely to this burden. Temporal self-regulation theory and the dual-process model describe similar theoretical constructs that might predict heavy episodic drinking. The aims of this study were to test the utility of temporal self-regulation theory in predicting heavy episodic drinking, and examine whether the theoretical relationships suggested by the dual-process model significantly extend temporal self-regulation theory. METHODS This was a predictive study with 149 Australian adults. Measures were questionnaires (self-report habit index, cues to action scale, purpose-made intention questionnaire, timeline follow-back questionnaire) and executive function tasks (Stroop, Tower of London, operation span). Participants completed measures of theoretical constructs at baseline and reported their alcohol consumption two weeks later. Data were analysed using hierarchical multiple linear regression. RESULTS Temporal self-regulation theory significantly predicted heavy episodic drinking (R2=48.0-54.8%, p<0.001) and the hypothesised extension significantly improved the prediction of heavy episodic drinking frequency (ΔR2=4.5%, p=0.001) but not peak consumption (ΔR2=1.4%, p=0.181). Intention and behavioural prepotency directly predicted heavy episodic drinking (p<0.01). Planning ability moderated the intention-behaviour relationship and inhibitory control moderated the behavioural prepotency-behaviour relationship (p<0.05). CONCLUSIONS Both temporal self-regulation theory and the extended temporal self-regulation theory provide good prediction of heavy episodic drinking. Intention, behavioural prepotency, planning ability and inhibitory control may be good targets for interventions designed to decrease heavy episodic drinking.
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Shield KD, Gmel G, Gmel G, Mäkelä P, Probst C, Room R, Rehm J. Life-time risk of mortality due to different levels of alcohol consumption in seven European countries: implications for low-risk drinking guidelines. Addiction 2017; 112:1535-1544. [PMID: 28318072 DOI: 10.1111/add.13827] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/04/2017] [Accepted: 03/15/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Low-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Life-time mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts. METHODS The maximum acceptable voluntary premature mortality risk was determined to be one in 1000, with sensitivity analyses of one in 100. Life-time mortality risks for different alcohol consumption levels were estimated by combining disease-specific relative risk and mortality data for seven European countries with different drinking patterns (Estonia, Finland, Germany, Hungary, Ireland, Italy and Poland). Alcohol consumption data were obtained from the Global Information System on Alcohol and Health, relative risk data from meta-analyses and mortality information from the World Health Organization. RESULTS The variation in the life-time mortality risk at drinking levels relevant for setting guidelines was less than that observed at high drinking levels. In Europe, the percentage of adults consuming above a risk threshold of one in 1000 ranged from 20.6 to 32.9% for women and from 35.4 to 54.0% for men. Life-time risk of premature mortality under current guideline maximums ranged from 2.5 to 44.8 deaths per 1000 women in Finland and Estonia, respectively, and from 2.9 to 35.8 deaths per 1000 men in Finland and Estonia, respectively. If based upon an acceptable risk of one in 1000, guideline maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men. CONCLUSIONS If low-risk alcohol guidelines were based on an acceptable risk of one in 1000 premature deaths, then maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men, and some of the current European guidelines would require downward revision.
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Affiliation(s)
- Kevin D Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gerrit Gmel
- School of Electrical Engineering and Telecommunications, University of New South Wales, Kensington, Australia
| | - Gerhard Gmel
- Epidemiology and Statistics Section, Addiction Suisse, Lausanne, Switzerland
| | - Pia Mäkelä
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare THL, Helsinki, Finland
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Centre for Social Research on Alcohol and Drugs, Stockholm University, Sweden
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Bø R, Landrø NI. Inhibitory control and response monitoring are not systematically related to weekly alcohol consumption in the general population. Psychopharmacology (Berl) 2017; 234:1761-1768. [PMID: 28280883 DOI: 10.1007/s00213-017-4578-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/20/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND In alcohol use disorder, deficits in cognitive control (i.e., inhibition and response monitoring) might underlie the loss of self-control and, thereby, failure to adjust alcohol consumption in response to associated negative consequences. According to the continuum hypothesis, the magnitude of these deficits should be related in a stair-case manner, with the greatest deficits among its heaviest consumers. The current study aims at investigating this association in the general population. METHODS This is a cross-sectional study of 397 participants aged 18-64 years, who self-reported their mean weekly alcohol consumption and were assessed with the stop-signal task, estimating inhibitory efficiency (stop-signal reaction time; SSRT) and response monitoring (post-error slowing; PES). Set-shifting ability was investigated by the intra-extra dimensional (IED) set-shifting task. Three ANCOVAs were performed with SSRT, PES, and IED as the dependent variables (DV), respectively, and alcohol consumption levels as the independent variable. Covariates were included when they were significantly associated with the DV. RESULTS Compared to the teetotalers, all levels of alcohol consumption were significantly associated to lower SSRT, which implies more efficient inhibitory control; however, there was no significant difference in SSRT between other consumption levels. The two highest consumption groups had significantly shorter PES when compared to teetotalers and/or the lowest consumption group, implying less behavioral adjustment after failures. IED was not significantly related to the alcohol consumption levels. CONCLUSIONS There was no stair-case relation between weekly consumption levels and cognitive control functions within this general population, which might be due to the limited consumption range investigated.
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Affiliation(s)
- Ragnhild Bø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, P.O. box 1094, Blindern, 0317, Oslo, Norway.
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, P.O. box 1094, Blindern, 0317, Oslo, Norway
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Rehm J, Gmel GE, Gmel G, Hasan OSM, Imtiaz S, Popova S, Probst C, Roerecke M, Room R, Samokhvalov AV, Shield KD, Shuper PA. The relationship between different dimensions of alcohol use and the burden of disease-an update. Addiction 2017; 112:968-1001. [PMID: 28220587 PMCID: PMC5434904 DOI: 10.1111/add.13757] [Citation(s) in RCA: 633] [Impact Index Per Article: 90.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/19/2016] [Accepted: 01/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). METHODS Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. RESULTS In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. CONCLUSIONS Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Campbell Family Mental Health Research Institute, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Institute for Clinical Psychology and Psychotherapy, TU DresdenDresdenGermany
| | - Gerhard E. Gmel
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Alcohol Treatment CenterLausanne University HospitalLausanneSwitzerland
- Addiction SwitzerlandLausanneSwitzerland
- University of the West of EnglandBristolUK
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
| | - Omer S. M. Hasan
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
| | - Svetlana Popova
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoOntarioCanada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute for Clinical Psychology and Psychotherapy, TU DresdenDresdenGermany
| | - Michael Roerecke
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Robin Room
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVictoriaAustralia
- Centre for Social Research on Alcohol and DrugsStockholm UniversityStockholmSweden
| | - Andriy V. Samokhvalov
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Kevin D. Shield
- Section of Cancer SurveillanceInternational Agency for Research on CancerLyonFrance
| | - Paul A. Shuper
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
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Connor J, Kydd R, Maclennan B, Shield K, Rehm J. Alcohol-attributable cancer deaths under 80 years of age in New Zealand. Drug Alcohol Rev 2017; 36:415-423. [PMID: 27306121 DOI: 10.1111/dar.12443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/20/2016] [Accepted: 05/11/2016] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND AIMS Cancer deaths made up 30% of all alcohol-attributable deaths in New Zealanders aged 15-79 years in 2007, more than all other chronic diseases combined. We aimed to estimate alcohol-attributable cancer mortality and years of life lost by cancer site and identify differences between Māori and non-Māori New Zealanders. DESIGN AND METHODS We applied the World Health Organization's comparative risk assessment methodology at the level of Māori and non-Māori subpopulations. Proportions of specific alcohol-related cancers attributable to alcohol were calculated by combining alcohol consumption estimates from representative surveys with relative risks from recent meta-analyses. These proportions were applied to both 2007 and 2012 mortality data. RESULTS Alcohol consumption was responsible for 4.2% of all cancer deaths under 80 years of age in 2007. An average of 10.4 years of life was lost per person; 12.7 years for Māori and 10.1 years for non-Māori. Half of the deaths were attributable to average consumption of <4 standard drinks per day. Breast cancer comprised 61% of alcohol-attributable cancer deaths in women, and more than one-third of breast cancer deaths were attributable to average consumption of <2 standard drinks per day. Mortality data from 2012 produced very similar findings. DISCUSSION AND CONCLUSIONS Alcohol is an important and modifiable cause of cancer. Risk of cancer increases with higher alcohol consumption, but there is no safe level of drinking. Reduction in population alcohol consumption would reduce cancer deaths. Additional strategies to reduce ethnic disparities in risk and outcome are needed in New Zealand. [Connor J, Kydd R, Maclennan B, Shield K, Rehm J. Alcohol-attributable cancer deaths under 80 years of age in New Zealand. Drug Alcohol Rev 2017;36:415-423].
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Affiliation(s)
- Jennie Connor
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Robyn Kydd
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Brett Maclennan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Kevin Shield
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Khadjesari Z, Hardoon SL, Petersen I, Hamilton FL, Nazareth I. Impact of Financial Incentives on Alcohol Consumption Recording in Primary Health Care Among Adults with Schizophrenia and Other Psychoses: A Cross-Sectional and Retrospective Cohort Study. Alcohol Alcohol 2017; 52:197-205. [PMID: 28182195 PMCID: PMC5860463 DOI: 10.1093/alcalc/agw076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 09/16/2016] [Accepted: 09/30/2016] [Indexed: 12/24/2022] Open
Abstract
Aims Lack of financial incentive is a frequently cited barrier to alcohol screening in primary care. The Quality and Outcomes Framework (QOF) pay for performance scheme has reimbursed UK primary care practices for alcohol screening in people with schizophrenia since April 2011. This study aimed to determine the impact of financial incentives on alcohol screening by comparing rates of alcohol recording in people with versus those without schizophrenia between 2000 and 2013. Methods Cross-sectional and retrospective cohort study. Alcohol data were extracted from The Health Improvement Network (THIN) database of UK primary care records using (a) Read Codes for level of alcohol consumption, (b) continuous measures of drinking (e.g. units a week) and (c) Read Codes for types of screening test. Results A total of 14,860 individuals (54% (8068) men and 46% (6792) women) from 409 general practices aged 18–99 years with schizophrenia were identified during April 2011–March 2013. Of these, 11,585 (78%) had an alcohol record, of which 99% (8150/8257) of Read Codes for level of consumption were eligible for recompense in the QOF. There was an 839% increase in alcohol recording among people with schizophrenia over the 13-year period (rate ratio per annum increase 1.19 (95% CI 1.18–1.20)) compared with a 62% increase among people without a severe mental illness (rate ratio per annum increase 1.04 (95% CI 1.03–1.05)). Conclusion Financial incentives offered by the QOF appear to have a substantial impact on alcohol screening among people with schizophrenia in UK primary care. Short summary Alcohol screening among people with schizophrenia increased dramatically in primary health care following the introduction of the UK pay for performance incentive scheme (Quality and Outcomes Framework) for severe mental illness, with an 839% rise (>8-fold increase) compared with a 62% increase among people without a over the 13-year study period (2000–2013).
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Affiliation(s)
- Zarnie Khadjesari
- Department of Primary Care and Population Health, University College London, Upper Third Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF
- Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF UK
| | - Sarah L. Hardoon
- Department of Primary Care and Population Health, University College London, Upper Third Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, Upper Third Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF
| | - Fiona L. Hamilton
- Department of Primary Care and Population Health, University College London, Upper Third Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, Upper Third Floor, Royal Free Campus, Rowland Hill Street, London NW3 2PF
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Khadjesari Z, White IR, McCambridge J, Marston L, Wallace P, Godfrey C, Murray E. Validation of the AUDIT-C in adults seeking help with their drinking online. Addict Sci Clin Pract 2017; 12:2. [PMID: 28049515 PMCID: PMC5209877 DOI: 10.1186/s13722-016-0066-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/08/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The abbreviated Alcohol Use Disorder Identification Test for Consumption (AUDIT-C) is rapidly becoming the alcohol screening tool of choice for busy practitioners in clinical settings and by researchers keen to limit assessment burden and reactivity. Cut-off scores for detecting drinking above recommended limits vary by population, setting, country and potentially format. This validation study aimed to determine AUDIT-C thresholds that indicated risky drinking among a population of people seeking help over the Internet. METHOD The data in this study were collected in the pilot phase of the Down Your Drink trial, which recruited people seeking help over the Internet and randomised them to a web-based intervention or an information-only website. Sensitivity, specificity, and positive and negative likelihood ratios were calculated for AUDIT-C scores, relative to weekly consumption that indicated drinking above limits and higher risk drinking. Receiver-operating characteristic (ROC) curves were created to assess the performance of different cut-off scores on the AUDIT-C for men and women. Past week alcohol consumption was used as the reference-standard and was collected via the TOT-AL, a validated online measure of past week drinking. RESULTS AUDIT-C scores were obtained from 3720 adults (2053 female and 1667 male) searching the internet for help with drinking, mostly from the UK. The area under the ROC curve for risky drinking was 0.84 (95% CI 0.80, 0.87) (female) and 0.80 (95% CI 0.76, 0.84) (male). AUDIT-C cut-off scores for detecting risky drinking that maximise the sum of sensitivity and specificity were ≥8 for women and ≥8 for men; whereas those identifying the highest proportion of correctly classified individuals were ≥4 for women and ≥5 for men. AUDIT-C cut-off scores for detecting higher risk drinking were also calculated. CONCLUSIONS AUDIT-C cut-off scores for identifying alcohol consumption above weekly limits in this largely UK based study population were substantially higher than those reported in other validation studies. Researchers and practitioners should select AUDIT-C cut-off scores according to the purpose of identifying risky drinkers and hence the relative importance of sensitivity and/or specificity.
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Affiliation(s)
- Zarnie Khadjesari
- Department of Primary Care and Population Health, UCL Royal Free Campus, Upper Third Floor, Rowland Hill Street, London, NW3 2PF UK
- Health Service and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Ian R. White
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SR UK
| | - Jim McCambridge
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD UK
| | - Louise Marston
- Department of Primary Care and Population Health, UCL Royal Free Campus, Upper Third Floor, Rowland Hill Street, London, NW3 2PF UK
| | - Paul Wallace
- Department of Primary Care and Population Health, UCL Royal Free Campus, Upper Third Floor, Rowland Hill Street, London, NW3 2PF UK
| | - Christine Godfrey
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD UK
| | - Elizabeth Murray
- Department of Primary Care and Population Health, UCL Royal Free Campus, Upper Third Floor, Rowland Hill Street, London, NW3 2PF UK
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Bertholet N, Daeppen JB, Cunningham JA, Burnand B, Gmel G, Gaume J. Are young men who overestimate drinking by others more likely to respond to an electronic normative feedback brief intervention for unhealthy alcohol use? Addict Behav 2016; 63:97-101. [PMID: 27450907 DOI: 10.1016/j.addbeh.2016.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/20/2016] [Accepted: 07/15/2016] [Indexed: 01/22/2023]
Abstract
AIM To tested whether the efficacy of an internet-based brief intervention that included normative drinking feedback varied with estimations of the drinking of others. METHODS This study is a secondary analysis of a randomized controlled trial showing an intervention effect on weekly drinking. Participants were males with unhealthy alcohol use (mean age [SD]=20.8 [1.1]). Before the trial, participants were asked to estimate the percentage of men their age who drink more than they do. Using their self-reported drinking data, the "perceived" percentage of people their age and gender who drink more than they do, and data from Swiss statistics, we classified participants as overestimating (>+10%), accurately (-10% to +10%) or underestimating (<-10%) drinking by others. RESULTS Of 734 participants with complete data, 427 overestimated, 205 accurately estimated and 102 underestimated the drinking of others. The mean (SD) number of drinks per week was 9.8 (7.9) and AUDIT score was 10.6 (4.2). In stratified negative binomial regression models predicting drinks per week, at 6months, and controlling for baseline drinks per week, the intervention was effective among those overestimating (IRR[95%CI]=0.86[0.74;0.98]), but showed no effect among those accurately estimating (IRR[95%CI]=0.83[0.66;1.03]) or underestimating IRR[95%CI]=1.21[0.92;1.60]) the drinking of others. CONCLUSIONS Perception of drinking by others appears to be a moderator of effect of an electronic feedback intervention among hazardous drinkers. This finding is consistent with the hypothesis that correcting the perceptions of others' drinking is a potential mechanism of action in normative feedback paradigms.
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Affiliation(s)
- Nicolas Bertholet
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland.
| | - Jean-Bernard Daeppen
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
| | - John A Cunningham
- National Institute for Mental Health Research, Australian National University, Canberra, Australia and Centre for Addiction and Mental Health, Toronto, Canada
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Jacques Gaume
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
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Fonager K, Sabroe S. A comparative analysis of different methods for obtaining estimates of alcohol consumption in a Danish population survey. Scand J Public Health 2016. [DOI: 10.1177/14034948010290041001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: The aim of the present study was to compare different measures of alcohol consumption used in a Danish survey. Methods: A stratified random sample was extracted from the Civil Registration System. From January 1997 to January 1998 approximately 8 telephone interviews were conducted every day, including Sundays and holidays, ending with a total of 3,050 interviews after 1 year. Two main approaches to measure alcohol consumption were used: the quantity-frequency and the recent occasion approaches; the latter is subdivided into previous week and previous day approaches. Results: The overall estimated number of units (= 12 g of pure alcohol) per week was 6.8 (95% confidence intervals (CI ): 6.5- 7.1) , 6.7 (95% CI: 6.4-7.1 ) and 8.5 (95% CI: 7.8-9.1 ) for the quantity-frequency, previous week and previous day approaches, respectively. A total of 50% of the men and 70% of the women did not drink alcohol the previous day. Among people classified as high consumers in the previous week and previous day approaches, less than 60% and 30%, respectively, were similarly classified in the quantity-frequency approach. Conclusion: There was agreement on the level of alcohol consumption between the quantity-frequency and previous week approaches, but higher estimates when using the previous day approach. The previous day approach varied more in relation to the interview day and season compared with the quantity-frequency approach and the previous week approach. The recent occasions approach showed some difficulties in classifying the individuals. If the alcohol consumption is included in a model as a risk indicator or a confounder, the quantity-frequency approach would be more preferable than the recent occasion approach.
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Affiliation(s)
- Kirsten Fonager
- Department of Epidemiology and Social Medicine, University of Aarhus, Aarhus, Denmark,
| | - Svend Sabroe
- Department of Epidemiology and Social Medicine, University of Aarhus, Aarhus, Denmark
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Abstract
This study examined the longitudinal changes in alcohol consumption among elderly Japanese, characterized the subtrajectories within the aggregate trend, and examined potential predictors of these trajectories. Data come from a nationally representative survey of 2,566 persons in Japan, ages 60 to 96, followed over five waves between 1987—1999. Hierarchical linear modeling and cluster analysis were used to uncover trajectories of alcohol use. Multinomial logistic regression was employed to examine the predictors of trajectory association at baseline. Alcohol use appears relatively stable between ages 60 and 70, but declines thereafter. Further, there are three subtrajectories: stable, declining, and curvilinear (in addition to abstainers). Predictors of these trajectories varied by trajectory. Alcohol use may continue to be an important part of life at older ages. However, older drinkers appear to follow four drinking trajectories. Demographic characteristics and stressors may be associated with these trajectories. Knowledge of these trajectories may aid in targeting of interventions.
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Rehm J, Greenfield TK, Kerr W. Patterns of Drinking and Mortality from Different Diseases—An Overview. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009145090603300203] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alcohol has been linked to a considerable burden of disease worldwide. Recent epidemiological research has shown that dimensions of alcohol exposure other than average volume are causal in the etiology of disease. Based on a systematic, computer-assisted search, this article attempts a qualitative review of this literature. Results show that cardiovascular disease, especially ischaemic heart disease, is linked to patterns of drinking: regular and light to moderate drinking, and drinking with meals are cardioprotective; heavy drinking occasions have been associated with detrimental outcomes and increases in disease risk. For cancers, consumption of spirits is linked to higher risk of cancers of the upper digestive tract. Spirits also may play a particular role in causing liver cirrhosis in addition to heavy drinking occasions. Finally, injuries are especially related to high blood alcohol concentration and to the frequency of heavy drinking occasions. Overall, these findings strongly indicate that alcohol epidemiology should include adequate pattern measures into future research.
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Ashley MJ, Rehm J, Bondy S, Single E, Rankin J. Beyond Ischemic Heart Disease: Are There other Health Benefits from Drinking Alcohol? ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009145090002700403] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Evidence is growing that alcohol consumption confers health benefits beyond protection from ischemic heart disease. We review this evidence with regard to cerebrovascular disease, peripheral vascular disease, diabetes, cholelithiasis (gallstones), cognitive functioning, and stress reduction and subjective psychosocial benefits. Other possible benefits are briefly considered. The weight of evidence suggests that low-level alcohol consumption offers some protection against ischemic stroke. The evidence that moderate alcohol consumption protects against diabetes and gallstones is also fairly strong. The possibility of other health benefits cannot be dismissed. For all the conditions considered, more research is indicated. The application of more appropriate statistical techniques, studies of patterns of drinking, and experimental approaches to delineating underlying mechanisms should enable firmer conclusions to be drawn. A better understanding of both the benefits and the risks of alcohol use for individuals and populations will facilitate the development of appropriate program and policy interventions to promote health.
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Fortin M, Muckle G, Anassour-Laouan-Sidi E, Jacobson SW, Jacobson JL, Bélanger RE. Trajectories of Alcohol Use and Binge Drinking Among Pregnant Inuit Women. Alcohol Alcohol 2016; 51:339-46. [PMID: 26409003 PMCID: PMC4830408 DOI: 10.1093/alcalc/agv112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/27/2015] [Accepted: 09/02/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study investigated trajectories of alcohol use and binge drinking among Inuit women starting from a year before pregnancy until a year after delivery, examined transition rates between time periods, and established whether specific factors could be identified as predictors of changes in alcohol behaviors. METHODS Drinking trajectories and movement among alcohol users and binge drinkers (i.e. non-binging and binging) were explored by Markov modeling across time periods. Two hundred and forty-eight Inuit women from Arctic Quebec were interviewed at mid-pregnancy, and at 1 and 11 months postpartum to obtain descriptive data on alcohol use during the year before pregnancy, the conception period, the pregnancy and the year after delivery. RESULTS The proportions of drinkers and bingers were 73 and 54% during the year prior to pregnancy and 62 and 33% after delivery. Both alcohol use and binge drinking trajectories demonstrated a significant drop in prevalence between the year before conception to the conception period. We also noted high probabilities of becoming an abstainer or not binging at this time. However, up to 60% of women continued to drink alcohol during pregnancy. Women in couples and not consuming marijuana were more likely to decrease their binge drinking at conception. CONCLUSIONS This study emphasizes the importance of including the period around conception in the definition of drinking patterns during pregnancy. The importance of considering alcohol consumption in a multidimensional way (personal, familial and social determinants) is also addressed while trying to minimize problems both for the fetus and the mother.
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Affiliation(s)
- Marilyn Fortin
- Department of Psychology, Laval University, Québec, QC, Canada Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Québec, QC, Canada
| | - Gina Muckle
- Department of Psychology, Laval University, Québec, QC, Canada Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Québec, QC, Canada
| | | | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Richard E Bélanger
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Québec, QC, Canada Department of Pediatrics, Centre Mère-enfant Soleil, CHUQ, Laval University, Québec, QC, Canada
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Charitonidi E, Studer J, Gaume J, Gmel G, Daeppen JB, Bertholet N. Socioeconomic status and substance use among Swiss young men: a population-based cross-sectional study. BMC Public Health 2016; 16:333. [PMID: 27079787 PMCID: PMC4832558 DOI: 10.1186/s12889-016-2949-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) is often inversely related to health outcomes and is likely to play a role in the use of psychoactive substances among young individuals, although little consensus exists on the association between SES and substance use. The purpose of the study was to determine the association of three SES indicators (perceived family income, education level of participants, and parental education level) with past year use of alcohol, tobacco, cannabis, other illicit drugs and non-medical use of prescription drugs (NMPD) among Swiss young men. METHODS Population-based cross-sectional study of 5,702 men at mean age twenty. Associations between SES indicators and substance use were assessed with regression models adjusted for age and linguistic region. RESULTS Participants with average or below average perceived family income were less likely to report any use of alcohol (OR = O.75) but more likely to use tobacco daily (OR = 1.31) and cannabis weekly (OR = 1.27) compared to those with perceived above average family income. Participants whose parents had only achieved obligatory education were less likely to engage in any use of alcohol (OR = 0.30), monthly risky single occasion drinking (RSOD, defined as 6 or more drinks per occasion) (OR = 0.48), any use of cannabis (OR = 0.53) and other illicit drugs (OR = 0.58), whereas those whose parents had only achieved secondary education were less at risk of engaging in cannabis (OR = 0.66 for any use and OR = 0.77 for more than once a week use) and other illicit drugs (OR = 0.74) use, compared to those whose parents had achieved tertiary education. Compared to participants who completed secondary or tertiary education, those who completed only obligatory education reported a higher risk of tobacco (OR = 1.18 for any use, OR = 1.31 for daily use), cannabis (OR = 1.23 for any use, OR = 1.37 for more than once a week use), and other illicit drugs (OR = 1.48) use. No association was found between NMPD and the studied SES variables. CONCLUSION The relationship between SES and substance use was complex in this sample. Higher socioeconomic status was associated with more alcohol and other illicit drugs use, while lower socioeconomic status was related to more tobacco use. Education level and perceived family income may have different impacts on substance use and may vary by substance.
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Affiliation(s)
- Eleni Charitonidi
- Doctoral School, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. .,Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Beaumont 21b, P2, 02, 1011, Lausanne, Switzerland.
| | - Joseph Studer
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Beaumont 21b, P2, 02, 1011, Lausanne, Switzerland
| | - Jacques Gaume
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Beaumont 21b, P2, 02, 1011, Lausanne, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Beaumont 21b, P2, 02, 1011, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Beaumont 21b, P2, 02, 1011, Lausanne, Switzerland
| | - Nicolas Bertholet
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Beaumont 21b, P2, 02, 1011, Lausanne, Switzerland
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Tanner-Smith EE, Risser MD. A meta-analysis of brief alcohol interventions for adolescents and young adults: variability in effects across alcohol measures. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:140-51. [PMID: 26905387 PMCID: PMC4824184 DOI: 10.3109/00952990.2015.1136638] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Brief alcohol interventions are one approach for reducing drinking among youth, but may vary in effectiveness depending on the type of alcohol assessments used to measure effects. OBJECTIVES To conduct a meta-analysis that examined the effectiveness of brief alcohol interventions for adolescents and young adults, with particular emphasis on exploring variability in effects across outcome measurement characteristics. METHOD Eligible studies were those using an experimental or quasi-experimental design to examine the effects of a brief alcohol intervention on a post-intervention alcohol use measure for youth aged 11-30. A comprehensive literature review identified 190 unique samples that were included in the meta-analysis. Taking a Bayesian approach, we used random-effects multilevel models to estimate the average effect and model variability across outcome measurement types. RESULTS Brief alcohol interventions led to significant reductions in self-reported alcohol use among adolescents (g = 0.25, 95% credible interval [CrI 0.13, 0.37]) and young adults (g = 0.15, 95% CrI [0.12, 0.18]). These results were consistent across outcomes with varying reference periods, but varied across outcome construct type and assessment instruments. Among adolescents, effects were larger when measured using the Timeline Followback; among young adults, effects were smaller when measured using the Alcohol Use Disorders Identification Test. CONCLUSION The strength of the beneficial effects of brief alcohol interventions on youth's alcohol use may vary depending upon the outcome measure utilized. Nevertheless, significant effects were observed across measures. Although effects were modest in size, they were clinically significant and show promise for interrupting problematic alcohol use trajectories among youth.
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Affiliation(s)
- Emily E. Tanner-Smith
- Department of Human and Organizational Development, Peabody Research Institute, Vanderbilt University, Nashville, TN, USA
| | - Mark D. Risser
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
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Gaume J, Magill M, Mastroleo NR, Longabaugh R, Bertholet N, Gmel G, Daeppen JB. Change Talk During Brief Motivational Intervention With Young Adult Males: Strength Matters. J Subst Abuse Treat 2016; 65:58-65. [PMID: 26947118 DOI: 10.1016/j.jsat.2016.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 01/21/2016] [Accepted: 01/27/2016] [Indexed: 11/16/2022]
Abstract
Client change talk (CT) during motivational interviewing (MI) has been described as a predictor of change in alcohol use. We examined the predictive validity of different strength levels of CT within a brief MI session for 174 young men from the general population screened as hazardous drinkers. CT was measured using the MI Skill Code (MISC 2.1) and categorized with positive (toward change) and negative (against change) valence and 3 strength levels (1=low, 2=medium, 3=high). Analyses included linear regression models predicting drinking at 3-month follow-up, while controlling for baseline drinking. Frequency of overall negative CT (i.e., sum of -1, -2, -3) significantly predicted poorer drinking outcomes. In a multivariate model entering frequency of CT utterances at each level of strength (i.e. +1, +2, +3, -1, -2, -3), the directionality of negative strength ratings was consistently in the expected direction, but only CT-2 was statistically significant. In contrast, overall CT positive (i.e., sum of +1, +2, +3) was not a significant predictor of less alcohol use, but the multivariate model showed that the presence of CT+3 significantly predicted less drinking at 3-month follow-up. Averaged strength summary score (i.e. on the scale from -3 to +3) was a significant predictor of better outcome, while percent positive CT was not. Moderation analyses showed that young men with lower baseline readiness to change or lower alcohol problem severity had higher follow-up drinking when they expressed more CT+1 or CT+2, while the opposite pattern was observed with those reporting higher baseline readiness to change or higher alcohol problem severity. Mixed findings for varying levels of positive CT strength might explain previous studies showing poor predictive validity of positive client language in MI. Together with other studies in similar settings, these findings suggest the importance of advanced MI techniques to shape client language to soften negative change talk (also known as sustain talk) and elicit positive CT verbalized with high intensity.
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Affiliation(s)
- Jacques Gaume
- Alcohol Treatment Center, Lausanne University Hospital, Avenue de Beaumont 21bis - P2, 1011, Lausanne, Switzerland; Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI, 02912, USA.
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI, 02912, USA.
| | - Nadine R Mastroleo
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI, 02912, USA; College of Community and Public Affairs, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY, 13902, USA.
| | - Richard Longabaugh
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI, 02912, USA.
| | - Nicolas Bertholet
- Alcohol Treatment Center, Lausanne University Hospital, Avenue de Beaumont 21bis - P2, 1011, Lausanne, Switzerland.
| | - Gerhard Gmel
- Alcohol Treatment Center, Lausanne University Hospital, Avenue de Beaumont 21bis - P2, 1011, Lausanne, Switzerland.
| | - Jean-Bernard Daeppen
- Alcohol Treatment Center, Lausanne University Hospital, Avenue de Beaumont 21bis - P2, 1011, Lausanne, Switzerland.
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Bertholet N, Cunningham JA, Faouzi M, Gaume J, Gmel G, Burnand B, Daeppen JB. Internet-based brief intervention for young men with unhealthy alcohol use: a randomized controlled trial in a general population sample. Addiction 2015; 110:1735-43. [PMID: 26173842 DOI: 10.1111/add.13051] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/20/2015] [Accepted: 08/08/2015] [Indexed: 12/01/2022]
Abstract
AIM To test the efficacy of an internet-based brief intervention (IBI) in decreasing alcohol use among young Swiss men aged 21 years on average. DESIGN Two parallel-group randomized controlled trial with a 1 : 1 allocation ratio containing follow-up assessments at 1 and 6 months post-randomization SETTING Internet-based study in a general population sample. PARTICIPANTS Twenty-one-year-old men from Switzerland with unhealthy alcohol use (> 14 drinks/week or ≥ 6 drinks/occasion at least monthly or Alcohol Use Disorders Identification Test (AUDIT) scores ≥ 8) INTERVENTION: IBI consisting of (1) normative feedback, (2) feedback on consequences of alcohol use, (3) calorific value of reported consumption, (4) computed blood alcohol concentration for reported consumption, (5) indication of risk, (6) information on alcohol and health and (7) recommendations indicating low-risk drinking limits. Control condition: no intervention (assessment only). MEASUREMENTS At 1 and 6 months: quantity/frequency questions on alcohol use (primary outcome: number of drinks/week) and binge drinking prevalence; at 6 months: AUDIT score, consequences of drinking (range = 0-12). FINDINGS Follow-up rates were 92% at 1 month and 91% at 6 months. At 6 months, participants in the intervention group (n = 367) reported greater reductions in the number of drinks/week than participants in the control group (n = 370) [treatment × time interaction, incidence rate ratio (RR) = 0.86, 95% confidence interval (CI) = 0.78; 0.96], but no significant differences were observed on binge drinking prevalence. There was a favourable intervention effect on AUDIT scores (IRR = 0.93, 95% CI = 0.88; 0.98), but not on the number of consequences (IRR = 0.93, 95% CI = 0.84; 1.03). CONCLUSIONS An internet-based brief intervention directed at harmful alcohol use among young men led to a reduction in self-reported alcohol consumption and AUDIT scores compared with a no-intervention control condition (assessment only).
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Affiliation(s)
- Nicolas Bertholet
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
| | - John A Cunningham
- Center for Mental Health Research, Australian National University, Canberra, Australia and Centre for Addiction and Mental Health, Toronto, Canada
| | - Mohamed Faouzi
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Jacques Gaume
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerhard Gmel
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Alcohol Treatment Center, Department of Community Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
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Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe. Eur J Epidemiol 2015; 31:21-30. [PMID: 26467937 PMCID: PMC4756032 DOI: 10.1007/s10654-015-0092-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/08/2015] [Indexed: 11/13/2022]
Abstract
Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude of its effect, and whether it is due to regular high intake or episodic binge drinking remain unclear. The aim of this paper was to estimate the contribution of alcohol to mortality in four Central and Eastern European countries. We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe is a prospective multi-centre cohort study in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns. Random population samples of 34,304 men and women aged 45–69 years in 2002–2005 were followed up for a median 7 years. Drinking volume, frequency and pattern were estimated from the graduated frequency questionnaire. Deaths were ascertained using mortality registers. In 230,246 person-years of follow-up, 2895 participants died from all causes, 1222 from cardiovascular diseases (CVD), 672 from coronary heart disease (CHD) and 489 from pre-defined alcohol-related causes (ARD). In fully-adjusted models, abstainers had 30–50 % increased mortality risk compared to light-to-moderate drinkers. Adjusted hazard ratios (HR) in men drinking on average ≥60 g of ethanol/day (3 % of men) were 1.23 (95 % CI 0.95–1.59) for all-cause, 1.38 (0.95–2.02) for CVD, 1.64 (1.02–2.64) for CHD and 2.03 (1.28–3.23) for ARD mortality. Corresponding HRs in women drinking on average ≥20 g/day (2 % of women) were 1.92 (1.25–2.93), 1.74 (0.76–3.99), 1.39 (0.34–5.76) and 3.00 (1.26–7.10). Binge drinking increased ARD mortality in men only. Mortality was associated with high average alcohol intake but not binge drinking, except for ARD in men.
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