Alcohol consumption trajectories and self-rated health: findings from the Stockholm Public Health Cohort

Self-rated health and quality of life in female sex workers with substance use disorders in Tehran, Iran

BACKGROUND

While self-rated health (SRH) and quality of life (QoL) has been associated with substance use disorders (SUDs) in sex-working populations, little is known about this association in Iran. This study aimed to assess QoL and SRH in Iranian female sex workers (FSWs) in Tehran.

METHOD

FSWs were recruited using convenience sampling methods from substance abuse treatment centers in Tehran that exclusively provided services for women. Participants completed an interviewer-administered demographic questionnaire in Persian and the Iranian version of the Short Form Health Survey (SF-36). Descriptive analyses, means and standard deviations; frequency and percentages, t-test and one-way ANOVA, and Chi-square tests were utilized to analyze the data.

RESULTS

The mean age among 161 participants clinically diagnosed with SUD was 34.09 years (SD 7.97; range: 18-57). The total mean QoL score was 41.03 (SD: 12.92). The highest and lowest mean scores were observed in the physical functioning (52.23) and role emotional (26.64) dimensions, respectively. Significant differences (p < 0.05) in QoL were observed according to education and marital status, and the average QoL score was lower in women who reported permanent marriages and women who were illiterate. The average score of QoL was significantly higher in employed women. Overall, 51.6% of the women rated their health as sub-optimal, with divorced participants and women who were illiterate more likely to rate their health as sub-optimal (p < 0.05).

CONCLUSION

Results emphasize the need for mental, physical, and sexual health screening and gender-specific interventions to improve QoL in this population. Further investigation may elucidate the consequences of poor SRH and QoL on SUD treatment adherence, sexual risk behavior, and morbidity and mortality in FSWs.

Predictors of beverage-specific, alcohol consumption trajectories: A Swedish population-based cohort study

Aim: The aim of the study was to examine whether changes in alcohol consumption over time differ according to beverage types, and to what extent socioeconomic, lifestyle and health-related factors predict beverage-specific trajectories in Sweden. Study design: We included participants from the Stockholm Public Health Cohort who were surveyed repeatedly in 2002, 2010 and 2014. Alcohol consumption trajectories were constructed for 13,152 individuals with valid information on amount and frequency of drinking. Preferred beverage types (i.e., beer, wine or spirits) were defined based on the most consumed beverages. Multinomial logistic regression was used to quantify individual predictors of different trajectories, overall and by beverage type. Results: Overall 56.9% of respondents were women, the mean age was 49.2 years, SD (13.1). Wine was cited as the preferred beverage for 72.4% of participants, and stable moderate drinking was the most common trajectory regardless of beverage type (68.2%, 54.9% and 54.2% in individuals with wine, beer and spirits as preferred beverages, respectively). Associations between drinking trajectories and baseline lifestyle factors did not differ by beverage type. Lower socioeconomic position (SEP) was associated with unstable moderate wine drinking (for unskilled manual SEP: adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.23, 1.93), unstable heavy beer drinking (for skilled manual SEP: aOR 1.99, 95% CI 1.14, 3.52; and unskilled manual SEP: aOR 1.72, 95% CI 1.05, 2.82), and former beer drinking trajectory (for skilled manual SEP: aOR 1.81; 95% CI 1.21, 2.72; and unskilled manual SEP: aOR 1.66; 95% CI 1.17, 2.37). Conclusion: Lower SEP was associated with unstable heavy drinking of beer, former beer drinking, and unstable moderate wine drinking trajectories indicating that targeted alcohol prevention programmes need to focus on these groups.

Predicting self-perceived general health status using machine learning: an external exposome study

BACKGROUND

Self-perceived general health (SPGH) is a general health indicator commonly used in epidemiological research and is associated with a wide range of exposures from different domains. However, most studies on SPGH only investigated a limited set of exposures and did not take the entire external exposome into account. We aimed to develop predictive models for SPGH based on exposome datasets using machine learning techniques and identify the most important predictors of poor SPGH status.

METHODS

Random forest (RF) was used on two datasets based on personal characteristics from the 2012 and 2016 editions of the Dutch national health survey, enriched with environmental and neighborhood characteristics. Model performance was determined using the area under the curve (AUC) score. The most important predictors were identified using a variable importance procedure and individual effects of exposures using partial dependence and accumulated local effect plots. The final 2012 dataset contained information on 199,840 individuals and 81 variables, whereas the final 2016 dataset had 244,557 individuals with 91 variables.

RESULTS

Our RF models had overall good predictive performance (2012: AUC = 0.864 (CI: 0.852-0.876); 2016: AUC = 0.890 (CI: 0.883-0.896)) and the most important predictors were "Control of own life", "Physical activity", "Loneliness" and "Making ends meet". Subjects who felt insufficiently in control of their own life, scored high on the De Jong-Gierveld loneliness scale or had difficulty in making ends meet were more likely to have poor SPGH status, whereas increased physical activity per week reduced the probability of poor SPGH. We observed associations between some neighborhood and environmental characteristics, but these variables did not contribute to the overall predictive strength of the models.

CONCLUSIONS

This study identified that within an external exposome dataset, the most important predictors for SPGH status are related to mental wellbeing, physical exercise, loneliness, and financial status.

Alcohol use as a predictor of the course of major depressive disorder: a prospective population-based study

AIMS

There are indications that problematic alcohol use may negatively impact the course of major depressive disorder (MDD). However, most studies on alcohol use and adverse MDD outcomes are conducted amongst MDD populations with (severe) alcohol use disorder in psychiatric treatment settings. Therefore, it remains unclear whether these results can be generalised to the general population. In light of this, we examined the longitudinal relationship between alcohol use and MDD persistence after a 3-year follow-up amongst people with MDD from the general population.

METHODS

Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a psychiatric epidemiological prospective study comprising four waves amongst the adult Dutch general population (n = 6.646). The study sample (n = 642) consisted of those with 12-month MDD who participated at the follow-up wave. The outcome was 12-month MDD persistence after the 3-year follow-up, which was assessed via the Composite International Diagnostic Interview version 3.0. Weekly alcohol consumption was operationalised as non-drinking (0 drinks), low-risk drinking (⩽7 drinks; reference), at-risk drinking (women 8-13 drinks, men 8-20 drinks) and high-risk drinking (women ⩾14, men ⩾21 drinks). We performed univariate and multiple logistic regression analyses, which were adjusted for various socio-demographic and health-related factors.

RESULTS

The majority (67.4%) of the MDD sample were female, while the mean age was 47.1 years. Amongst these, 23.8% were non-drinkers, 52.0% were low-risk drinkers and 14.3% and 9.4% were at-risk and high-risk drinkers, respectively. Around one-quarter of the sample (23.6%) met the criteria for a persistent MDD after 3-year follow-up. No statistically significant association was found between alcohol use and MDD persistence, either for the crude model or the adjusted models. In comparison to low-risk drinking, the full adjusted model showed no statistically significant associations between MDD persistence and non-drinking (odds ratio (OR) = 1.15, p = 0.620), at-risk drinking (OR = 1.25, p = 0.423), or high-risk drinking (OR = 0.74, p = 0.501).

CONCLUSIONS

Contrary to our expectations, our findings showed that alcohol use was not a predictor of MDD persistence after 3-year follow-up amongst people with MDD from the general population.

Trajectories of alcohol consumption in relation to all-cause mortality in patients with cardiovascular disease: a 35-year prospective cohort study

BACKGROUND AND AIMS

Research into alcohol consumption and cardiovascular disease (CVD) patients' prognosis has largely ignored the longitudinal dynamics in drinking behaviour. This study measured the association between alcohol consumption trajectories and mortality risk in CVD patients.

DESIGN

Prospective cohort study.

SETTING

UK-based Whitehall II Study.

PARTICIPANTS

A total of 1306 participants with incident non-fatal CVD (coronary heart disease/stroke) events.

MEASUREMENTS

Up to eight repeated measures of alcohol intake were available for each patient from the most recent assessment phase pre-incident CVD and all subsequent phases post-incident CVD, spanning up to three decades. Six trajectory groups of alcohol consumption were identified using group-based trajectory modelling and related to the risk of all-cause mortality, adjusting for demographics and changes in life-style and health status.

FINDINGS

Three hundred and eighty deaths were recorded during a median follow-up of 5 years after patients' last alcohol assessment. Compared with patients who consistently drank moderately (≤ 14 units/week), former drinkers had a greater risk of mortality (hazard ratio = 1.74, 95% confidence interval = 1.19-2.54) after adjustment for covariates. There was no significantly increased risk of mortality in long-term abstainers, reduced moderate drinkers, stable or unstable heavy drinkers. Cross-sectional analyses based only on drinking information at patients' last assessment found no significant differences in mortality risk for abstainers, former or heavy drinkers versus moderate drinkers.

CONCLUSIONS

Cardiovascular disease patients who consistently drink ≤ 14 units/week appear to have a similar risk of mortality to those who are long-term abstainers, which does not support a protective effect of moderate drinking on total mortality. Cardiovascular disease patients who stop drinking appear to have increased mortality risk compared with continuous moderate drinkers, but this may be linked to poor self-rated health before cardiovascular disease onset.

Longitudinal Associations of Former and Current Alcohol Consumption with Psychosocial Outcomes among Colorectal Cancer Survivors 1-15 Years after Diagnosis

We aimed to explore positive and negative associations of consuming alcohol with psychosocial outcomes among colorectal cancer (CRC) survivors. We used data of an observational prospective cohort study, consisting of 2625 Dutch CRC survivors enrolled 1-11 years post-diagnosis that were followed-up in 4 yearly surveys. Generalized estimated equation models were used to examine longitudinal associations between alcohol consumption and anxiety, depression, and health-related quality of life (HRQoL), while correcting for sociodemographic, lifestyle and clinical characteristics. Compared to lifetime abstainers, former alcohol consumption was associated with more depressive symptoms, and worse global quality of life and social functioning, while current drinking was associated with less anxiety, depression and better HRQoL. More drinks per week was associated with less nausea/vomiting. Compared to abstainers, moderate (≤7 drinks/week) and heavy alcohol consumption (>7 drinks/week) were associated with less anxiety and depression and better HRQoL, mostly attributable to wine consumption. Whereas current alcohol consumption was longitudinally associated with less anxiety and depression and better HRQoL, former drinking was associated with worse psychosocial outcomes, although based on a small sample size. It is important to consider that besides the potential negative effects of alcohol on patients' health, alcohol consumption may be positively related with psychosocial outcomes.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2022.2044063.

Preconceptional paternal alcohol consumption and the risk of child behavioral problems: a prospective cohort study

Animal studies demonstrated that paternal alcohol exposure before conception increases the risk of adverse neurodevelopment in offspring, but limited evidence is known in humans. Based on Shanghai-Minhang Birth Cohort Study, we aimed to examine associations between preconceptional paternal alcohol consumption and child behavioral problems. Paternal alcohol consumption during the last 3 months before conception was obtained by maternal report. Children born to fathers who drank alcohol at least once a week were classified as exposed. Child behavioral problems were assessed using the Child Behavior Checklist (CBCL) at age of 2, 4, and 6. Negative binomial regression was used to estimate the rate ratio (RR) of CBCL raw scores in 796 offspring. The risks of rating scores on anxious/depressed were increased by 33% (RR 1.33, 95% CI 1.09, 1.61) and 37% (RR 1.37, 95% CI 1.02, 1.84) among boys in the exposed group at age of 4 and 6, respectively. We also found that risks of somatic complaints were increased by 18% (RR 1.18, 95%CI 1.00, 1.40) and 65% (RR 1.65, 95%CI 1.14, 2.38) among girls in the exposed group at age of 4 and 6. The increased risks of sleep problems (RR 1.25, 95% CI 1.00, 1.55) in girls at age 4, thought problems (RR 1.32, 95% CI 1.01, 1.73) in girls at age 6, rule-breaking behaviors (RR 1.35, 95% CI 1.09, 1.67) in boys at age 6 were also found. The risks of CBCL scores on anxious/depressed and sleep problems in girls at age 4, as well as the risks of somatic complaints and rule-breaking behaviors in boys at age 6 increased with the level of exposure to paternal alcohol consumption. Our findings provided preliminary evidence that preconceptional paternal alcohol consumption may increase risks of child behavioral problems.

Low fruit and vegetable intake is associated with poor self-rated health in the Czech part of the HAPIEE study

Background: Although fruits and vegetables are considered a pillar of healthy eating, previous evidence suggests that their consumption in Eastern European countries is low, and their association with health outcomes has rarely been researched in this region. Aim: To examine the effect of fruit and vegetable intake on self-rated health (SRH) in the Czech arm of the Health, Alcohol and Psychosocial factors in Eastern Europe prospective cohort study. Methods: Dietary data on fruit and vegetable intake was measured at baseline using food frequency questionnaires, and SRH from the second wave was chosen as the main outcome. The relationship between fruit and vegetable intake and SRH was analysed using multivariable ordinal regression. Results: A total of 4255 persons aged 45-69, in good and very good SRH at baseline were included in the longitudinal analysis, with a median follow-up time of 3.7 years. In the second wave, 218 (5.1%) individuals reported poor or very poor SRH. In the fully adjusted model, individuals in the lowest fruit and vegetable intake quartile had higher odds of poor SRH compared to those in the highest quartile (OR = 1.24, 95% CI: 1.01-1.52). When examined separately, the results were similar: for vegetables (OR = 1.25, 95% CI: 1.03-1.51) and fruit (OR = 1.18, 95% CI: 0.97-1.44). Conclusion: The observed longitudinal association suggests that low fruit and vegetable intake is associated with poor SRH in the Czech Republic. Considering almost half of our sample reported less than the daily recommended intake of 400 grams of fruits and vegetables, higher consumption should be supported.

To drink, or to exercise: That is (not) the question! Daily effects of alcohol consumption and exercise on well-being

Drinking alcohol and exercising are two of the most popular ways of dealing with stress. Despite the fact that they often co-occur, few studies have examined the role of the two activities together in everyday well-being. The current research aimed to investigate the dynamics between these two daily activities and various indices of well-being in a natural environment by using a daily diary method and ecological momentary assessment. We asked 478 adults to record their alcohol intake, exercising activity, and momentary well-being, three times a day for 2 weeks. Significant detrimental effects of drinking alcohol and beneficial effects of exercising on well-being were observed on the next day, whereas no significant effect of well-being was found on the likelihood of drinking and exercising on the second day. Furthermore, sleep quality was identified as one of the factors influencing the changes of well-being induced by the drinking and exercising engaged in the previous day. The present research allows us to deepen our understanding of the lagged relationship between the daily activities of drinking alcohol/exercising and well-being and demonstrates the underlying mechanism for the observed effects. Theoretical and practical implications are discussed.

Association between Lifetime Tobacco Use and Alcohol Consumption Trajectories and Cardiovascular and Chronic Respiratory Diseases among Older People

Background: We identify representative types of simultaneous tobacco use and alcohol consumption trajectories across the life course and estimate their association with cardiovascular and chronic respiratory diseases (CVDs and CRDs) among older people in Chile. Methods: We used data from a population-representative, face-to-face and longitudinal-retrospective survey focused on people aged 65–75 (N = 802). To reconstruct trajectory types, we employed weighted multichannel sequence analysis. Then, we estimated their associations with CVDs and CRDs through weighted logistic regression models. Results: Long-term exposure to tobacco use and alcohol consumption across life are associated with the highest CVD and CRD risks. Long-term nonsmokers and nondrinkers do not necessarily show the lowest CVDs and CRDs risks if these patterns are accompanied by health risk factors such as obesity or social disadvantages such as lower educational levels. Additionally, trajectories showing regular consumption in one domain but only in specific periods of life, whether early or late, while maintaining little or no consumption across life in the other domain, lead to lower CVDs or CRDs risks than trajectories indicating permanent consumption in both domains. Conclusions: A policy approach that considers CVDs and CRDs as conditions that strongly depend on previous individual experiences in diverse life domains can contribute to the improved design and evaluation of preventive strategies of tobacco use and alcohol consumption across the life course.

Lifetime employment, tobacco use, and alcohol consumption trajectories and cardiovascular diseases in old age

Despite the great advances of life course epidemiology studies during the last decade in understanding the general health effects of employment trajectories, research has yet to evaluate the effects of employment trajectories along with other major risk factors, such as tobacco and alcohol consumption, on cardiovascular diseases (CVDs)-the main cause of deaths worldwide. This is highly relevant, since health advantages in one domain (e.g., being a permanent formal full-time worker) may offset health disadvantages in other domains (e.g., being a regular smoker or alcohol consumer); conversely, disadvantages in both domains may interact, leading to even greater health risks. Considering these knowledge gaps, this research has two main objectives: (1) to reconstruct simultaneous employment, tobacco use, and alcohol consumption trajectories over the life course (from birth to old age) and (2) to measure the association between these trajectories and CVD in old age. Drawing on a rich and comprehensive life history dataset and using multichannel sequence and regression analyses, we analyzed a cohort of individuals aged 65-75 in Chile, a Latin American country with high social inequalities and scarce research on this matter. Our study shows that following a trajectory of formal employment together with no tobacco and alcohol use reduces CVD risk by 36 percentage points relative to a similar employment trajectory but with regular tobacco and alcohol use. Even with an employment trajectory characterized by constant informal employment or permanent inactivity, a life course free of regular tobacco and alcohol use shows protective effects against CVD. This study stresses the importance of health policies that consider CVD as a condition that strongly depends on individual experiences in multiple life domains and across different life stages.