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Pérez-Romero C, Barrio G, Donat M, Moreno A, Guerras JM, Pulido J, Belza MJ, Regidor E. Heavy Drinking by Occupation in Spain: Differences Between Weekdays and the Weekend. J Community Health 2024; 49:235-247. [PMID: 37839065 DOI: 10.1007/s10900-023-01288-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/17/2023]
Abstract
Estimating occupational disparity in heavy drinking jointly for weekdays and the weekend may be misleading for prevention purposes, because reasons for disparity in both periods may differ. The main objective was to assess occupational disparity in heavy average drinking (HAD) by week period and sex. 42,108 employees aged 16-64 were recruited from national surveys in Spain between 2011 and 2020. The outcome was HAD, defined as daily alcohol intake over 20 g (men) or 10 g (women). Occupation was classified in 15 categories. HAD adjusted prevalence ratios (HAD-aPRs) taking all occupations as reference, and relative adjusted excess prevalences (HAD-aEPs) comparing the weekend to weekdays in each occupation, were estimated using Poisson regression models with robust variance adjusted for sociodemographic and health covariates. The HAD-aPRs comparing each occupation with all occupations ranged 0.63-1.92 on weekdays and 0.65-1.45 on the weekend, with the highest aPRs on weekdays in construction, hospitality and primary-sector workers (1.92-1.62). The weekend-weekdays HAD-aEPs by occupation ranged 2.60-8.33, with the highest values in technicians/administrators, other professionals, teachers and health professionals (8.33-6.44). The global aEP was higher in women (6.04) than in men (3.92), especially in occupations just mentioned (8.70-11.73 in women vs. 3.64-6.32 in men). There was a considerable relative disparity in HAD risk between occupations on weekdays, with the highest risks in certain low-skilled occupations. Such disparity decreased on the weekend. The relative weekend increase in HAD risk was greater in women and in certain high-skilled occupations. This should be considered when designing prevention interventions on harmful drinking.
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Affiliation(s)
- César Pérez-Romero
- National School of Public Health, Carlos III Health Institute, 5 Avenida Monforte de Lemos, 28029, Madrid, Spain.
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, 5 Avenida Monforte de Lemos, 28029, Madrid, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marta Donat
- National School of Public Health, Carlos III Health Institute, 5 Avenida Monforte de Lemos, 28029, Madrid, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Almudena Moreno
- Sociology and Social Work Department, Universidad Pública de Navarra, Avenida de Cataluña, 31006, Pamplona, Spain
| | - Juan-Miguel Guerras
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Epidemiology Center, Carlos III Health Institute, 5 Avenida Monforte de Lemos, 28029, Madrid, Spain
| | - José Pulido
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Public and Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Plaza de Ramón y Cajal, 28040, Madrid, Spain
| | - María-José Belza
- National School of Public Health, Carlos III Health Institute, 5 Avenida Monforte de Lemos, 28029, Madrid, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Enrique Regidor
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Public and Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Plaza de Ramón y Cajal, 28040, Madrid, Spain
- Health Research Institute of San Carlos (IdISSC), Hospital Clínico San Carlos, Calle Profesor Martín Lagos, 28040, Madrid, Spain
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Smith BT, Warren CM, Andreacchi AT, Schwartz N, Hobin E. The Joint Effect of Education and Alcohol Use on 100% Alcohol-attributable Hospitalization or Death in Canada. Epidemiology 2024; 35:64-73. [PMID: 37756281 DOI: 10.1097/ede.0000000000001674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Individuals with low socioeconomic position (SEP) experience disproportionately greater alcohol-attributable harm than individuals with high SEP despite similar or less alcohol use (i.e., the alcohol harm paradox). We examined the sex/gender- specific independent and joint effects of education and heavy drinking or volume of alcohol use on 100% alcohol-attributable hospitalization or death. METHODS We conducted a cohort study among 199,125 current and former alcohol users aged 15-64 years from population-representative Canadian Community Health Surveys (2000-2008) linked to hospitalization and mortality records through 2017. We estimated the sex/gender-specific associations between education and heavy drinking or volume of alcohol use and incident 100% alcohol-attributable hospitalization or death using multivariable Fine and Gray subdistribution hazard models with competing risk (non-100% alcohol-attributable deaths), assessing additive interactions using the Synergy Index (S). RESULTS Overall, heavy drinking prevalence and volume of alcohol use were similar or lower in individuals with lower education compared with higher education. Lower education levels compared with a bachelor's degree or above were associated with increased 100% alcohol-attributable hospitalization or death [e.g., less than high school, men: hazard ratio (HR) = 2.78; 95% CI = 2.17, 3.56; women: HR = 2.98; 95% CI = 2.00, 4.44]. We found superadditive joint effects between low education and heavy drinking (men: S = 1.22; 95% CI = 1.14, 1.30; women: S = 1.34; 95% CI = 0.88, 2.04) and low education and higher volume of alcohol use (e.g., excess volume, men: S = 1.30; 95% CI = 1.05, 1.62; women: S = 1.41; 95% CI = 0.77, 2.58), with larger inequities in women than men with similar alcohol use. CONCLUSIONS Our study is consistent with the hypothesis that increased vulnerability to alcohol use among individuals with lower education partially explains the alcohol harm paradox in Canada.
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Affiliation(s)
- Brendan T Smith
- Public Health Ontario, Toronto, Ontario, Canada and
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Alessandra T Andreacchi
- Public Health Ontario, Toronto, Ontario, Canada and
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Erin Hobin
- Public Health Ontario, Toronto, Ontario, Canada and
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Jensen HAR, Møller SR, Christensen AI, Davidsen M, Juel K, Petersen CB. Trends in social inequality in mortality in Denmark 1995-2019: the contribution of smoking- and alcohol-related deaths. J Epidemiol Community Health 2023; 78:18-24. [PMID: 37451846 PMCID: PMC10715496 DOI: 10.1136/jech-2023-220599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND During the past decades, social inequality in mortality has increased in several countries, including Denmark. Modifiable risk factors, such as smoking and harmful alcohol consumption, have been suggested to moderate the association between socioeconomic position and health-related outcomes. The present study aims to investigate the contribution of smoking- and alcohol-related deaths to the trends in educational inequality in mortality in Denmark 1995-2019 among individuals aged 30-74 years. METHODS Nationwide data on mortality and highest attained educational level divided into quartiles were derived from administrative registers. Alcohol-related mortality was directly estimated using information on alcohol-related deaths from death certificates. Smoking-related mortality was indirectly estimated using the Peto-Lopez method. The contribution of smoking- and alcohol-related deaths to the social inequality gap in mortality 1995-2019 was calculated. RESULTS Alongside a decrease in all-cause mortality in Denmark 1995-2019, absolute differences in the mortality rate (per 100 000 person-year) between the lowest and the highest educational quartile increased from 494 to 607 among men and from 268 to 376 among women. Among both men and women, smoking- and alcohol-related deaths explained around 60% of the social inequality in mortality and around 50% of the increase in mortality inequality. CONCLUSION Smoking and harmful alcohol consumption continue to be important risk factors and causes of social inequality in mortality, with around half of the increase in Denmark 1995-2019 being attributable to smoking- and alcohol-related deaths. Future healthcare planning and policy development should aim at reducing social inequality in modifiable health risk behaviours and their negative consequences.
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Affiliation(s)
| | - Sofie Rossen Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Lange S, Zhu Y, Probst C. Evaluation of the risk relationship between average alcohol volume consumed and suicide: An analysis of mortality linked cohort data. medRxiv 2023:2023.11.22.23298895. [PMID: 38045329 PMCID: PMC10690349 DOI: 10.1101/2023.11.22.23298895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Objective To evaluate the relationship between average alcohol volume consumed per day and suicide. Methods Data from the annual, cross-sectional US National Health Interview Survey, 1997-2018, was obtained, and linked to the 2019 National Death Index. The association between average alcohol volume consumed in grams per day (g/day) and suicide was quantified using Cox proportional hazards model (multiplicative) and Aalen's additive hazard model. All analyses were stratified by sex, and adjusted for education, marital status, race/ethnicity, and survey year. Results On the multiplicative scale, for males, former drinkers and those who consumed on average (40, 60] g/day had about 53% (HR=1.53, 95% CI: 1.10, 2.13) and 77% (HR=1.77, 95% CI: 1.17, 2.66) greater risk of dying by suicide, compared to lifetime abstainers, respectively. There was no significant association found for former or current drinkers among females, on the multiplicative scale. On the additive scale, for males and females, being a former drinker was associated with 11.4 (95% CI: 2.3, 20.4) and 5.6 (95% CI: 0.8, 10.4) additional deaths per 100,000 person years, compared to lifetime abstainers. For males only, drinking (40, 60] g/day on average was associated with 23.2 (95% CI: 6.7, 39.7) additional deaths per 100,000 person years. Level of education was not found to modify the focal relationship for males or females. Conclusions The findings suggest that the relationship between average alcohol volume consumed per day and suicide is nuanced. Additional research on the respective relationship is needed, including repeated measures of average alcohol consumption over time. What is already known on this topic There is a dearth of studies on the sex-specific relationship between average alcohol volume consumed per day and suicide. The one existing study, from South Korea, found that for males as average alcohol volume consumed increased, the likelihood of death by suicide also increased. For females it was not possible to estimate the risk associated with the upper level of consumption due to a zero-cell count. What this study adds This is the first systematic investigation of the sex-specific relationship between average alcohol volume consumed per day and death by suicide using a large linked dataset from the United States. It is also the first to evaluate the modifying effect of education, an important indicator of socioeconomic status, on the respective relationship. How this study might affect research practice or policy The findings were not in line with the sparse existing literature, indicating that this line of research is not yet resolved and more research is needed.
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Donat M, Regidor E, Barrio G, Ambrosio E, Sordo L, Guerras JM, Politi J, Belza MJ. Increase in educational inequalities in alcohol-related mortality in Spain during a period of economic growth. Addiction 2023; 118:1920-1931. [PMID: 37203875 DOI: 10.1111/add.16264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS Alcohol-related mortality risk is almost always greater in lower than higher socio-economic positions (SEPs). There is little information on the evolution of this SEP gradient and its relationship with the economic cycle. Some results suggest that during economic expansions, there is a hypersensitivity of low-SEP people to harmful drinking. The main objective of this study was to measure the evolution of educational inequality in alcohol-related and non-alcohol related mortality by sex and age group in Spain during 2012-19. DESIGN, SETTING AND MEASUREMENTS This is a repeated cross-sectional study. This study includes all residents in Spain aged 25 years and over from 2012 to 2019. (1) We calculated age-standardized mortality rates (ASMRs) from strongly/moderately alcohol-related causes (directly alcohol-attributable, unspecified liver cirrhosis, liver and upper aerodigestive tract cancers and moderately alcohol-related), weakly alcohol-related causes and other causes by educational level. (2) We used age-adjusted relative index of inequality (RII) and slope index of inequality (SII) to measure relative and absolute educational inequality in mortality, respectively. (3) Age-adjusted annual percentage change (APC) was also used to measure linear trends in mortality by educational level. RII, SII and APC were obtained from negative binomial regression. FINDINGS Between 2012-15 and 2016-19, economic growth accelerated, the RII in mortality from strongly/moderately alcohol-related causes increased from 2.0 to 2.2 among men and from 1.1 to 1.3 among women, and the SII in deaths/100 000 person-years from 181.4 to 190.9 among men and from 18.9 to 46.5 among women. It also increased relative and absolute inequality in mortality from weakly alcohol-related and other causes of death in both men and women. These increases in inequality were due primarily to a flattening or even reversal of the downward mortality trend among low- and medium-educated people. CONCLUSIONS During the economic expansion of 2012-19 in Spain, changes in mortality risk from strongly/moderately alcohol-related causes were especially unfavourable among low- and medium-educated people.
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Affiliation(s)
- Marta Donat
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Enrique Regidor
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Madrid, Spain
- Health Research Institute of San Carlos (IdISSC), Madrid, Spain
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Emilio Ambrosio
- Department of Psychobiology, Faculty of Psychology, National University of Distance Education (UNED), Madrid, Spain
| | - Luis Sordo
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Madrid, Spain
| | - Juan Miguel Guerras
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Julieta Politi
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
| | - María J Belza
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Abstract
Behavioural economic accounts of addiction conceptualize harmful drug use as an operant reinforcer pathology, emphasizing that a drug is consumed because of overvaluation of smaller immediate rewards relative to larger delayed rewards (delay discounting) and high drug reinforcing value (drug demand). These motivational processes are within-individual determinants of behaviour. A third element of learning theory posits that harmful drug use depends on the relative constraints on access to other available activities and commodities in the choice context (alternative reinforcers), reflecting the substantial influence of environmental factors. In this Perspective, we integrate alternative reinforcers into the contemporary behavioural economic account of harmful drug use - the contextualized reinforcer pathology model - and review empirical literature across the translational spectrum in support of this model. Furthermore, we consider how increases in drug-related mortality and health disparities in addiction can be understood and potentially ameliorated via a contextualized reinforcer pathology model in which lack of alternative reinforcement is a major risk factor for addiction.
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Affiliation(s)
| | - James MacKillop
- Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University/St Joseph’s Healthcare Hamilton, Hamilton, Ontario Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | - James G. Murphy
- Department of Psychology, University of Memphis, Memphis, TN USA
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Nadkarni A, Gandhi Y, Bhatia U, Velleman R. Closing the treatment gap for alcohol use disorders in low- and middle-income countries. Glob Ment Health (Camb) 2023; 10:e3. [PMID: 36843876 DOI: 10.1017/gmh.2022.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/14/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022] Open
Abstract
The alcohol-attributable disease burden is greater in low- and middle-income countries (LMICs) as compared to high-income countries. Despite the effectiveness of interventions such as health promotion and education, brief interventions, psychological treatments, family-focused interventions, and biomedical treatments, access to evidence-based care for alcohol use disorders (AUDs) in LMICs is limited. This can be explained by poor access to general health and mental health care, limited availability of relevant clinical skills among health care providers, lack of political will and/or financial resources, historical stigma and discrimination against people with AUDs, and poor planning and implementation of policies. Access to care for AUDs in LMICs could be improved through evidence-based strategies such as designing innovative, local and culturally acceptable solutions, health system strengthening by adopting a collaborative stepped care approach, horizontal integration of care into existing models of care (e.g., HIV care), task sharing to optimise limited human resources, working with families of individuals with AUD, and leveraging technology-enabled interventions. Moving ahead, research, policy and practice in LMICs need to focus on evidence-based decision-making, responsiveness to context and culture, working collaboratively with a range of stakeholders to design and implement interventions, identifying upstream social determinants of AUDs, developing and evaluating policy interventions such as increased taxation on alcohol, and developing services for special populations (e.g., adolescents) with AUDs.
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Scarpa S, Grahn R, Lundgren LM. Compulsory care of individuals with severe substance use disorders and alcohol- and drug-related mortality: A Swedish registry study. Front Psychiatry 2023; 14:1106509. [PMID: 36741106 PMCID: PMC9889928 DOI: 10.3389/fpsyt.2023.1106509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023] Open
Abstract
AIM This study used 17 year of Swedish registry data (2003-2019) for 25,125 adults assessed for their severity of substance use to identify the baseline factors predicting the risk of being court-ordered into compulsory care and examine the association between admission to compulsory care and mortality risks due to alcohol- or drug-related causes. METHODS AND MATERIALS Addiction Severity Index (ASI) assessment data were linked to register data on demographic characteristics, compulsory care, and alcohol- and drug-related mortality. Cox regression models were used to identify baseline factors predictive of post-assessment admission to compulsory care in the 5 years post-substance use assessment. Discrete-time random-effect logistic regression models were used to examine the association between compulsory care duration and alcohol or drug-related mortality risks. Propensity score matching was used for validation. RESULTS The first models identified that younger age, female gender, and ASI composite scores for drug use, mental health and employment were significantly associated with the risk of placement in compulsory care for drugs other than alcohol. Female gender and ASI composite scores for alcohol, drug use and employment were significantly associated with compulsory care treatment for alcohol use. The second models showed that older individuals and men were more likely to die due to alcohol-related causes, while younger individuals and men were more likely to die due to drug-related causes. Length of stay in compulsory care institutions significantly increased the likelihood of dying due to substance use-related causes. Propensity scores analyses confirmed the results. CONCLUSION In Sweden, a significant concern is the higher likelihood of women and young individuals to be court-ordered to compulsory care. Although compulsory care is often advocated as a life-saving intervention, our findings do not provide strong support for this claim. On the contrary, our findings show that admission to compulsory care is associated with a higher risk of substance use-related mortality. Factors such as compulsory care often not including any medical or psychological therapy, together with relapse and overdose after discharge, may be possible contributing factors to these findings.
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Affiliation(s)
- Simone Scarpa
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Robert Grahn
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Lena M Lundgren
- Department of Social Work, Umeå University, Umeå, Sweden.,Graduate School of Social Work, University of Denver, Denver, CO, United States
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Rehm J, O'Donnell A, Kaner EFS, Jane LLopis E, Manthey J, Anderson P. Differential impact of minimum unit pricing on alcohol consumption between Scottish men and women: controlled interrupted time series analysis. BMJ Open 2022; 12:e054161. [PMID: 35851006 PMCID: PMC9315916 DOI: 10.1136/bmjopen-2021-054161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the immediate impact of the introduction of minimum unit pricing (MUP) in Scotland on alcohol consumption and whether the impact differed by sex, level of alcohol consumption, age, social grade and level of residential deprivation of respondents. DESIGN Primary controlled interrupted time series analysis and secondary before-and-after analysis of the impact of introducing MUP in Scotland using alcohol consumption data for England as control. SETTING Data from Kantar Worldpanel's Alcovision survey, a continuous retrospective online timeline follow-back diary survey of the previous week's alcohol consumption. PARTICIPANTS 53 347 women and 53 143 men. INTERVENTIONS Introduction of a minimum price of 50 pence per UK unit (6.25 pence/g) for the sale of alcohol in Scotland on 1 May 2018. MAIN OUTCOME MEASURES Number of grams of alcohol consumed per week, in total, in off-trade (eg, at home) and in on-trade (eg, in pubs, restaurants). RESULTS Primary interrupted time series analyses found that the introduction of MUP was associated with a drop in reported weekly total alcohol consumption of 5.94 g (95% CI 1.29 to 10.60), a drop in off-trade consumption of 3.27 g (95% CI -0.01 to 6.56) and a drop in on-trade consumption of 2.67 g (95% CI -1.48 to 6.82). Associated reductions were larger for women than for men and were greater among heavier drinkers than for lighter drinkers, except for the 5% of heaviest drinking men for whom an associated increase in consumption was found. Secondary before-and-after analyses found that reductions in consumption were greater among older respondents and those living in less deprived areas. The introduction of MUP was not associated with a reduction in consumption among younger men and men living in more deprived areas. CONCLUSIONS Greater policy attention needs to be addressed to the heaviest drinking men, to younger men and to men who live in more deprived areas.
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Affiliation(s)
- Jürgen Rehm
- Social and Epidemiological Research, CAMH, Toronto, Ontario, Canada
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen F S Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eva Jane LLopis
- Department of Health Promotion, Maastricht University, Maastricht, Limburg, The Netherlands
- ESADE Business School, Ramon Llull University, Barcelona, Spain
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Peter Anderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Saul C, Lange S, Probst C. Employment Status and Alcohol-Attributable Mortality Risk-A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022; 19:7354. [PMID: 35742600 DOI: 10.3390/ijerph19127354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022]
Abstract
Being unemployed has been linked to various health burdens. In particular, there appears to be an association between unemployment and alcohol-attributable deaths. However, risk estimates presented in a previous review were based on only two studies. Thus, we estimated updated sex-stratified alcohol-attributable mortality risks for unemployed compared with employed individuals. A systematic literature search was conducted in August 2020 using the following databases: Embase, MEDLINE, PsycINFO, and Web of Science. The relative risk (RR) of dying from an alcohol-attributable cause of death for unemployed compared with employed individuals was summarized using sex-stratified random-effects DerSimonian-Laird meta-analyses. A total of 10 studies were identified, comprising about 14.4 million women and 19.0 million men, among whom there were about 3147 and 17,815 alcohol-attributable deaths, respectively. The pooled RRs were 3.64 (95% confidence interval (CI): 2.04–6.66) and 4.93 (95% CI 3.45–7.05) for women and men, respectively. The findings of our quantitative synthesis provide evidence that being unemployed is associated with an over three-fold higher risk of alcohol-attributable mortality compared with being employed. Consequently, a global public health strategy connecting brief interventions and specialized care with social services assisting those currently unemployed is needed.
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Greaves L, Poole N, Brabete AC. Sex, Gender, and Alcohol Use: Implications for Women and Low-Risk Drinking Guidelines. Int J Environ Res Public Health 2022; 19:ijerph19084523. [PMID: 35457389 PMCID: PMC9028341 DOI: 10.3390/ijerph19084523] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/06/2023]
Abstract
Alcohol use is coming under increasing scrutiny with respect to its health impacts on the body. In this vein, several high-income countries have issued low-risk drinking guidelines in the past decade, aiming to educate the public on safer levels of alcohol use. Research on the sex-specific health effects of alcohol has indicated higher damage with lower amounts of alcohol for females as well as overall sex differences in the pharmacokinetics of alcohol in male and female bodies. Research on gender-related factors, while culturally dependent, indicates increased susceptibility to sexual assault and intimate partner violence as well as more negative gender norms and stereotypes about alcohol use for women. Sex- and gender-specific guidelines have been issued in some countries, suggesting lower amounts of alcohol consumption for women than men; however, in other countries, sex- and gender-blind advice has been issued. This article reports on a synthesis of the evidence on both sex- and gender-related factors affecting safer levels of drinking alcohol with an emphasis on women’s use. We conclude that supporting and expanding the development of sex- and gender-specific low-risk drinking guidelines offers more nuanced and educative information to clinicians and consumers and will particularly benefit women and girls.
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Affiliation(s)
- Lorraine Greaves
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence: (L.G.); (A.C.B.)
| | - Nancy Poole
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
| | - Andreea C. Brabete
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
- Correspondence: (L.G.); (A.C.B.)
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Donat M, Barrio G, Guerras JM, Herrero L, Pulido J, Belza MJ, Regidor E. Educational Gradients in Drinking Amount and Heavy Episodic Drinking among Working-Age Men and Women in Spain. Int J Environ Res Public Health 2022; 19. [PMID: 35410052 DOI: 10.3390/ijerph19074371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 02/04/2023]
Abstract
Alcohol-related harm decreases as socioeconomic position increases, although sometimes the opposite happens with alcohol intake. The objective was to know the educational gradient in monthly measures of drinking amount and heavy episodic drinking (HED) among people aged 25−64 years in Spain from 1997−2017. Such gradient was characterized with the relative percent change (PC) in drinking measures per year of education from generalized linear regression models after adjusting for age, year, region, marital status and immigration status. Among men, the PCs were significantly positive (p < 0.05) for prevalence of <21 g alcohol/day (2.9%) and 1−3 HED days (1.4%), and they were negative for prevalences of 21−40 g/day (−1.1%), >40 g/day (−6.0%) and ≥4 HED days (−3.2%), while among women they ranged from 3.6% to 5.7%. The gradient in prevalences of >40 g/day (men) and >20 g/day (women) was greatly attenuated after additionally adjusting for HED, while that of ≥4 HED days was only slightly attenuated after additionally adjusting for drinking amount. Among women, the gradients, especially in HED measures, seem steeper in 2009−2017 than in 1997−2007. Educational inequality remained after additional adjustment for income and occupation, although it decreased among women. These results can guide preventive interventions and help explain socioeconomic inequalities in alcohol-related harm.
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13
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Boyd J, Sexton O, Angus C, Meier P, Purshouse RC, Holmes J. Causal mechanisms proposed for the alcohol harm paradox-a systematic review. Addiction 2022; 117:33-56. [PMID: 33999487 PMCID: PMC8595457 DOI: 10.1111/add.15567] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/17/2020] [Accepted: 04/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The alcohol harm paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol-related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another. METHODS This was a systematic review. We searched MEDLINE (1946-January 2021), EMBASE (1974-January 2021) and PsycINFO (1967-January 2021), supplemented with manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol-related harm and socio-economic position. Papers were set in Organization for Economic Cooperation and Development high-income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations. RESULTS Seventy-nine papers met the inclusion criteria and initial coding revealed that these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: individual, life-style, contextual, disadvantage, upstream and artefactual. Explanations related to risk behaviours, which fitted within the life-style domain, were the most frequently proposed (n = 51) and analysed (n = 21). CONCLUSIONS While there are many potential explanations for the alcohol harm paradox, most research focuses on risk behaviours while other explanations lack empirical testing.
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Affiliation(s)
- Jennifer Boyd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Olivia Sexton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Robin C. Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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14
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Probst C, Lange S, Kilian C, Saul C, Rehm J. The dose-response relationship between socioeconomic deprivation and alcohol-attributable mortality risk-a systematic review and meta-analysis. BMC Med 2021; 19:268. [PMID: 34736475 PMCID: PMC8569998 DOI: 10.1186/s12916-021-02132-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Individuals with low socioeconomic status (SES) experience a higher risk of mortality, in general, and alcohol-attributable mortality in particular. However, a knowledge gap exists concerning the dose-response relationships between the level of socioeconomic deprivation and the alcohol-attributable mortality risk. METHODS We conducted a systematic literature search in August of 2020 to update a previous systematic review that included studies published up until February of 2013. Quantitative studies reporting on socioeconomic inequality in alcohol-attributable mortality among the general adult population were included. We used random-effects dose-response meta-analyses to investigate the relationship between the level of socioeconomic deprivation and the relative alcohol-attributable risk (RR), by sex and indicator of SES (education, income, and occupation). RESULTS We identified 25 eligible studies, comprising about 241 million women and 230 million men, among whom there were about 75,200 and 308,400 alcohol-attributable deaths, respectively. A dose-response relationship between the level of socioeconomic deprivation and the RR was found for all indicators of SES. The sharpest and non-linear increase in the RR of dying from an alcohol-attributable cause of death with increasing levels of socioeconomic deprivation was observed for education, where, compared to the most educated individuals, individuals at percentiles with decreasing education had the following RR of dying: women: 25th: 2.09 [95% CI 1.70-2.59], 50th: 3.43 [2.67-4.49], 75th: 4.43 [3.62-5.50], 100th: 4.50 [3.26-6.40]; men: 25th: 2.34 [1.98-2.76], 50th: 4.22 [3.38-5.24], 75th: 5.87 [4.75-7.10], 100th: 6.28 [4.89-8.07]. CONCLUSIONS The findings of this study show that individuals along the entire continuum of SES are exposed to increased alcohol-attributable mortality risk. Differences in the dose-response relationship can guide priorities in targeting public health initiatives.
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Affiliation(s)
- Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, M5S 2S1, Canada. .,Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, 69120, Heidelberg, Germany. .,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, 01187, Dresden, Germany
| | - Celine Saul
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, 01187, Dresden, Germany.,Dalla Lana School of Public Health, University of Toronto, M5T 3 M7, Toronto, ON, Canada.,Centre for Interdisciplinary Addiction Research, University of Hamburg, 20246, Hamburg, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation, 125009
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15
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Díaz LA, Idalsoaga F, Fuentes-López E, Márquez-Lomas A, Ramírez CA, Roblero JP, Araujo RC, Higuera-de-la-Tijera F, Toro LG, Pazmiño G, Montes P, Hernandez N, Mendizabal M, Corsi O, Ferreccio C, Lazo M, Brahmania M, Singal AK, Bataller R, Arrese M, Arab JP. Impact of Public Health Policies on Alcohol-Associated Liver Disease in Latin America: An Ecological Multinational Study. Hepatology 2021; 74:2478-2490. [PMID: 34134172 DOI: 10.1002/hep.32016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Alcohol-associated liver disease (ALD) is the leading cause of liver-related mortality in Latin America, yet the impact of public health policies (PHP) on liver disease is unknown. We aimed to assess the association between alcohol PHP and deaths due to ALD in Latin American countries. APPROACH AND RESULTS We performed an ecological multinational study including 20 countries in Latin America (628,466,088 inhabitants). We obtained country-level sociodemographic information from the World Bank Open Data source. Alcohol-related PHP data for countries were obtained from the World Health Organization Global Information System of Alcohol and Health. We constructed generalized linear models to assess the association between the number of PHP (in 2010) and health outcomes (in 2016). In Latin America, the prevalence of obesity was 27% and 26.1% among male and female populations, respectively. The estimated alcohol per capita consumption among the population at 15 years old or older was 6.8 L of pure alcohol (5.6 recorded and 1.2 unrecorded). The overall prevalence of alcohol use disorders (AUD) was 4.9%. ALD was the main cause of cirrhosis in 64.7% of male and 40.0% of female populations. A total of 19 (95%) countries have at least one alcohol-related PHP on alcohol. The most frequent PHP were limiting drinking age (95%), tax regulations (90%), drunk-driving policies and countermeasures (90%), and government monitoring systems and community support (90%). A higher number of PHP was associated with a lower ALD mortality (PR, 0.76; 95% CI, 0.61-0.93; P = 0.009), lower AUD prevalence (PR, 0.80; 95% CI, 0.65-0.99; P = 0.045), and lower alcohol-attributable road traffic deaths (PR, 0.81; 95% CI, 0.65-1.00; P = 0.051). CONCLUSIONS Our study indicates that in Latin America, countries with higher number of PHP have lower mortality due to ALD, lower prevalence of AUD, and lower alcohol-attributable road traffic mortality.
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Affiliation(s)
- Luis Antonio Díaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Idalsoaga
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Juan Pablo Roblero
- Sección Gastroenterología, Hospital Clínico Universidad de Chile, Escuela de Medicina Universidad de Chile, Santiago, Chile
| | - Roberta C Araujo
- Gastroenterology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Luis Guillermo Toro
- Hepatology and Liver Transplant Unit, Hospitales de San Vicente Fundación de Medellín y Rionegro, Medellin, Colombia
| | - Galo Pazmiño
- Department of Gastroenterology, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Pedro Montes
- Department of Gastroenterology, Hospital Nacional Daniel A. Carrión, Callao, Perú
| | - Nelia Hernandez
- Clínica de Gastroenterología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República Uruguay, Montevideo, Uruguay
| | - Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Oscar Corsi
- Departamento de Medicina Interna, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catterina Ferreccio
- Public Health Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Center for Chronic Diseases, ACCDis, Santiago, Chile
| | - Mariana Lazo
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA.,Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA.,Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mayur Brahmania
- Department of Medicine, Division of Gastroenterology, Western University, London Health Sciences Center, London, ON, Canada
| | - Ashwani K Singal
- Division of Transplant Hepatology, Department of Medicine, Avera Transplant Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | - Ramon Bataller
- Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Marco Arrese
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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16
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Jaffe K, Nosova E, Maher L, Hayashi K, Milloy MJ, Richardson L. Income generation and the patterning of substance use: A gender-based analysis. Drug Alcohol Depend 2021; 226:108862. [PMID: 34198138 DOI: 10.1016/j.drugalcdep.2021.108862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous research has demonstrated how income-generating activities among marginalized people who use drugs (PWUD)-including employment, income assistance, street-based activities, sex work, and illegal activities-can provide both benefit (e.g., additional income) and harm (e.g., violence, criminalization). However, little is known about gender differences in factors such as drug use patterns that are associated with income-generating activities among PWUD. METHODS Using data from prospective cohorts of HIV-positive and HIV-negative PWUD in Vancouver, Canada, we conducted exploratory gender-stratified analyses of associations between substance use patterns and income-generating activities, using generalized linear mixed-models. RESULTS Participants reported income sources as employment (23.4 %), income assistance (88.1 %), street-based activities (24.9 %), sex work (15.2 %), drug dealing (31.5 %), or other illegal activities (13.9 %). GLMM results showed gendered patterns of engagement in specific income-generating activities and some diverging patterns of substance use. For instance, men receiving income assistance were less likely to use opioids (Adjusted odds ratio(AOR) = 0.64; 95 % confidence interval(CI) = 0.50-0.82) and women engaged in sex work were more likely to use crack-cocaine (AOR = 2.74, 95 % CI = 2.22-3.37). However, results reflected primarily converging patterns of substance use between women and men across income-generating activities, particularly for drug dealing and other illegal activities. CONCLUSIONS Our results suggest that substance use patterns may be more closely associated with income generation context than gender. Given potential harms associated with some income generation activities, results highlight the need for further investigation of the social and structural context of income generation, its intersections with gender and substance use, and the expansion of low-threshold work opportunities.
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17
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Irizar P, Puddephatt JA, Gage SH, Fallon V, Goodwin L. The prevalence of hazardous and harmful alcohol use across trauma-exposed occupations: A meta-analysis and meta-regression. Drug Alcohol Depend 2021; 226:108858. [PMID: 34214883 DOI: 10.1016/j.drugalcdep.2021.108858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Trauma exposure is associated with hazardous and/or harmful alcohol use. Occupational groups frequently exposed to trauma may be at risk of alcohol harm. This meta-analysis determined the prevalence of hazardous and harmful alcohol use across trauma-exposed occupations and meta-regressions explored the impact of pre-defined covariates on the variance in prevalence estimates. METHOD Literature was searched from 2000 to March 2020, using Scopus, Web of Science and PsycINFO. Studies were included in the meta-analysis if they used a standardized measure of alcohol use (e.g., Alcohol Use Disorder Identification Test (AUDIT)). Studies were excluded if they measured alcohol use following an isolated sentinel event (e.g., 9/11). The following occupations were included: first responders, health care workers, Armed Forces, war journalists and train drivers. RESULTS 1882 studies were identified; 55 studies were eligible. The pooled prevalence of hazardous use was 22% (95% Confidence Intervals [CI]: 17%-27%) and 11% (95% CI: 8%-14%) for harmful use. Hazardous alcohol use was significantly lower in health care workers (13%; 95% CI: 10%-16%) than first responders (26%; 95% CI: 20%-32%) and Armed Forces (34%; 95% CI: 18%-52%). There was marked heterogeneity across studies and higher prevalence rates in low-quality studies. The meta-regression identified higher proportion of males and younger mean age as predictors of variance. CONCLUSIONS Male-dominated occupations, such as police officers and military personnel, showed higher levels of hazardous and harmful alcohol use, indicating that interventions tailored specifically for these occupational groups may be needed.
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Affiliation(s)
- Patricia Irizar
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom.
| | - Jo-Anne Puddephatt
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Suzanne H Gage
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Laura Goodwin
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
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18
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Borrell C, Palència L, Bosakova L, Gotsens M, Morrison J, Costa C, Dzurova D, Deboosere P, Lustigova M, Marí-Dell'Olmo M, Rodopoulou S, Santana P. Socioeconomic Inequalities in Chronic Liver Diseases and Cirrhosis Mortality in European Urban Areas before and after the Onset of the 2008 Economic Recession. Int J Environ Res Public Health 2021; 18:8801. [PMID: 34444557 DOI: 10.3390/ijerph18168801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 01/16/2023]
Abstract
Objective: To analyse the trends in chronic liver diseases and cirrhosis mortality, and the associated socioeconomic inequalities, in nine European cities and urban areas before and after the onset of the 2008 financial crisis. Methods: This is an ecological study of trends in three periods of time: two before (2000–2003 and 2004–2008), and one after (2009–2014) the onset of the economic crisis. The units of analysis were the geographical areas of nine cities or urban areas in Europe. We analysed chronic liver diseases and cirrhosis standardised mortality ratios, smoothing them with a hierarchical Bayesian model by each city, area, and sex. An ecological regression model was fitted to analyse the trends in socioeconomic inequalities, and included the socioeconomic deprivation index, the period, and their interaction. Results: In general, chronic liver diseases and cirrhosis mortality rates were higher in men than in women. These rates decreased in all cities during the financial crisis, except among men in Athens (rates increased from 8.50 per 100,000 inhabitants during the second period to 9.42 during the third). Socioeconomic inequalities in chronic liver diseases and cirrhosis mortality were found in six cities/metropolitan areas among men, and in four among women. Finally, in the periods studied, such inequalities did not significantly change. However, among men they increased in Turin and Barcelona and among women, several cities had lower inequalities in the third period. Conclusions: There are geographical socioeconomic inequalities in chronic liver diseases and cirrhosis mortality, mainly among men, that did not change during the 2008 financial crisis. These results should be monitored in the long term.
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19
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Peña S, Mäkelä P, Laatikainen T, Härkänen T, Männistö S, Heliövaara M, Koskinen S. Joint effects of alcohol use, smoking and body mass index as an explanation for the alcohol harm paradox: causal mediation analysis of eight cohort studies. Addiction 2021; 116:2220-2230. [PMID: 33404149 DOI: 10.1111/add.15395] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/29/2020] [Accepted: 12/23/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Lower socio-economic status (SES) is associated with higher alcohol-related harm despite lower levels of alcohol use. Differential vulnerability due to joint effects of behavioural risk factors is one potential explanation for this 'alcohol harm paradox'. We analysed to what extent socio-economic inequalities in alcohol-mortality are mediated by alcohol, smoking and body mass index (BMI), and their joint effects with each other and with SES. DESIGN Cohort study of eight health examination surveys (1978-2007) linked to mortality data. SETTING Finland. PARTICIPANTS A total of 53 632 Finnish residents aged 25+ years. MEASUREMENTS The primary outcome was alcohol-attributable mortality. We used income as an indicator of SES. We assessed the joint effects between income and mediators (alcohol use, smoking and BMI) and between the mediators, adjusting for socio-demographic indicators. We used causal mediation analysis to calculate the total, direct, indirect and mediated interactive effects using Aalen's additive hazards models. FINDINGS During 1 085 839 person-years of follow-up, we identified 865 alcohol-attributable deaths. We found joint effects for income and alcohol use and income and smoking, resulting in 46.8 and 11.4 extra deaths due to the interaction per 10 000 person-years. No interactions were observed for income and BMI or between alcohol and other mediators. The lowest compared with the highest income quintile was associated with 5.5 additional alcohol deaths per 10 000 person-years (95% confidence interval = 3.7, 7.3) after adjusting for confounders. The proportion mediated by alcohol use was negative (-69.3%), consistent with the alcohol harm paradox. The proportion mediated by smoking and BMI and their additive interactions with income explained 18.1% of the total effect of income on alcohol-attributable mortality. CONCLUSIONS People of lower socio-economic status appear to be more vulnerable to the effects of alcohol use and smoking on alcohol-attributable mortality. Behavioural risk factors and their joint effects with income may explain part of the alcohol harm paradox.
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Affiliation(s)
- Sebastián Peña
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,Doctoral Programme in Population Health, University of Helsinki, Helsinki, Finland.,Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Pia Mäkelä
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, Faculty of Medicine, University of Eastern Finland, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Joensuu, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Satu Männistö
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Markku Heliövaara
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
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20
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Peña S, Mäkelä P, Härkänen T, Heliövaara M, Gunnar T, Männistö S, Laatikainen T, Vartiainen E, Koskinen S. Measurement error as an explanation for the alcohol harm paradox: analysis of eight cohort studies. Int J Epidemiol 2021; 49:1836-1846. [PMID: 32995840 DOI: 10.1093/ije/dyaa113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite reporting lower levels of alcohol consumption, people with lower socio-economic status (SES) experience greater alcohol-related harm. Whether differential biases in the measurement of alcohol use could explain this apparent paradox is unknown. Using alcohol biomarkers to account for measurement error, we examined whether differential exposure to alcohol could explain the socio-economic differences in alcohol mortality. METHODS Participants from eight representative health surveys (n = 52 164, mean age 47.7 years) were linked to mortality data and followed up until December 2016. The primary outcome was alcohol-attributable mortality. We used income and education as proxies for SES. Exposures include self-reported alcohol use and four alcohol biomarkers [serum gamma-glutamyl transferase (available in all surveys), carbohydrate-deficient transferrin, alanine aminotransferase and aspartate aminotransferase (available in subsamples)]. We used shared frailty Cox proportional hazards to account for survey heterogeneity. RESULTS During a mean follow-up of 20.3 years, totalling 1 056 844 person-years, there were 828 alcohol-attributable deaths. Lower SES was associated with higher alcohol mortality despite reporting lower alcohol use. Alcohol biomarkers were associated with alcohol mortality and improved the predictive ability when used in conjunction with self-reported alcohol use. Alcohol biomarkers explained a very small fraction of the socio-economic differences in alcohol mortality, since hazard ratios either slightly attenuated (percent attenuation range 1.0-12.1%) or increased. CONCLUSIONS Using alcohol biomarkers in addition to self-reported alcohol use did not explain the socio-economic differences in alcohol mortality. Differential bias in the measurement of alcohol use is not a likely explanation for the alcohol-harm paradox.
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Affiliation(s)
- Sebastián Peña
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland.,Doctoral Programme in Population Health, University of Helsinki, Helsinki, Finland.,Facultad de Medicina, University Diego Portales, Santiago, Chile
| | - Pia Mäkelä
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Markku Heliövaara
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Teemu Gunnar
- Department of Government Services, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Satu Männistö
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, Faculty of Medicine, University of Eastern Finland, 70211 Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), 80211 Joensuu, Finland
| | - Erkki Vartiainen
- International Affairs and Research Support Office, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
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21
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Subbaraman MS, Mulia N, Ye Y, Greenfield TK, Kerr WC. Alcohol policy effects on 100% chronic alcohol-attributable mortality across racial/ethnic subgroups. Prev Med 2021; 145:106450. [PMID: 33549683 PMCID: PMC8631687 DOI: 10.1016/j.ypmed.2021.106450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
In the United States, some racial/ethnic minorities suffer from higher rates of chronic alcohol problems, and alcohol-related morbidity and mortality than Whites. Furthermore, state-level alcohol policies may affect racial/ethnic subgroups differentially. We investigate effects of beverage-specific taxes and government control of spirits retail on alcohol-related mortality among non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic American Indians/Alaska Natives (AI/AN) and Hispanics using death certificate and state-level alcohol policy data for 1999-2016. Outcomes were analyzed as mortality rates (per 10,000) from 100% alcohol-attributable chronic conditions ("100% chronic AAD"). Statistical models regressed racial/ethnic-specific logged mortality rates on state-level, one-year lagged and logged beer tax, one-year lagged and logged spirits tax, and one-year lagged government-controlled spirits sales, adjusted for mortality trends, fixed effects for state, and clustering of standard errors. Government control was significantly (P < 0.05) related to 3% reductions in Overall and non-Hispanic White mortality rates, and 4% reductions in Hispanic mortality rates from 100% chronic AAD. Tax associations were not robust. Results support that government control of spirits retail is associated with significantly lower 100% AAD from chronic causes Overall and among non-Hispanic Whites and Hispanics. Government control of spirits retail may reduce both population-level 100% chronic AAD as well as racial/ethnic disparities in 100% chronic AAD.
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Affiliation(s)
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | | | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
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Dance S, Dack C, Lasheras C, McMahon C, Scott P, Adams S. Exploring the use of workplaces to recruit "hard-to-reach" male drinkers to a survey on alcohol use and awareness of health messages. BMC Public Health 2021; 21:623. [PMID: 33789645 PMCID: PMC8011195 DOI: 10.1186/s12889-021-10697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Lower socioeconomic status (SES) groups, particularly lower SES males, are at greater risk of alcohol-related harm than higher SES groups, despite drinking at the same level or less. However, they are rarely recruited for research through typical recruitment strategies. Consequently, limited evidence exists on patterns of alcohol use and effectiveness of public health messages for these groups. Using workplaces to recruit male drinkers from lower SES backgrounds may provide a feasible and accessible approach to research participation and enable improved understanding of alcohol use, drinking motives and acceptance of alcohol-related public health messages in this underrepresented and high-risk group. We investigated workplace-based strategies to recruit male drinkers from lower SES backgrounds. We also investigated their experiences and motivations for alcohol use, and acceptance of alcohol-related public health messages. Methods A feasibility element investigated the effectiveness of workplace-based strategies to recruit male drinkers from lower SES backgrounds in the south west of England. A pilot element investigated this population’s experiences and motivations for alcohol use, and acceptance of alcohol-related public health messages, through a mixed-methods survey. Results Feasibility results indicated that workplace-based recruitment strategies, including recruiting participants in person at their workplace and providing a financial incentive, effectively led to the recruitment of 84 male drinkers (70% recruitment rate), predominately from lower SES backgrounds, to a survey. Pilot results indicated that more than half of participants were at increasing risk of alcohol-related harm, and approximately one fifth engaged in weekly heavy episodic drinking. Participation in campaigns aimed at reducing alcohol use, and knowledge of government alcohol consumption guidelines, were low. Participants reported negative beliefs about alcohol including health effects, dependency and excess use, and financial and occupational effects. Positive beliefs about alcohol included relaxation, socialising, and enjoyment. Conclusions Workplace-based recruitment, using in-person recruitment and a financial incentive, may be a feasible strategy to recruit male drinkers from lower SES backgrounds. Pilot results may direct larger scale research aiming to understand alcohol use in this population and inform targeted public health messages. Workplace-based recruitment may represent a promising avenue for future research aiming to tackle inequalities in participation in alcohol research.
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Affiliation(s)
- Sarah Dance
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | - Charlotte Dack
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | - Celia Lasheras
- Public Health Department, Bath & North East Somerset Council, Bath, BA2 5RP, UK
| | - Cathy McMahon
- Public Health Department, Bath & North East Somerset Council, Bath, BA2 5RP, UK
| | - Paul Scott
- Public Health Department, Bath & North East Somerset Council, Bath, BA2 5RP, UK
| | - Sally Adams
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
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Rossow I, Amundsen EJ, Samuelsen SO. Socio-economic differences in all-cause mortality in people with alcohol use disorder: a prospective cohort study. Addiction 2021; 116:53-59. [PMID: 32267578 DOI: 10.1111/add.15070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/08/2020] [Accepted: 04/01/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS While alcohol-attributable mortality rates are higher in low socio-economic status (SES) groups, less is known about SES differences in all-cause mortality in alcohol use disorder (AUD). The aim of this study was to explore whether there are SES differences in people with AUD, regarding (i) treatment admission, (ii) all-cause mortality risk and (iii) relative mortality risk. DESIGN AND SETTING A prospective cohort study in Norway, follow-up period from 2009-10 to 2013. Data on SES and mortality were obtained through linkages to national registries, using national unique ID numbers. PARTICIPANTS AUD patients (age 20+) admitted to treatment in 2009-10 (n = 11 726) and age and gender frequency-matched controls from the general population (n = 12 055). MEASUREMENTS The SES indicator was education level (low, intermediate and high). Mortality was calculated as deaths per 1000 person-years during the 4-year observation period. FINDINGS Admission to AUD treatment was elevated in the low compared with the high SES categories (OR = 3.31, 95% CI = 3.09, 3.55). Among AUD patients, mortality risk was elevated in the low SES category (HR = 1.23, 95% CI = 1.04, 1.45). Relative mortality risk from AUD was significantly higher in the high SES (HR = 8.65, 95% CI = 6.16, 12.14) compared with the low SES categories (HR = 3.29, 95% CI = 2.61, 4.15). CONCLUSION Admission to treatment for alcohol use disorders in Norway appears to decrease with increasing socio-economic status, and relative mortality risk from alcohol use disorder appears to increase with increasing socio-economic status.
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Affiliation(s)
- Ingeborg Rossow
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Ellen J Amundsen
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Sven Ove Samuelsen
- Department of Mathematics, University of Oslo, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Polanska K, Kaleta D. Correlates of Alcohol Consumption Among a Socially-Disadvantaged Population in Poland. Int J Environ Res Public Health 2020; 17:E9074. [PMID: 33291767 DOI: 10.3390/ijerph17239074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 01/04/2023]
Abstract
Alcohol consumption at a level exceeding existing recommendations is one of the leading risk factors for death and disability worldwide. The aim of the study was to identify correlates of alcohol drinking among a socially-disadvantaged population in Poland. The cross-sectional study covered 1644 adult social assistance beneficiaries from the Piotrkowski district (rural area in central Poland). A detailed questionnaire filled in during a face-to-face interview allowed for the collection of socio-demographic, lifestyle-related (including alcohol consumption) and health status data. About 42% of the participants, including 67% of the men and 30% of the women, exceeded the recommended level of alcohol consumption. In the adjusted model, the men tended not to follow recommendations for alcohol consumption more frequently than the women (OR = 4.5, p < 0.001). The higher odds of not following alcohol-related recommendations were also observed for the subjects declaring having a permanent or temporary job compared to the unemployed participants (OR = 1.2, p = 0.04). A lower healthy lifestyle index (indicating an unhealthy lifestyle related to a diet, body mass index (BMI), physical activity, and tobacco smoking) was associated with not following recommendations for alcohol consumption (OR = 1.1, p = 0.04). Our study indicates that being men, having a permanent or a temporary job, and coexistence of other unfavorable lifestyle-related factors are important correlates of not following recommendations for alcohol consumption among the beneficiaries of government welfare assistance.
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Bahk J, Kang HY, Khang YH. Age- and cause-specific contributions to the life expectancy gap between Medical Aid recipients and National Health Insurance beneficiaries in Korea, 2008-2017. PLoS One 2020; 15:e0241755. [PMID: 33141849 PMCID: PMC7608888 DOI: 10.1371/journal.pone.0241755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022] Open
Abstract
Recipients of Medical Aid, a government-funded social assistance program for the poor, have a shorter life expectancy than National Health Insurance beneficiaries in Korea. This study aims to explore the contributions of age and major causes of death to the life expectancy difference between the two groups. We used the National Health Information Database provided by the National Health Insurance Service individually linked to mortality registration data of Statistics Korea between 2008 and 2017. Annual abridged life tables were constructed and Arriaga’s life expectancy decomposition method was employed to estimate age- and cause-specific contributions to the life expectancy gap between National Health Insurance beneficiaries and Medical Aid recipients. The life expectancy difference between National Health Insurance beneficiaries and Medical Aid recipients was 14.5 years during the period of 2008–2017. The age groups between 30 and 64 years accounted for 78.7% and 67.5% of the total life expectancy gap in men and women, respectively. Cancer was the leading cause of death contributing to excess mortality among Medical Aid recipients compared to National Health Insurance beneficiaries. More specifically, alcohol-attributable deaths (such as alcoholic liver disease, liver cancer, liver cirrhosis, and alcohol/substance abuse), suicide, and cardiometabolic risk factor–related deaths (such as cerebrovascular disease, ischemic heart disease, and diabetes) were the leading contributors to the life expectancy gap. To decrease excess deaths in Medical Aid recipients and reduce health inequalities, effective policies for tobacco and alcohol regulation, suicide prevention, and interventions to address cardiometabolic risk factors are needed.
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Affiliation(s)
- Jinwook Bahk
- Department of Public Health, Keimyung University, Daegu, South Korea
| | - Hee-Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
| | - Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
- * E-mail:
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26
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Probst C, Kilian C, Sanchez S, Lange S, Rehm J. The role of alcohol use and drinking patterns in socioeconomic inequalities in mortality: a systematic review. The Lancet Public Health 2020; 5:e324-e332. [DOI: 10.1016/s2468-2667(20)30052-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/21/2022]
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27
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Almquist YB, Bishop L, Gustafsson NK, Berg L. Intergenerational transmission of alcohol misuse: mediation and interaction by school performance in a Swedish birth cohort. J Epidemiol Community Health 2020; 74:598-604. [PMID: 32332116 PMCID: PMC7320796 DOI: 10.1136/jech-2019-213523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/11/2020] [Accepted: 03/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Children whose parents misuse alcohol have increased risks of own alcohol misuse in adulthood. Though most attain lower school marks, some still perform well in school, which could be an indicator of resilience with protective potential against negative health outcomes. Accordingly, the aim of this study was to examine the processes of mediation and interaction by school performance regarding the intergenerational transmission of alcohol misuse. METHODS Data were drawn from a prospective Swedish cohort study of children born in 1953 (n=14 608). Associations between parental alcohol misuse (ages 0-19) and participants' own alcohol misuse in adulthood (ages 20-63) were examined by means of Cox regression analysis. Four-way decomposition was used to explore mediation and interaction by school performance in grade 6 (age 13), grade 9 (age 16) and grade 12 (age 19). RESULTS Mediation and/or interaction by school performance accounted for a substantial proportion of the association between parental alcohol misuse and own alcohol misuse in adulthood (58% for performance in grade 6, 27% for grade 9 and 30% for grade 12). Moreover, interaction effects appeared to be more important for the outcome than mediation. CONCLUSION Above-average school performance among children whose parents misused alcohol seems to reflect processes of resilience with the potential to break the intergenerational transmission of alcohol misuse. Four-way decomposition offers a viable approach to disentangle processes of interaction from mediation, representing a promising avenue for future longitudinal research.
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Affiliation(s)
- Ylva B Almquist
- Department of Public Health Sciences, Stockholm University, Faculty of Social Sciences, Stockholm, Sweden
| | - Lauren Bishop
- Department of Public Health Sciences, Stockholm University, Faculty of Social Sciences, Stockholm, Sweden
| | - Nina-Katri Gustafsson
- Department of Public Health Sciences, Stockholm University, Faculty of Social Sciences, Stockholm, Sweden
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, Faculty of Social Sciences, Stockholm, Sweden
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28
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Wang Y, Lu H, Hu M, Wu S, Chen J, Wang L, Luo T, Wu Z, Liu Y, Tang J, Chen W, Deng Q, Liao Y. Alcohol Consumption in China Before and During COVID-19: Preliminary Results From an Online Retrospective Survey. Front Psychiatry 2020; 11:597826. [PMID: 33324263 PMCID: PMC7723925 DOI: 10.3389/fpsyt.2020.597826] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Alcohol is an important aspect of Chinese culture, and alcohol use has been traditionally accepted in China. People with stress, anxiety, and depression may use more alcohol. More people reported symptoms of anxiety and depression during the outbreak of COVID-19. Thus, people may drink more alcohol during the outbreak of COVID-19 than before COVID-19. Methods: An online retrospective survey was conducted on a total sample of 2,229 participants. Drinking behaviors before and during COVID-19, current risky drinking and hazardous drinking, and the association between high-risk drinking and mental health problems (depression, anxiety, and stress) were assessed via self-reported measures on the Alcohol Use Disorders Identification Test (AUDIT) and the 21-item Depression Anxiety Stress Scales (DASS-21). Results: This study found that, compared with before COVID-19, alcohol consumption was slightly decreased during COVID-19 (from 3.5 drinks to 3.4 drinks, p = 0.035) in the overall sample. Most (78.7%) alcohol drinkers were males. Before and during COVID-19, males consumed more drinks per week (4.2 and 4.0 vs. 1.3 and 1.2 drinks), had a higher percentage of heavy drinking (8.1 and 7.7% vs. 4.4 and 2.7%), and more drinking days per week (2.1 and 2.1 vs. 1.0 and 0.9 days). Males also had more risky drinking (43.2 vs. 9.3%) and hazardous drinking (70.2 vs. 46.6%) than female counterparts. This study also found that high-risk drinking predicted anxiety in females. Conclusions: This study suggests a slight reduction in alcohol consumption during COVID-19. However, hazardous drinking is common, especially among male alcohol drinkers. Males consumed more alcohol, had more risky and hazardous drinking than female counterparts both before and during COVID-19. Public health policy makers should pay more attention to developing effective, population-based strategies to prevent harmful alcohol consumption.
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Affiliation(s)
- Yunfei Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center of Mental Disorders, Changsha, China
| | - Heli Lu
- Department of Psychosomatic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Maorong Hu
- Department of Psychiatry, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shiyou Wu
- The Third Affiliated Hospital of Guizhou Medical University, Qiannan, China
| | - Jianhua Chen
- Shanghai Clinical Research Center for Mental Health, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Wang
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Tao Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Jiangxi Mental Hospital, Nanchang, China
| | - Zhenzhen Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center of Mental Disorders, Changsha, China
| | - Yueheng Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center of Mental Disorders, Changsha, China
| | - Jinsong Tang
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Neurobiology of Zhejiang Province, Hangzhou, China
| | - Wei Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Neurobiology of Zhejiang Province, Hangzhou, China
| | - Qijian Deng
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center of Mental Disorders, Changsha, China
| | - Yanhui Liao
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Neurobiology of Zhejiang Province, Hangzhou, China.,Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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29
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Pruckner N, Hinterbuchinger B, Fellinger M, König D, Waldhoer T, Lesch OM, Gmeiner A, Vyssoki S, Vyssoki B. Alcohol-Related Mortality in the WHO European Region: Sex-Specific Trends and Predictions. Alcohol Alcohol 2019; 54:593-598. [DOI: 10.1093/alcalc/agz063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/14/2019] [Accepted: 07/04/2019] [Indexed: 12/17/2022] Open
Abstract
Abstract
Aims
Alcohol is an important risk factor for morbidity and mortality, especially within the European region. Differences in per capita consumption and drinking patterns are possible reasons for regional differences and diverging trends in alcohol-related health outcomes.
Methods
Twenty-nine countries within the World Health Organization (WHO) European region were evaluated for trends and predictions in alcohol-related deaths within the last four decades using data available from the WHO Health for All database.
Results
Between 1979 and 2015, age-standardised death rates due to selected alcohol-related causes decreased significantly for both sexes in all assessed countries of the WHO European region, but regional differences are still pronounced. Assuming a similar trend in the future, the model predicted a further decrease until the year 2030.
Conclusion
Even though alcohol-related mortality may have decreased within the last decades, the detrimental effects of alcohol consumption and alcohol dependence remain a considerable burden of disease within Europe.
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Affiliation(s)
- Nathalie Pruckner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Barbara Hinterbuchinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Matthäus Fellinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Daniel König
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Thomas Waldhoer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Otto M Lesch
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Andrea Gmeiner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Sandra Vyssoki
- Department of Health Sciences, St. Pölten University of Applied Sciences, Fachhochschule St. Pölten GmbH Matthias Corvinus - Straße 15, 3100 St. Pölten, Austria
| | - Benjamin Vyssoki
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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30
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Abstract
Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.
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Affiliation(s)
- Andre F Carvalho
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia.
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31
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Castañeda SF, Garcia ML, Lopez-Gurrola M, Stoutenberg M, Emory K, Daviglus ML, Kaplan R, Giachello AL, Molina KM, Perreira KM, Youngblood ME, Vidot DC, Talavera GA. Alcohol use, acculturation and socioeconomic status among Hispanic/Latino men and women: The Hispanic Community Health Study/Study of Latinos. PLoS One 2019; 14:e0214906. [PMID: 30947280 PMCID: PMC6449031 DOI: 10.1371/journal.pone.0214906] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/21/2019] [Indexed: 12/20/2022] Open
Abstract
The objective of this study was to examine the prevalence and patterns of alcohol use among U.S. Hispanic/Latino adults of diverse backgrounds. The population-based Hispanic Community Health Study/ Study of Latinos (HCHS/SOL) enrolled a cohort of Hispanic/Latino adults (N = 16,415) ages 18–74 years at time of recruitment, from four US metropolitan areas between 2008–11. Drinking patterns and socio-demographics questionnaires were administered as part of the baseline examination. The relationship between age, sex, socio-demographics, acculturation, current alcohol use, and alcohol risk disorder, defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) [no risk (i.e., never drinker), low risk (i.e., women<7 drinks/week; men<14 drinks/week), and at-risk (i.e., women>7 drinks/week; men>14 drinks/week)] were assessed in unadjusted and adjusted multinomial logistic regression analyses. Men reported a higher prevalence than women of at-risk drinking. For women, increased odds of at-risk alcohol use was associated with: a younger age, greater education, full-time employment, and acculturation after adjustment. For men, having a lower income (vs. higher income) or a higher income (vs. not reported) and being employed fulltime (vs. retired) was associated with at-risk alcohol use. For both men and women, there were variations in odds of at-risk drinking across Hispanic/Latino heritage backgrounds, after adjustment. Exact values, odds ratios and p-values are reported within the text. Common factors across sex associated with at-risk drinking included being of Mexican background and being employed full-time. Intervention strategies should consider diversity within the Hispanic/Latino community when designing alcohol abuse prevention programs.
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Affiliation(s)
- Sheila F. Castañeda
- Southbay Latino Research Center, School of Public Health, San Diego State University, San Diego, California, United States of America
- * E-mail:
| | - Melawhy L. Garcia
- Department of Health Science, California State University, Long Beach, Long Beach, California, United States of America
| | - Maria Lopez-Gurrola
- Southbay Latino Research Center, School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Mark Stoutenberg
- Department of Health & Human Performance, University of Tennessee at Chattanooga, Chattanooga, Tennessee, United States of America
| | - Kristen Emory
- School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Robert Kaplan
- Einstein College of Medicine, Bronx, New York, United States of America
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Aida L. Giachello
- Northwestern University, Chicago, Illinois, United States of America
| | - Kristine M. Molina
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Krista M. Perreira
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | - Denise C. Vidot
- University of Miami, Miami, Florida, United States of America
| | - Gregory A. Talavera
- Southbay Latino Research Center, School of Public Health, San Diego State University, San Diego, California, United States of America
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32
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Wang F, Tipoe GL, Yang C, Nanji AA, Hao X, So KF, Xiao J. Lycium barbarum Polysaccharide Supplementation Improves Alcoholic Liver Injury in Female Mice by Inhibiting Stearoyl-CoA Desaturase 1. Mol Nutr Food Res 2018; 62:e1800144. [PMID: 29797417 DOI: 10.1002/mnfr.201800144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/04/2018] [Indexed: 01/21/2023]
Abstract
SCOPE Lycium barbarum polysaccharide (LBP) is a water fraction of wolfberry, which has been demonstrated to possess a hepatoprotective effect in several liver disease models. However, the anti-alcoholic liver disease (anti-ALD) mechanism of LBP has not been investigated thoroughly. Its protective effects on both male and femal mice are investigated in the current study. METHODS AND RESULTS A chronic ethanol-fed ALD in vivo model is applied to study the effect of LBP in both male and female mice. It is observed that ethanol causes more severe liver injury in female than male mice, and the ameliorative effects of LBP are also more significant in female mice, which are impaired after complete bilateral oophorectomy. The hepatic SCD1 expression is found to be positively correlated with the severity of the liver damage and the main mediator of LBP inducer of protection. The AMPK-CPT pathway is also activated by LBP to rebalance the dysregulated lipid metabolism during ALD development. By using concurrent sodium palmitate and an ethanol-induced in vitro cell damage model in AML-12 cell line, it is characterized that LBP directly interacts with ERα instead of ERβ to activate the SCD1-AMPK-CPT pathway. CONCLUSIONS LBP is an effective and safe hepatoprotective agent against ALD primarily through the SCD1-AMPK-CPT pathway after ERα agonist.
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Affiliation(s)
- Fei Wang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Tongji Hospital, Tongji University School of Medicine, 389 Xin Cun Road, Shanghai, 200065, China
| | - George L Tipoe
- School of Biomedical Sciences, The University of Hong Kong, Pokfulam, 999077, Hong Kong
| | - Changqing Yang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Tongji Hospital, Tongji University School of Medicine, 389 Xin Cun Road, Shanghai, 200065, China
| | - Amin A Nanji
- School of Medicine, Dalhousie University, Halifax, Nova Scotia, B3H1V, Canada
| | - Xiangfeng Hao
- Yinchuan Bairuiyuan Biotechnology, Yinchuan, 750200, China
| | - Kwok-Fai So
- GMH Institute of CNS Regeneration, Guangdong Medical Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou, 510632, China
| | - Jia Xiao
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Tongji Hospital, Tongji University School of Medicine, 389 Xin Cun Road, Shanghai, 200065, China.,School of Biomedical Sciences, The University of Hong Kong, Pokfulam, 999077, Hong Kong.,GMH Institute of CNS Regeneration, Guangdong Medical Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou, 510632, China
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Machado ÍE, Monteiro MG, Monteiro RA, Lana FCF, Gawryszewski VP, Malta DC. Trends in mortality rates where alcohol was a necessary cause of death in Brazil, 2000-2013. Rev Panam Salud Publica 2018; 42:e9. [PMID: 31093038 PMCID: PMC6386057 DOI: 10.26633/rpsp.2018.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/09/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To analyze trends in mortality due to diseases and conditions fully attributable to alcohol in Brazil. METHODS This was an ecological time-series study. Proportional, specific, and age-standardized mortality rates between 2000 and 2013 that were due to underlying or contributing causes fully attributable to alcohol use were analyzed by sex, ethnicity/skin color, age group, and region of residence in the country. Data on deaths were obtained from the Brazilian Mortality Information System (SIM). Prais-Winsten regression was used to analyze trends. RESULTS Deaths with underlying causes and/or conditions contributing to death fully attributable to alcohol accounted for 2.5% of total deaths in the period. There were more deaths among men (3.8%) than among women (0.7%). In both sexes, there was a higher proportion of deaths in those 40-49 years old (27.9%) and those of black or pardo (mixed race) skin color (48.8%). Between 2000 and 2013, there was an upward trend in specific mortality rates attributable to alcohol in the country as a whole (average annual growth rate (AAGR) = 5.59%; 95% confidence interval (CI) = 3.55%-7.68%), especially in people aged less than 20 years old, in pardos (AAGR = 13.42%; 95% CI = 9.70%-17.25%), and in residents of the North region (AAGR = 17.01%; 95% CI = 14.94%-19.13%), the Northeast region (AAGR = 15.49%; 95% CI = 10.61%-20.58%), and the Midwest region (AAGR = 8.40%; 95% CI = 5.57%-11.32%). CONCLUSION Alcohol is an important and growing cause of premature death in Brazil, especially among men, black/pardo people, and the population living in the most disadvantaged regions. This overall increase in the harmful use of alcohol reflects ethnic and socioeconomic inequalities in Brazil, and it also points to the need for population-based policies to reduce the impact of morbidity and to prevent early mortality.
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Affiliation(s)
- Ísis Eloah Machado
- Nursing Postgraduate Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Maristela Goldnadel Monteiro
- Mental Health and Substance Use Unit, Pan American Health Organization (PAHO/WHO), Washington, D.C., United States of America
| | - Rosane Aparecida Monteiro
- Department of Social Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Francisco Carlos Félix Lana
- Department of Maternal and Child Nursing and Public Health, Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Vilma Pinheiro Gawryszewski
- Health Information and Analysis Unit, Pan American Health Organization (PAHO/WHO), Washington, D.C., United States of America
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, Escola de Enfermagem, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Sidorchuk A, Goodman A, Koupil I. Social class, social mobility and alcohol-related disorders in Swedish men and women: A study of four generations. PLoS One 2018; 13:e0191855. [PMID: 29444095 PMCID: PMC5812607 DOI: 10.1371/journal.pone.0191855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 01/08/2018] [Indexed: 12/12/2022] Open
Abstract
Objectives To investigate whether and how social class and social mobility in grandparents and parents predict alcohol-related disorders (ARDs) in males and females aged 12+ years, and whether intergenerational social prediction of ARDs varies across time periods. Methods The study sample included four successive generations (G) of Swedish families from the Uppsala Birth Cohort Multigenerational Study: G0 born 1851–1912; G1 born 1915–1929; G2 born 1940–1964 and G3 born 1965–1989. Two study populations were created, each consisting of grandparents, parents and offspring: population I ‘G0-G1-G2’ (offspring n = 18 430) and population II ‘G1-G2-G3’ (offspring n = 26 469). Registers and archives provided data on ancestors’ socio-demographic factors and ARD history, together with offspring ARD development between 1964–2008. Cox regression models examined the hazard of offspring ARD development according to grandparental social class and grandparental-to-parental social trajectories, controlling for offspring birth year, grandmother’s and mother’s marital status and parental ARDs. Results Disadvantaged grandparental social class predicted increased ARD risk in offspring in population I, although the effect attenuated and became non-significant in males after adjusting for parental characteristics (adjusted hazard ratio (HR) = 1.80 (95%CI; 1.07, 3.03) in females, HR = 1.32 (95%CI; 0.93, 1.89) in males). In population II, no increase in ARD risk by grandparental social was evident. In both populations, males were at the highest ARD risk if both parents and grandparents belonged to disadvantaged social class (population I: HR = 1.82 (95%CI; 1.22–2.72); population II: HR = 1.68 (95%CI; 1.02–2.76)). Conclusions Intergenerational social patterning of ARDs appears to be time-contextual and gender-specific. The role of grandparental social class in developing ARDs in grandchildren seems to decline over time, while persistent grandparental-to-parental social disadvantage remains associated with higher ARD risk in males. When targeting higher risk groups, continuity of familial social disadvantage, particularly among males, should be considered.
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Affiliation(s)
- Anna Sidorchuk
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Anna Goodman
- Department of Public Health Sciences, Stockholm Unviersity, Stockholm, Sweden
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ilona Koupil
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm Unviersity, Stockholm, Sweden
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Giusto A, Puffer E. A systematic review of interventions targeting men's alcohol use and family relationships in low- and middle-income countries. Glob Ment Health (Camb) 2018; 5:e10. [PMID: 29632682 DOI: 10.1017/gmh.2017.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 10/16/2017] [Accepted: 10/25/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Problem drinking accounts for 9.6% of disability-adjusted life years worldwide. It disproportionally affects men and has disabling physical, psychological, and behavioral consequences. These can lead to a cascade of negative effects on men's families, with documented ties to intimate partner violence (IPV) and child maltreatment. These multi-level problems are often exacerbated where poverty rates are high, including low and middle-income countries (LMICs). In contexts where strong patriarchal norms place men in positions of power, family-level consequences are often even more pronounced. METHODS We conducted a systematic review of the literature on interventions in LMICs targeting men's problem drinking and any family-related outcomes. Cochrane and PRISMA procedures guided the review. The search was conducted in PsychInfo, PubMed, and Web of Science. RESULTS The search yielded 1357 publications. Nine studies from four different countries met inclusion criteria. Of those, only one had the primary goal of simultaneously improving drinking and a related family-level outcome (IPV). Six of the studies documented modest improvements on both drinking and couples or family outcomes. Strategies common to these included cognitive-behavioral techniques, communication skills training, narrative therapy, and participatory learning. Gender-transformative approaches were associated with reduced IPV and more equitable gender norms, and motivational interviewing and behavioral approaches were beneficial for reducing alcohol use. CONCLUSIONS Findings highlight the scarcity of interventions addressing men's drinking and its effects on families, particularly for parent-child outcomes. However, results point to strategies that, combined with other evidence-based family interventions can guide the development and rigorous evaluation of integrated programs.
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Pulido J, Vallejo F, Alonso-López I, Regidor E, Villar F, de la Fuente L, Domingo-Salvany A, Barrio G. Directly alcohol-attributable mortality by industry and occupation in a Spanish Census cohort of economically active population. Drug Alcohol Depend 2017; 180:93-102. [PMID: 28886397 DOI: 10.1016/j.drugalcdep.2017.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 11/25/2022]
Abstract
AIMS To assess disparities in directly alcohol-attributable (DAA) mortality by industry/occupation in Spain during 2002-2011 and the contribution of different socio-demographic factors, including socioeconomic position, to explain such disparity. METHODS Nationwide cohort study covering 16 million economically active people living in Spain in 2001. Deaths at age 25-64 were analyzed. Subjects were classified by employment status, industry and occupation at baseline. Poisson regression models were built, calculating rate ratios (RRs) compared to all employees or those in the education sector. RESULTS DAA mortality was much higher in the unemployed than in employees (Crude RR: 2.4; 95% CI: 2.3-2.6) and varied widely across industries/occupations. Crude RRs>3.0 (p<0.05) compared to teachers were found in employees in extractive industries/fishing, agriculture/livestock, construction, catering/accommodation and protective services. Socio-demographic factors, especially age, gender and educational attainment contributed more to explain risk disparities than other factors or potential selection bias. However, after exhaustive sociodemographic adjustment, including education attainment and material wealth, a RR>1.33 (p<0.05) remained in unemployed, catering/accommodation employees and unskilled construction workers. RRs were significantly larger in women than men (p<0.05) among mineworkers/fishworkers/sailors (RR=8.6 vs. 1.2) and drivers (RR=3.7 vs. 1.0). CONCLUSIONS The results could be extrapolated to all alcohol-attributable mortality since disparities for other strongly alcohol-related deaths, although smaller, were in the same direction. Given the wide occupational disparities in alcohol-attributable mortality, implementation of special measures to reduce this mortality in the highest risk groups is fully justified. Future research should better characterize the explanatory factors of disparities and their role in the causal chain.
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Affiliation(s)
- José Pulido
- National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; Department of Preventive Medicine and Public Health, Madrid Complutense University, Ciudad Universitaria s/n, E-28040 Madrid, Spain.
| | - Fernando Vallejo
- National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain.
| | - Ignacio Alonso-López
- National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain.
| | - Enrique Regidor
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; Department of Preventive Medicine and Public Health, Madrid Complutense University, Ciudad Universitaria s/n, E-28040 Madrid, Spain.
| | - Fernando Villar
- National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain.
| | - Luis de la Fuente
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avenida Monforte de Lemos 5, E-28029 Madrid, Spain; National Epidemiology Center, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain.
| | - Antonia Domingo-Salvany
- IMIM, Institut Hospital del Mar d'Investigacions Mèdiques, Carrer del Dr. Aiguader, 88, E-08003 Barcelona, Spain.
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Avenida Monforte de Lemos 5, E-28029 Madrid, Spain.
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Sawicka M, Tracy DK. Naltrexone efficacy in treating alcohol-use disorder in individuals with comorbid psychosis: a systematic review. Ther Adv Psychopharmacol 2017; 7:211-224. [PMID: 28959434 PMCID: PMC5593217 DOI: 10.1177/2045125317709975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 02/23/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Psychotic illnesses, such as schizophrenia, are typically enduring and disabling conditions, impacting individual, family, and societal outcomes. Individuals with these face greater vulnerabilities in developing alcohol-use disorder (AUD). Furthermore, the nature of psychoses, often manifesting with paranoia, cognitive impairment, a lack of insight, sub-optimal treatment adherence, and stigma from others, means that they can pose unique treatment challenges when these two conditions comorbidly occur. These challenges mean that the standard literature on the effectiveness of the opioid antagonist naltrexone in AUD does not necessarily translate to this vulnerable population. METHODS Following PRISMA guidelines, we herein systematically reviewed the evidence for naltrexone in individuals with both psychosis and AUD. Overall, there is a paucity of research in this important area, with only nine reports meeting search criteria, only four of which were randomized control trials. Studies compared naltrexone with: placebo, another pharmaceutical agent, or upon changes to baseline drinking behaviour. One study evaluated the long-acting injectable formulation of this drug. RESULTS Most studies, including the methodologically more robust ones, supported naltrexone's effectiveness over placebo in terms of reduction in drinking days and numbers of drinks consumed on such days in this cohort. Work comparing naltrexone to other pharmaceutical interventions showed approximate equivalence with disulfiram, and modest superiority over acamprosate. CONCLUSIONS On this limited evidence base, this review endorses the use of naltrexone as both safe and effective in those with both psychotic illnesses and AUD. Several key issues remain to be elucidated. Critically, study designs meant that they were limited to individuals with good engagement with services, and levels of adherence were attained that are unlikely to be replicated in this cohort in real-world settings. Finally, effects of specific psychosis symptomatology, not least paranoia and insight, upon naltrexone use, and the reverse directional potential of 'double dysphoria' from an opioid antagonist remain largely unexplored.
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Affiliation(s)
- Martyna Sawicka
- Cognition, Schizophrenia and Imaging Laboratory, Department of Psychosis Studies, The Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Derek K Tracy
- Consultant Psychiatrist, The Memorial Hospital, Woolwich, London SE18 3RG, UK
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Mies GW, Treur JL, Larsen JK, Halberstadt J, Pasman JA, Vink JM. The prevalence of food addiction in a large sample of adolescents and its association with addictive substances. Appetite 2017; 118:97-105. [PMID: 28826746 DOI: 10.1016/j.appet.2017.08.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 01/08/2023]
Abstract
The prevalence of overweight and obesity is increasing, due to, among other factors, increased availability of highly palatable food (food high in fat, salt and/or sugar). It has been proposed that certain foods and/or eating behaviours may be addictive, to a degree comparable to substances of abuse. The Yale Food Addiction Scale (YFAS) measures 'food addiction' by translating the diagnostic criteria for substance use disorder to eating behaviour. So far, only a few studies have examined the prevalence of food addiction in children with the YFAS for children (YFAS-C). Large-scale studies, especially among adolescents, are lacking. Adolescence is of particular interest because it is a period wherein unhealthy eating behaviours or addictive tendencies are likely to develop. The current study examines the prevalence of food addiction using the YFAS-C in a large group of Dutch adolescents (N = 2653) aged 14-21 years. With Generalized Estimation Equation (GEE) analysis we tested the relationship between food addiction symptoms and smoking, cannabis use, alcohol use, and sugar intake through drinks, while controlling for gender, age, educational level and weight class. In the total sample 2.6% met the criteria for a food addiction 'diagnosis', and the average symptom count was 1.0 (SD = 1.3, range 0-7). Symptoms of food addiction were positively associated with smoking, alcohol use, cannabis use and sugar intake. We propose that future studies focus on possible genetic/(neuro)biological mechanisms involved in both food addiction and substance use and that longitudinal designs are needed to examine possible causal pathways.
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Affiliation(s)
- Gabry W Mies
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Jorien L Treur
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Junilla K Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Jutka Halberstadt
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, The Netherlands
| | - Joëlle A Pasman
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Jacqueline M Vink
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
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Sadler S, Angus C, Gavens L, Gillespie D, Holmes J, Hamilton J, Brennan A, Meier P. Understanding the alcohol harm paradox: an analysis of sex- and condition-specific hospital admissions by socio-economic group for alcohol-associated conditions in England. Addiction 2017; 112:808-817. [PMID: 27981670 DOI: 10.1111/add.13726] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/22/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS In many countries, conflicting gradients in alcohol consumption and alcohol-associated mortality have been observed. To understand this 'alcohol harm paradox' we analysed the socio-economic gradient in alcohol-associated hospital admissions to test whether it was greater in conditions which were: (1) chronic (associated with long-term drinking) and partially alcohol-attributable, (2) chronic and wholly alcohol-attributable, (3) acute (associated with intoxication) and partially alcohol-attributable and (4) acute and wholly alcohol-attributable. Our aim was to clarify how (1) drinking patterns (e.g. intoxication linked to acute admissions or dependence linked to chronic conditions) and (2) non-alcohol causes (e.g. smoking and poor diet which are risks for partially alcohol-attributable conditions) contribute to the paradox. DESIGN Regression analysis testing the modifying effects of condition-group (1-4 above) and sex on the relationship between area-based deprivation and admissions. SETTING England, April 2010-March 2013. PARTICIPANTS A total of 9 239 629 English hospital admissions where a primary or secondary cause was one of 36 alcohol-associated conditions. MEASUREMENTS Admissions by condition and deciles of Index of Multiple Deprivation (IMD). Socio-economic gradient measured as the relative index of inequality (RII, the slope of a linear regression of IMD on admissions adjusted for overall admission rate). Conditions were categorized by ICD-10 code. FINDINGS A socio-economic gradient in hospitalizations was seen for all conditions, except partially attributable chronic conditions. The gradient was significantly steeper for conditions which were wholly attributable to alcohol and for acute conditions than for conditions partially alcohol-attributable and for chronic conditions. Gradients were steeper for men than for women in cases of wholly alcohol attributable conditions. CONCLUSIONS There is a socio-economic gradient in English hospital admission for most alcohol-associated conditions. The greatest inequalities are in conditions associated with alcohol dependence, such as liver disease and mental and behavioural conditions, and in acute conditions, such as alcohol poisoning and assault. Socio-economic differences in harmful drinking patterns (dependence and intoxication) may contribute to the 'alcohol harm paradox'.
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Affiliation(s)
- Susannah Sadler
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lucy Gavens
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Duncan Gillespie
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Lewis RJ, Mason TB, Winstead BA, Gaskins M, Irons LB. Pathways to Hazardous Drinking Among Racially and Socioeconomically Diverse Lesbian Women: Sexual Minority Stress, Rumination, Social Isolation, and Drinking to Cope. Psychol Women Q 2016; 40:564-581. [PMID: 28138208 DOI: 10.1177/0361684316662603] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lesbian women engage in more hazardous drinking than heterosexual women yet we know relatively little about what explains this disparity. In the present study, race, socioeconomic status, minority stress, general psychological processes and distress were examined as pathways to hazardous drinking among young (18-35 years) Black and non-Hispanic White lesbian women. We used the psychological mediation framework adaptation of minority stress theory and the reserve capacity model as theoretical underpinnings of the conceptual model in the current study. Self-identified lesbian participants (N= 867) completed a one-time online survey that assessed race, socioeconomic status, perceived sexual minority discrimination, proximal minority stress (concealment, internalized homophobia, lack of connection to lesbian community), rumination, social isolation, psychological distress, drinking to cope, and hazardous drinking. Cross-sectional results demonstrated that being Black was associated with hazardous drinking via sequential mediators of rumination, psychological distress, and drinking to cope. Socioeconomic status was associated with hazardous drinking via sequential mediators of sexual minority discrimination, proximal minority stress, rumination, social isolation, psychological distress, and drinking to cope. Understanding these pathways can aid researchers and clinicians studying and working with lesbians who are at risk for hazardous drinking.
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Affiliation(s)
- Robin J Lewis
- Department of Psychology, Old Dominion University and Virginia Consortium Program in Clinical Psychology
| | | | - Barbara A Winstead
- Department of Psychology, Old Dominion University and Virginia Consortium Program in Clinical Psychology
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Cousins G, Mongan D, Barry J, Smyth B, Rackard M, Long J. Potential Impact of Minimum Unit Pricing for Alcohol in Ireland: Evidence from the National Alcohol Diary Survey. Alcohol Alcohol 2016; 51:734-740. [PMID: 27542987 DOI: 10.1093/alcalc/agw051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/01/2016] [Indexed: 11/14/2022] Open
Abstract
AIM One of the main provisions of the Irish Public Health (Alcohol) Bill is the introduction of a minimum unit price (MUP) for alcohol in Ireland, set at €1.00/standard drink. We sought to identify who will be most affected by the introduction of a MUP, examining the relationship between harmful alcohol consumption, personal income, place of purchase and price paid for alcohol. METHOD A nationally representative survey of 3187 respondents aged 18-75 years, completing a diary of their previous week's alcohol consumption. The primary outcome was purchasing alcohol at <€1.00/standard drink; secondary outcome was purchasing alcohol at <€1.00/standard drink off-sales. Primary exposures were harmful alcohol consumption (AUDIT-C > 5), low personal annual income (<€20,000) and place of purchase (off- or- on-sales). RESULTS One in seven respondents (14%) spent <€1.00/standard drink, with a median spend of 0.78/standard drink. High-risk drinkers (OR 1.56, 95% CI 1.09-2.23), men (OR 1.95, 95% CI 1.43-2.66), people on low income (OR 1.64, 95% CI 1.20-2.23) and those purchasing alcohol off-sales (OR 21.9, 95% CI 12.5-38.1) were most likely to report purchasing alcohol at <€1.00/standard drink. Forty-four per cent of alcohol consumed was purchased off-sales. Of those purchasing off-sales, 30% bought cheap alcohol. High-risk drinkers, men and those on low income were most likely to report paying < €1.00/standard drink off-sales. CONCLUSION Heavy drinkers, men and those on low income seek out the cheapest alcohol. The introduction of a MUP in Ireland is likely to target those suffering the greatest harm, and reduce alcohol-attributable mortality in Ireland. Further prospective studies are needed to monitor consumption trends and associated harms following the introduction of minimum unit pricing of alcohol.
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Affiliation(s)
- Gráinne Cousins
- School of Pharmacy, Royal College of Surgeons in Ireland, Ardilaun House, 111 St. Stephen's Green, Dublin 2, Ireland
| | | | - Joe Barry
- Population Health Medicine, Trinity College Dublin , Ireland
| | - Bobby Smyth
- Department of Public Health and Primary Care, Trinity College Dublin, Ireland
| | - Marion Rackard
- National Social Inclusion Office, Health Services Executive, Ireland
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Roche A, Kostadinov V, Fischer J, Nicholas R, O'Rourke K, Pidd K, Trifonoff A. Addressing inequities in alcohol consumption and related harms. Health Promot Int 2016; 30 Suppl 2:ii20-35. [PMID: 26420810 DOI: 10.1093/heapro/dav030] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Social determinants, or the conditions in which individuals are born, grow, live, work and age, can result in inequities in health and well-being. However, to-date little research has examined alcohol use and alcohol-related problems from an inequities and social determinants perspective. This study reviewed the evidence base regarding inequities in alcohol consumption and alcohol-related health outcomes in Australia and identified promising approaches for promoting health equity. Fair Foundations: the VicHealth framework for health equity was used as an organizing schema. The review found that social determinants can strongly influence inequities in alcohol consumption and related harms. In general, lower socioeconomic groups experience more harm than wealthier groups with the same level of alcohol consumption. While Australia has implemented numerous alcohol-related interventions and policies, most do not explicitly aim to reduce inequities, and some may inadvertently exacerbate existing inequities. Interventions with the greatest potential to decrease inequities in alcohol consumption and alcohol-related harms include town planning, zoning and licensing to prevent disproportionate clustering of outlets in disadvantaged areas; interventions targeting licensed venues; and interventions targeting vulnerable populations. Interventions that may worsen inequities include national guidelines, technological interventions and public drinking bans. There is a need for further research into the best methods for reducing inequities in alcohol consumption and related harms.
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Affiliation(s)
- Ann Roche
- National Centre for Education and Training on Addiction (NCETA), Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Victoria Kostadinov
- National Centre for Education and Training on Addiction (NCETA), Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Jane Fischer
- National Centre for Education and Training on Addiction (NCETA), Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Roger Nicholas
- National Centre for Education and Training on Addiction (NCETA), Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Kerryn O'Rourke
- Victorian Health Promotion Foundation, 15-31 Pelham Street, Carlton Victoria 3053, Melbourne, Australia
| | - Ken Pidd
- National Centre for Education and Training on Addiction (NCETA), Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Allan Trifonoff
- National Centre for Education and Training on Addiction (NCETA), Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
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Kröner PT, Mankal PK, Dalapathi V, Shroff K, Abed J, Kotler DP. Alcohol-Attributable Fraction in Liver Disease: Does GDP Per Capita Matter? Ann Glob Health 2015; 81:711-7. [PMID: 27036730 DOI: 10.1016/j.aogh.2015.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The alcohol-attributable fraction (AAF) quantifies alcohol's disease burden. Alcoholic liver disease (ALD) is influenced by alcohol consumption per capita, duration, gender, ethnicity, and other comorbidities. In this study, we investigated the association between AAF/alcohol-related liver mortality and alcohol consumption per capita, while stratifying to per-capita gross domestic product (GDP). METHODS Data obtained from the World Health Organization and World Bank for both genders on AAF on liver disease, per-capita alcohol consumption (L/y), and per-capita GDP (USD/y) were used to conduct a cross-sectional study. Countries were classified as "high-income" and "very low income" if their respective per-capita GDP was greater than $30,000 or less than $1,000. Differences in total alcohol consumption per capita and AAF were calculated using a 2-sample t test. Scatterplots were generated to supplement the Pearson correlation coefficients, and F test was conducted to assess for differences in variance of ALD between high-income and very low income countries. FINDINGS Twenty-six and 27 countries met the criteria for high-income and very low income countries, respectively. Alcohol consumption per capita was higher in high-income countries. AAF and alcohol consumption per capita for both genders in high-income and very low income countries had a positive correlation. The F test yielded an F value of 1.44 with P = .357. No statistically significant correlation was found among alcohol types and AAF. Significantly higher mortality from ALD was found in very low income countries relative to high-income countries. DISCUSSION Previous studies had noted a decreased AAF in low-income countries as compared to higher-income countries. However, the non-statistically significant difference between AAF variances of low-income and high-income countries was found by this study. A possible explanation is that both high-income and low-income populations will consume sufficient amount of alcohol, irrespective of its type, enough to weigh into equivalent AAF. CONCLUSIONS No significant difference of AAF variance was found between high-income and very low income countries relating to sex-specific alcohol consumption per capita. Alcohol consumption per capita was greater in high-income countries. Type of preferred alcohol did not correlate with AAF. ALD related mortality was less in high-income countries as a result of better developed healthcare systems. ALD remains a significant burden globally, requiring prevention from socioeconomic, medical, and political realms.
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Khang YH, Kim HR. Socioeconomic Inequality in mortality using 12-year follow-up data from nationally representative surveys in South Korea. Int J Equity Health 2016; 15:51. [PMID: 27001045 PMCID: PMC4802872 DOI: 10.1186/s12939-016-0341-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/15/2016] [Indexed: 11/23/2022] Open
Abstract
Background Investigations into socioeconomic inequalities in mortality have rarely used long-term mortality follow-up data from nationally representative samples in Asian countries. A limited subset of indicators for socioeconomic position was employed in prior studies on socioeconomic inequalities in mortality. We examined socioeconomic inequalities in mortality using follow-up 12-year mortality data from nationally representative samples of South Koreans. Methods A total of 10,137 individuals who took part in the 1998 and 2001 Korea National Health and Nutrition Examination Surveys were linked to mortality data from Statistics Korea. Of those individuals, 1,219 (12.1 %) had died as of December 2012. Cox proportional hazard models were used to estimate the relative risks of mortality according to a wide range of socioeconomic position (SEP) indicators after taking into account primary sampling units, stratification, and sample weights. Results Our analysis showed strong evidence that individuals with disadvantaged SEP indicators had greater all-cause mortality risks than their counterparts. The magnitude of the association varied according to gender, age group, and specific SEP indicators. Cause-specific analyses using equivalized income quintiles showed that the magnitude of mortality inequalities tended to be greater for cardiovascular disease and external causes than for cancer. Conclusion Inequalities in mortality exist in every aspect of SEP indicators, both genders, and age groups, and four broad causes of deaths. The South Korean economic development, previously described as effective in both economic growth and relatively equitable income distribution, should be scrutinized regarding its impact on socioeconomic mortality inequalities. Policy measures to reduce inequalities in mortality should be implemented in South Korea. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0341-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul, 03080, South Korea. .,Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Hye-Ryun Kim
- Korea Institute for Health and Social Affairs, Sejong, South Korea
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Mackenbach JP, Kulhánová I, Bopp M, Borrell C, Deboosere P, Kovács K, Looman CWN, Leinsalu M, Mäkelä P, Martikainen P, Menvielle G, Rodríguez-Sanz M, Rychtaříková J, de Gelder R. Inequalities in Alcohol-Related Mortality in 17 European Countries: A Retrospective Analysis of Mortality Registers. PLoS Med 2015; 12:e1001909. [PMID: 26625134 PMCID: PMC4666661 DOI: 10.1371/journal.pmed.1001909] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/20/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in alcohol-related mortality have been documented in several European countries, but it is unknown whether the magnitude of these inequalities differs between countries and whether these inequalities increase or decrease over time. METHODS AND FINDINGS We collected and harmonized data on mortality from four alcohol-related causes (alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental poisoning by alcohol) by age, sex, education level, and occupational class in 20 European populations from 17 different countries, both for a recent period and for previous points in time, using data from mortality registers. Mortality was age-standardized using the European Standard Population, and measures for both relative and absolute inequality between low and high socioeconomic groups (as measured by educational level and occupational class) were calculated. Rates of alcohol-related mortality are higher in lower educational and occupational groups in all countries. Both relative and absolute inequalities are largest in Eastern Europe, and Finland and Denmark also have very large absolute inequalities in alcohol-related mortality. For example, for educational inequality among Finnish men, the relative index of inequality is 3.6 (95% CI 3.3-4.0) and the slope index of inequality is 112.5 (95% CI 106.2-118.8) deaths per 100,000 person-years. Over time, the relative inequality in alcohol-related mortality has increased in many countries, but the main change is a strong rise of absolute inequality in several countries in Eastern Europe (Hungary, Lithuania, Estonia) and Northern Europe (Finland, Denmark) because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries, alcohol-related causes now account for 10% or more of the socioeconomic inequality in total mortality. Because our study relies on routinely collected underlying causes of death, it is likely that our results underestimate the true extent of the problem. CONCLUSIONS Alcohol-related conditions play an important role in generating inequalities in total mortality in many European countries. Countering increases in alcohol-related mortality in lower socioeconomic groups is essential for reducing inequalities in mortality. Studies of why such increases have not occurred in countries like France, Switzerland, Spain, and Italy can help in developing evidence-based policies in other European countries.
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Affiliation(s)
- Johan P. Mackenbach
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ivana Kulhánová
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Katalin Kovács
- Demographic Research Institute, Hungarian Central Statistical Office, Budapest, Hungary
| | - Caspar W. N. Looman
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Pia Mäkelä
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Gwenn Menvielle
- Sorbonne Universités, Université Pierre et Marie Curie (Paris 6), INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (UMRS 1136), Paris, France
| | | | | | - Rianne de Gelder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Koch MB, Diderichsen F, Grønbæk M, Juel K. What is the association of smoking and alcohol use with the increase in social inequality in mortality in Denmark? A nationwide register-based study. BMJ Open 2015; 5:e006588. [PMID: 25967987 PMCID: PMC4431124 DOI: 10.1136/bmjopen-2014-006588] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The aim of this paper is to estimate the impact of smoking and alcohol use on the increase in social inequality in mortality in Denmark in the period 1985-2009. DESIGN A nationwide register-based study. SETTING Denmark. PARTICIPANTS The whole Danish population aged 30 years or more in the period 1985-2009. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome is mortality rates in relation to educational attainments calculated with and without deaths related to smoking and alcohol use. An absolute measure of inequality in mortality is applied along with a result on the direct contribution from smoking and alcohol use on the absolute difference in mortality rates. The secondary outcome is life expectancy in relation to educational attainments. RESULTS Since 1985, Danish overall mortality rates have decreased. Alongside the improvement in mortality, the absolute difference in the mortality rate (per 100,000 persons) between the lowest and the highest educated quartile grew from 465 to 611 among men and from 250 to 386 among women. Smoking and alcohol use have caused 75% of the increase among men and 97% of the increase among women. Among men the increase was mainly caused by alcohol. In women the increase was mainly caused by smoking. CONCLUSIONS The main explanation for the increase in social inequality in mortality since the mid-1980s is smoking and alcohol use. A significant reduction in the social inequality in mortality can only happen if the prevention of smoking and alcohol use are targeted to the lower educated part of the Danish population.
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Affiliation(s)
- Mette Bjerrum Koch
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Kydd RM, Connor J. Inconsistency in reporting abstention and heavy drinking frequency: associations with sex and socioeconomic status, and potential impacts. Alcohol Alcohol 2015; 50:333-45. [PMID: 25648932 DOI: 10.1093/alcalc/agu106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 12/22/2014] [Indexed: 01/18/2023] Open
Abstract
AIMS To describe inconsistencies in reporting past-year drinking status and heavy drinking occasions (HDOs) on single questions from two different instruments, and to identify associated characteristics and impacts. METHODS We compared computer-presented Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) with categorical response options, and mental health interview (MHI) with open-ended consumption questions, completed on the same day. Participants were 464 men and 459 women aged 38 (91.7% of surviving birth cohort members). Differences in dichotomous single-item measures of abstention and HDO frequency, associations of inconsistent reporting with sex, socioeconomic status (SES) and survey order, and impacts of instrument choice on associations of alcohol with sex and SES were examined. RESULTS The AUDIT-C drinking frequency question estimated higher past-year abstention prevalence (AUDIT = 7.6%, MHI = 5.4%), with one-third of AUDIT-C abstainers being MHI drinkers. Only AUDIT-C produced significant sex differences in abstainer prevalence. Inconsistencies in HDO classifications were bidirectional, but with fewer HDOs reported on the MHI than AUDIT-C question. Lower SES was associated with inconsistency in abstention and weekly+ HDOs. Abstention and higher HDO frequency were associated with lower SES overall, but sex-specific associations differed by instrument. CONCLUSIONS In this context, data collection method affected findings, with inconsistencies in abstention reports having most impact. Future studies should: (a) confirm self-reported abstention; (b) consider piloting data collection methods in target populations; (c) expect impacts of sex and SES on measurements and analyses.
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Affiliation(s)
- Robyn M Kydd
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Jennie Connor
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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