An Irish film and multimedia competition that promotes the responsible use of alcohol amongst third-level students was highlighted as a model of best practice at EU level today (19.10.11).
DARE2BDRINKAWARE.ie – which is organised by drinkaware.ie, in association with the Digital Hub Development Agency – was invited to present to the European Alcohol and Health Forum (EAHF) in Brussels, in recognition of the competition’s success in promoting a responsible drinking message to young people in Ireland.
The EAHF was established by the European Commission to support the implementation of the EU Alcohol Strategy. Its members include representatives from public health bodies; the media and advertising industries; alcohol producers; research institutions; and health, consumer and youth NGOs. > > > > Read More
Drinking guidelines have rarely provided recommendations for different age groups despite evidence of significant age effects on alcohol consumption and related risks. This study attempted to quantify the degree of risk associated with lower levels of consumption for people under 25 years of age, with the broader purpose of informing the development of Canadian low-risk drinking guidelines.
A random community-based sample of 540 youth aged 16–23 (54.4% female) completed an interview concerning alcohol consumption patterns and a broad range of acute health and social harms. Logistic regression analyses were designed to test whether there were discernible thresholds of risk as a function of both gender and age.
A significant proportion of young people consumed in excess of adult drinking limits recommended by the Centre for Addiction and Mental Health (CAMH) to minimise risk of alcohol-related harm. Compared with abstainers, rates of reported harm increased linearly with increasing frequency and quantity levels. However, problems were most strongly associated with consumption in excess of two drinks per occasion and a frequency of more than once a week. No independent effects of age or gender were identified.
The CAMH guidelines for adult drinkers do not adequately address acute risks for young people. More specific guideline recommendations for young people could be considered with a more prominent focus on drinking quantity (one to two drinks per occasion), and a recommended frequency of consumption (once a week).
Over recent years the South East Alcohol Innovation Programme (SEAIP) delivered a variety of projects aiming to reduce alcohol-related harm across the South East. The programme was commissioned by the Government Office for the South East and delivered by the Centre for Public Innovation.
The evaluation, supported by Lundbeck pharmaceutical company, covers 10 projects, assessing their performance and potential for cost savings over the period between 2009-2011. Key findings support recommendations from the Alcohol Improvement Programme's list of High Impact Changes. > > > > Read More
The extant literature offers little information about the longitudinal course of alcohol use among stimulant users, particularly those in rural areas, but it is plausible that reductions in stimulant use are accompanied by increases in heavy drinking.
The objective of this study was to examine the longitudinal relationships between heavy drinking days and latent trajectories of powder cocaine, crack cocaine, and methamphetamine use.
Participants (n = 710) were identified via Respondent-Driven Sampling in 3 rural communities in each of 3 states, with interviews conducted every 6 months over 3 years. Latent trajectory classes for powder cocaine, crack cocaine, and methamphetamine use were identified by conducting latent class growth analysis (LCGA). Generalized linear models (GLM) were conducted to examine how these latent classes were associated with the number of heavy drinking days in the past 30 days.
Heavy drinking days did not significantly change over time when adjusting for covariates. Compared to those with a “fast low” trajectory of crack use, those with “steady high” and “declining” trajectories had more heavy drinking days. Compared to those with a “fast low” trajectory of powder cocaine use, those with a “steady moderate” trajectory had more heavy drinking days. Trajectories of methamphetamine use were not significantly associated with heavy drinking days.
In conclusion, heavy alcohol use changes little over time among rural stimulant users. Many rural cocaine users could potentially benefit from interventions aimed at curtailing heavy drinking.
Request Reprint E-Mail: tfborders@uams.edu
The relationship between alcohol consumption and ischaemic heart disease (IHD) risk is complex and several issues remain unresolved because many studies used rather crude exposure measures often based on one or two questions. The objective of this study was to investigate the association between heavy drinking occasions and IHD mortality while controlling for average daily alcohol intake and separating former drinkers from lifetime abstainers.
Cox regression analyses were used with IHD mortality as the outcome in a sample of 9934 participants of the US National Alcohol Surveys conducted in 1984 and 1995.
To the end of 2006, 326 deaths from IHD were recorded in the 11- to 22-year follow-up period. Any past heavy drinking occasions in former drinkers [hazard ratio (HR) = 2.06; 95% confidence interval (95% CI): 1.10–3.85] compared with former drinkers without such drinking occasions, and any heavy drinking occasion in current drinkers at baseline (HR = 2.05; 95% CI: 1.03–3.98) compared with current drinkers with average daily intake of one to two drinks, were associated with higher IHD mortality in men and any heavy drinking occasions among drinkers of up to 1 drink average consumption in women with similar effect size. Confounding effects from age, race, education, employment, income, marital status, geographical region, depression score, survey period or other drug use were small.
Among former and current drinkers, heavy drinking occasions should be taken into account when examining the complex association of alcohol consumption on IHD mortality risk.
To investigate the association between alcohol consumption and urinary incontinence among Japanese women.
A total of 300 women aged 40–75 years were recruited from the community in middle and southern Japan. A validated food frequency questionnaire was given face-to-face to obtain information on dietary intake and habitual alcohol consumption. Urinary incontinence status was ascertained using the International Consultation on Incontinence Questionnaire-Short Form.
Among the 298 eligible participants, 82 women (27.5%) experienced urine leakage. The prevalence of alcohol drinking and mean ethanol intake were slightly higher among the incontinent women (39%; 7.1, standard deviation 24.1 g/day) than others without the condition (35.6%; 4.3, standard deviation 10.7 g/day). Relative to non-drinkers, the adjusted odds ratios of urinary incontinence were 1.31 (95% confidence interval 0.74–2.33) for alcohol drinking and 1.69 (95% confidence interval 0.42–6.81) for ethanol intake over 32 g/day, though the increases in risk did not reach statistical significance.
Little association is evident between alcohol consumption and urinary incontinence in middle-aged and older Japanese women. Further studies are required to define the role of alcohol as a contributing factor of this distressing condition.
High cardiovascular diseases (CVD) mortality among the middle aged is a major cause of reduced life expectancy in Russia, especially among men. Hazardous alcohol consumption is suspected to be a powerful contributing factor.
All men (1099) and women (519) aged 30–70 years who died between 1 January 2008 and 31 August 2009 from CVD in the city of Arkhangelsk, north-west Russia, were included. CVD mortality was stratified by age, gender and diagnosis. For the cases diagnosed by forensic pathologists, the blood alcohol concentration (BAC) was determined. The forensic autopsy rate was 72% for men and 62% for women.
Age-standardized CVD mortality rate (all age groups) in men was higher than in women. The largest male–female ratio (4.3) was observed in the age group of 50–59 years. Alcoholic and unspecified cardiomyopathies were the most dominant of CVD mortalities in women, and second in men aged <50 years; they accounted for 50 and 25% of deaths, respectively. About one-third of men and women who died from CVD aged <60 years had consumed alcohol shortly before death. This occurred most frequently among the diagnostic groups ‘other acute or subacute cardiac ischaemia’, ‘atherosclerotic heart disease’ and ‘cardiomyopathies’. Alcohol was more likely to be found at autopsy in men than in women (odds ratio 1.55; 95% confidence interval 1.14–2.10). No difference was found for those who died from myocardial infarction, cerebrovascular diseases and cardiomyopathies. Of the deceased, <1% had a BAC of ≥4 g/l.
A high proportion of subjects who died from CVD in Arkhangelsk consumed alcohol shortly before death. It was highest among males aged 50–59 years. The largest gender difference in mortality, highest absolute number of premature CVD deaths, and the highest proportion of alcohol-positive autopsies occurred among them. Since associations with alcohol consumption varied considerably between the types of CVD diagnoses, this observation should be taken into account when planning future research. Our study does not provide evidence that cardiovascular deaths are misclassified cases of acute alcohol poisoning.
Previous research has associated abnormalities in frontal lobe functioning with alcohol relapse. In this study, we used diffusion tensor imaging to investigate whether frontal white matter integrity measured at the start of treatment differs between persons with alcohol use disorders (AUD) who sustain treatment gains and those who return to heavy use after treatment.
Forty-five treatment-seeking AUD inpatients and 30 healthy control subjects were included in the study. Six months after completing treatment, 16 of the AUD participants had resumed heavy use (RHU) and 29 others remained abstinent or drank minimally (treatment sustainers [TS]). Voxel-wise group comparisons (TS vs. RHU) were performed on fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity maps generated from each subject's diffusion tensor imaging scan at the start of treatment.
We found significantly lower FA and significantly higher RD in the frontal lobes of the RHU group, relative to the TS group. The RHU group data are consistent with previous reports of abnormal frontal white matter tract abnormalities in persons with AUD.
It is possible that the lower FA and higher RD in the RHU group reflect microstructural injury to frontal circuitries, and these may underlie the reduced cognitive control amid heightened reward sensitivity associated with resumption of heavy drinking.
Request Reprint E-Mail: mjtaylor@ucsd.edu
Forum Comments
Background: A large percentage of observational prospective studies have shown that women who consume alcohol show an increase in their risk of developing breast cancer. In general, the relation seems to be stronger for women who drink in binges, are also taking post-menopausal hormonal therapy, and/or have low intakes of dietary folate. Most studies have shown that heavier drinkers are at the greatest risk.
The present analysis is from the Nurses’ Health Study, which is one of the first prospective studies to point out an association between alcohol consumption and breast cancer. It attempts to determine if both the amount of alcohol and the frequency of drinking affect risk, and also whether the cumulative alcohol intake over the adult years relates to the risk of breast cancer.
Comments on present paper: As is usual from the Nurses’ Health Study, the present analyses are very well done. Theoretically, the repeated assessments of consumption over time should provide a better estimate of long-term alcohol intake. It is interesting, however, that in these analyses, the risks of cancer associated with alcohol were almost the same whether based on the amounts of alcohol consumed at baseline in 1980 or on the cumulative average based on repeated assessments of intake through the years.
When adjusting for the cumulative lifetime consumption, there was no effect of the frequency of consumption (1-2, 3-4, or 5-7 days per week). This is different from the usual findings for the association between alcohol intake and cardiovascular disease, where more frequent intake is associated with greater protection.
Again, when adjusting for cumulative intake, there was only a weak relation with cancer from the reported maximum number of drinks per day; While there was not a clear trend, the highest risk ratio (RR = 1.21, CI 0.99-1.47) was for women reporting 6 or more drinks/day.
Both for the reported intake between ages 18 and 40 (based on recall) and the intake after age 40, the adjusted estimate of cancer risk showed a sharp increase at 10-19.9 g/day, although an increase in risk was present to a lesser degree in both age groups at 5 – 9.9 g/day. There was little difference in the effects of intake before 40 years and intake thereafter. No differences in association with breast cancer risk were seen according to type of beverage consumed.
Several reviewers pointed out that observational studies report “associations,” and often provide hypotheses to explain their findings; but “causation” cannot be proved from such studies alone. As one Forum reviewer stated: “The authors correctly present data as associations. Sometimes, the general population, health authorities, and the media automatically assume that an association clearly identifies a cause, and often advise very stringent measures based on such observational data.”
Modification of breast cancer risk associated with alcohol consumption by folate: A primary concern of several Forum reviewers was that the investigators did not evaluate folate intake as a potential confounder, even though the Nurses’ Health Study has extensive dietary data on its subjects. Previous reports from this study suggest that the excess risk of breast cancer associated with alcohol consumption may be reduced (or eliminated) by adequate folate intake.1,2 These investigators had previously reported that the risk of breast cancer associated with alcohol intake was strongest among women with total folate intake of less than 300 μg/d (for alcohol intake >15 g/d versus less than 15 g/d, multivariate RR 1.32, CI 1.15-1.50). For women who consumed at least 300 μg/d of total folate, the multivariate RR for intake of at least 15 g/d of alcohol versus less than 15 g/d was 1.01 (CI 0.92-1.20).
Similarly, Baglietto et al3 reported that the estimated hazard ratio for breast cancer of an alcohol consumption of 40 g/day or more was 2.00 (CI 1.14-3.49) for women with intakes of 200 μg/day of folate and 0.77 (0.33-1.80) for those with intakes of 400 μg/day of folate. Further, Beilby et al4 observed marked reductions in odds ratios for breast cancer among women with higher levels of serum folate, as have many others.5-10
Tjønneland et al11 also reported that an association between alcohol intake and risk of breast cancer was present mainly among women with low folate intake. A RR of 1.19 (CI 0.99-1.42) per 10 g average daily alcohol intake was found for women with a daily folate intake below 300 μg, while among women with a folate intake higher than 350 μg, they could not show an association between the alcohol intake and the breast cancer incidence rate (e.g., for folate intake >400 μg, the RR was 1.01, CI 0.85-1.20). On the other hand, Feigelson et al12 found no evidence of an interaction between levels of dietary folate and alcohol and associations with breast cancer risk.
One reviewer stated: “This is a well conducted cohort study, with good assessment of the exposure variable and good assessment of the outcome variable. While a number of potential confounders have been considered and controlled for, it is unfortunate that diet as a potential confounder has not been taken into account.”
Another reviewer commented: “The results are plausible from the pathophysiological point of view: alcohol intake increases estrogen levels and this means that women have a slightly lower risk for osteoporosis and a slightly higher risk for breast cancer. When we tell the public that current data suggest small to moderate amounts of alcohol protect against cardiovascular disease, osteoporosis, diabetes mellitus, and vascular dementia, we should also state that breast cancer risk in women is slightly increased.”
He adds that the authors of this paper put their findings into perspective when they conclude: “An individual will need to weigh the modest risks of light to moderate alcohol use on breast cancer development against the beneficial effects on cardiovascular disease to make the best personal choice regarding alcohol consumption.”
