Relationship of Life-Course Drinking Patterns to Diabetes, Heart Problems, and Hypertension Among Those 40 and Older in the 2005 U.S. National Alcohol

The goal of this study was to estimate relationships between life-course drinking patterns and the risks of self-reported diabetes, heart problems, and hypertension.

Respondents to the 2005 National Alcohol Survey, age 40 and older, reported ever having a doctor or health professional diagnose each of the health-problem outcomes.

Retrospective earlier-life drinking patterns were characterized by lifetime abstention and the frequency of 5 drinking days (i.e., days on which five or more drinks were consumed) in the respondent's teens, 20s, and 30s. Past-year drinking patterns were measured through intake volume and 5 days.

Potential confounders in the domains of demographics, socioeconomic resources, and other health-risk variables--that is, depression, distress, sense of coherence, body mass index, tobacco use, marijuana use, childhood abuse, and family history of alcohol problems--were controlled through propensity-score matching.

After matching, lifetime abstainers were found to be at increased risk of diabetes compared with both lifetime and current moderate drinkers. Exdrinkers were found to be at increased risk of diabetes, heart problems, and hypertension. Higher volume drinkers without monthly 5 days were found to be at reduced risk of diabetes relative to moderate-volume current drinkers. Heavy-occasion drinkers were found to be at increased risk of hypertension.

Regular lower quantity alcohol intake may be protective against adult onset of diabetes, but no evidence of protection from heart problems or hypertension was found. Both life course–defined and past year–defined drinking groups exhibit substantial clustering of confounding risk variables, indicating the need for modeling strategies like propensity-score matching.

Increased risks among exdrinkers suggest a substantial "sick-quitter" effect.


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Request Reprint E-Mail: wkerr@arg.org



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Alcohol and type 2 diabetes. A review

To describe a) the association between alcohol consumption and the risk of type 2 diabetes (T2D) and b) the impact of alcohol on the glycemic control with and without anti-diabetic drugs.

We searched MEDLINE and the Cochrane Library data base with the key words “Diabetes Mellitus, type 2” and “Alcohol Drinking” in English-language studies in adults.

For the first part of the review we selected meta-analyses, review articles and observational studies more recent than year 1990 including at least 1000 participants. For the second part of the review we included all articles more recent than year 1990.

Most observational studies find a J-shaped association between alcohol intake and incidence of T2D. Interestingly, drinking pattern plays a role, i.e. binge drinking increases the risk of T2D.

Opposing information exists about the influence of beverage type. In T2D the acute effects on plasma glucose, insulin, fatty acids and triglyceride vary, in part depending on concomitant intake of food.

Acute alcohol intake does not induce hypoglycemia in diet treated T2D, but increases the risk of hypoglycemia in sulphonylurea treated patients.

In most studies, long-term alcohol use is associated with improved glycemic control in T2D.

Alcohol consumption reduces the incidence of T2D, however, binge drinking seems to increase the incidence. Acute intake of alcohol does not increase risk of hypoglycemia in diet treated subjects with T2D, only when sulphonylurea is co-administered.

Long-term alcohol use seems to be associated with improved glycemic control in T2D probably due to improved insulin sensitivity.

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Request Reprint E-Mail: annapiet@rm.dk

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Adolescent alcohol use trajectories: Predictors and subsequent problems

This study aimed at identifying different alcohol drinking trajectories in early to late adolescence. We also examined whether certain factors predicted membership of a specific trajectory and to what extent trajectory membership was linked to later negative consequences.

Data were drawn from a longitudinal cohort study starting with 1923 adolescents including all seventh grade students in six school districts in Stockholm, Sweden 2001 (age 14), with follow-up in 2002, 2003, and 2006 (age 19).

Cluster- and multinomial logistic regression analyses revealed four developmental pathways: low, gradually increasing, high, and suddenly increasing consumption.

“High consumers” and “sudden increasers” reported higher levels of alcohol consumption, heavy episodic drinking, and alcohol-related problems both at age 14–16 and at age 19.

The “gradual increasers” were more likely to smoke cigarettes, have easy access to alcohol, visit youth recreation centres, have friends who drink, and report a poorer health, compared to the “low consumer/abstainer group”.

“High consumers” were more likely to have drinking peers than both “low consumers/abstainers” and “gradual increasers”.

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Request Reprint E-Mail: anna-karin.danielsson@ki.se

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The effect of alcohol drinking on erectile dysfunction in Chinese men

Erectile dysfunction (ED), smoking, and alcohol drinking are common in middle-aged men. Although smoking has been shown to be a risk factor of ED in Chinese and other populations, the relationship between drinking alcohol and ED is not clear.

The Family Planning Association of Hong Kong conducted the Men Health Survey in 2004. In all, 1506 men aged 20–70 years were recruited by stratified random sampling of the male population. Face-to-face interviews were used to collect information on drinking and smoking and other life style factors, morbidities, and sociodemographic status during household visits. The more sensitive information on sexual activity and ED was obtained by a self-completed questionnaire at the end of the interview. A total of 816 subjects aged 31–60 years currently active in sexual activity were included in the present analysis.

Compared with never drinkers, alcohol drinkers who consumed three or more standard drinks (one standard drink equals 12 g of alcohol) a week were more likely to report EDs as defined by having both sexual dissatisfaction and erectile difficulty (odds ratio (OR)=2.27, 95% confidence interval (CI)=1.28–4.03) after adjusting for age and cigarette smoking.

When analyzed separately by smoking habit, the risks were higher in current smokers (OR=2.27, 95 CI%=1.01–5.11) than never smokers (OR=1.91, 95% CI=0.68–5.35).

Our results suggest that alcohol drinking of three or more standard drinks per week might reduce sexual satisfaction and impair erectile function in current smokers and might have less effect in never smokers.


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Request Reprint E-Mail: hrmrlth@hkucc.hku.hk


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The Complexity of Alcohol Drinking: Studies in Rodent Genetic Models

Risk for alcohol dependence in humans has substantial genetic contributions. Successful rodent models generally attempt to address only selected features of the human diagnosis. Most such models target the phenotype of oral administration of alcohol solutions, usually consumption of or preference for an alcohol solution versus water. Data from rats and mice for more than 50 years have shown genetic influences on preference drinking and related phenotypes.

This paper summarizes some key findings from that extensive literature. Much has been learned, including the genomic location and possible identity of several genes influencing preference drinking. We report new information from congenic lines confirming QTLs for drinking on mouse chromosomes 2 and 9.

There are many strengths of the various phenotypic assays used to study drinking, but there are also some weaknesses. One major weakness, the lack of drinking excessively enough to become intoxicated, has recently been addressed with a new genetic animal model, mouse lines selectively bred for their high and intoxicating blood alcohol levels after a limited period of drinking in the circadian dark.

We report here results from a second replicate of that selection and compare them with the first replicate.


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Request Reprint E-Mail: crabbe@ohsu.edu


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Editorial - Go easy on ‘sin tax’

It is a sad fact that excessive drinking of alcohol has destructive effects on health and productivity. Our health experts agree on that.

Even the drinkers themselves know that not only are they invariably ill, their pockets are almost always empty and their heads too heavy to do any useful work the morning after the day before.

So does the World Health Organisation, which has been campaigning against excessive drinking, and has come to the conclusion that the best way out is to put alcohol beyond the reach of drinkers through high taxes, among other, more sensible measures.

At the same time, Finance Ministers have, seemingly, discovered one of the easiest ways to plug budget deficits: Slapping ‘‘sin tax’’ on alcohol every year.

While all these profound musings are going on, the health authorities know full well that if you price bottled alcoholic beverages beyond the means of the majority drinkers, they will only resort to unhygienic, dangerous brews which invariably make them twice as unproductive, impotent, blind or dead. . . . . . .

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Business as usual for food and alcohol marketers

THE advertising and marketing industries have breathed a sigh of relief after the federal government decided against a big crackdown on food and alcohol marketing, but public health advocates vow the fight is far from over.

Marketers were bracing for a range of government restrictions that would have hampered their ability to market food and alcohol brands, including the possible end of self-regulation.

Despite wide-ranging recommendations proposed by an influential government-appointed committee including University of Melbourne's Professor Rob Moodie and professor of health policy at Curtin University Mike Daube, Canberra has stuck with the status quo in what is seen as a win for advertising agencies and their food, beverage and alcohol clients. . . . . . .

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Is There an Active Gene-Environment Correlation in Adolescent Drinking Behavior?

A scale based on alcohol-related behaviors and an item on shared friends from the National Merit Twin Study were used in an attempt to confirm the finding of Cleveland et al. (1995, J Genet Psychol 166:153–169) of gene-environment correlation in adolescents’ drinking behavior, a correlation based on the differential selection of peers.

Results from samples of 490 MZ and 336 same-sex DZ pairs were consistent in direction with the hypothesis, although quantitatively modest.

This consistency appeared, however, to depend entirely on the female twins in the sample.


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Request Reprint E-Mail: loehlin@psy.utexas.edu



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Long-Term Modulations in the Vertebral Transcriptome of Adolescent-Stage Rats Exposed to Binge Alcohol

Dangerous alcohol consumption practices are common in adolescents, yet little is known about their consequences on attainment of peak bone mass and long-term skeletal integrity. We previously demonstrated that binge alcohol-exposed adolescent rats showed site-specific reductions in accruement of bone mineral density and bone strength, which were incompletely recovered following prolonged alcohol abstinence. Currently, we analysed the vertebral transcriptome of adolescent rats following alcohol treatment and abstinence to identify long-term molecular changes in the lumbar spine.

Sixty male adolescent Sprague-Dawley rats were assigned to one of six treatment groups receiving binge alcohol (3 g/kg) or saline i.p., 3 consecutive days (acute binge), 4 consecutive weekly (3-day) binge cycles (chronic binge) or 4 weekly binge cycles followed by a 30-day abstinence period (chronic binge with abstinence). Following treatment, lumbar vertebrae were assayed for global transcriptional changes using gene array technology.

Analysis of the adolescent rat vertebral transcriptome identified clusters of binge alcohol-sensitive genes displaying differential expression patterns starting before bone damage was seen and persisting after alcohol treatment was discontinued. Functional grouping of these gene clusters identified candidate cellular pathways affected following acute and chronic binge treatment, as well as pathways remaining modulated following abstinence.

These results demonstrate that binge alcohol exposure can produce disruptions of normal bone gene expression patterns in the adolescent rat that persist well beyond the period of active intoxication. This data may have relevance to peak bone mass attainment and future risk of skeletal disease in adolescents engaging in repeated binge-drinking episodes.

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Request Reprint E-Mail: jcallaci@lumc.edu


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Effective Prevention against Risky Underage Drinking — The Need for Higher Excise Taxes on Alcoholic Beverages in Germany

The study aimed to explore the place of taxation in preventing underage binge drinking in Germany.

We reviewed evidence on the role of excise taxes on alcohol in preventing alcohol problems and underage drinking. We analyzed historical German data on tax on alcoholic beverages and compared this with European data, finally calculating tax scenarios and their impact on underage binge drinking.

Germany applies lower taxes than many other European countries and alcohol beverage prices have decreased by 30% relative to overall price levels during the last 40 years.

An optimal tax rate for reducing underage drinking would be set between the European average tax rates and Scandinavian tax rate levels.

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Request Reprint E-Mail: Effertz@mba.uni-hamburg.de


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Saponins from Panax japonicus Protect Against Alcohol-Induced Hepatic Injury in Mice by Up-regulating the Expression of GPX3, SOD1 and SOD3

The purpose of this study was to investigate the possible mechanism(s) of saponins from Panax japonicus (SPJ) on alcohol-induced hepatic damage in mice.

SPJ were identified by high performance liquid chromatography-evaporative light scattering detection-mass spectrometry (LC–ELSD–MS). Non-toxic concentrations of SPJ were assayed on alcohol-induced hepatic injury in male ICR mice and human hepatic cells. The protective effects were evaluated by biochemical values, histopathological observations and the relative gene expression.

In vitro, SPJ showed significant hydroxyl radical scavenging capacity. In vivo, SPJ (50 mg/kg) could rectify the pathological changes of aspartate transaminase, alanine transaminase, malondialdehyde, reduced glutathione (GSH), glutathione peroxidase (GPX), catalase (CAT) and superoxide dismutase (SOD) caused by alcohol metabolism to normal levels except for hepatic GSH and CAT.

In hepatic cells, the results were in agreement with foregoing results determined in mice after pretreatment of SPJ (100 µg/ml). RT–PCR results showed that CAT, GPX and SOD mRNA decreased by alcohol metabolism were reversed, in which GPX3, SOD1 and SOD3 could return to a normal level, but CAT, GPX1 and SOD2 mRNA were still evidently lower than the control. Histopathological observations provided supportive evidence for biochemical analyses.

SPJ plays an important role in the protection of the structure and function of hepatic mitochondria and karyon by directly scavenging reactive oxygen species/free radicals and up-regulating the expression of antioxidant enzymes (SOD, GPX and CAT), especially to GPX3, SOD1 and SOD3.


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Request Reprint E-Mail: liangen_shi@126.com


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Circadian Clock Gene Polymorphisms in Alcohol Use Disorders and Alcohol Consumption

Circadian clock genes are involved in the development of drug-induced behaviors and regulate neurotransmission pathways in addiction. Our aim was to study whether circadian clock gene polymorphisms predispose to alcohol dependence or abuse or other alcohol-related characteristics.

The study sample comprised of 512 individuals having alcohol dependence or alcohol abuse (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)) and their 511 age- and sex-matched controls. This population-based sample was drawn from a cohort (n = 7415), representative of the Finnish general population aged 30 and over. Altogether 42 single-nucleotide polymorphisms of 19 genes related to the circadian pacemaker system were genotyped.

ARNTL rs6486120 T⁺ allelic status (P = 0.0007, q = 0.17), ADCYAP1 rs2856966 GG genotype (P = 0.0006, q = 0.17) and VIP CC haplotype (rs3823082–rs688136) (P = 0.0006) were suggestively associated with alcohol consumption in socially drinking controls. ARNTL2 GT haplotype (rs7958822–rs4964057) associated suggestively with alcohol abuse diagnosis (P = 0.0013). Earlier findings on the associations of DRD2 and NPY with alcohol dependence were supported: DRD2/ANKK1 Taq1A₁ increased (P = 0.04) and NPY Pro7 decreased (P = 0.01) the risk of alcohol dependence.

ARNTL, ARNTL2, VIP and ADCYAP1 were indicated as having influence on alcohol use or abuse. The role of DRD2 and NPY on alcohol dependence was also supported.


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Request Reprint E-Mail: leena.kovanen@thl.fi


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Chronic alcohol consumption and intestinal thiamin absorption: effects on physiological and molecular parameters of the uptake process

Thiamin is essential for normal cellular functions, and its deficiency leads to a variety of clinical abnormalities. Humans and other mammals obtain the vitamin via intestinal absorption.

The intestine is exposed to two sources of thiamin, a dietary and a bacterial (i.e., normal microflora of the large intestine) source. Chronic alcohol consumption is associated with thiamin deficiency, which is caused (in part) by inhibition in intestinal thiamin absorption.

However, little is known about the physiological and molecular aspects of the intestinal thiamin uptake process that are affected by chronic alcohol use.

To address these issues, we used rats fed an alcohol-liquid diet and human intestinal epithelial HuTu-80 cells chronically exposed to ethanol as model systems.

The results showed that chronic alcohol feeding to rats led to a significant inhibition in carrier-mediated thiamin transport across both the jejunal brush-border membrane and basolateral membrane domains.

This was associated with a significant reduction in level of expression of thiamin transporter-1 (THTR-1), but not THTR-2, at the protein and mRNA levels. Level of expression of the heterogenous nuclear RNA of THTR-1 in the intestine of alcohol-fed rats was also decreased compared with their pair-fed controls. Chronic alcohol feeding also caused a significant inhibition in carrier-mediated thiamin uptake in rat colon.

Studies with HuTu-80 cells chronically exposed to ethanol also showed a significant inhibition in carrier-mediated thiamin uptake. This inhibition was associated with a reduction in level of expression of human THTR-1 and THTR-2 at the protein, mRNA, and transcriptional (promoter activity) levels.

These studies demonstrate that chronic alcohol feeding inhibits intestinal thiamin absorption via inhibition of the individual membrane transport event across the polarized absorptive epithelial cells. Furthermore, the inhibition is, at least in part, mediated via transcriptional mechanism(s).


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Request Reprint E-Mail: hmsaid@uci.edu


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Screening, Diagnosing and Prevention of Fetal Alcohol Syndrome: Is This Syndrome Treatable?

Prenatal alcohol exposure can lead to a wide range of adverse effects on a developing fetus. As a whole, these teratogenic outcomes are generally known as fetal alcohol spectrum disorders, the most severe of which is fetal alcohol syndrome (FAS).

Clinically, children diagnosed with FAS vary greatly in their presentation of symptoms, likely due to the amount of alcohol and timing of exposure, as well as maternal and genetic influences. All these factors play a role in determining the mechanisms through which alcohol damages a developing brain, the details of which are still largely unknown.

However, continuing research and recent developments have provided promising results that may lead to screening mechanisms and treatment therapies for children with FAS.

Here we review the teratogenic effects of alcohol, strategies for detecting maternal alcohol consumption, identification of fetal biological markers, and prevention methods for FAS.


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Request Reprint E-Mail: gig@georgetown.edu


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Cannabis as a substitute for alcohol and other drugs

Substitution can be operationalized as the conscious choice to use one drug (legal or illicit) instead of, or in conjunction with, another due to issues such as: perceived safety; level of addiction potential; effectiveness in relieving symptoms; access and level of acceptance. This practice of substitution has been observed among individuals using cannabis for medical purposes.

This study examined drug and alcohol use, and the occurrence of substitution among medical cannabis patients.

Anonymous survey data were collected at the Berkeley Patient's Group (BPG), a medical cannabis dispensary in Berkeley, CA. (N = 350) The sample was 68% male, 54% single, 66% White, mean age was 39; 74% have health insurance (including MediCal), 41% work full time, 81% have completed at least some college, 55% make less than $40,000 a year. Seventy one percent report having a chronic medical condition, 52% use cannabis for a pain related condition, 75% use cannabis for a mental health issue.

Fifty three percent of the sample currently drinks alcohol, 2.6 was the average number of drinking days per week, 2.9 was the average number of drinks on a drinking occasion. One quarter currently uses tobacco, 9.5 is the average number of cigarettes smoked daily. Eleven percent have used a non-prescribed, non OTC drug in the past 30 days with cocaine, MDMA and Vicodin reported most frequently. Twenty five percent reported growing up in an abusive or addictive household. Sixteen percent reported previous alcohol and/or drug treatment, and 2% are currently in a 12-step or other recovery program. Forty percent have used cannabis as a substitute for alcohol, 26% as a substitute for illicit drugs and 66% as a substitute for prescription drugs. The most common reasons given for substituting were: less adverse side effects (65%), better symptom management (57%), and less withdrawal potential (34%) with cannabis.

The substitution of one psychoactive substance for another with the goal of reducing negative outcomes can be included within the framework of harm reduction. Medical cannabis patients have been engaging in substitution by using cannabis as an alternative to alcohol, prescription and illicit drugs.

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Changing Substance Abuse Patterns among Older Admissions: 1992 and 2008

Treatment admissions aged 50 or older increased from 6.6 percent of all admissions 12 years of age or older in 1992 to 12.2 percent in 2008.

Between 1992 and 2008, the proportion of older admissions that reported primary alcohol abuse decreased from 84.6 to 59.9 percent, while the proportion that reported primary heroin abuse more than doubled (from 7.2 to 16.0 percent).

The proportion of older admissions that reported multiple substances of abuse nearly tripled, increasing from 13.7 percent in 1992 to 39.7 percent in 2008.

In 2008, older admissions who initiated use of their primary substance of abuse within the past 5 years were more likely than those in 1992 to have reported prescription pain relievers as their primary substance (25.8 vs. 5.4 percent).

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Alcohol consumption and the risk of breast cancer among BRCA1 and BRCA2 mutation carriers

Alcohol consumption increases the risk of breast cancer among women in the general population, but its effect on women who carry a BRCA gene mutation is unclear.

We conducted a case-control study of 1925 matched pairs of predominantly premenopausal women who carry a BRCA1 or a BRCA2 mutation. Information on current alcohol consumption was obtained from a questionnaire administered during the course of genetic counselling or at the time of enrolment.

A modest inverse association between breast cancer and reported current alcohol consumption was observed among women with a BRCA1 mutation (OR = 0.82, 95% CI 0.70–0.96), but not among women with a BRCA2 mutation (OR = 1.00; 95% CI 0.71–1.41).

Compared to non-drinkers, exclusive consumption of wine was associated with a significant reduction in the risk of breast cancer among BRCA1 carriers (p-trend = 0.01).

Alcohol consumption does not appear to increase breast cancer risk in women carrying a BRCA gene mutation.

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Request Reprint E-Mail: steven.narod@wchospital.ca

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IS ALCOHOL CONSUMPTION TRULY PROTECTIVE FOR DEVELOPING RHEUMATOID ARTHRITIS?

The Annual European Congress of Rheumatology

AB0179

A recent case-control study has suggested an inverse association between alcohol intake and the risk of developing rheumatoid arthritis (RA). Moreover, in experimental studies with collagen-induced arthritis in mice, alcohol had an anti-inflammatory and anti-destructive effect. It is unclear however, if the protective effect of alcohol is specific for RA, or whether it is also present in other kinds of arthritis.

To evaluate whether there is an inverse correlation between alcohol consumption and the risk of developing rheumatoid arthritis.

Included were patients from the Leiden Early Arthritis Cohort (EAC) with RA (n=651), other forms of arthritis (reactive arthritis, spondylarthropathy or psoriatic arthritis) (n=273) and osteoarthritis (OA) (n=73), as well as 5877 general population controls from the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis study. Alcohol consumption was recorded at baseline. The effect of alcohol consumption on the risk of developing disease was analyzed by univariate and multivariate logistic regression. The latter analysis was corrected for age and gender since these differed between the various groups.

Alcohol consumption was associated with a significantly lower risk of RA. However, alcohol intake was also associated with a significantly lower risk of other forms of arthritis and OA(Table 1). The degree of systemic inflammation, as reflected by the level of the erythrocyte sedimentation rate (ESR), was inversely correlated with alcohol consumption.

To investigate if alcohol consumption may be particularly protective against the development of RA compared to other arthritides, a subgroup analysis was performed comparing the RA patients stratified for ACPA-status, with the patients with other forms of arthritis (n=273).

This revealed a particularly protective effect in ACPA-positive RA patients (n=257) (OR 0.59, 95% CI 0.36-0.99), which did not remain significant however, after adjustment for the ESR-level (OR 0.63, 95% CI 0.38-1.07).

Patients presenting with arthritis report less alcohol consumption than population controls, regardless of the type of arthritis. The inverse correlation between the ESR level and alcohol consumption suggests that patients with more severe systemic inflammation drink less alcohol, or alternatively, that alcohol may protect against the development of more systemic inflammation.

Although we cannot exclude that alcohol consumption may be particularly protective against ACPA-positive RA, it appears that the largest part of the protective effect of alcohol is not specific for rheumatoid arthritis.

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Pivotal Role of TLR4 Receptors in Alcohol-Induced Neuroinflammation and Brain Damage

Toll-like receptors play an important role in the innate immune response, although emerging evidence indicates their role in brain injury and neurodegeneration. Alcohol abuse induces brain damage and can sometimes lead to neurodegeneration.

We recently found that ethanol can promote TLR4 signaling in glial cells by triggering the induction of inflammatory mediators and causing cell death, suggesting that the TLR4 response could be an important mechanism of ethanol-induced neuroinflammation.

This study aims to establish the potential role of TLR4 in both ethanol-induced glial activation and brain damage.

Here we report that TLR4 is critical for ethanol-induced inflammatory signaling in glial cells since the knockdown of TLR4, by using both small interfering RNA or cells from TLR4-deficient mice, abolished the activation of microtubule-associated protein kinase and nuclear factor-B pathways and the production of inflammatory mediators by astrocytes.

Our results demonstrate, for the first time, that whereas chronic ethanol intake upregulates the immunoreactive levels of CD11b (microglial marker) and glial fibrillary acidic protein (astrocyte marker), and also increases caspase-3 activity and inducible nitric oxide synthase, COX-2, and cytokine levels [interleukin (IL)-1β, tumor necrosis factor-, IL-6] in the cerebral cortex of female wild-type mice,

TLR4 deficiency protects against ethanol-induced glial activation, induction of inflammatory mediators, and apoptosis.

Our findings support the critical role of the TLR4 response in the neuroinflammation, brain injury, and possibly in the neurodegeneration induced by chronic ethanol intake.


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Request Reprint E-Mail: guerri@cipf.es


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The Effects of Husband’s Alcohol Consumption on Married Women in Three Low-Income Areas of Greater Mumbai

Gender-based violence rooted in norms, socialization practices, structural factors, and policies that underlie men’s abusive practices against married women in India is exacerbated by alcohol.

The intersection of domestic violence, childhood exposure to alcohol and frustration, which contribute to drinking and its consequences including forced sex is explored through analysis of data obtained from 486 married men living with their wives in a low-income area of Greater Mumbai.

SEM shows pathways linking work-related stress, greater exposure to alcohol as a child, being a heavy drinker, and having more sexual partners (a proxy for HIV risk). In-depth ethnographic interviews with 44 married women in the study communities reveal the consequences of alcohol on women’s lives showing how married women associate alcohol use and violence with different patterns of drinking.

The study suggests ways alcohol use leads from physical and verbal abuse to emotional and sexual violence in marriage. Implications for gendered multi-level interventions addressing violence and HIV risk are explored


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Request Reprint E-Mail: marlene.berg@icrweb.org

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Early Release of Selected Estimates Based on Data From the 2009 National Health Interview Survey

The 15 measures included in the present report are lack of health insurance coverage and type of coverage, usual place to go for medical care, obtaining needed medical care, receipt of influenza vaccination, receipt of pneumococcal vaccination, obesity, leisure-time physical activity, current smoking, alcohol consumption, human immunodeficiency virus (HIV) testing, general health status, personal care needs, serious psychological distress, diagnosed diabetes, and asthma episodes and current asthma.

For each selected health measure, a figure is presented showing the trend over time from 1997 through 2009 for the total population, followed by figures and tables showing estimates by age group and sex, based on data from the 2009 NHIS. Also, estimates (adjusted by age, sex, or both, where appropriate) are provided for three race/ethnicity groups (Hispanic; non-Hispanic white, single race; and non-Hispanic black, single race) using data from the 2009 NHIS. Key findings are highlighted by bullets, and data tables containing the values displayed in the figures are included at the end of each section. In addition to providing age-adjusted estimates for Early Release measures that are also Healthy People 2010 (3) Leading Health Indicators (i.e., lack of health insurance coverage, usual place to go for medical care, receipt of influenza vaccination, receipt of pneumococcal vaccination, obesity, leisure-time physical activity, and current smoking), this release provides overall age-adjusted and crude estimates by sex for all indicators. The NHIS questions used to define the selected health measures are provided in the Appendix.

9. Alcohol consumption

PDF Version (47 KB)

• Figure 9.1. Percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year: United States, 1997-2009
• Figure 9.2. Percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year, by age group and sex: United States, 2009
• Figure 9.3. Age-sex-adjusted percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year, by race/ethnicity: United States, 2009
• Data tables for Figures 9.1-9.3

Complete copy of release [PDF - 728 KB]


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Is the Scottish population living dangerously? Prevalence of multiple risk factors: the Scottish Health Survey 2003

Risk factors are often considered individually, we aimed to investigate the prevalence of combinations of multiple behavioural risk factors and their association with socioeconomic determinants.

Multinomial logistic regression was used to model the associations between socioeconomic factors and multiple risk factors from data in the Scottish Health Survey 2003. Prevalence of five main behavioural risk factors - smoking, alcohol, diet, overweight/obesity, and physical inactivity, and the odds in relation to demographic, individual and area socioeconomic factors.

Full data were available on 6,574 subjects (80.7% of the survey sample). Nearly the whole adult population (97.5%) reported to have at least one behavioural risk factor; while 55% have three or more risk factors; and nearly 20% have four or all five risk factors. The most important determinants for having four or five multiple risk factors were low educational attainment which conferred around a 3-fold increased odds compared to high education; and residence in the most deprived communities (relative to least deprived) which had greater than 3-fold increased odds.

The prevalence of multiple behavioural risk factors was high and the prevalence of absence of all risk factors very low. These behavioural patterns were socioeconomically determined. Policy to address factors needs to be joined up and better consider underlying socioeconomic circumstances

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A Review of Evidence Related to Drug Driving in the UK: A Report Submitted to the North Review Team

Sir Peter North has been invited to advise Ministers on the merits of specific proposals for changes to the legislative regime for drink and drug driving, reporting by the end of March 2010. In order to assist the North Review team in the work being undertaken, Clockwork Research has been contracted to submit a review drawing together and synthesising evidence on a variety of issues relating to drug driving.

This report has been compiled from a review of a broad range of data sources including:
a) UK Government research reports;
b) European Council reports;
c) Reports from transport authorities in other jurisdictions;
d) EU research programmes reports;
e) Papers that have appeared in academic journals; and
f) Information and reports provided by independent drug expert organisations.

As well as desk-based research, semi-structured interviews were conducted with relevant UK stakeholders, including coroners and their clerks, toxicologists, police officers and a representative from the Home Office Scientific Development Branch. These interviews served to inform our understanding of the current practices involving drug driving cases in the UK.

The report is structured around five chapters, each focusing on one of the questions presented to Clockwork Research. Each chapter adopts a similar structure: following a brief introduction providing background information, the chapter reviews evidence that addresses the question. Evidence gaps are identified, and the chapter concludes with a summary of the key points, together with recommendations where appropriate.


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Behaviour does not fully explain the high risk of chronic liver disease in less educated men in Hungary

Hungary has among the highest mortality rates from chronic liver disease (CLD) and cirrhosis in Europe. Usually, conventional behavioural factors are hypothesized as the cause of the high risk of CLD.

A case–control study was performed with 287 cases and 892 controls to study the relationship between socio-economic and behavioural factors and the risk of CLD. Liver disease was verified by physical examination and blood tests. Blood samples were collected for detecting hepatitis B, C and E virus infection. Information on exposure factors was recorded by the participating physicians and by self-administered questionnaire. Simple regression analysis was used to study the relationship between CLD/cirrhosis and potential risk factors as alcohol intake (amount and source), problem drinking, cigarette smoking, physical activity, viral hepatitis infections, socio-economic factors (education, financial and marital status). Multiple regression analysis was used to identify whether the effect of socio-economic factors is fully mediated by health behaviour (smoking, alcohol consumption, physical activity).

The univariate analysis showed that heavy alcohol consumption, problem drinking, former and heavy cigarette smoking, single, separated or divorced marital status, bad or very bad perceived financial status and lower education significantly increased the risk of CLD/cirrhosis. The effect of marital status and of education did not change after adjustment for behavioural factors, but the effect of perceived financial status disappeared.

The effect of low socio-economic status on the risk of CLD/cirrhosis is only partially explained by conventional behavioural risk factors in Hungary.

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Request Reprint E-Mail: voko@caesar.elte.hu


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Predicting alcohol consumption during the month before and after beginning college

We sought to determine predictors of drinking the month before and after beginning college, as well as changes in drinking between these two periods among adjudicated students. We conducted these analyses to inform individual and university-wide approaches to addressing underage drinking, particularly among the heaviest drinkers.

The sample consisted of 143 students entering college, adjudicated during their first semester, and interviewed during the same semester. The sample consisted of 43% women. Drinking data were collected through the Time-Line Follow-Back interview.

The average number of drinking days (DD) during the first month of college was 7.0 (SD = 4.7), the average number of drinks per drinking day (DDD) was 7.4 (SD = 3.4), and the average volume of standard drink units consumed during this month was 56.3 (SD = 51.2). Students had volunteered for a two-year college facilitation study, and had been invited to participate after receiving a citation for violating university alcohol policies. Analyses consisted of nine backward elimination regression analyses with nine variables entered as predictors (one was a control variable). Age of first intoxication was related to every dependent measure. Men had a higher August DDD, September DDD, and September volume than women. Roommate drinking level was associated with September DDD and September volume. Out-of-state students had a lower August volume than in-state students. High school rank was inversely related to September drinking days. SAT score, declared major status, and fraternity/sorority status were not related to drinking according to these multivariate analyses.

Results suggest that approaches to underage drinking for adjudicated students may need to be tailored according to age of first intoxication. Results also suggest the drinking level of the heaviest drinking roommate may moderate individual level interventions. Further, interventions applied to an entire dorm room may prove efficacious. Results also suggest that high school rank, rather than SAT scores, should be used as college entry criteria to yield a drier incoming class. Results may not generalize to non-adjudicated students.

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Mothers' intentions to introduce their adolescent to alcohol use: does mothers' alcohol use effect intentions?

To assess mothers' intentions to introduce their adolescent to alcohol and to examine whether their own alcohol use influences their intentions.

Mothers (N = 161) of children aged 12.5 years (SD = 0.8) completed measures of their alcohol use and their intentions and attitudes towards their children beginning to drink alcohol.

Overall, 68% of mothers reported that parents should introduce their children to alcohol at home before they reach the age of 18, (in contrast with NHMRC guidelines, which recommend delaying alcohol use until age 18). While there were some statistically significant differences in mothers' intentions and beliefs according to their own alcohol use, these were small or medium effects, and tended to be differences in degree rather than in kind and not likely to be of practical importance.

Introducing their children to the use of alcohol is a role mothers see as important, and one they generally felt sufficiently equipped to carry out. Mothers' intentions to initiate their children into alcohol use were remarkably similar despite differences in mothers' own alcohol use. This suggests that approaches to education and guidance for parents are unlikely to need to take mothers' alcohol use into account when planning ways to support parents in this aspect of their role, at least for mothers of early adolescents.

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Request Reprint E-Mail: Rachel.roberts@adelaide.edu.au

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Alcohol, Other Drugs, and Health: Current Evidence

Current Issue: March–April 2010

Interventions and Assessments

• Overdose in Patients Prescribed Opioids
• Severity of Unhealthy Alcohol Use in Hospitals and Implications for Brief Intervention
• Abstinence versus Controlled Drinking as a Treatment Goal
• Home- versus Office-based Buprenorphine Induction: Impact on 30-Day Retention
• Treatment with SSRIs May Improve Depression in Patients with Substance Abuse Disorders
• Community-based Screening and Brief Intervention Is Effective at Identifying and Treating Older Adults with Depression and Substance Misuse

Health Outcomes

• Isn’t Alcohol Good for My Heart? Alcohol and Cardiovascular Risk in HIV-Infected and Uninfected Men
Increased Use of Opioids for Chronic Pain in Patients with Mental-Health and Substance-Use Disorders
• Drug-Addicted Patients Vulnerable to Overdose Death in the 4 Weeks Following Medication-Free Treatment
• Moderate Alcohol Consumption Might Worsen Nonalcoholic Steatohepatitis
• Factors Associated with Failure to Receive Outpatient Treatment among HIV Inpatients Who Use Crack Cocaine
• Factors Associated with Mortality in Alcohol Withdrawal
• Moderate Drinking Is Not Associated with Increased Weight Gain among Women

Training Opportunity

• National Mentoring Network Promotes Buprenorphine Treatment among Patients with Opioid Dependence

Slide Presentations

• Update on Alcohol, Other Drugs, and Health
• Journal Club

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Workshop on alcohol marketing “How to pave the way for effective regulation of alcohol marketing in Europe”

4th European Alcohol Policy Conference 21 – 22 June 2010,

Brussels Workshop on alcohol marketing on 22 June 10.30-12.00

What theory tells us about effective alcohol marketing regulations Results of the project Focus on Alcohol Safe Environments (FASE) Speaker: Anouk van den Broeck Msc. STAP – Dutch institute for alcohol policy

Keeping up appearances Comparing evidence based evaluations with monitoring exercises of the industry Speaker: Avalon de Bruijn Msc; on behalf of EUCAM (European Centre for Monitoring Alcohol Marketing); www.EUCAM.info

The Loi Evin in theory and practice Example of a best practice of an alcohol marketing regulation in Europe Speaker: Dr. Michel Craplet, ANPAA

Talking about an alcohol marketing ban…why not? Elaborating about juridical obstacles for an alcohol marketing ban in Europe. Speaker: Dr. Markus Zöckler, Institut für Völkerrecht- Universität München

Please contact avandenbroeck@stap.nl for participation or further information

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