State liquor laws as enablers for impaired driving and other impaired behaviors.

In theory, liquor control laws are meant to promote temperance. In most states, however, a purveyor of alcoholic beverages does not have to stop serving a customer until she/he appears "intoxicated"; this means that many people continue to be served alcohol long after they have reached the legal limit for impaired driving, .10 per cent blood alcohol concentration (BAC). Objective impairment and increased injury risk substantially precede clinical signs of intoxication. State liquor control laws should be changed to establish a maximum permissible number of drinks that may be served so that patrons are unlikely to exceed a maximum BAC (.10 per cent or .15 per cent) and to adopt a BAC of .10 per cent or .15 per cent as presumptive evidence that a patron has been served too much. Currently five states have a cutoff based at least in part on BAC, while the remaining states either have cutoffs based on appearance of intoxication or no cutoff at all.     

Alcohol brief intervention in bars and taverns: a 12-month follow-up study of Operation Drinksafe in Australia

This study examined the effect of an alcohol brief interventionprogram on drinkers in bars and taverns. A 12-month follow-upwas conducted with 1211 patrons who took part in a program calledOperation Drinksafe involving 118 hotels and clubs in northcoast New South Wales, Australia. The brief intervention took~5 min and consisted of a personalized risk assessment usingthe Alcohol Use Disorders Identification Test (AUDIT) in combinationwith a breathalyser to determine blood alcohol concentration(BAC). At follow-up, almost half (46%) the participants reportedreduced their alcohol consumption. The mean AUDIT score reducedby 15%, weekly alcohol consumption by 13% and frequency of bingedrinking by 19%. Those previously drinking at ‘harmful’levels reduced most (AUDIT 29%, consumption 22% and binge frequency37%). Females had almost twice the odds of reducing consumptioncompared to males (OR 1.75, CI: 1.33–2.33) as did participantswith initial consumption above the mean (OR 2.03, CI: 1.58–2.60).Older respondents showed smaller reductions than young peoplein composite AUDIT score, but greater reductions on consumptionand binge frequency scales. Although a control group was notfeasible, these findings suggest that a brief intervention program,presented in an interesting way to drinkers in bars and taverns,may effectively reduce risky alcohol consumption. Brief interventionsmay be particularly beneficial for those drinking at hazardousand harmful levels who are ready to change their drinking pattern.The partnership between police and health services was the cornerstoneof this intervention, and helped to foster co-operation andacceptance from licensees and their customers.     

Pseudo-drunk-patron evaluation of bar-staff compliance with Western Australian liquor law

Abstract: Compliance of bar staff with the Western Australian liquor law prohibiting service to drunk patrons was assessed through the deployment of actors trained to behave in a drunken manner. The serving practices of 23 licensed premises (19 hotels and four nightclubs) were examined. During 120 visits to hotel and nightclub bars, more than 350 drink orders were placed by pairs of pseudo-drunk actors who ordered up to three drinks each on each visit. On placing these drink orders, pseudo-drunks were refused service by bar staff on only 12 occasions. The rate of refusal of service across all premises was 10 per cent of visits. Partial interventions by servers, such as offering food or low-alcohol or nonalcoholic drinks, occurred in only four instances of the 120 visits. Qualitative observations and results obtained from a separate study examining a subsample of the servers who trained in responsible service of alcohol are discussed.     

The association of alcohol consumption with outcome of pregnancy

Patterns of alcohol consumption were assessed in 12,440 pregnant women interviewed at the time of delivery. Only 92 women (0.7 per cent) reported drinking 14 or more drinks per week, with most consuming fewer than 21 drinks per week. In the crude data, alcohol intake of 14 or more drinks per week was associated with a variety of adverse pregnancy outcomes, including low birthweight, gestational age under 37 weeks, stillbirth, and placenta abruptio. After use of logistic regression to control for confounding by demographic characteristics, smoking, parity and obstetric history, only the association of placenta abruptio with alcohol consumption of 14 or more drinks per week remained statistically significant. With the exception of placenta abruptio, alcohol intake of fewer than 14 drinks per week was not associated with and increased risk of any adverse outcome. No association was seen with congenital malformations at any level of alcohol intake.     

Knowledge of alcohol-related problems in clinical staff in psychiatric community resource centres in Glasgow

We report on a survey of knowledge of alcohol-related problems in the multi-disciplinary staff in 12 general adult psychiatry community resource centres. In total we obtained data from 111 staff, the majority of whom (63%) were community psychiatric nurses (CPNs). Seventy-three per cent of staff routinely ask clients about their alcohol consumption and 66% felt that they could identify those clients with an alcohol problem. We identified gaps in knowledge that could be seen as significant, for example, the legal driving limit and the number of units of alcohol in bottles of wine and spirits. Less than a third of staff knew the criteria for alcohol dependence. The majority of staff were able to recognise clinical complications of alcohol abuse and to identify alcohol withdrawal symptoms. We consider that it would be useful to provide a simple concise data-sheet, containing basic information about alcohol, for clinical staff.     

Determination of lifetime injury mortality risk in Canada in 2002 by drinking amount per occasion and number of occasions

Injury is the leading cause of alcohol-attributable mortality in Canada. Risk is determined by amount consumed per occasion and accumulates across drinking episodes. The authors estimated alcohol-attributable injury mortality in Canada for 2002 by combining the absolute risk of injury unrelated to alcohol with relative risks that were specific to gender and consumption per occasion, while taking into account lifetime number of drinking occasions. The absolute risk increased as number of drinking occasions and number of drinks per occasion increased. The absolute risk remained relatively low at fewer than 2 drinking occasions per month, regardless of number of drinks. Absolute risk levels reached 1 in 1,000 at 5 or more drinks once per month for men and at 5-7 drinks once per month for women. The probability of mortality was 1 in 100 for all levels of consumption above 3 drinks 3 times per week for men and above 5 drinks 3 times per week for women. No safe level of consumption is recommended based on these results, although risk is much lower for consuming 3 standard drinks or less fewer than 3 times per week. Absolute risk reflects long-term effects of drinking patterns and is important for risk-communication and alcohol-control policy.     

Patterns of common drug use in teenagers

Abstract: To ascertain current levels of drug use among teenagers and to examine interrelationships in use, a two-stage cluster sample of Victorian secondary school students in years 7 (aged 12 to 13 years), 9 (14 to 15 years) and 11 (16 to 17 years) were surveyed using a questionnaire on computer. Tobacco use and alcohol consumption were evaluated by self-reported frequency of use and seven-day retrospective diaries. Marijuana and coffee consumption were assessed by self-reported frequency of recent use. The questionnaire was completed by 2525, a participation rate of 83 per cent Tobacco use rose with year, with 24 per cent of young women and 16 per cent of young men in year 11 being regular smokers. Trends across year level for heavier alcohol consumption were also observed, with just under 10 per cent of year 11 students reporting a weekly consumption higher than the current recommended guidelines for adults. Strong interrelationships in drug use were found, with a pattern of association between smoking and drinking consistent with a mutual elevation of risk. Frequent use of tobacco and alcohol had a high risk for associated marijuana use. Coffee consumption carried a significant independent association with regular smoking. Teenage substance use is common and most occurs at low level and frequency. However, for a substantial and increasing minority across the teenage years, high levels of tobacco and alcohol consumption potentially compromise health. Frequent alcohol or tobacco use rather than heavy intermittent consumption is most likely to be associated with concurrent substance use potentially damaging to health.     

What if Americans drank less? The potential effect on the prevalence of alcohol abuse and dependence.

OBJECTIVES. Several advisory committees have recently recommended that alcohol consumption be limited to moderate levels. Moderate drinking has been defined generally as not more than two drinks per day for healthy men and not more than one drink per day for healthy, nonpregnant women. The impact of reducing alcohol consumption to within the recommended guidelines on the prevalence of two serious alcohol-related problems was examined by modeling the relationship between average daily ethanol intake and alcohol abuse and dependence. METHODS. The recommended drinking guidelines, both in their existing form and modified by a measure of impairment, were applied to the observed distribution of consumption derived from a large representative survey of the US general population. RESULTS. The results demonstrated that restricting drinking to the maximum allowable levels under the existing and the modified guidelines would reduce the prevalence of alcohol abuse and dependence by 14.2% and 47.1%, respectively, in the adult US general population. CONCLUSIONS. Implications of these findings are discussed in terms of the validity of the assumptions underlying the models and the nature and direction of future research that would form the basis of newly developed guidelines for safe drinking limits.     

Smoking in hotels: prevalence,and opinions about restrictions

Abstract: Exposure to high levels of environmental tobacco smoke can occur in hotels. Controversy exists about smoking regulation on licensed premises. This survey of 138 people attending one of three Newcastle hotels during 1993 found that 57 per cent of respondents were nonsmokers. Fifty-eight per cent (95 per cent confidence interval (CI) 50 to 66 per cent) of respondents in these hotels believed their health was being adversely affected by other people's smoke in the hotel. Seventy per cent (CI 62 to 78 per cent), including half the smokers, were in favour of restriction of smoking in the hotels. Most preferred the establishment of smoke-free areas to the introduction of total smoking bans in hotels. The failure of hotels to regulate smoking suggests that a legislative approach is required. The case for legislation would be strengthened by a larger study elsewhere in Australia.     

Alcohol drinking, consumption patterns and breast cancer among Danish nurses: a cohort study

BACKGROUND: The aim of this study was to analyse the impact of alcohol intake and drinking pattern on the risk of breast cancer. METHODS: A total of 17 647 nurses were followed from 1993 until the end of 2001. At baseline participants completed a questionnaire on alcohol intake and other lifestyle-related factors. Data were analysed using Cox's proportional hazard model. RESULTS: During follow-up 457 women were diagnosed with breast cancer. The relative risk of breast cancer was 2.30 [Confidence interval (CI): 1.56-3.39] for alcohol intake of 22-27 drinks per week, compared to 1-3 drinks per week. Among alcohol consumers, weekly alcohol intake increased the risk of breast cancer with 2% for each additional drink consumed. Weekend consumption increased the risk with 4% for each additional drink consumed friday through sunday. Binge drinking of 4-5 drinks the latest weekday increased risk with 55%, compared with consumption of one drink. A possible threshold in risk estimates was found for consumption above 27 drinks per week. CONCLUSIONS: For alcohol consumption above the intake most frequently reported, the risk of breast cancer is increased. The risk is minor for moderate levels but increases for each additional drink consumed during the week. Weekend consumption and binge drinking imply an additional increase in breast cancer risk.     

HEAVY ALCOHOL DRINKING AND RELATED SYMPTOMS IN A POPULATION STUDY OF URBAN MEN

An age-stratified random sample of 228 men was selected fromthe urban districts of Solna and Sundbyberg in Stockholm. Twohundred of these men (90%) underwent a health survey comprisinga general medical examination, taking of a medical and socialhistory, blood and urine tests, roentgenography of the heartand lungs, ECG, electroneurography and computed tomography ofthe brain. The purpose of the present study was to determinealcohol consumption levels and their correlation with symptomsof heavy drinking and with age. The subjects were collectedaccording to a rectangular age distribution, with age rangesof 20–29, 30–39,40–49, 50–59 and 60–65years. Quartiles were used in order to obtain homogeneous strataand to group the sample concerning alcohol consumption. Twomeasures of alcohol consumption were used–the amount ofalcohol consumed in the previous week in g of absolute alcoholper day, and the typical peak consumption in the last six months.Three symptoms related to heavy drinking were studied: (1) inabilityto cut down or stop drinking, referred to here as subjective,relative loss of control over drinking; (2) morning shakes andmalaise relieved by drinking, termed morning drinks; (3) amnesiainduced by alcohol, referred to as blackouts. Ten per cent ofthe men had all three alcohol symptoms and 52% had no alcoholsymptoms at all. Twenty-nine per cent had lost control overthe amount they drank. Blackouts were noted for 33% and morningdrinks for 25%. Three groups of participants with different degrees of exposureto alcohol were distinguished: 41 low consumers without alcoholsymptoms; an intermediate group of 106 participants; and a heavy-drinkinggroup of 53 men with high consumption and two or more symptoms.There was no significant age difference between any of the groupsI–III. Twenty-seven per cent belonged to the heavy-drinkinggroup in this sample from the general population.     

AN OBSERVATIONAL STUDY OF YOUNG ADULTS' DRINKING GROUPS--II. DRINK PURCHASING PROCEDURES, GROUP PRESSURES AND ALCOHOL CONSUMPTION BY COMPANIONS AS PREDICTORS OF ALCOHOL CONSUMPTION

Quantitative observations were made of 200 groups in bars cateringfor young adults. Most drinkers were members of groups in whichround-buying procedures were used. Purchasing procedures weregood predictors of alcohol consumption among males, accountingfor 15% of the variance in consumption. Males who purchasedrounds tended to consume more alcohol than did males who didnot purchase drinks for others. Drinkers with companions whoconsumed large amounts of alcohol tended to consume more alcoholand tended to have higher drinking rates. Considered alone,the average amount consumed by companions accounted for 62%and 48% the variance in alcohol consumption by males and femalesrespectively. Qualitative observations and interviews with 200 patrons arealso described Findings from the interviews indicate that therewere considerable pressures on males and females to conformto the ‘institution’ and to the ‘rules’of round-buying. However, the quantitative observations showedthat the majority of females did not openly purchase drinks.This suggests that observational procedures can provide usefulchecks on findings obtained from questioning procedures.     

Alcohol-attributable and alcohol-preventable mortality in Denmark: an analysis of which intake levels contribute most to alcohol’s harmful and beneficial effects

The aim of the study was to quantify alcohol-attributable and -preventable mortality, totally and stratified on alcohol consumption in Denmark 2010, and to estimate alcohol-related mortality assuming different scenarios of changes in alcohol distribution in the population. We estimated alcohol-attributable and -preventable fractions based on relative risks of conditions causally associated with alcohol from meta-analyses and information on alcohol consumption in Denmark obtained from 14,458 participants in the Danish National Health Survey 2010 and corrected for adult per capita consumption. Cause-specific mortality data were obtained from the Danish Register of Causes of Death. In total, 1,373 deaths among women (5.0 % of all deaths) and 2,522 deaths among men (9.5 % of all deaths) were attributable to alcohol, while an estimated number of 765 (2.8 %) and 583 (2.2 %) deaths were prevented by alcohol. Of the alcohol-attributable deaths, 73 and 81 % occurred within the high alcohol consumption group (>14/21 drinks/week for women/men). A reduction of 50 % in the alcohol consumption was associated with a decrease of 1,406 partly alcohol-attributable deaths (46 %) and 37 alcohol-preventable deaths (3 %). Total compliance with sensible drinking guidelines with a low risk limit (<7/14 drinks/week) and a high risk limit (<14/21 drinks/week) was associated with a reduction of 2,380 and 1,977 alcohol-attributable deaths, respectively. In summary, 5.0 % of deaths among women and 9.5 % of deaths among men were attributable to alcohol in Denmark 2010. The minority of Danish women and men had high alcohol consumption (16 and 26 %). However, the majority of all alcohol-attributable deaths among women and men were caused by high consumption (73 and 81 %).     

Alcoholic beverage consumption and breast cancer incidence

Recent case-control studies have suggested that alcohol consumption may be associated with breast cancer incidence. This report is a retrospective cohort study of over 95,000 women who were members of the Kaiser Foundation Health Plan of Northern California. The stated alcohol consumption of these women was recorded at a multiphasic screening examination taken from 1964 to 1972 prior to any diagnosis of breast cancer. The incidence of breast cancer in this cohort was greater for women who drank, and among these drinkers, incidence increased in an irregular trend with heavier alcohol consumption. Control for the effects of race, education, smoking, and reproductive variables related to breast cancer all but eliminated the overall increased relative risk of drinkers compared with that of nondrinkers. However, the relatively small group of women who stated that they had three or more alcoholic drinks per day (5.2 per cent of the total) had a significantly elevated relative risk of 1.4 (p = 0.035) compared with nondrinkers, despite control for all available confounding variables. No significant interaction effect of smoking and alcohol was found. Women who had less than three drinks per day had no increased relative risk over nondrinkers. The results of this study might be explained either by an unrecognized carcinogenic effect of alcohol on breast tissue or by the confounding effect of other factors associated with heavy alcohol use.     

Alcohol consumption and mortality: a dose-response analysis in terms of time

PurposeLow-to-moderate alcohol consumption is associated with decreased mortality. However, many aspects of this association are still debated. Our aim was to complement available information by conducting a dose-response analysis of the association between alcohol consumption and survival time.MethodsIn a Swedish population-based cohort of 67,706 middle-aged and elderly men and women, frequency and amount of drinking were assessed through a self-administrated questionnaire. During 15 years of follow-up, 13,323 participants died. Differences in survival (10th percentile differences, PDs) according to levels of alcohol consumption were estimated using Laplace regression.ResultsWe found evidence of nonlinearity between alcohol consumption and survival. Among women, we observed a rapid increase in survival up to 6 g/d of alcohol consumption (0.5 drinks/d) where survival was 17 months longer (PD = 17 months, 95% confidence interval, 10 to 24). After this peak, higher alcohol consumption was progressively associated with shorter survival. Among men, survival improved up to 15 g/d (1.5 drinks/d) where we observed a PD of 15 months (95% confidence interval, 8 to 22).ConclusionsLow alcohol consumption was associated with improved survival up to 1.5 years for women with an average consumption of 0.5 drinks per day and to 1.3 years for men with an average consumption of 1.5 drinks per day.     

Dietary, physical activity and sedentary behaviour among Australian secondary students in 2005

The aim of this study was to provide a current assessment of Australian secondary students' self-reported dietary, physical activity and sedentary behaviour. This study also examined the relationship between television viewing and students' dietary behaviour. Data are from a cross-sectional survey of 18 486 secondary students in 2005 from all Australian states except Western Australia. Participants reported their usual daily consumption (number of serves) of vegetables and fruit; their weekly consumption of unhealthy/non-core foods including fast food meals, snack foods and high-energy drinks; their engagement in moderate-vigorous physical activity over the previous week; and hours spent using electronic media for entertainment and doing homework on school days. The study found that 20% of students were meeting the daily requirement of four serves of vegetables, whereas 39% were eating the recommended three daily serves of fruit. Consumption of unhealthy/non-core foods was high, with 46% of students having fast food meals at least twice a week, 51% eating snack foods four or more times per week and 44% having high-energy drinks four or more times per week. Fourteen per cent of students engaged in recommended levels of physical activity and 29% engaged in recommended levels of sedentary behaviour. Age and gender differences occurred for most measures, and there were some socio-economic status differences. Heavier television use was associated with lower consumption of fruit and higher consumption of unhealthy/non-core foods. On the basis of the results of this study, it appears that a significant proportion of Australian secondary students fall short of current, national dietary and physical activity recommendations for teenagers. Continual monitoring of these behaviours is essential to help inform research and policy and identify where future efforts should be directed.     

Smoking and drinking habits before and during pregnancy in Spanish women.

STUDY OBJECTIVE--To investigate possible changes in smoking and drinking habits during pregnancy and to elucidate the sociodemographic factors associated with these changes in Spanish women. DESIGN--A cross-sectional survey. PARTICIPANTS AND SETTING--A total of 1004 pregnant women of between 12 and 18 weeks of gestation who were attending the antenatal clinic of the main regional hospital of Valencia (Spain) during 1989 were studied. All participants completed the study and only one eligible woman refused to participate when approached. MEASUREMENTS AND MAIN RESULTS--Information was obtained by structured questionnaire (Euromac questionnaire), which included items on age, educational level, marital status, occupation, parity, previous and present smoking habits, and previous and present alcohol consumption. Women were asked about the consumption of cigarettes and alcohol for a typical week before they knew they were pregnant, and details of current consumption were obtained for the week before the interview. The number of drinks taken per week was later converted to the amount of absolute alcohol (in g). Sixty per cent of the women smoked and 72% drank alcohol before pregnancy. Forty eight per cent of smokers stopped smoking and 37% of drinkers stopped drinking alcohol during pregnancy. No sociodemographic factor showed an independent association with either smoking or drinking cessation. Only the number of cigarettes and the amount of alcohol consumed before pregnancy were identified as significant independent predictors for stopping. CONCLUSIONS--Pregnant Spanish women seemed to stop smoking at about three times the rate found in Spanish women in the reproductive years. The sociodemographic variables usually associated with stopping smoking could not account for the high rate of quitting in these Spanish women, a rate higher than that in women from other developed countries. The high prevalence of smoking before pregnancy might explain not only the high rate of stopping smoking but also the absence of a well defined profile of "quitters". In our study, high levels of alcohol consumption were limited to a small group of pregnant women, and preventive efforts should be focused on this group.     

The public perception of the risks and benefits of alcohol consumption

Abstract: A survey of the community was undertaken in August 1989 to assess the public's perception of the risks and benefits of alcohol use, and their understanding of recommended levels of safe alcohol consumption. A household sample of 500 men and women (18 to 65 years) in metropolitan and rural New South Wales were asked their opinions about the risks and benefits of alcohol use, the health and social consequences of ‘drinking too much’, and the number of standard drinks that would produce a low, medium and high risk to the health of an adult man and woman. The major perceived benefits of alcohol use were relaxation and medication; the major health and social problems attributed to alcohol abuse were brain and liver damage, and domestic violence and family problems. The quantities of alcohol which respondents thought could be consumed with a ‘low’ risk to health were close to National Health and Medical Research Council recommended levels of safe consumption.     

An evaluation of ventilation system flow rates and levels of carbon dioxide,ambient temperature,and relative humidity in restaurants

Studies of the indoor air quality of restaurants have rarely focused on ventilation system performance in relation to air pollutants and climatic factors. This study was conducted in eight restaurants to examine this issue by determining the ventilation flow rates and the levels of carbon dioxide (CO2), ambient temperature, and relative humidity during at least one complete shift of serving a meal. The mean values of number of dining patrons, ventilation flow rates, and the levels of CO2, ambient temperature, and relative humidity were not significantly different in the nonsmoking dining rooms and the smoking dining rooms. The mean ventilation flow rates in individual restaurants ranged from 42-113 cubic feet per minute per person (cfm/person), overall exceeding the recommended lower limit of 30 cfm/person. The mean levels of CO2 in two restaurants (646 and 819 ppm) were below, and in the other six restaurants (ranging 1,012-1,820 ppm) were above the recommended upper limit of 1000 ppm. The levels of CO2 in each restaurant significantly correlated with the number of dining patrons and in four restaurants accumulated gradually over time. In the nonsmoking dining rooms, the levels of CO2 increased significantly as the ventilation How rates decreased. The mean ambient temperature in restaurants (ranging from 22 degrees C - 24 degrees C) were within the recommended range of 20 degrees C - 26 degrees C. The mean relative humidity in six restaurants (ranging from 46%-59%) were within the recommended upper limit of 60 percent, and in two restaurants (62% and 71%) were slightly higher than this recommended limit. It was concluded that although the mean ventilation flow rates in all restaurants exceeded the recommended value, the design of the ventilation system or the distribution of air flow rate in some sections of restaurants were not appropriate to keep the levels of CO2 and relative humidity at some measurement locations below the recommended limits.     

Relationship of abdominal obesity with alcohol consumption at population scale

Background The high energy content of alcohol makes its consumption a potential contributor to the obesity epidemic. Aim of the study To determine whether alcohol consumption is a risk factor for abdominal obesity, taking into account energy underreporting. Methods The subjects were Spanish men (n = 1491) and women (n = 1563) aged 25–74 years who were examined in 1999–2000, in a population-based cross-sectional survey in northeastern Spain (Girona). Dietary intake, including alcohol consumption, was assessed using a food frequency questionnaire. Anthropometric variables were measured. Results The mean consumption of alcohol was 18.1 ± 20.7 g/d in men and 5.3 ± 10.4 g/d in women. 19.3% of men and 2.3% of women reported alcohol consumption of more than 3 drinks per day. The consumption of alcohol was directly associated with total energy intake in men (P < 0.001) and women (P = 0.001). The proportion of energy underreporting significantly (P < 0.001) decreased with higher amounts of alcohol drinking in both genders. Multiple logistic regression analysis, controlled for energy underreporting, smoking, educational level, leisure-time physical activity, energy, and diet quality, revealed that consuming more than 3 drinks of alcohol (>30 g ethanol) was significantly associated with the risk of abdominal obesity (Odds ratio 1.80; 1.05, 3.09) and exceeding recommended energy consumption (Odds ratio 1.97; 1.32, 2.93) in men. A very small number (2.13%) of women in this population reported high levels of alcohol consumption. Conclusions Alcohol consumption in elevated amounts was associated with risk of abdominal obesity in men, independent of energy underreporting.