Patterns of alcohol consumption in the Kimberley aboriginal population.

OBJECTIVE: To estimate patterns of alcohol consumption and alcohol-related problems among adult Aborigines in the Kimberley region of Western Australia. DESIGN: A community survey of adult Aborigines. PARTICIPANTS: A stratified random sample of 516 Aboriginal men and women over the age of 15 years in the Kimberley. MAIN OUTCOME MEASURES: Participants' reports of their frequency and quantity of alcohol consumption, and their lifetime experience of alcohol-related problems; and the laboratory measure gamma-glutamyltranspeptidase. RESULTS: Aborigines in the Kimberley were more likely to be non-drinkers than non-Aborigines in the Australian population, but the majority of drinkers consumed hazardous amounts of alcohol: 85% (95% Cl, 82% to 88%) of drinkers in the population were estimated to be drinking above the level defined by the National Health and Medical Research Council (NHMRC) as harmful. CONCLUSION: Alcohol abuse among Aborigines in the Kimberley is a major public health problem which requires urgent action.     

Alcohol consumption patterns in South Australia: 1983

The alcohol consumption patterns of adult South Australians were surveyed by the Australian Bureau of Statistics in October 1983. Results indicate that, since 1977, there has been a significant increase in alcohol consumption by women, while the overall consumption of alcohol, particularly beer, by older men has significantly decreased. Comparisons are made between the drinking behaviour of men and women, and the implications for medical personnel are presented.     

Alcohol consumption and the risk of alcohol related cirrhosis in women

The risks in women of cirrhosis with a likely primary alcohol aetiology were estimated for various levels of alcohol consumption in a case-control study. Data were obtained from 41 women with a first diagnosis of cirrhosis who had no evidence of non-alcohol-related cirrhosis; three matched controls were interviewed for each case. Significant increases in the risk of cirrhosis were detected at levels of consumption between 41 and 60 g daily; above this level a dose-response relation was observed. The risk of cirrhosis did not appear to be influenced by other nutritional factors or history of liver disease or use of hepatotoxic drugs. One per cent of Australian women consume more than 40 g alcohol daily, yet more than 90% of women identified with cirrhosis consumed alcohol at this level. Preventive interventions to reduce alcohol consumption in the small group of women who consume more than 40 g daily have the potential to reduce substantially the incidence of alcohol related cirrhosis.     

Alcohol, tobacco and analgesics--Busselton, 1972.

Mass health examinations carried out in Busselton in November and December, 1972, revealed that drinking and smoking were more prevalent amongst men, whereas more women took analgesic drugs. Compared with older age groups more young people consumed alcohol, tobacco and analgesics. Younger people are also taking up smoking and drinking at earlier ages than the older age groups. These findings stress the need for better health education to alter the attitudes of younger people. The people of Busselton would support legislation to allow spot breathalyser tests for drivers, women (70%) providing stronger support than men (57%). This suggests that public opinion could support continuing legislation to combat road accidents. Comparisons between the North Shore, Sydney, and Busselton populations indicated somewhat higher proportions of the urban people were consuming alcohol, tobacco and analgesics, particularly urban women. However, both Australian samples revealed disturbingly high proportions of subjects taking excessive monthly quantities of analgesics (3% to 5%) compared with the United Kingdom (2-8%). Previous reports of the high proportion of Traralgon people taking drugs or medication is supported by the Busselton data, which suggest the Australia requires stricter statutory control of analgesics, compulsory warnings on labels and restriction of sales to pharmacists.     

Cancer case-survival rates for South Australia: a comparison with US rates and a preliminary investigation of time trends

Five-year relative case-survival rates for all cancers collectively are similar in South Australia (49%) and the United States (50%). This suggests that outcomes of cancer treatment do not vary appreciably between the two populations. There is an indication of higher survival rates in South Australia for melanoma, Hodgkin's disease, multiple myeloma and gastric cancer, but lower survival rates for cancers of the thyroid, corpus uteri, prostate, colon, kidney and lung. The differences in point estimates of the rates were most conspicuous for Hodgkin's disease, multiple myeloma and prostatic cancer. The reasons for a cautious interpretation of these findings are discussed and some possible explanations are suggested. South Australian data point to an upward trend in survival rates between the diagnostic periods 1977-1980 and 1981-1985 for patients with Hodgkin's disease, diffuse large-cell lymphomas, melanomas and cancers of the prostate and rectum.     

Licit psychostimulant consumption in Australia, 1984-2000: international and jurisdictional comparison

OBJECTIVES: To examine trends in the licit consumption of the psychostimulants dexamphetamine and methylphenidate in Australia and nine other countries from 1994 to 2000 and in each State and Territory of Australia from 1984 to 2000. DESIGN: Annual rates of consumption of psychostimulants were compared using Poisson regression models. All drug consumption was standardised to defined daily doses per 1000 population per day. MAIN OUTCOME MEASURES: Rates of consumption of each psychostimulant in each country and in each Australian State and Territory. RESULTS: For the 10 countries from 1994 to 2000, total psychostimulant consumption increased by an average 12% per year, with the highest increase from 1998 to 2000. Australia and New Zealand ranked third in total psychostimulant use after the United States and Canada. Australia consumed significantly more than the United Kingdom, Sweden, Spain, the Netherlands, France or Denmark. In Australia, from 1984 to 2000, the rate of consumption of licit psychostimulants increased by 26% per year, with an 8.46-fold increase from 1994 to 2000. Western Australia ranked first, with nearly twice the consumption rate of total psychostimulants as New South Wales, which ranked second. Methylphenidate is the main psychostimulant consumed in the US and Canada, and dexamphetamine in Australia. CONCLUSIONS: The consumption of psychostimulants in Australia is high internationally and varies significantly between States and Territories. The results imply varied jurisdictional prescribing determinants and supply processes throughout Australia, which may require new national prescribing standards and access to online patient data for prescribers and dispensers.     

Down's syndrome in South Australia.

In a survey of Down's syndrome in South Australia, 921 persons, both living and deceased, were identified; 717 individuals with the disorder were living in South Australia. Cytogenetic confirmation of the diagnosis had been made in 774 cases. From 1955 to 1977, the over-all incidence of Down's syndrome at birth was found to be 1.175/1000 live births. The incidence of Down's syndrome was significantly lower over the last five years of this period than for the first 18 years; thus it appears that the incidence of Down's syndrome in South Australia is falling. Analysis of maternal age changes with time has not revealed any changes to the maternal age-specific rates for Down's syndrome, although the rate for mothers aged 25 years or younger appears to be falling. The proportion of Down's syndrome babies born to women aged 35 years or more has decreased from 65.7% for those born before 1950 to 30.4% for those born from 1975 to 1977; similarly, the median maternal age has fallen from 37.12 years to 28.25 years. Regression analyses of maternal age rates for Down's syndrome by single years have produced figures suitable for genetic counselling. A plea is made that Down's syndrome should become a notifiable condition.     

Estimating Australia's abortion rates 1985-2003

AIM: To estimate national rates of induced abortion in Australia from 1985 to 2003, using Medicare claim statistics for private patients and hospital morbidity statistics for public patients. DESIGN AND SETTING: Estimates were based on Australian and South Australian data collections relating to abortions. SA hospital morbidity statistics were compared with SA statutory notifications of abortions to estimate the accuracy of these collections. Medicare statistics on abortion procedures performed on private patients in South Australia were then compared with hospital morbidity statistics for private patients. National statistics on abortion derived from Medicare and hospital morbidity statistics were adjusted for inaccuracies found in these sources. MAIN OUTCOME MEASURES: Numbers of induced abortions in Australia for each year from 1985 to 2003; abortion rates per 1000 women aged 15-44 years. RESULTS: Abortion numbers based on Medicare claims by private patients overestimated by 18.7% the number of abortions derived from statutory notifications in South Australia during the period 1988-89 to 1999-00. Hospital morbidity data using principal diagnosis codes relating to medical abortion overestimated statutory notifications by 2.3% (mainly because of readmissions). National statistics were adjusted for these overestimations and for the estimated 14.1% of private patients who would not have submitted Medicare claims (based on surveys of private-clinic patients in New South Wales and Victoria). The estimated Australian abortion rate increased from 17.9 per 1000 women aged 15-44 in 1985 to a peak of 21.9/1000 in 1995, then declined to 19.7/1000 in 2003 (estimated number of abortions, 84,460). CONCLUSION: There are no data currently available for deriving accurate numbers of induced abortions in Australia. Suggestions are made for collection of national statistics.     

Alcohol and cancer: a position statement from Cancer Council Australia

The Cancer Council Australia (CCA) Alcohol Working Group has prepared a position statement on alcohol use and cancer. The statement has been reviewed by external experts and endorsed by the CCA Board. Alcohol use is a cause of cancer. Any level of alcohol consumption increases the risk of developing an alcohol-related cancer; the level of risk increases in line with the level of consumption. It is estimated that 5070 cases of cancer (or 5% of all cancers) are attributable to long-term chronic use of alcohol each year in Australia. Together, smoking and alcohol have a synergistic effect on cancer risk, meaning the combined effects of use are significantly greater than the sum of individual risks. Alcohol use may contribute to weight (fat) gain, and greater body fatness is a convincing cause of cancers of the oesophagus, pancreas, bowel, endometrium, kidney and breast (in postmenopausal women). The existing evidence does not justify the promotion of alcohol use to prevent coronary heart disease, as the previously reported role of alcohol in reducing heart disease risk in light-to-moderate drinkers appears to have been overestimated. CCA recommends that to reduce their risk of cancer, people limit their consumption of alcohol, or better still avoid alcohol altogether. For individuals who choose to drink alcohol, CCA recommends that they drink only within the National Health and Medical Research Council guidelines for alcohol consumption.     

Use of a questionnaire in general practice to increase the recognition of patients with excessive alcohol consumption

A self administered questionnaire, the health survey questionnaire, was designed to detect excessive alcohol consumption and mailed to patients who were registered with two general practices. Replies were received from 2572(75%) of 3452 patients. Excessive consumption was taken as 42 units of alcohol per week or more for men and 21 units per week or more for women: 1 unit = approximately 10 g ethanol and is equivalent to a half pint of beer, one glass of wine, or one standard measure of spirits. One hundred and twenty men (11%) and 68 women (5%) were identified by their responses to the questionnaire as excessive drinkers. According to their responses, roughly half of these expressed some concern about their drinking. In the practice where a disease register was kept 18 patients had been recorded as heavy drinkers before the study, and an additional 74 were detected by the questionnaire. Within 12 months after the questionnaire survey three groups of respondents were reviewed: (a) the excessive drinkers, (b) those who indicated concern about drinking but did not exceed the limits for excessive consumption, and (c) a random sample of those who were in neither of these two categories. Patients in these three groups were interviewed in a standard fashion to determine their alcohol consumption. Breath alcohol measurement was also carried out and a blood sample taken for the estimation of mean cell volume, gamma glutamyltranspeptidase activity, and serum aspartate transaminase activity. There were highly significant correlations between estimates of consumption obtained by the questionnaire and those obtained at interview except among the women who were excessive consumers, whose responses to the questionnaire indicated levels of consumption that were much higher than those to which they admitted at interview. Stated weekly consumption at interview that was above the limits set for the study was used as the standard measure for comparing the questionnaire with the other indicators of excessive drinking. The questionnaire had a considerably greater estimated sensitivity in detecting male excessive consumers than any of the blood tests. Among the women it apparently performed less well, although the numbers stating excessive consumption at interview were small. Breath alcohol measurement was positive in only a few of the excessive drinkers. The use of this simple and inexpensive instrument is likely to prove widely acceptable to patients in general practice and should result in a considerable increase in the recognition by general practitioners of patients with excessive alcohol consumption.     

Tuberculosis surveillance in the South Australian aboriginal community

Tuberculosis (TB) is still a significant problem in Aboriginal people. There are higher rates of active TB and evidence of continuing transmission among this group. We sought to define the specific epidemiological risks and best methods of surveillance for TB in Aboriginal people in South Australia. We compared the incidence of active TB in Aboriginal people in South Australia with that of the total number of cases in non-Aboriginal people from 1978 to 1988, and studied the prevalence of infection in four Aboriginal communities in South Australia. Incidence rates of active TB were four times higher in South Australian Aboriginal people than the total South Australian rates. Specific age analysis revealed higher active disease notification rates in Aboriginal people aged 45-54 years and 55-64 years. The notification rate for Aboriginal men was almost three times the rate for women. Standardized incidence ratios of active TB cases for Aboriginal communities were higher in rural and traditional communities than in urban Aboriginal people. Infection prevalence, measured by tuberculin skin testing, varied from 7.7% to 30.8% in the different communities but did not correlate with the standardized incidence ratios. We conclude that (i) South Australian Aboriginal people are suffering a higher rate of active TB disease than the total South Australian community, and (ii) that the disease and infection rates vary between communities and between age and sex groups. The discrepancy between disease notifications rates, as measured by standardized incidence ratios, and infection prevalence requires further investigation. To improve TB control in Aboriginal people, programmes need to be altered to be more appropriate for this group.     

Psychotropic drugs in Australia: consumption patterns

This paper reviews studies of psychotropic drug use in Australia, analyses results from the Australian Health Surveys and compares the findings with those from other countries. It identifies subpopulations with high rates of drug use, which may consequently be at greater risk of drug-related harm. The levels of consumption of psychotropic agents in Australia were estimated from the results of studies conducted in community and institutional settings between 1970 and 1986. In the absence of more recent data national prevalence rates were derived from analysis of data provided by the Australian Health Surveys (AHS) of 1977-1978 and 1983-1984, and comparisons were made with rates available from other countries. While the prevalence of current and frequent use of drugs for nervous conditions was found to have decreased in most age groups over this period, it was consistently higher in females than in males, and increased with age. An analysis of the 1983-1984 AHS data revealed that the consumption of "medicines for nervous conditions" fell by 35% but that no change occurred in the prevalence of persons taking sleeping medicines. This fall appeared to occur in both rural and urban populations. Further analysis of data relating to the consumption of hypnotic agents revealed that changes occurred in the patterns of use within age and gender subgroups. Significant differences were observed between Australian States in consumption rates of sleeping medicines (chi 2 = 282.2; df = 7; P less than 0.01) and of medicines for nervous conditions (chi 2 = 289.7; df = 7; P less than 0.01). There were high rates of use of medicines for sleep in South Australia and of medicines for nervous conditions in Queensland. The prevalence of use of both drugs for sleep (rs = 0.71; P less than 0.05) and drugs for nervous conditions (rs = 0.77; P less than 0.05) was related to the rate of consultations with doctors. Preliminary surveys of various non-British subpopulations including Aborigines were inconclusive. These results have implications for reducing the harm associated with the use of psychotropic agents, particularly hypnotics and drugs for nervous conditions, in Australia.     

Trends in alcohol consumption by pregnant women. 1985 through 1988

To examine trends in alcohol consumption among pregnant women, we examined data collected from 21 states participating in the Behavioral Risk Factor Surveillance System for 4 consecutive years: 1985 through 1988. Overall, 429 (25%) of 1712 pregnant women and 19,903 (55%) of 36,057 nonpregnant women 18 to 45 years of age reported using alcohol in the previous month. Pregnant women who used any alcohol reported consuming a median of four drinks per month, whereas nonpregnant women who used any alcohol reported nine. The prevalence of alcohol consumption among pregnant women declined steadily, from 32% in 1985 to 20% in 1988, but the median number of drinks per month for pregnant women who drank did not change. No decline was observed among the less educated or those under the age of 25 years. In 1988, the prevalence of alcohol use among pregnant women remained highest among smokers (37%) and the unmarried (28%). Although the overall consumption of alcohol by pregnant women in the United States appears to be declining, special efforts are needed to reduce alcohol use among pregnant women who are smokers, unmarried, less educated, or younger, women who may already be at high risk of a poor pregnancy outcome.     

Prior alcohol consumption and mortality following acute myocardial infarction

CONTEXT: Studies have found that individuals who consume 1 alcoholic drink every 1 to 2 days have a lower risk of a first acute myocardial infarction (AMI) than abstainers or heavy drinkers, but the effect of prior drinking on mortality after AMI is uncertain. OBJECTIVE: To determine the effect of prior alcohol consumption on long-term mortality among early survivors of AMI. DESIGN AND SETTING: Prospective inception cohort study conducted at 45 US community and tertiary care hospitals between August 1989 and September 1994, with a median follow-up of 3.8 years. PATIENTS: A total of 1913 adults hospitalized with AMI between 1989 and 1994. MAIN OUTCOME MEASURE: All-cause mortality, compared by self-reported average weekly consumption of beer, wine, and liquor during the year prior to AMI. RESULTS: Of the 1913 patients, 896 (47%) abstained from alcohol, 696 (36%) consumed less than 7 alcoholic drinks/wk, and 321 (17%) consumed 7 or more alcoholic drinks/wk. Compared with abstainers, patients who consumed less than 7 drinks/wk had a lower all-cause mortality rate (3.4 vs 6.3 deaths per 100 person-years; hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.43-0.71) as did those who consumed 7 or more drinks/wk (2.4 vs 6.3 deaths per 100 person-years; HR, 0.38; 95% CI, 0.25-0.55; P<.001 for trend). After adjusting for propensity to drink and other potential confounders, increasing alcohol consumption remained predictive of lower mortality for less than 7 drinks/wk, with an adjusted HR of 0.79 (95% CI, 0.60-1.03), and for 7 or more drinks/wk, with an adjusted HR of 0.68 (95% CI, 0.45-1.05; P =.01 for trend). The association was similar for total and cardiovascular mortality, among both men and women, and among different types of alcoholic beverages. CONCLUSION: Self-reported moderate alcohol consumption in the year prior to AMI is associated with reduced mortality following infarction.     

Does a blood alcohol level of 0.15 or more identify accurately problem drinkers in a drink-driver population?

OBJECTIVE: To determine whether a blood alcohol concentration (BAC) of 0.15 or more identifies accurately problem drinking in an apprehended drinking driver. DESIGN: Cross-sectional analytic study of 86 drink drivers ("diagnostic test study"). SETTING: St Vincent's Hospital, Melbourne, drink-driver education programme. SUBJECTS: Men aged between 18-25 years, applying for relicensing after disqualification, who were participants at 10 consecutive drink-driver education courses conducted in early 1987. OUTCOME MEASURES: Self-reports of the amount of alcohol consumed and the amount of money spent on alcohol per week, the standard Michigan Alcoholism Screening Test (MAST) score and the blood alcohol level at apprehension. The first three measures were used as reference standards for alcohol-related problems, against which the blood alcohol level was compared. MAJOR RESULTS: Scatter plots of BAC against amount consumed, amount spent and the MAST scores showed that a large proportion of the heaviest drinkers were not identified by the BAC. Log-transformed correlation coefficients were: for amount spent v. amount consumed, r = 0.73; for MAST score v. amount consumed, r = 0.52, and for MAST score v. amount spent r = 0.53. Correlating the BAC with the log of the MAST score gave r = 0.21, BAC with log of the amount consumed, r = 0.20, and BAC with log of the amount spent, r = 0.15. Comparing a BAC of 0.15 or more with a MAST score of greater than or equal to 5, we obtained a sensitivity of 0.36, a specificity of 0.76, a positive predictive value of 0.86, and a negative predictive value of 0.23. The prevalence of heavy drinking as measured by the MAST score was 0.80. CONCLUSION: A blood alcohol concentration of 0.15 or more identifies only a third of the problem drinkers in this sample of drink drivers. Although it selected a group of drinkers with alcohol-related problems, it missed most of the problem drinkers and did not reliably identify the heaviest drinkers.     

Sensorimotor and physiological effects of various alcoholic beverages.

Effects of a standard dose of alcohol (1.3 g/kg) in the form of Canadian rye whisky, Canadian beer and a sparkling table wine were compared with those of a nonalcoholic carbonated control beverage. Sixteen young male and eight female subjects, all moderate drinkers, were tested in a Latin square design. Measurements were made on the pursuit rotor and quantitative Romberg tests, and of skin temperature, heart rate, malar flush and blood alcohol concentration during the prealcohol baseline period and at regular intervals over the 4-hour drinking period. The three alcoholic beverages produced blood alcohol curves that did not differ significantly. All three alcoholic beverages produced increasing sensorimotor impairment over time, which corresponded in degree to the increasing blood alcohol concentration. There were no significant differences between the three beverages on either the sensorimotor or physiological measures at any blood alcohol value. The results of this study indicate that the degree of impairment after alcohol ingestion in a socially relevant manner is not dependent on the type of beverage consumed, but only on the resulting blood alcohol concentration.     

Long-term trends in cancer mortality for Indigenous Australians in the Northern Territory

OBJECTIVE: To examine long-term trends in cancer mortality in the Indigenous people of the Northern Territory (NT) of Australia. DESIGN: Comparison of cancer mortality rates of the NT Indigenous population with those of the total Australian population for 1991-2000, and examination of time trends in cancer mortality rates in the NT Indigenous population, 1977-2000. PARTICIPANTS: NT Indigenous and total Australian populations, 1977-2000. MAIN OUTCOME MEASURES: Cancer mortality rate ratios and percentage change in annual mortality rates. RESULTS: The NT Indigenous cancer mortality rate was higher than the total Australian rate for cancers of the liver, lungs, uterus, cervix and thyroid, and, in younger people only, for cancers of the oropharynx, oesophagus and pancreas. NT Indigenous mortality rates were lower than the total Australian rates for renal cancers and melanoma and, in older people only, for cancers of the prostate and bowel. Differences between Indigenous and total Australian cancer mortality rates were more pronounced among those aged under 64 years for most cancers. NT Indigenous cancer mortality rates increased over the 24-year period for cancers of the oropharynx, pancreas and lung, all of which are smoking-related cancers. CONCLUSIONS: Cancer is an important and increasing health problem for Indigenous Australians. Cancers that affect Indigenous Australians to a greater extent than other Australians are largely preventable (eg, through smoking cessation, Pap smear programs and hepatitis B vaccination).     

Climatic temperature and variation in the incidence of sudden infant death syndrome between the Australian states.

OBJECTIVE: To describe the relationship between climatic temperature and the incidence of sudden infant death syndrome (SIDS) for the Australian States and examine the extent to which differences in climatic temperature might explain the regional variation of SIDS in Australia. DESIGN: Case series study. A generalised linear model was used to model the association between monthly average temperature and the incidence of SIDS. SETTING: The report is population based. Data are available from all Australian States. SUBJECTS: Cases of SIDS from birth to less than 12 months of age occurring in Queensland (1981-1987), New South Wales (1981-1987), Victoria (1984-1987), Tasmania (1975-1989), South Australia (1980-1989), and Western Australia (1980-1988). RESULTS: Every one degree Celsius decrease in average monthly temperature within the range 9 degrees C to 25 degrees C is associated with a 10.6% (95% confidence interval, 9.6%-11.7%) increase in the incidence of SIDS. Climatic temperature accounts for 84% of the interstate variation in the rate of SIDS. After controlling for the effect of temperature, a significant overall difference in SIDS incidence remains (P less than 0.0001) for the Australian States. CONCLUSION: Climatic temperature accounts for most but not all of the regional variation of SIDS incidence in the Australian States. The remaining variation may reflect differences in the maternal and infant characteristics of the State populations.