Alcohol Consumption During Pregnancy: Baseline Data from a Scottish Prospective Study

The results are reported from the first of four phases of a prospective study on the association between alcohol consumption during pregnancy and fetal harm. These data revealed a generally low level of alcohol consumption amongst the 1,008 respondents. Self-reported alcohol consumption was slightly, but significantly, positively correlated with previous obstetric problems. Evidence from other studies indicates that between 1.8 per cent and 4.8 per cent of the study group may run an enhanced risk of producing damaged babies.     

The Prevalence of Disturbances of Eating Behaviour in a Portuguese Female University Population

This paper reports the results of a questionnaire constructed to identify the prevalence of bulimia nervosa (BN), binge eating and other manifestations of concern with body and shape and habits of consumption of alcohol, tobacco and illicit drugs among female university students in Lisbon. It was sent out to 1542 subjects and responses from 50.1 per cent were obtained. Among those students who responded, 55.1 per cent desired to lose weight, 25 per cent reported weight fluctuations in the previous year, 12 per cent were dieting at that moment and 48.8 per cent had been on a diet before. The prevalence of BN was 3 per cent and 13.2 per cent of subjects reported at least two binge eating episodes per week (binge-eaters). Bulimics and binge-eaters were heavier, wanted to lose more weight, had used diets before more frequently, and reported ponderal oscillations more frequently than controls. They also reported more frequent consumption of alcohol, tobacco and illicit drugs than controls, but this is not statistically significant.     

Alcoholism in Black Male Heroin Addicts

This study systematically evaluates the presence of alcoholism and alcohol problems in a large sample of black male heroin addicts. Of 192 addicts 24 per cent were diagnosed as alcoholics and 13 per cent as probable alcoholics when objective criteria for alcoholism were used. An additional 19 per cent reported isolated problems with alcohol. Thus 56 per cent of this sample of addicts had experienced some problem because of alcohol. The occurrence of such problems as medical complications from alcohol and use of non-beverage alcohol indicates the seriousness of their alcohol use. Among subgroups of the study sample, the highest rate of alcoholism was in addicts currently addicted - 49 per cent; while the lowest rate of alcoholism was in addicts who were in successful treatment – 22 per cent. Thus, a sizeable portion of the heroin addict population is having problems from the use of two drugs - heroin and alcohol.     

The 16 per cent Solution and other Mysteries concerning the Accuracy of Alcohol Consumption Estimates based on Sales Data *

Whether based on production, tax or sales statistics, estimates of alcohol consumption are subject to bias arising from record keeping procedures and from unrecorded consumption. Based on an analysis of the accuracy of consumption estimates derived from sales statistics in Ontario, two significant biases are identified. The first problem concerns the use of 16 per cent as the conversion factor for wine. As the consumption of 12 per cent table wines has increased, this figure is no longer appropriate and results in an over estimation of total alcohol consumption by about 2 per cent. The second major problem is the unrecorded home production of wine and wine brandy, which results in an underestimation of consumption by about 6 to 7 per cent. The available evidence concerning other types of unrecorded production indicates that they are not significant. It is concluded that sales data underestimate ‘true’ alcohol consumption in Ontario by about 4 to 6 per cent at this time.     

Brief interventions in routine health care: a population-based study of conversations about alcohol in Sweden

Aims To investigate how brief alcohol interventions are delivered in routine practice in the Swedish health‐care system. Design, setting and participants A cross‐sectional sample of 6000 individuals representative of the adult population aged 18–64 years registered in the Swedish total population register was drawn randomly. Data were collected in 2010 by means of a mail questionnaire. The response rate was 54%. Measurements The questionnaire consisted of 27 questions, of which 15 variables were extracted for use in this study. Whether alcohol had been discussed and the duration, contents, experiences and effects of any conversations about alcohol, as reported by patients themselves, were assessed. Findings Sixty‐six per cent of the respondents had visited health‐care services in the past 12 months and 20% of these had had one or more conversations about alcohol during these visits (13% of the population aged 18–64 years). The duration of the conversations was generally brief, with 94% taking less than 5 minutes, and were not experienced as problematic. The duration, contents, experiences and effects of these conversations generally varied between abstainers, moderate, hazardous and excessive drinkers. Twelve per cent of those having a conversation about alcohol reported that it led to reduced alcohol consumption. Reduced alcohol consumption was more likely when conversations lasted for 1–10 minutes rather than less than 1 minute and included advice on how to reduce consumption. Conclusions Population survey data in Sweden suggest that when health‐care professionals give brief advice to reduce alcohol consumption, greater effects are observed when the advice is longer and includes advice on how to achieve it.     

Liver morphology in morbid obesity: a literature study

Literature on liver morphology in untreated obesity reveals varying prevalences of various pathological findings. The purpose of this literature study was to summarize and evaluate the published observations and to discuss discrepant findings. A complete search was aimed at utilizing bibliographic methods including a computerized survey. Forty-one original articles were included, comprising information on liver morphology in 1515 morbidly obese patients. Liver biopsy was considered normal in 12 per cent of the cases. The most frequent abnormality reported was fatty change, present in 80 per cent of the biopsies. Portal inflammation was also common (33 per cent). Fibrosis, mainly portal or periportal, was observed in 29 per cent. Cirrhosis, however, involved only 3 per cent. Study of relationships between the degree of liver change and certain possible pathogenetic factors (eg degree and duration of obesity, age, sex, alcohol consumption, diabetes mellitus) does not point towards a single causal factor. Co-influence of additional pathogenetic factors are likely in the development of liver changes in morbid obesity.     

Alcohol Consumption Among Victims of Violence and Among Comparable U.K. Populations

Controlled investigations of alcohol consumption in victims of assault are lacking. A prospective survey was performed to compare victims' drinking habits with age and sex matched U.K. populations. All 539 adult victims of assault who attended an inner-city Accident and Emergency (A and E) Department in 1986 were interviewed. Seventy-four per cent of male victims and 42% of female victims reported alcohol consumption in the 6 hours prior to assault: 30% of males and 4% of females had consumed <10 units. Forty per cent males and 25% of females exceeded established safe-levels of consumption while 16% of males and 26% of females demonstrated abnormally high gamma-GT levels. Mean expenditure on alcohol by assault victims was 14% of net income, compared to 7.5% by the U.K. adult population overall. Results suggested that young male victims of assault may not be distinguishable from other young males on the basis of habitual or binge alcohol consumption. Assault victims over 25 years of age drank excessively compared to control populations and should be a priority group for alcohol education programmes.     

Alcohol consumption among unemployed youths: results from a prospective study

A prospective study, including all 1083 pupils in the final year of compulsory schooling in a municipality in northern Sweden, was performed. Ninety-seven point nine per cent of the pupils were followed up after five years. They completed a comprehensive self-administered questionnaire including questions on alcohol consumption. Among men a positive correlation between long-standing unemployment (> 20 weeks) and alcohol consumption at the beginning and at the end of the study, as well as the change in consumption during the follow-up period was seen. This correlation was still present when earlier alcohol consumption and socio-economic variables were controlled for. In women there was a positive correlation between unemployment and the level of alcohol consumption, but a negative correlation between unemployment and change in consumption. When controlling for motherhood and alcohol intake at the start of the study the correlation turned positive. Unemployment among women did not seem to affect recruitment to the high consumption group. Our remits support the suggestion that unemployment may be a risk indicator for increasing alcohol consumption among young people, particularly in young men.     

Women's alcohol consumption and risk for alcohol-exposed pregnancies in Russia

Aims Alcohol‐exposed pregnancies (AEP) are the direct cause of fetal alcohol spectrum disorders (FASD). This study examines drinking patterns among pregnant and non‐pregnant women of childbearing age in Russia, a country with one of the highest levels of alcohol consumption in the world. Design Cross‐sectional survey. Setting Seven public women's clinics in two locations: St Petersburg (SPB) and the Nizhny Novgorod region (NNR). Participants A total of 648 pregnant and non‐pregnant childbearing‐age women. Measurements A face‐to‐face structured interview assessed alcohol consumption, pregnancy status/possibility of becoming pregnant and consumption before and after pregnancy recognition. Findings Eighty‐nine per cent of non‐pregnant women reported consuming alcohol and 65% reported binge drinking in the past 3 months; 47% in NNR and 28% in SPB reported binges at least monthly. Women who might become pregnant consumed alcohol similarly to women who were not likely to become pregnant, and 32% of women in SPB and 54% in NNR were categorized as at risk for AEP. There was a significant decline in drinking after pregnancy identification. Twenty per cent of pregnant women reported consuming alcohol and 6% in SBP (none in NNR) reported binge drinking; however, a high prevalence of binge drinking was found among women who might become pregnant or who were trying to conceive. Conclusions Russian women substantially reduce drinking after pregnancy recognition compared to pre‐pregnancy levels. No reductions were found prior to pregnancy recognition, either when a woman might become pregnant or when she was trying to conceive. The pre‐conception period presents a risk window and, therefore, a prevention opportunity.     

Effect of Economic Changes on Scottish Drinking Habits 1978–82

An increase in excise duty on beer and other alcoholic beverages in March 1981 caused their price to increase faster than the retail price index and average disposable incomes. Unemployment was rising simultaneously. The influence of these economic changes on drinking habits was explored by comparing the survey responses of 463‘regular drinkers’in the Lothians in 1978/79 and 1981/82. Total alcohol consumption fell by 18 per cent between these two occasions, and associated adverse effects by 16 per cent. The influences of social class, income, and employment and marital status, and of changes in these, were examined. Although rising unemployment was responsible for up to 20 per cent of the reduction in consumption, and heavy drinkers appeared to be selectively at risk of losing their jobs, the increased price of alcohol was the major influence. Heavy drinkers and dependent drinkers both reduced their consumption at least as much as light or moderate drinkers and suffered fewer adverse effects as a result. Increasing the excise duty on alcohol can therefore be an effective public health measure.     

Alcohol in Pregnancy: patterns and association with socio-economic, psychological and behavioural factors

This study investigated alcohol consumption during pregnancy and its relationships with socio-economic, psychological and behavioural factors in 1463 women. Information about alcohol consumption in the preceding 7 days was obtained by structured interview at booking, 28 and 36 weeks gestation. The prevalence of current drinking was about 50% at each interview. Combining the three interviews, the cumulative prevalence of drinking was 71%. Six per cent reported drinking l00g/wk or more at at least one interview, a level of consumption which has been reported to be associated with adverse foetal outcome. Higher proportions of drinkers than non-drinkers were married, better educated, of higher social class and financial status. These factors were also associated with higher levels of consumption amongst those who drank. There was little evidence of an association between drinking and psychiatric state. Smoking was not associated with drinking status but was strongly related to the amount drunk by drinkers. Cluster analysis of heavier drinkers indicated the presence of a small sub-group of socially disadvantaged women. These findings carry implications for both prevention and perinatal epidemiology.     

Drinking context and other influences on the drinking of 15-year-old New Zealanders

This study investigated the influence of the situational characteristics of the drinking setting and a number of parental, personal and demographic variables on adolescents’alcohol use. The sample were 15-year-old participants in a multidisciplinary longitudinal study carried out in New Zealand. Measures of alcohol consumption were self reported amount of alcohol consumed on the most recent drinking occasion and amount usually consumed. All of the situational variables investigated had an effect on the amount of alcohol consumed on the most recent occasion. Greater amounts of alcohol were consumed if the alcohol was obtained from peers or by the 15-year-olds themselves, if the drink was consumed away from their own home, in the presence of peers only, and during the evening. More money to spend each week and lower SES were also associated with reports of greater alcohol consumption on the most recent drinking occasion. Adolescents with female friends who approved of drinking reported greater amounts of alcohol, the effect of female friends was most marked in the lower amounts reported by males who had female friends that disapproved of drinking. For amount of alcohol usually consumed, reports of larger amounts of alcohol were associated with more money available to spend each week and with lower SES. Furthermore, both males and females reported greater usual amounts if their male friends approved of drinking; female friends’approval was associated with greater amounts of alcohol usually being consumed, this effect was strongest for males. Sixty-eight per cent of the 15-year-olds indicated that they thought they definitely or probably would get drunk in the future.     

Alcohol and suicide—the Portuguese experience

An analysis of regional (18 regions) and temporal (1931–89) covariation of suicide rates and indicators of alcohol use and abuse in Portugal is reported. In the time series analysis, a positive relationship was found. An increase in per capita alcohol consumption of one litre is accompanied by a simultaneous increase in the male suicide rate of 1.9 per cent. This is comparable to what has been reported for France and Denmark, but considerably less than that found in Norway, Sweden and Hungary. In the regional data, there was a substantial negative correlation between the variables. However, after controlling for religious and family integration, the latter correlation became small and insignificant but still negative. A possible explanation is suggested for the different outcomes of the two analyses.     

Risky drinking and alcohol use patterns in a national sample of women of childbearing age

AIMS: We examined risky drinking and alcohol use patterns associated with prenatal effects of alcohol exposure in women of childbearing age, using various definitions of low-risk drinking. DESIGN: Computer-assisted telephone interview (CATI) methodology was used to gather information in a cross-sectional survey on alcohol use and problems, pregnancy and likelihood of future pregnancy. SETTING: Participants were respondents in the 2000 National Alcohol Survey (NAS, N10, response rate 58%) which includes men and women from all 50 states of the United States and the District of Columbia. PARTICIPANTS: A total of 1504 women aged 18-39 years were included; 72 were pregnant, 511 were currently not pregnant but reported being likely to be pregnant in the next 5 years, and 921 women were neither pregnant nor likely to be in the next 5 years. MEASUREMENTS: Various alcohol use patterns in the past 12 months including average volume, amount per session, drinking with food and time spent drinking were assessed. FINDINGS: Seven per cent of childbearing age women exceeded guidelines used to classify women as risky drinkers in the past month. Thirty per cent were classified as risky drinkers when these guidelines were extended to past-year drinking. Examination of specific alcohol use patterns revealed that while under 10% of risky drinkers reported past-month heavy episodic drinking, 30% or more reported heavy episodic drinking and exceeding daily limits for alcohol consumption in the past year. CONCLUSIONS: Public health professionals should note that past-year drinking in a significant proportion of women of childbearing age exceeds guidelines for alcohol use. When targeting such prevention efforts, they should thus include assessment of past-year alcohol use patterns.     

Alcohol and all-cause mortality in Europe 1982-1990: a pooled cross-section time-series analysis

Aim. To test the relationship between alcohol consumption and all-cause mortality. Design. Data: Yearly mortality rates and per capita consumption from 25 European countries between 1982 and 1990. Statistical models. This paper employs time-series cross-sectional data to model the relationships between alcohol consumption and all-cause mortality. The data are derived from 25 European countries in the 1980s. The statistical analyses controlling cross-sectional correlation and timewise autoregression were used to implement the econometric modelling. Findings. Increases (decreases) in the per capita consumption of 1 litre of pure alcohol were associated with increases (decreases) of 1.3% in all-cause mortality rates. The beverage-specific analyses indicated a significant relationship between consumption of beer and all-cause mortality only. Conclusion. The data show that per capita alcohol consumption, according to reported levels in Europe, is related to all-cause mortality and is thus of relevance to public health.     

Survival of black patients with gastric cancer in Soweto, Johannesburg, South Africa

In a series of 39 black gastric cancer patients, treated at Baragwanath Hospital, Soweto, Johannesburg, the time of 50 per cent mortality was 3.5 months, half that of white patients. Patients' median age was lower than that of white patients, 58 versus 70 yr. Male/female ratio was 1.3:1. Black patients presented late; no patients' lesions were at clinical stages I and II, compared with 5-15 per cent reported for white patients. Weight loss, abdominal pain and vomiting were predominant features. Frequencies of smoking and of alcohol consumption in male and female patients appeared much the same as those prevailing in the general population. No marked differences between patients and controls were apparent in socioeconomic state, educational level, general dietary intake, nor in ownership of a refrigerator.     

The economic costs of alcohol-related absenteeism and reduced productivity among the working population of New Zealand

Lost productivity accounts for a significant proportion of the total cost of alcohol. This study quantifies the costs associated with alcohol consumption using survey data collected from four alcohol surveys conducted in Auckland between November 1990 to May 1992. The total sample size was 4662, of which 2638 were drinkers in paid employment. A computer-assisted telephone interviewing system was used to interview a random sample that closely matched the Auckland population. Respondents gave information about their typical alcohol consumption and frequency of absences from paid employment which were a result of their drinking. They also gave a report of the number of times in the past 12 months when they felt their work had been impaired as a result of their drinking. The cost of absenteeism was recorded as the number of times a respondent reported time away from work multiplied by gross income. Estimates of reduced work efficiency were derived from US figures, which estimated a 25% reduction in work performance among heavy alcohol users; 3.7% of the sample reported alcohol-related absences and 12% reported reduced efficiency days. There was a significant difference in both the number and cost of absentee and reduced efficiency days reported between the top 10% and the bottom 10% drinkers. A conservative estimate of alcohol-related lost productivity among the working population of New Zealand (with a population of 3.4 million and a per capita absolute alcohol consumption of 9.7 litres) was found to be $57 million per year.     

Pulmonary function in alcoholics

Twenty-three chronic alcoholics were investigated by means of pulmonary function studies. All 23 patients had respiratory symptoms. Clinically, 21 (91 per cent) of 23 patients were diagnosed as having chronic bronchitis, and 14 patients (60 per cent) had dyspnea. The maximal mid-expiratory flow and single breath diffusing capacity for carbon monoxide (SBDCO) were abnormal in 16 (70 per cent) and 14 (61 per cent) patients, respectively. Twenty-two of 23 patients had one or more abnormal function. The total lung capacity, residual volume, vital capacity, 1 second forced expiratory volume and SBDCO progressively declined with increasing alcohol consumption. An attempt was made to separate the pulmonary effects of alcohol from (1) the effects of previous pulmonary infections, (2) the effects of cigarette smoking, and (3) the effects of cirrhosis of the liver. The data suggest that either alcohol itself through some unknown mechanism may be a causative agent in producing lung disease or that alcohol makes a higher percentage of the population susceptible to the harmful effects of cigarette smoking.     

Recognition of alcoholic liver disease in a district general hospital.

Two-hundred-and-two patients with alcoholic liver disease whose investigations included a liver biopsy were seen in a district general hospital over a seven year period. Thirty-five percent presented with general gastrointestinal symptoms rather than with overt liver disease or previously recognised excess consumption of alcohol. Recognition of the alcohol problem was assisted by the finding of a raised mean corpuscular volume (MCV) and/or gammaglutamyl transpeptidase (GGTP). The use of these methods of detection is discussed in relation to the rapid rise in alcohol consumption in the United Kingdom, and the high mortality of cirrhosis reported from special centres. Twnety-two per cent of the patients were found to have an established cirrhosis, and there was some evidence that the women were more susceptible to some of the toxic effects of alcohol. Early detection can be enhanced by a high level of suspicion, wider recognition of the significance of a high MCV, and the greater use of GGTP estimations.     

Consistency of reported alcohol use by pregnant women: anonymous versus confidential questionnaires with item nonresponse differences

BACKGROUND: Self-report is the best method to attain information about moderate alcohol consumption. However, reported alcohol consumption before and during pregnancy is sensitive to response bias. METHODS: We compared identical questionnaires completed either confidentially or anonymously by pregnant women. A representative half of the pregnant women in Oslo attending ultrasound screening between June 2000 and May 2001 were invited to join a confidential questionnaire study. Another group of pregnant women, selected in the identical manner, were asked to answer the same questionnaire anonymously during the summer of 2001. The questionnaire was completed by 1749 confidentially and 191 anonymously (response rate 93.4% vs 84.4%). For the current study, only women with Scandinavian ethnicity were included: 1707 and 178, respectively. Measures were T-ACE (screening measure for pregnancy risk drinking), reported frequency of alcohol use, Standard Units (SU) per occasion (po), SU per week, and binge drinking (>or=5 SU po), before and during pregnancy. RESULTS: There were no significant differences in reported alcohol consumption between the confidential and the anonymous group for the sample as a whole. Any alcohol consumption was reported by 22.6% and 23.3% during pregnancy week 7-12 and 13+ (confidential group) versus 22.5% and 25.8% (anonymous group). Differences between the groups tended to be larger for SU per week (p=0.07 both before pregnancy and after week 12 of pregnancy) than for the indirect alcohol (T-ACE) and the binge drinking questions. In the confidential group, the women with lower education had close to twice as high item nonresponse on the direct alcohol questions during pregnancy compared with those with higher education. This difference was smaller in the anonymous group. The rate of smoking was not reported differently in the anonymous group. CONCLUSIONS: Among pregnant women, there was no significant difference in self-reported alcohol consumption obtained by confidential or anonymous questionnaires.