Age,Alcohol Consumption and the Experiencing of Negative Consequences of Drinking in Four Scandinavian Countries1

Based on data from a comparative survey of drinking in four Scandinavian countries (Finland, Iceland, Norway and Sweden), use of alcohol and negative consequences of drinking were studied in relation W age. Clear differences were found between age-groups as regards experiencing such negative consequences in respect of both men and women. These differences were to a large extent a reflection of similar differences between the age-groups in regard to alcohol consumption and intoxication frequency. However, it was also found that when both alcohol consumption and intoxication frequency were maintained at a constant level, age in itself seemed to influence the experiencing of negative consequences. The study also indicates that in all age-groups there are national differences in drinking patterns and thus in the experiencing of negative consequences of drinking which do not reflect the national differences in total alcohol consumption.     

The experiencing of positive consequences of drinking in four Scandinavian countries1

Based on data from a comparative survey of drinking in four Scandinavian countries (Finland, Iceland, Norway and Sweden), the experiencing of positive consequences of drinking was studied in relation to alcohol consumption, intoxication frequency and the experiencing of negative consequences of drinking. In all four countries a substantial portion–both of the men and of the women–reported having experienced various positive effects of drinking during the last 12 months. The positive consequences clearly correlated with yearly alcohol consumption and even more with intoxication frequency. A strong link between the experiencing of positive and negative consequences of drinking was also found. The study also indicates that there are national differences in the experiencing of positive consequences of drinking which do not reflect the national differences in total alcohol consumption.     

Trauma in Cirrhosis: An Indicator of the Pattern of Alcohol Abuse in Different Societies

While some morbidities associated with the excessive use of alcohol are related to the total amount of alcohol consumed--cirrhosis being an example--other pathologies, such as trauma and those of psycho-social origin, are mainly related to the frequency of acute alcoholic intoxication rather than to the total amount consumed. The balance between these two types of alcohol-associated morbidities can provide an indication of the relative frequency of intoxication, and thus of the pattern of alcohol abuse in a population. Since trauma is highly associated with acute alcoholic intoxication, the prevalence of bone fractures was determined in cirrhotics in nine countries. The prevalence of rib and vertebral fractures on routine chest x-rays showed a 17-fold variation in the different countries, from 2% and 6% in Spain and Italy to 30% and 34% in Canada and the USA, suggesting marked differences in the pattern of alcohol abuse to intoxication. Conversely, the prevalence of cirrhosis is twice as high in Spain and Italy than in Canada and the USA. A strong positive correlation between per capita consumption and cirrhosis mortality (r = 0.86; p less than 0.01) exists among the nine countries studied, while the correlation between per capita alcohol consumption and the prevalence of trauma is not statistically significant (r = 0.40). Supporting a strong association between trauma and alcoholic intoxication, the prevalence of trauma was found to be highly correlated: r = 0.88, p less than 0.002, with the degree of concern for the psycho-social consequences of alcohol abuse in the different countries. Data indicate that trauma can be used as an objective indicator to assess the pattern of alcohol abuse in a population.     

Episodic heavy drinking in four Nordic countries: a comparative survey

Aims . The purpose of this study was to compare the phenomenon of episodic heavy drinking (binge drinking) and its different indicators in the Nordic countries.
Design . A comparative survey of four Nordic countries.
Setting . Telephone interviews in Denmark, 1997; Finland, 1996; Norway, 1996; and Sweden 1996-97.
Participants . Random samples of men and women aged 19-71 years.
Measurements . Episodic heavy drinking was measured by the frequency of subjective intoxication, of drinking six or more drinks at a time (6+), and of negative consequences (mainly hangover symptoms). Additionally, annual consumption and measures of intake per occasion were used.
Findings . Annual consumption, overall frequency of drinking and frequency of drinking 6+ were highest in Denmark and lowest in Norway. Frequency of subjectively defined intoxication was highest in Finland. There it was clearly higher than the frequency of drinking 6+, whereas in Denmark the contrary was observed. Finnish and Norwegian men and Danish women reported the largest quantities drunk per occasion. Results on 6+ frequency and the prevalence of negative consequences, with annual consumption held constant, suggest that Danes have the least concentrated drinking pattern. With annual consumption held constant, Norwegians report as high a frequency of intoxication, as do Finns.
Conclusions . The relations between subjective and more objective measures of episodic heavy drinking vary considerably between the Nordic countries. The results suggest that the definition, acceptability and experience of intoxication vary even when a set of relatively homogeneous countries are compared.     

Intoxication after an Acute Dose of Alcohol: An Assessment of Its Association with Alcohol Consumption Patterns By using Twin Data

We examined the hypothesis that genetically determined differences in sensitivity to alcohol explain some of the genetic variation in alcohol consumption pattern. Self-report data on average weekly alcohol consumption and self-ratings of intoxication after a standard dose of ethanol (0.75 g/kg body weight), used as an index of sensitivity, were obtained on 206 Australian twin pairs. Significant genetic covariance between weekly consumption and level of intoxication after alcohol intake was found in males, lower ratings of intoxication being associated with increased consumption. However, when direction of causation models were fitted to the male twin data, the hypothesis that decreased sensitivity was a cause of increased consumption was rejected. The major causal effect was that of weekly consumption on level of sensitivity. A similar, although nonsignificant, trend was observed in females. The strength of the association between self-report of average weekly consumption and level of intoxication after a standard dose of alcohol supports the validity of the former measure.     

Alcohol drinking pattern and subjective health in a population-based study

AIMS: Some patterns of alcohol consumption (e.g. binge drinking, drinking outside of meals) have been associated with detrimental effects on health outcomes. Subjective health provides a global assessment of health status and is a strong predictor of total mortality; however, little is known about its relationship with alcohol drinking pattern. The association between several drinking patterns (i.e. drinking intensity and frequency, frequency of intoxication, drinking outside of meals, and beverage type) and subjective health was examined in a random sample of 3586 women and men. DESIGN: A population-based cross-sectional study. METHODS: Subjective health was assessed using the physical and mental health component summaries of the Short Form-36 health survey questionnaire. Alcohol consumption refers to the 30 days before the interview. Analysis of covariance compared gender-specific mean scores across alcohol drinking patterns. FINDINGS: Overall, non-current drinkers reported poorer physical and mental health than life-time abstainers and current drinkers, while no consistent differences were found between life-time abstainers and current drinkers. In female current drinkers, daily drinking, beer and mixed beverage consumption were associated with better mental health. In male current drinkers, moderate alcohol consumption (2-2.9 drinks per day), wine and mixed beverage consumption were associated with better physical health. Intoxication and liquor consumption were associated with poorer mental health in women and poorer physical health in men. No consistent associations were found for drinking outside meals. CONCLUSIONS: Aspects of drinking pattern may affect subjective health differentially in women and men. Overall, intoxication and liquor drinking are associated with poorer self-perceived health status than regular, moderate consumption of other alcoholic beverages.     

Alcohol Advertising,Consumption and Abuse: a covariance-structural modelling look at Strickland's data ⋆

Re-analysis employing covariance-structural models was conducted on Strickland's (1983) survey data on 772 drinking students from Grades 7, 9 and 11. These data bear on the relations among alcohol consumption, alcohol abuse, association with drinking peers and exposure to televised alcohol advertising. Whereas Strickland used a just-identified model which, therefore, could not be tested for goodness of fit, our re-analysis tested several alternative models, which could be contradicted by the data. One model did fit his data particularly well. Its major implications are as follows: (1) Symptomatic consumption, negative consequences and self-rated severity of alcohol-related problems apparently reflect a common underlying factor, namely alcohol abuse. (2) Use of alcohol to relieve distress and frequency of intoxication, however, appear not to reflect abuse, although frequent intoxication contributes substantially to it. (3) Alcohol advertising affects consumption directly and abuse indirectly, although peer association has far greater impact on both consumption and abuse. These findings are interpreted as lending little support to further restrictions on advertising.     

Problems Associated with Average Alcohol Consumption and Frequency of Intoxication in a Medical Population

The relationship between patterns of alcohol consumption and adverse consequences of drinking was examined in a cross-sectional study of hospital patients. Regular drinking that exceeds 40 g per day by males and 25 g per day by females was found to increase significantly the risk of a variety of alcohol-related medical and psychosocial problems. Similarly, frequent consumption of six or more drinks per occasion significantly increased the risk of problems for both men and women. Among males elevated average daily consumption contributed more to alcohol-related problems than frequency of intoxication, while the opposite was true for females. These results indicate that the frequency and amount of alcohol consumption are important risk factors for both nonalcoholics and alcoholics, and that measures of drinking pattern may be useful for screening purposes.     

The Preoccupation with Alcohol Scale: Development and Validation

The purpose of the present study was to develop a psychometrically sound measure of preoccupation with alcohol in a group of young, heavy drinking men and to examine some correlates of this drinking style. A brief Preoccupation with Alcohol Scale (PAS) was derived that exhibited substantial internal consistency. Data from a sample of the 67 males indicated that higher PAS scores were significantly related to alcohol consumption and frequency of intoxication within many different contextual circumstances. The PAS was also related to alcohol problems after controlling for average daily alcohol consumption and frequency of intoxication, suggesting that scores on the PAS are related to, but not redundant with, level of alcohol consumption. Results from a cross-validation sample provided additional support for these findings. The authors suggest that a preoccupation with alcohol may be a cognitive-behavioral risk factor for the development of severe alcohol problems and alcoholism.     

Alcohol-related negative consequences among drinkers around the world

Aims This paper examines (i) gender and country differences in negative consequences related to drinking; (ii) relative rates of different consequences; and (iii) country‐level predictors of consequences. Design, setting and participants Multi‐level analyses used survey data from the Gender, Alcohol, and Culture: An International Study (GENACIS) collaboration. Measurements Measures included 17 negative consequences grouped into (i) high endorsement acute, (ii) personal and (iii) social. Country‐level measures included average frequency and quantity of drinking, percentage who were current drinkers, gross domestic product (GDP) and Human Development Index (HDI). Findings Overall, the three groupings of consequences were reported by 44%, 12% and 7% of men and by 31%, 6% and 3% of women, respectively. More men than women endorsed all consequences, but gender differences were greatest for consequences associated with chronic drinking and social consequences related to male roles. The highest prevalence of consequences was in Uganda and lowest in Uruguay. Personal and social consequences were more likely in countries with higher usual quantity, fewer current drinkers and lower scores on GDP and HDI. However, significant interactions with individual‐level quantity indicated a stronger relationship between consequences and usual quantity among drinkers in countries with lower quantity, more current drinkers and higher scores on GDP and HDI. Conclusions Both gender and country need to be taken into consideration when assessing adverse drinking consequences. Individual measures of alcohol consumption and country‐level variables are associated with experiencing such consequences. Additionally, country‐level variables affect the strength of the relationship between usual quantity consumed by individuals and adverse consequences.     

Positive and negative consequences of alcohol drinking among young university students in Finland

In a sample of 1663 female and 707 male Finnish university students in their first study year, the female students reported less negative and less positive consequences of alcohol drinking than their male counterparts. The female students also drank less, less frequently and less often for intoxication. However, the profile of negative and positive consequences of drinking was similar for both genders; 74.6% of the female students and 80.0% of the males had more positive than negative experiences from alcohol. Both the positive and negative consequences of drinking correlated positively to alcohol consumption and drinking for intoxication. About half of the students who had many positive consequences of drinking were not heavy drinkers and did not report many negative consequences. Depression, anxiety, stress or psychosomatic symptoms did not correlate with either with positive or negative consequences of drinking, nor with alcohol consumption. Drinking for anxiety, depression, stress or the reduction of tension appeared to be infrequent. Young Finnish university students mostly drink for the positive consequences of drinking.     

Alcohol Consumption and Ischemic Heart Disease: Some Evidence from Population Studies*

Spatial correlations for a series of countries in each of three years, and for the states of the U.S.A. in one year, confirmed previous reports of a negative association between mortality from ischemic heart disease (IHD) and per capita alcohol consumption, and of a positive association between the latter and liver cirrhosis mortality. A temporal analysis of the same variable for each of 19 countries gave results consistent with the well-established consumption-cirrhosis relationship but inconsistent with the postulated ‘protective’ effect of alcohol consumption on IHD. For consumption and cirrhosis there were 18 highly significant positive coefficients, while for IHD and consumption, 13 were positive and 6 negative, and 8 out of 19 were not significant. These results did not appear to be attributable either to the absence of adjustment for the effect of the 8th revision of the International Classification of Diseases or to the lack of a time lag in the consumption data. The difference in the findings of the spatial and temporal analyses suggests that the association between IHD mortality and alcohol consumption in general populations is dependent upon variation in a third as yet unidentified factor. Such a factor would be expected to correlate with alcohol consumption cross-nationally but remain more or less constant through time in any given country. Certain food habits appear to have this characteristic.     

Alcohol use and negative consequences among American college students in West Germany.

Numerous investigations have recently focused on the prevalence and causes of problem drinking among American college students. The present study examined alcohol consumption and negative consequences due to drinking among 216 American college students at an American university in West Germany. American students in Germany reported a substantially higher frequency and amount of drinking, along with higher rates of negative consequences as compared to their stateside peers. The data are discussed in terms of the relationship between the American collegiate life-style of alcohol abuse and life in an alcohol-permissive society. Recommendations for changing the collegiate norm of alcohol abuse are presented.     

Smoking and Intoxication after Alcohol Challenge in Women and Men: Genetic Influences

In an earlier analysis, men and women who were current or former smokers were found to report feeling less intoxicated on average than nonsmokers after ingestion of a challenge dose of alcohol. Here, we examine whether differences in subjective response to alcohol and a tendency to smoke cigarettes are transmitted together in families; and, if so, whether this association might be entirely explained by the same heritable factors that influence alcohol intake (as we might expect if both smoking and subjective intoxication are influenced by some general susceptibility for substance use). Alcohol challenge data on 388 Australian male and female twins (194 complete pairs) were reanalyzed using multivariate genetic analysis to evaluate the association between cigarette smoking and self-report intoxication after a standard dose of alcohol. In women, we could not reject the hypothesis of complete genetic overlap between effects on intoxication rating and history of smoking, and a significant residual genetic correlation between smoking and postalcohol intoxication persisted even when genetic influences on alcohol consumption were controlled for. In men, the familial association seemed to be largely environmentally mediated and associated with differences in drinking history. These findings prompt the question of whether, in some individuals, cigarette smoking may contribute to the development of tolerance to the effects of alcohol.     

Predictors and outcomes of variability in subjective alcohol intoxication among college students: an event-level analysis across 4 years

Background: Individual differences in subjective alcohol intoxication, as measured by laboratory‐based alcohol challenge, have been identified as a phenotypic risk factor for alcohol use disorders. Further, recent evidence indicates that subjective alcohol response is also associated with event‐level physiological consequences among college students, including blackouts and hangovers. Methods: The current investigation tested predictors of and outcomes associated with subjective intoxication in the natural drinking environment. In a preliminary laboratory alcohol‐challenge study (n = 53), we developed a brief measure of subjective alcohol intoxication for use in event‐level research. Participating students in the principal study (n = 1,867; 63% women; 54% Caucasian) completed 30 days of Web‐based self‐monitoring in each of the 4 college years. Results: In the principal study, generalized estimating equation analyses revealed that both lighter drinking and a family history of alcohol problems predicted greater subjective intoxication after accounting for estimated blood alcohol concentration (eBAC). Moreover, greater subjective intoxication during a given drinking episode was associated with negative alcohol‐related consequences, illicit drug use, and unsafe sex, and at higher eBACs, was associated with aggression, sex, and property crime. Students who on average experienced greater subjective intoxication were also more likely to experience negative consequences and engage in illicit drug use, sex, unsafe sex, and aggression. Conclusions: These findings suggest that both within‐person variability and between‐person individual differences in subjective intoxication may be risk factors for adverse drinking outcomes at the event level. Intervention efforts aimed at reducing problems associated with collegiate drinking may benefit from consideration both of who experiences greater subjective intoxication and of the situations in which they are more likely to do so.     

Alcohol consumption in the European Community: uniformity and diversity in drinking patterns

Within the European Community (EC) drinking patterns in the southern countries can be characterised by daily consumption of wine at meals, and in the northern countries by less frequent consumption of beer outside meats. Yet, as in past decades in the southern countries beer consumption and in the northern countries mine consumption strongly increased, the question is whether the distinction in drinking patterns still applies. This paper (1) describes for each country of the EC total alcohol consumption, (2) examines the frequency and the context of consumption of the new beverage type and (3) analyses whether subpopulations, defined by sex, age and educational level, differ m the adoption of the new beverage type. In all countries wine is consumed more often at meals compared to beer. Older people consume beer in greater numbers and more frequently than younger people, who consume beer in greater numbers. People of higher educational level consume the new beverage type mare often compared to people of lower educational level, who consume the traditional beverage type more frequently. Finally, males and females differ less in the frequency of consumption of the new beverage type than in the frequency of the traditional beverage type.     

Alcohol control policies and alcohol consumption by youth: a multi-national study

Aims The study examined relationships between alcohol control policies and adolescent alcohol use in 26 countries. Design Cross‐sectional analyses of alcohol policy ratings based on the Alcohol Policy Index (API), per capita consumption and national adolescent survey data. Setting Data are from 26 countries. Participants Adolescents (aged 15–17 years) who participated in the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) or national secondary school surveys in Spain, Canada, Australia, New Zealand and the United States. Measurements Alcohol control policy ratings based on the API; prevalence of alcohol use, heavy drinking and first drink by age 13 based on national secondary school surveys; per capita alcohol consumption for each country in 2003. Analysis Correlational and linear regression analyses were conducted to examine relationships between alcohol control policy ratings and past 30‐day prevalence of adolescent alcohol use, heavy drinking and having first drink by age 13. Per capita consumption of alcohol was included as a covariate in regression analyses. Findings More comprehensive API ratings and alcohol availability and advertising control ratings were related inversely to the past 30‐day prevalence of alcohol use and prevalence rates for drinking three to five times and six or more times in the past 30 days. Alcohol advertising control was also related inversely to the prevalence of past 30‐day heavy drinking and having first drink by age 13. Most of the relationships between API, alcohol availability and advertising control and drinking prevalence rates were attenuated and no longer statistically significant when controlling for per capita consumption in regression analyses, suggesting that alcohol use in the general population may confound or mediate observed relationships between alcohol control policies and youth alcohol consumption. Several of the inverse relationships remained statistically significant when controlling for per capita consumption. Conclusions More comprehensive and stringent alcohol control policies, particularly policies affecting alcohol availability and marketing, are associated with lower prevalence and frequency of adolescent alcohol consumption and age of first alcohol use.     

Alcohol and Self-Rated Health in a Mediterranean Country: The Role of Average Volume, Drinking Pattern, and Alcohol Dependence

Background: The association between average alcohol consumption and self‐rated ill‐health is “J‐shaped” in Scandinavian and Anglo‐Saxon countries, but it has shown an inverse linear relationship in the few studies conducted in Mediterranean countries, based on average volume solely. Objective: To examine the relationship between alcohol and self‐rated health in the general population of a Mediterranean country, by simultaneously taking into account average volume, drinking pattern, and alcohol abuse. Methods: From 2000 to 2005, we conducted telephone interviews on 12,037 persons, representative of the population aged 18 to 64 years in Madrid, Spain. The drinking pattern encompassed binge drinking, beverage preference, and drinking at mealtimes. Alcohol abuse was estimated by the CAGE test. The association between each alcohol‐related variable and self‐rated suboptimal (fair, poor, or very poor) health was estimated from logistic regression, with adjustment for the remaining alcohol‐related variables and other potential confounders. Results: In comparison with never‐drinkers, suboptimal health was less frequent among occasional drinkers [odds ratio (OR) 0.72; 95% confidence interval (CI): 0.61 to 0.86], average moderate drinkers (OR 0.57; 95% CI: 0.48 to 0.69), and excessive drinkers (OR 0.51; 95% CI: 0.36 to 0.72), but more frequent among former drinkers with ≥1 year of abstinence (OR 1.30; 95% CI: 1.03 to 1.64). Frequency of suboptimal health was likewise higher in subjects with ≥3 episodes of binge drinking (OR 1.55; 95% CI: 1.12 to 2.14) or alcohol abuse (OR 1.47; 95% CI: 1.22 to 1.76). No differences were observed in suboptimal health according to beverage preference or drinking at mealtimes. Results in each gender were similar to those for total study participants. Conclusions: Occasional, moderate, and excessive consumption of alcohol are associated with better self‐rated health, even after adjustment for drinking pattern and alcohol abuse. In contrast, former‐drinking, frequent binge drinking, and alcohol abuse are all associated with suboptimal self‐rated health.     

Alcohol consumption on pancreatic diseases

Although the association between alcohol and pancreatic diseases has been recognized for a long time,the impact of alcohol consumption on pancreatitis and pancreatic cancer(PC)remains poorly defined.Nowadays there is not consensus about the epidemiology and the beverage type,dose and duration of alcohol consumption causing these diseases.The objective of this study was to review the epidemiology described in the literature for pancreatic diseases as a consequence of alcoholic behavior trying to understand the association between dose,type and frequency of alcohol consumption and risk of pancreatitis and PC.The majority of the studies conclude that high alcohol intake was associated with a higher risk of pancreatitis(around 2.5%-3% between heavy drinkers and 1.3%between non drinkers).About 70%of pancreatitis are due to chronic heavy alcohol consumption.Although this incidence rate differs between countries,it is clear that the risk of developing pancreatitis increases with increasing doses of alcohol and the average of alcohol consumption vary since 80 to 150 g/d for 10-15 years.With regard to PC, the role of alcohol consumption remains less clear,and low to moderate alcohol consumption do not appear to be associated with PC risk,and only chronic heavy drinking increase the risk compared with lightly drinkers.In a population of 10%-15%of heavy drinkers, 2%-5%of all PC cases could be attributed to alcohol consumption.However,as only a minority(less than 10%for pancreatitis and 5%for PC)of heavily drinkers develops these pancreatic diseases,there are other predisposing factors besides alcohol involved.Genetic variability and environmental exposures such as smoking and diet modify the risk and should be considered for further investigations.     

Alcohol and pancreatitis mortality at the population level: experiences from 14 western countries

Aims To test if there is relationship between alcohol consumption and pancreatitis mortality at the population level. Data and methods Annual pancreatitis death rates for 1950–95 were converted into age‐adjusted mortality rates per 100 000 inhabitants. Per capita alcohol consumption was measured by alcohol sales. The relationship was estimated with time‐series analysis on data from 14 western countries. Several models were tested with different assumptions about risk function and lag structure. Results According to the assumed most appropriate model, a positive relationship was found in each country, and statistical significance was reached in all countries except from Finland, Italy and Canada. The magnitude of the association was fairly consistent across countries, with the alcohol effect parameters ranging between 0.05 and 0.14. However, Sweden and Norway deviated from this pattern with estimates between 0.30 and 0.40. Conclusions Pancreatitis joins a wide range of causes of death where the mortality rate is influenced by per capita alcohol consumption, and more so in northern Europe. It is suggested that pancreatitis mortality is an important indicator of alcohol‐related harm, not least because a large amount of morbidity is likely to be connected to the mortality rate.