Drinking habits and prevalence of heavy drinking among primary health care outpatients and general population

Aims. To identify the target group for brief alcohol intervention in primary health care and to compare the prevalence of heavy drinking in two different primary health care populations and the general population in the same geographical area. Design. Drinking data were collected from outpatients of primary health care by a questionnaire containing the CAGE test and quantity-frequency alcohol consumption questions and from a sample of the general population by a telephone survey, including the CAGE. The index of heavy drinking was for men three, and for women two, affirmative answers in CAGE which though not specifically a consumption questionnaire is a good marker of heavy drinking. Setting. Two different primary health care populations (primary health care clinic and occupational health care clinic) and the general population in a Finnish health care area. Participants. Consecutive 1861 primary health care clinic and 2942 occupational health care clinic outpatients and 544 randomly selected adults in the general population, contacted by telephone. Findings. The primary health care clinic patients drank significantly more per occasion than the patients of the occupational health care clinic (75 vs. 66 g. in men; 33 vs. 27 g. in women) and fewer times per week (0.8 vs. 0.9 in men; 0.5 vs. 0.6 in women). The patients in the primary health care clinic also reported drinking more per week (76 vs. 67 g. in men; 23 vs. 19 g. in women); among women the difference was significant. Among men the prevalences of heavy drinking in the primary health care clinic, occupational health care clinic and general population were 20%, 17% and 16%, respectively ( p 0.05). Among women the corresponding figures were 9%, 6% and 13% ( p 0.05). Conclusions. The high prevalence of heavy drinking found in the study confirms the importance of brief intervention by general practitioners. The study also indicates that prevalence and drinking habits depend on the type of clinic and heavy drinkers in general may not be over-represented in primary health care. This study raises the question, especially among women, of how to reach and to provide health advice to those heavy drinkers who do not attend primary health care facilities.     

Effectiveness of structured questionnaires for screening heavy drinking in middle-aged women

BACKGROUND: There is a need for an effective and feasible alcohol screening instrument. The aim of the study was to evaluate how the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire perform in comparison with the original AUDIT and what the optimal cutoffs are when screening for heavy drinking among women. METHODS: All the 40-year-old women in the city of Tampere, Finland, are invited yearly for a health screening. From 1 year, data from 894 women (response rate 68.2%) invited for a health screening were utilized in the study. The original 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, AUDIT-3, AUDIT-QF, and CAGE were evaluated against the Timeline Followback. Consumption of at least 140 g of absolute ethanol per week on average during the past month was considered heavy drinking. RESULTS: In the Timeline Followback, the mean+/-SD weekly reported alcohol consumption was 45+/-67 g (range 0-936 g) of absolute ethanol. Of the women, 6.2% (55/894) were heavy drinkers. The optimal combination of sensitivity and specificity was reached for the AUDIT with cutoff > or =6, for the AUDIT-C with cutoff > or =5, for the Five Shot with cutoff > or =2.0, for the AUDIT-PC with cutoff > or =4, and for the AUDIT-QF with cutoff > or =4. When choosing the optimal cutoffs, the AUDIT-C, the Five Shot, the AUDIT-PC, and the AUDIT-QF performed as well as the 10-item AUDIT. With these cutoffs, sensitivities were 0.84 to 0.93 and specificities were 0.83 to 0.90. The AUDIT-3 and the CAGE did not perform as well as the other questionnaires. CONCLUSIONS: The 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, and AUDIT-QF seem to be equally effective tools in screening for heavy drinking among middle-aged women. However, their applicability is achieved only if the cutoffs are tailored according to gender.     

Drinking contexts and drinking problems among black and white women

This study explored whether black and white women differ in how often they drink in particular types of social settings and if drinking in different contexts independently predicts alcohol-related problems. The analysis was based on the interview responses of 635 black and 663 white women drinkers who represent sub-samples from a nationwide survey of 5221 respondents conducted in 1984. The findings revealed that white women are more likely to attend restaurants, bars and parties away from home than black women and that a larger proportion of their alcohol consumption occurs in these settings than among black women. Factor analysis was used to develop scales on the the frequency of drinking in different social contexts. The results confirmed a three-dimensional factor structure that distinguished between drinking at home; drinking in social settings such as bars, restaurants and parties; and drinking in outdoor public areas like street comers and parks. A simultaneous equations path analysis was used to model the relationships among drinking contexts, the frequency of heavier drinking, drinking problems, race and other social characteristics. The major findings of the resulting models were that drinking contexts independently predict drinking problems and that race is not directly associated with drinking contexts or alcohol-related problems. However racial differences do exert significant indirect effects on social settings and drinking problems through differences in socio-economic status and normative attitudes. The conclusion emphasizes the complexity of the interrelationships of ethnic and social characteristics that underlie visible racial differences in the social patterns and situational contexts of alcohol use.     

Time trends in heavy drinking among middle-aged and older adults in Denmark

Background:  Studies have indicated an increasing proportion of heavy drinking among middle-aged and older Danes. Trends in consumption are often extremely sensitive to influence from various components of the time trends but only few have explored the age, period and cohort-related influences on late life alcohol consumption. By using age, period, and cohort modeling this study explores the time trends in heavy drinking.
Methods:  Data derive from five National Health and Morbidity Surveys conducted by the Danish National Institute of Public Health in 1987, 1994, 2000, 2003, and 2005. A total of 15,144 randomly selected Danes between the age of 50 and 74 were interviewed about their alcohol intake on the last weekday and their alcohol intake in the last week. By applying the age-period-cohort model the probability of heavy alcohol drinking is estimated to separate the influence of age, period (calendar time) and cohort (year of birth).
Results:  The unadjusted probability of heavy drinking declines by age and increases by calendar year and year of birth for both men and women. However, the negative effect of age is attenuated for women when adjusted for birth cohort, indicating that the proportion of heavy drinking women increases in younger birth cohorts. This trend is not observed for men as their drinking pattern mainly increase slightly by calendar year.
Conclusions:  Our Danish observations for older aged individuals correspond to the social and cultural changes in the 1960s and 1970s that possibly have affected the drinking behavior of the cohorts. Time trend analyses, such as this may serve as an excellent opportunity to extrapolate and forecast alcohol mortality and morbidity.     

Drinking pattern and mortality in middle-aged men and women

Aims To address the prospective association between alcohol drinking pattern and all‐cause mortality. Design Population‐based cohort study conducted between 1993 and 2003. Setting Denmark. Participants A total of 26 909 men and 29 626 women aged 55–65 years. Measurements We obtained risk estimates for all‐cause mortality for different levels of quantity and frequency of alcohol intake adjusted for life‐style factors, including diet. Findings During follow‐up, 1528 men and 915 women died. For the same average consumption of alcohol, a non‐frequent intake implied a higher risk of death than a frequent one. Conclusions Drinking pattern and not just the total amount of alcohol consumed is important for the association between alcohol intake and mortality. These results suggest that future public guidelines concerning sensible alcohol drinking should include messages about drinking pattern together with quantity of alcohol.     

The relationship between gallbladder disease and smoking and drinking habits in middle-aged Japanese

Background: Background: Few studies have investigated the association between smoking and ultrasonographically diagnosed gallbladder (GB) disease, and their results were uncertain. This study was conducted to examine the association between smoking and drinking and GB diseases. Methods: A total of 9947 subjects (age, 30–69 years; 4953 men and 4994 women) voluntarily received a paid medical check-up at our center in Yamanashi Prefecture in Japan. All of the subjects underwent abdominal ultrasonographic (US) examination, a demographic check, and a biochemical test, and answered a self-administered questionnaire asking about smoking habits and alcohol consumption. Of the 9947 subjects, 483 had gallstones, 819 had gallbladder polyps, and 169 were in a state of postcholecystectomy. We compared the findings in this group with the findings in 8417 people (4144 males and 4273 females) with normal gallbladder. Results: Multiple regression analysis among males showed that cigarette smoking was inversely related to GB polyps (odds ratio, [OR], 0.76; 95% confidence internal [CI], 0.59–0.98 and OR, 0.74; 95% CI, 0.56–0.98, respectively, for current and ex-smokers). Ex-smokers a showed positive association with the postcholecystectomy state (OR, 2.56; 95% CI, 1.18–5.52). Light drinkers showed an inverse relation to GB stones (OR, 0.69; 95% CI, 0.49–0.99), and heavy drinkers showed an inverse relation to GB polyps (OR, 0.68; 95% CI, 0.51–0.90). Current drinkers showed an inverse relation to the postcholecystectomy state (OR, 0.48; 95% CI, 0.28–0.83). Conclusions: Cigarette smoking was inversely related to gallbladder polyps in males and was positively related to the postcholecystectomy state. Drinking was inversely related to gallstones, GB polyps, and the postcholecystectomy state in males. Received: July 19, 2001 / Accepted: November 2, 2001     

Drinking habits of elderly Chinese

A random sample of 612 elderly Chinese was interviewed on their drinking habits. About 36.5% never drank, 50.3% drank less than once a month, 10% between one and three times a month, and 3.2% four or more times a week. Only two subjects had symptoms of mild alcohol dependence with SADQ scores of 10 and 12, and another two had alcohol-related gastritis.     

Trends in drinking habits among Finnish adolescents from 1977 to 1999

Aims. Trends in adolescent drinking habits in Finland from 1977 to 1999 are studied with special attention to the onset of problem use and gender differences. Design and setting. Biennial cross-sectional mailed surveys (Adolescent Health and Lifestyle Survey). Participants. Representative samples of 12, 14, 16 and 18-year-olds. The number of respondents varied from 2832 to 8390 and the response rate from 88% to 76%. Measurements. The frequencies of alcohol use and perceived drunkenness obtained from self-administered questionnaires. Findings. Alcohol use remained rare among 12-year-olds. The overall trends in the frequencies of alcohol use and drunkenness increased considerably over time among the 14-18-year-olds. Age-adjusted monthly drunkenness among 14, 16 and 18-year-olds rose from 13% (1981) to 27% (1999) among boys and 6% to 22% among girls. Throughout the study period, the drinking style among boys became more drunkenness-orientated with age, but the opposite was true among girls. Birth cohort investigation showed that the onset of drunkenness moved towards an earlier age. Earlier onset predicted higher prevalence of problem use at the age of 18. Boys developed a regular pattern of drunkenness steadily increasing between ages 14-18 while among girls the increase of drunkenness started to level off between ages 16 and 18. Conclusions. Alcohol use among 12-year-olds remained rare, but became more prevalent and drunkenness-orientated among 14-18 year-olds. Gender differences in problem use diminished. Nevertheless, notable differences persist in the onset and development of drunkenness-orientated use.     

Drinking reasons, drinking locations, and automobile accident involvement among collegians

Multiple regression analysis was used to examine the relationship of five drinking reason factors to drinking locations and consumption variables within a random sample of drinking college students surveyed by telephone. Hypotheses relating self-reported accident involvement after drinking and two specific reason factors - Opposite Sex/Drunkenness and Pleasure - were tested. Both Pleasure and Opposite Sex/Drunkenness were directly related to quantity consumed and to drinking in several away-from-home locations. Opposite Sex/Drunkenness reasons and frequency of drinking in cars significantly contributed to identifying males who reported accident involvement following drinking.     

Alcohol use and abuse: heavy drinking among methadone clients

This paper discusses alcohol use among methadone maintenance clients and narcotics users not in treatment. The data are derived from the Tri-State Ethnographic Project, a study of four methadone maintenance clinics in three states. Data indicate that methadone clients consume more alcohol than comparable age groups in the general population, but not more alcohol than narcotics users not in treatment. For a portion of the treatment population, however, heavy drinking presents significant problems. Sixteen percent of the treatment sample were found to be abusive pattern drinkers; that is, persons who report not only drinking heavily but also spending a great deal of time hanging out on the street, getting high, and consuming many other additional drugs. These abusive pattern drinkers reflect a pattern of polydrug use which began in their early teens and report multiple unsuccessful treatment attempts.     

Drinking styles and drinking problems

Little research has focused on the range of drinking styles within a particular society. The intent of this study was to continue the development of an empirical typology of drinking behavior by replicating and extending the results of two previous projects. The earlier work had looked mainly at "normal" drinking, while this study placed more emphasis on types of problem drinking and on the relationships among various types of "normal" and "problem" drinking. The data were taken from a 1979 national probability sample of the adult population of the United States, with 1,169 cases classified as current drinkers. The results clearly showed that a variety of drinking styles exist, regardless of whether one is concerned with "normal" or "pathological" drinking. More importantly, certain types of "normal" drinking and types of comportment while drinking were powerful predictors of "problem" drinking.     

Drinking and driving: drinking patterns and drinking problems

Two perspectives guide examinations of alcohol-related injury; studies of drinking behaviors which characterize the activities in which drinkers participate, and studies of drinking patterns which characterize individuals' likelihoods of intoxication. This paper presents a study of self-reported drinking and driving using both perspectives. A theoretical model of the relationships of drinking patterns and drinking behaviors to drinking and driving is derived. This model is used as the basis for analyses of self-reports of driving after drinking and driving while intoxicated. Using cross-sectional data from a study of alcohol-related injury in the United States, these self-reports were related to measures of respondent socio-demographics, drinking patterns, beverage preferences and routine activities. The results showed: (1) that the drinking pattern measures were significantly related to likelihoods of drinking and driving; (2) these measures were superior to alternate measures of drinking patterns in their ability to explain drinking and driving; (3) the measures of beverage preferences were unrelated to either measure of drinking and driving; and (4) that the utilization of certain venues for drinking (bars and restaurants) was significantly related to both measures of drinking and driving. It is concluded that observed socio-demographic differences in drinking and driving (e.g. related to ethnicity and marital status) are due to related differences in drinking patterns and drinking behaviors.     

The epidemiology of drinking among women of child-bearing age

OBJECTIVES: To estimate the prevalence of drinking, binge drinking (4 or more drinks), and alcohol abuse and dependence and to identify predictors of heavier drinking among women of child-bearing age (18-44 years). METHODS: Subjects are part of a national multistage random sample from the 2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). RESULTS: Binge drinking, abuse, and dependence are higher in younger (<30 years) pregnant and nonpregnant women. Among pregnant women, binge drinking is highest among Whites; alcohol abuse and dependence rates are relatively low and similar in all racial/ethnic groups. Among nonpregnant women, Whites and mixed race women have the highest rates of binge drinking. Alcohol abuse and dependence are highest among Native Hawaiian/Pacific Islanders, followed by Native American/Alaska Native women. Women who are White, younger (21-29 years), single, or cohabiting and with a higher income (> 40,000 US dollars) are at a higher risk for heavier drinking. CONCLUSIONS: Drinking and heavier drinking remain at high levels among women of child-bearing age. Prevention efforts must be comprehensive and should target pregnant women who are drinking and those who could become pregnant and are drinking at high-risk levels.     

Drinking reasons, alcohol consumption levels, and drinking locations among drunken drivers

In a DUI offender sample, four drinking reason factors are regressed on alcohol consumption variables and frequency of drinking in seven types of locations. Drinking for "pleasure" and "opposite sex/drunkenness" reasons are associated with both quantity consumed per occasion and away-from-home locations such as automobiles, bars, and parties, suggesting high traffic accident risk. "Escapism" reasons are related to quantity consumed per occasion, but are only weakly associated with specific locations; and "sociability" reasons are associated with drinking in friends' homes, but are not related to high consumption levels. Implications for DUI countermeasures are discussed.     

Life-time problem drinking and psychiatric co-morbidity among Ontario women 1

Women problem drinkers in the community, aged 15-64 years, with and without life-time psychiatric co-morbidity were compared to examine the association of this co-morbidity with alcohol consumption patterns, course and chronicity of problem drinking, treatment service utilization and other substance use and misuse. The women problem drinkers were also compared with non-problem drinkers on substance use patterns and utilization of services. The study employs data from the Mental Health Supplement to the Ontario Health Survey, a province-wide household population study. The University of Michigan Composite International Diagnostic Interview (UM-CIDI) was administered by trained lay interviewers and subsequently World Health Organization computer algorithms were used to generate DSM-III-R diagnoses based on the interview responses. Multiple logistic regression analysis indicated that psychiatric co-morbidity was associated with less education, earlier onset of problem drinking and one indicator of binge drinking. Co-morbidity also greatly increased the chances of women problem drinkers having sought mental health treatment. Women problem drinkers were significantly younger (about 7 years) than other women in the general population, perhaps an indicator of an increased mortality rate.