The relationship between stressful working conditions and high alcohol consumption and severe alcohol problems in an urban general population

The relationship between 15 measures of stressful working conditions and high alcohol consumption (35 g 100% ethanol per day or more for men and 25 g or more for women) was studied, using cross-sectional data from a general population survey of 1344 males and 1494 females; the ages 25–64 years in metropolitan Stockholm in 1984. In a longitudinal component of the study, hospitalization and mortality with alcohol-related diagnosis was assessed during 1984–90, and also the association between previous experience of unemployment and high alcohol consumption. Some of the associations, expressed as age-adjusted odds ratios, were positive and some were negative when high alcohol consumption was the endpoint, but there was a clear variation by sex and social class. Generally the positive associations were stronger among male non-manual employees. Among males, there was a clear association between stressful working conditions and subsequent risk of severe medical alcohol-related problems, but the precision of the estimates was low due to low number of cases. The odds ratio was 6.18 (95% confidence interval 1.86, 20.61) for twisted working positions and 6.74 (95% confidence interval 1.67, 27.19). Previous unemployment among males was associated with increased risk for high alcohol consumption, with an odds ratio of 5.71 (95% CI 1.39, 15.97) among those who had been unemployed more than once, and 1.67 (95% CI 0.76, 3.64) among those who had been unemployed once during the previous 5 years. Those and other increased odds ratios were lower when subjects with an alcohol diagnosis at inpatient care during 1980–84 were excluded in the analyses. On the whole, our findings are not conclusive. The strong, but imprecise associations between stressful working conditions and severe alcohol problems, are however challenging, and warrants further studies, preferably with longitudinal design and repeated measurements of both working condition and alcohol habits.     

Variations in quantity-frequency measures of alcohol consumption from a general population survey

This paper examines differences in quantity–frequency (QF) measures of alcohol consumption from the 1988 US National Health Interview Survey. Three methods—global QF, beverage-specific QF, and beverage-specific QF with drink size (QFS)—were used to estimate the average daily ethanol consumption (ADC) of current drinkers. These ADC estimates then were used to categorize drinkers into light, moderate or heavier drinking levels. Total prevalence estimates of heavier drinking were not significantly different among men, but were significantly higher with the QFS measure among women. All mean ADC scores were significantly different for both sexes. The global QF showed the lowest mean consumption, followed by the higher beverage-specific QF and QFS measures. Adding beverage type and drink size to the QF measures increased mean ADC scores for both men and women. However, moderately high correlations (0.84 for men and 0.88 for women) were found with ADC scores from the beverage-specific QF and QFS measures.     

饮酒方式与代谢综合征

以心血管危险因素、腹型肥胖、血脂异常、高血糖和高血压为特点的代谢综合征已成为世界范围内的一个主要公众健康问题.     

Influence of mild-to-moderate alcohol consumption on cardiovascular diseases in men from the general population

Background and methodsThere is controversy about the association between mild-to-moderate alcohol consumption and a reduced risk of cardiovascular diseases. The relationships between daily alcohol consumption and the incidence of acute myocardial infarction (MI) or ischemic stroke (IS) were examined in men in a community-based, prospective cohort study (n = 8014, age 40–80 years, mean age = 64.1 years). Alcohol consumption was categorized into 3 groups (A1, none or occasional; A2, ≤25 g/day; A3, >25 g/day as ethanol) at baseline.ResultsDuring the mean follow-up of 5.5 years, 53 MIs and 186 ISs occurred. On Cox regression analysis adjusted for age, hypertension, diabetes, dyslipidemia, smoking index, and body mass index (BMI), the hazard ratio (HR) for incident MI was significantly lower in the A2 group than in the A1 group (HR = 0.49, p = 0.043). The HR for incident MI in the A3 group tended to be lower than in the A1 group (HR = 0.53, p = 0.10). In obese subjects, while a significantly lower HR for incident MI in the A2 group was retained (HR = 0.29, p = 0.049), no significant difference in the HR of the A3 group compared with the A1 group was found. No significant differences were found in the IS-free curve among the 3 groups of alcohol consumption.ConclusionsAlcohol consumption may have a protective effect on the onset of MI but not on IS in the general population. A U-shaped relation between alcohol consumption and incident MI was found in obese subjects. An appropriate limit for daily alcohol consumption, depending on the risk of ischemic heart disease, may need to be established.     

Patterns of alcohol consumption after liver transplantation

Background—Uncertainty exists aboutthe extent and consequences of a return to alcohol consumption afterliver transplantation for alcoholic liver disease (ALD).
Aims—To determine the prevalenceand consequences of alcohol consumption in patients transplanted for ALD.
Methods—A retrospective casecontrolled study of all patients transplanted for ALD at the QueenElizabeth Hospital, Birmingham, between 1987 and 1996.
Results—Seventy patients with ALDwere transplanted, of which 59 survived more than three months; 56 wereinterviewed. Twenty eight had consumed some alcohol aftertransplantation; for the nine "heavy drinkers" (HD), the mediantime to resumption of alcohol intake was six months and for the 19 "moderate drinkers" (MD) it was eight months. There was nosignificant difference in episodes of acute rejection or compliancewith medication between those who were abstinent, MD, or HD.Histological evidence of liver injury was common in ALD patients whohad returned to drink. Mild fatty change was found in 1/11 biopsyspecimens from abstinent patients but moderate to severe fatty changeand ballooned hepatocytes were seen in 3/5 MD and 2/5 HD specimens. TwoHD patients had early fibrosis. One HD patient has died of alcoholrelated complications.
Conclusions—Moderate to heavyalcohol consumption occurs in patients transplanted for ALD. Patientrecall of abstinence advice is unreliable, and patients return toalcohol mainly within the first year after liver transplantation.Return to alcohol consumption after liver transplantation is associatedwith rapid development of histological liver injury including fibrosis.

Keywords:alcohol consumption; liver transplantation

     

Patterns of alcohol consumption and alcohol-impaired driving in the United States

Background:  Alcohol-related motor vehicle crashes kill approximately 17,000 Americans annually and were associated with more than $51 billion in total costs in 2000. Relatively little is known about the drinking patterns of alcohol-impaired (AI) drivers in the United States.
Methods:  2006 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed for alcohol consumption and self-reported AI driving among U.S. adults aged ≥18 years for all states. Alcohol consumption was divided into 4 categories: binge/heavy, binge/nonheavy, nonbinge/heavy, and nonbinge/nonheavy. Binge drinking was defined as ≥5 drinks for men or ≥4 drinks for women on one or more occasions in the past month, and heavy drinking was defined as average daily consumption of >2 drinks/day (men) or >1 drink/day (women). The prevalence of AI driving was examined by drinking pattern and by demographic characteristics. Logistic regression analysis was used to assess the association between drinking patterns and AI driving.
Results:  Five percent of drinkers were engaged in AI driving during the past 30 days. Overall, 84% of AI drivers were binge drinkers and 88% of AI driving episodes involved binge drinkers. By drinking category, binge/nonheavy drinkers accounted for the largest percentage of AI drivers (49.4%), while binge/heavy drinkers accounted for the most episodes of AI driving (51.3%). The adjusted odds of AI driving were 20.1 (95% CI: 16.7, 24.3) for binge/heavy, 8.2 (6.9, 9.7) for binge/nonheavy, and 3.9 (2.4, 6.3) for nonbinge/heavy drinkers, respectively.
Conclusions:  There is a strong association between binge drinking and AI driving. Most AI drivers and almost half of all AI driving episodes involve persons who are not heavy drinkers (based on average daily consumption). Implementing effective interventions to prevent binge drinking could substantially reduce AI driving.     

The relationship between stressful life situations and changes in alcohol consumption in a general population sample

Studies on the relationship between stressful life situations and alcohol consumption have almost exclusively been based on retrospective information from clinical populations. We conducted multiple regression analyses of the relationship between presumed stressful life conditions in 1965, life events during 1966–73 and psychosocial factors and amount of increase or decrease in alcohol consumption from 1965 to 1974 adjusting for age, alcohol consumption, education and health status in 1965. Data from surveys in 1965 and in 1974 in a general population sample of 4,864 subjects from Alameda County, California were used. The magnitude of the associations between the presumed stressful life situations and amount of change was generally low, although a few were statistically significant. However, among those aged 65 years and above, and especially among men, some of the associations were strong, but imprecise due to the low number of subjects in those ages. While a number of variables were associated with increase or decrease in alcohol consumption, the R²-values indicated that these variables explained little of the variation over time in alcohol consumption. Thus, people in general seem to cope with stressful life situations by means, other than a longstanding increase in alcohol consumption.     

The relationship between alcohol dependence and alcohol–related problems in a clinical population

The relationship between alcohol dependence and alcohol–related problems was studied in a group of 103 problem drinkers. Responses to a 46–item Alcohol Problems Questionnaire (APQ) were compared with the Severity of Alcohol Dependence Questionnaire (SADQ), alcohol consumption and demographic data. A strongly positive correlation was found between aggregate problems and dependence scores (r= 0.63; p = 0.001) which existed independently of the quantity of alcohol consumed. Analysis of questionnaire subscales revealed that certain problem domains were more closely related to particular aspects of dependence than others. A higher level of problems was found in subjects of younger age and lower socio-economic class. No significant sex differences were found. The implications of these findings are discussed.     

Changes in alcohol consumption in a general population in The Netherlands: a 9-year follow-up study

Changes in drinking patterns are described for men and women and per age group using data from a 9-year follow-up study in The Netherlands (n=1327). Aspects of drinking patterns in our study are drinking status, level of consumption and frequency of heavy drinking. The average consumption and average frequency of heavy drinking are used to examine changes at aggregate level. Changes at individual level are examined in terms of adopting certain drinking patterns (incidence) and continuing certain drinking patterns (chronicity). A small decrease is found in the proportion of drinkers for both sexes. Only women show a decrease in mean consumption. Average frequency of heavy drinking is stable for both sexes. At individual level, proportions of chronicity and incidence of drinking patterns are higher among men. Small aggregate changes in drinking patterns are accompanied by rather large shifts in individual's up-and-down level of consumption and frequency of heavy drinking. No or only very small period effects are observed and little evidence is found for a cohort effect among men. A negative association between incidence and age is found for drinking status among women, for low, moderate and high level of consumption and for heavy drinking for both sexes. In terms of chronicity, negative associations with age are found for drinking status of both sexes, and for high level of consumption and heavy drinking among men.     

Alcohol consumption and coronary calcification in a general population

BACKGROUND: A U- or J-shaped association exists between alcohol consumption and coronary heart disease. One of the proposed mechanisms for this association involves atherogenesis, but there are no data on the association between alcohol consumption and coronary atherosclerosis in asymptomatic subjects. Coronary calcification, a measure of coronary atherosclerosis, allows for the study of the association. METHODS: This cross-sectional study was performed using data from the population-based Rotterdam Coronary Calcification Study. Data on alcohol consumption were available for 1795 individuals without coronary heart disease. Mean +/- SD age of the participants was 71 +/- 5.7 years. Coronary calcification was detected on electron beam computed tomographic scans and quantified as a calcium score by the Agatston method. Extensive coronary calcification was defined as a calcium score above 400. RESULTS: In this population, 15.8% of individuals consumed no alcohol; 46.5% consumed 1 alcoholic drink or less per day; 16.9% consumed 1 to 2 drinks per day; and 20.9% consumed more than 2 drinks per day. A U-shaped association was found between alcohol consumption and coronary calcification. Compared with nondrinkers, the odds ratio of extensive coronary calcification was 0.60 (95% confidence interval [CI], 0.44-0.82) for those who consumed 1 drink or less daily; 0.51 (95% CI, 0.35-0.76) for those who consumed 1 to 2 drinks daily; and 0.90 (95% CI, 0.62-1.29) for those who consumed more than 2 drinks. The association remained after multivariate adjustment. CONCLUSIONS: The consumption of 2 alcoholic drinks or fewer per day was inversely associated with extensive coronary calcification. The risk of extensive coronary calcification was 50% lower in individuals who consumed 1 to 2 alcoholic drinks per day than in nondrinkers.     

The use of acute and preventative medical services by a general population: relationship to alcohol consumption

Aims. To investigate the hypothesis that increasing alcohol consumption is accompanied by increasing use of acute, but decreasing use of preventative, medical services among the general population. Design and participants. Health and life-style survey of 41 000 randomly-sampled adults in SE England who self-completed a validated questionnaire covering socio-demographics, alcohol and tobacco usage and use of acute (A&E department and general practitioner) and preventative (dental, optician, mammography and cervical cytology) services: the response rate was 60%. Measurements. Comparative use of acute and preventative health care services by patients with varying consumption of alcoholic beverages. This was estimated by the odds ratio for service use, after correcting for the following confounding variables; age, social class, ethnic group, employment status, whether lives with children or with other adults, whether is a carer, limiting long-term illness, depression status, smoking habit and use of private health insurance. Findings. There was increased use of accident and emergency services by the harmful and intermediate drinking groups compared with the safe drinking group. Male abstainers attended their A&E departments more frequently than 'safe limit' drinkers. With respect to preventative services, both male and female abstainers and harmful drinkers used dental services less than safe limit drinkers. For females, mammography and cervical cytology services were less frequently used by abstainers and by harmful drinkers. Conclusions. This study supports the generally held view that heavy alcohol consumers are disproportionate users of acute medical services but they are relative under-users of preventative medical care services. Alcohol abstainers are also over-users of acute services, but under-users of preventative services. These latter observations are relevant to the claims that moderate alcohol consumers have lower apparent morbidity and mortality rates compared to abstainers.     

The identification of alcohol dependence criteria in the general population

Aims. To assess the criteria used to identify alcohol dependence in the general population. Design and setting. Two independent probability surveys of the US household population 18 years of age and older were analyzed: the 1994 National Telephone Survey (NTS-94), which interviewed 637 respondents, and the 1988 National Household Interview Survey (NHIS-88) which interviewed 43 809 respondents in their homes. Participants. The analyses of the NHIS-88 dataset focused on drinkers who consumed at least 12 drinks of alcohol in the 12 months prior to the survey interview ( N = 22, 102). The analyses of the NTS-94 dataset focused on drinkers who consumed at least one drink in the 12 months prior to the survey interview ( N = 637). Measurements. Criteria for DSM-IV alcohol dependence were operationalized using 15 items from a standardized questionnaire. Findings. Analyses suggested that normal drinking behavior can be misidentified as dependence criteria. Results for men who drank up to two drinks per day suggest that if the dependence criteria were invalid, reductions in the prevalence of specific indicators of alcohol dependence would range from 0.3% to 5.2%. Correcting for the misidentification of alcohol dependence diagnosis would reduce the overall prevalence of alcohol dependence by 0.5%. Up to 7% of the men could have been diagnosed as alcohol-dependent and could have provided invalid reports. Conclusions. The identification of alcohol dependence in general population samples must include careful probing of the nature of drinking-related behavior reported by respondents. This will decrease misidentification of dependence criteria, increasing the validity of dependence diagnosis in survey research.     

Gender convergence in alcohol consumption and related problems: issues and outcomes from comparisons of New Zealand survey data

AIMS: This paper aims to compare women's and men's alcohol consumption patterns and alcohol-related problems in New Zealand in 1995 and 2000, by age groups. Secondary aims are to consider the findings in relation to debates on the gender convergence hypothesis regarding the link between gender convergence in alcohol consumption and possible explanations, such as social role convergence and policy changes. DESIGN: Data were collected in two general population surveys conducted in New Zealand in 1995 (n = 4232) and 2000 (n = 5113) using the same questionnaire. MEASUREMENTS: Quantity consumed on a typical drinking occasion, volume of absolute alcohol consumed per annum, proportions drinking 20+ litres per annum, proportion of total consumption consumed in heavy drinking occasions, frequency of consumption, proportion who drink enough to feel drunk at least once a week, proportions reporting three or more alcohol-related problems and attitudes to intoxication. FINDINGS: Evidence for gender convergence was found across a range of measures of alcohol consumption and alcohol-related problems. In the 20-39-year age group quantities of alcohol consumed on a typical occasion and the related measures of volume, drunkenness and problems all showed convergence. In the groups over 40 years of age convergence occurred in relation to frequency of drinking. In the groups below 20 years, which consumed relatively high quantities and where the differences in consumption between gender groups were relatively small, further convergence did not occur. CONCLUSIONS: Gender convergence took place in New Zealand from 1995 to 2000.     

Prevalence of alcohol use and the association between onset of use and alcohol-related problems in a general population sample in Germany

Aims. This paper examines the prevalence of alcohol use, alcohol-related problems and onset of regular alcohol use, including its association with the prevalence of CAGE symptoms. Design and participants. Data come from three nationally representative samples of the non-institutionalized German general population aged 18-59 years which were conducted annually between 1994 and 1996. Subjects ( n = 7501) were surveyed through telephone interviews. Findings. Overall, men were more likely to drink alcohol, to be heavier drinkers and to experience more alcohol problems than women. Prevalence of 12-month use was constant across age among males, but decreased with age among women. Prevalence of heavier drinking, however, increased with age in both sexes. While for both sexes the median age of onset decreased towards younger cohorts, the prevalence of regular use at younger ages increased more strongly among females compared to males. In all cohorts of both sexes, an association between early age of onset and negative consequences measured by the CAGE questionnaire could be observed. Odds ratios were significantly lower for life-time experience of at least two CAGE symptoms among respondents if they had started regular alcohol use later than their peers. Conclusions. The results indicate a narrowing of the gender gap due to an increasing prevalence of regular alcohol use for females across cohorts. Gender differences with regard to heavier drinking are still prominent. The findings confirm those of related studies in which early age of onset of regular alcohol use was found to be a significant predictor for life-time alcohol-related problems.     

Patterns of insulin resistance in the general population of southeast Spain

The aim of this study was to evaluate patterns of insulin resistance in the general population. The study was cross sectional. Clinical, anthropometric, and lipid measurements were made in 1226 persons aged 18-65 years. An oral glucose tolerance test (OGTT) was performed in 1020 subjects, with insulin levels determined at baseline and after 2 h. The homeostasis model assessment insulin resistance index (HOMA IR) and HOMA beta-cell function were calculated. Compared with subjects with normal glucose tolerance, the groups with abnormal OGTT had different baseline insulinemia, 2 h post OGTT insulinemia, HOMA IR and HOMA beta-cell indices. Serum insulin levels at baseline and 2 h after OGTT showed a characteristic pattern for each category of glucose tolerance, resulting from the different insulin responses. In the subjects with normal glucose tolerance, the pattern of the relationships between both types of serum insulin levels was exactly the same, so that it was possible to determine risk groups according to the ratio of baseline serum insulin/2 h insulin. HOMA IR and HOMA beta-cell were significantly associated with the risk of impaired fasting glucose, previously unknown diabetes mellitus, and known diabetes mellitus. These results support the rationale for introducing preventive measures against insulin resistance in the general population.     

Patterns of alcohol consumption: beverage effects on gender differences

This Data Note reports findings from 22 102 current drinkers who responded in the US National Interview Survey in 1988. Mean estimated alcohol intake of males exceeded that of females by a factor of two. Males drank more per occasion (ratio 1.45) and drank on more occasions (1.41). Mean ethanol content per drink was slightly less for males (ratio 0.95) attributable to a decreased proportion of drinks being wine and liquor. When beverage preferences were taken into account, the drinking patterns of males and females showed no meaningful differences among persons with similar levels of overall ethanol intake. The results do not support the view that the difference between ethanol consumption of males and females are due primarily to males drinking more per occasion. Apparent differences in drinking patterns are attributable to differences in preferred beverage.     

Patterns of alcohol consumption in white collar-workers–a cross-sectional and longitudinal study

A 6-year follow-up of a cohort of male and female while collar workers in whom there was baseline information on alcohol consumption and access co data on sickness absence, promotion and labour turnover, revealed that even moderate alcohol and consumption in this population was associated with social costs for the employer and the employee, particularly in terms of sickness absence. The longitudinal examination of consumption in this study suggests that early intervention in a drinking career may reduce alcohol consumption and consequently avoid years of morbidity and sickness absence, as well as having a favourable influence on promotion prospects and labour turnover.     

WHO working group on population levels of alcohol consumption

Target 17 of the Health Policy for Europe calls for the health-damaging consumption of dependence-producing substances such as alcohol, tobacco and psychoactive substances to be significantly reduced in all Member States between the year 1980 and the year 2000. With regard to alcohol, if is suggested that alcohol consumption be reduced by 25%, with particular attention to reducing harmful use. A question posed by a number of Member Slates is what is the level of per capita alcohol consumption of lowest risk to physical, psychological and social harm. A working group was convened to consider population levels of alcohol consumption with particular reference to the Member States of the European Region of WHO. A basis for understanding population problem experience can be established through the interaction between individual risk and distribution of consumption levels within the population. The working group concluded that public health policy within the European Region should continue to advise decreases of per capita consumption. Even when taking into account coronary heart disease, it can be concluded at the population level, across all ranges of alcohol consumption found in almost all countries of Europe, that a reduction in consumption is linked to better health. However, public health policy concerning alcohol should not be based solely on mortality. All outcomes of drinking, that is mortality, morbidity, social and criminal consequences, as well as quality of life, should be considered. The existing data relating alcohol consumption to health originates from countries primarily with a cultural experience of consuming alcohol. In those countries, where there is a cultural or religious tradition of not consuming alcohol, there can be no public health grounds for recommending alcohol consumption.