Living arrangements, heavy drinking and alcohol dependence

AIMS: To assess the variation in heavy drinking and alcohol dependence by living arrangements, and the contribution of social and behavioural factors to this variation. DESIGN: The Health 2000 survey is a nationally representative cross-sectional survey conducted in Finland in 2000-2001 (N = 4589 in the age-range of 30-54 years, response rate 81%). MEASUREMENTS: Living arrangements; married, cohabiting, living with other(s) than a partner, and living alone. Consumption of beer, wine and spirits in the past month was converted into grams of alcohol/week, and heavy drinking was classified as > or =280 (men) and > or =140 (women) grams/week. Twelve-month prevalence of alcohol dependence was diagnosed by a mental health interview (CIDI). FINDINGS: As compared to the married, cohabiting and living alone associated with heavy drinking (age-adjusted OR; 95% CI: 1.71;1.17-2.49 and OR 2.15;1.55-3.00 in men; OR 1.54;0.96-2.46 and OR 1.67;1.07-2.63 in women) and alcohol dependence (OR 2.29;1.44-3.64 and OR 3.66;2.39-5.59 in men; OR 2.56;1.10-5.94 and OR 4.43;2.03-9.64 in women). Living with other(s) than a partner associated with heavy drinking. Those who cohabited without children or lived alone had the highest odds for alcohol dependence. Among both genders, adjusting for main activity and financial difficulties attenuated the odds for heavy drinking and alcohol dependence by approximately 5-30% each, and additionally among women adjusting for urbanisation attenuated the odds for heavy drinking by approximately 15-45%. CONCLUSIONS: Cohabiting and living alone are associated with heavy drinking and alcohol dependence. Unemployment, financial difficulties and low social support, and among women also living in an urban area, seem to contribute to the excess risk.     

Genetic polymorphisms in alcohol metabolizing enzymes as related to sensitivity to alcohol-induced health effects

Three hundred sixty-seven middle-aged Japanese men were analyzed for genotypes of low K(m) aldehyde dehydrogenase (ALDH2) and cytochrome P450 2E1, and for the association with alcohol-induced health effects. Homozygotes for the normal ALDH2 gene (NN) and for the mutant gene (MM) and heterozygotes (NM) were found in 60, 6 and 33%, and homozygotes for the c1 gene (c1/1) and c2 gene (c2/2) of P450 2E1, and heterozygotes (c1/2) in 55, 5 and 40% of subjects, respectively. Mean alcohol consumption significantly differed in the three ALDH2 genotypes: 297 g per week in NN, 158 g in NM and 18 g in MM. It was not different in the three P450 2E1 genotypes, but tended to increase from cl/1 to c2/2 in the NN subjects while there was an inverse relationship in the subjects having the M gene. No difference in alcohol-induced health effects was observed in ALDH2 genotypes, but c2/2 genotype showed higher blood pressure and serum uric acid than the other P450 2E1 genotypes in the subjects consuming 200 g or more of alcohol per week. These results suggest an interactive effect of ALDH2 and P450 2E1 genes on alcohol consumption and a higher sensitivity to alcohol-induced health effects in c2/2 genotypes, although larger scale studies are required to confirm these findings.     

Application of aldehyde dehydrogenase 2 (ALDH2) genetic diagnosis in support of decreasing alcohol intake

Encouraging behavioral changes to decrease alcohol intake is not easy from the standpoint of health support. This study was conducted to examine whether the genetic diagnosis of ALDH2 polymorphism is useful in supporting those who want to decrease their alcohol intake. The participants in this study were 329 male employees who wanted to know the result of their ALDH2 genotype. We divided the 329 participants randomly into two groups. One was the "notified group" (n=157), and the other was the "non-notified group" (n=172). The subjects belonging to the "notified group" were informed of the results of the ALDH2 genotype diagnosis in April, 2003. Drinking habits and laboratory data were obtained before and after notification of the ALDH2 genotype. Among those with genotype ALDH2*1/*1, there was no significant change in drinking frequencies, nor was there any significant decline in liver function laboratory data in either of the groups before and after notification of the genotype. However, weekly alcohol intake tended to increase compared to that before notification. On the other hand, with regard to those with genotype ALDH2*1/*2, no significant changes in drinking frequencies or liver function laboratory data were evident in either group before and after notification of the genotype. However, the weekly alcohol intake tended to increase in the non-notified group, whereas it tended to decrease in the notified group. Although the result was not significant, it is suggested that, with further study and an increased sample size, the genetic diagnosis may be found to be useful.     

Effects of benzodiazepines on aldehyde dehydrogenase activity

The reported ability of benzodiazepines to increase human erythrocyte aldehyde dehydrogenase (ALDH) activity and reverse the disulfiram-induced inhibition of ALDH was reexamined. When ALDH activity assays were carried out spectrophotometrically on a hemoglobin-free lysate of human erythrocytes with propionaldehyde as substrate, addition of diazepam (10 μmol/1) did not affect the enzyme activity. When assays were carried out on intact or hemolysed erythrocytes using high performance liquid chromatographic technique with 3,4-dihydroxyphenylacetaldehyde as substrate, no significant increase in erythrocyte ALDH activity was found in the presence of chlordiazepoxide, oxazepam, diazepam, or desmethyldiazepam in the concentration range 1–20 μmol/1. Rather, a significant decrease (about 50%) in activity was obtained when lysed cells were incubated with 20 μmol/1 chlordiazepoxide. Diazepam inhibited the rat liver mitochondria! low Km ALDH activity by about 50%. Disulfiram inhibited the ALDH activity almost completely in assays on human erythrocyte or rat liver mitochondrial ALDH. The ALDH activity was not regained by the subsequent addition of diazepam, nor was the effect of disulfiram reduced when diazepam was added prior to disulfiram. In an alcoholic subject who was followed during onset of disulfiram (Antabuse) therapy, the concurrent use of diazepam did not prevent a rapid decline in blood ALDH activity. The present results suggest that benzodiazepines do not increase ALDH activity in vitro, nor interfere with the inhibition of ALDH by disulfiram.     

Epidemiology of heavy alcohol use in Ukraine: findings from the world mental health survey

AIMS: To describe the epidemiology of heavy alcohol use in Ukraine, using data from the world mental health (WMH) survey in Ukraine. METHODS: The WMH composite international diagnostic interview was administered in 2002 to a national probability sample of Ukrainian adults (n=4725). An algorithm for classifying heavy use in the past year was developed from self-reports about the quantity and frequency of drinking, and its convergent validity was demonstrated. Prevalence rates and socio-demographic risk factors were examined separately for men and women. RESULTS: The 12-month rates of heavy alcohol use were 38.7% in men and 8.5% in women (22.0% overall). Among heavy alcohol users, 92% of men and 52% of women consumed at least 80 g of ethanol in a typical drinking day on a monthly basis in the year before the interview. The most significant risk factors in men and women were age (26-54 years for men; 18-25 years for women), living in the Southeast region, being in the labour force whether employed or unemployed, and for men, low education and being the father of a young child. A highly significant linear relationship of number of risk factors with heavy alcohol use was found for both sexes. CONCLUSIONS: The rates for men were similar to those reported in a Russian national survey with the exception of Southeast Ukraine where the rate was >10% higher. The highest rates were among men who were middle-aged, fathers and unemployed. Future prospective studies are needed to assess the impact of heavy alcohol use on Ukrainian health, mental health and occupational and social functioning.     

Association of alcohol dehydrogenase 2 and aldehyde dehydrogenase 2 genotypes with fasting plasma glucose levels in Japanese male and female workers

AIMS: The objective was to clarify the effect of alcohol dehydrogenase 2 (ADH2) and aldehyde dehydrogenase 2 (ALDH2) genotypes on the diabetic risk in Japanese workers. METHODS: At the time of mandatory health checkup, the ADH2 and ALDH2 genotypes, as well as fasting plasma glucose (FPG) levels, body mass index (BMI), smoking habit, and weekly alcohol intake, were examined in 492 men and 183 women working at motor vehicle dealerships. RESULTS: In using two-way analysis of variance to manipulate ADH2 and ALDH2 genotypes and alcohol intake (>70 g/week for men and >35 g/week for women), the FPG level after the adjustment for age, BMI, smoking habit, and another genotype was significantly higher in the men with ADH2*1/1 genotype than in those with the other genotypes, but there was no significant difference in the FPG level between the men with and without ALDH2*1/1 genotype. In contrast, the women with ALDH2*1/1 genotype had significantly lower FPG levels than those with the other genotypes, but there was no significant difference in the FPG level between the women with and without ADH2*1/1 genotype. Also, a significant interaction between ethanol intake and ALDH2 genotypes was seen only in the women. CONCLUSIONS: These findings suggest that genotypes of ADH2 and ALDH2 can modify the diabetic risk, irrespective of amounts of alcohol consumed. Also, there may be sex differences in the effect of these enzyme genotypes on glucose metabolism.     

Habitual alcohol consumption and nutritional status of the elderly

The interrelationship between habitual alcohol consumption, dietary intakes and vitamin status was examined in 393 elderly subjects (188 men, 205 women, age range 65-90 years) resident in seven retirement homes throughout Italy. Individual food intake was assessed by the 7-day precise weighing method. Fasting blood was tested for riboflavin (erythrocyte glutathione reductase activity coefficient), thiamine (erythrocyte transketolase activity), retinol (fluorimetry) and folic acid status. Alcohol contributed on average 12 per cent of total energy intake in men, and 6 per cent in women. Forty-eight per cent of males and 39 per cent of females were classified as heavy drinkers (HD) with 48 and 28 g/d average alcohol intakes respectively. There was a general tendency for women to add alcohol to their habitual diet, as revealed by the positive correlation between total energy intake and alcohol intake. The higher energy intakes of HD women were also reflected in their higher body weights. Men tended to displace food energy partially by alcohol. Dietary risk of malnutrition, high for vitamin A, and moderate to low for vitamins B1 and B2, did not increase with alcohol consumption. Biochemical evidence of malnutrition indicated a significant deterioration of folate status in HD of both sexes, and for B1 in HD males only; there was no change in riboflavin status. Plasma levels of retinol were higher, and prevalence of vitamin A deficiency lower, in HD, a finding that warrants further investigation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sex-specific differences in the association of a common aldehyde dehydrogenase 2 gene polymorphism and alcohol consumption with stroke risk in a Korean population: a prospective cohort study

BACKGROUND/OBJECTIVESIt is well-known that alcohol consumption is associated with stroke risk as well as with aldehyde dehydrogenase 2 gene (ALDH2) polymorphisms. However, it is unclear whether ALDH2 polymorphisms are associated with stroke risk independent of alcohol consumption and whether such association is modified by sex. We evaluated sex-specific associations of a common ALDH2 polymorphism and alcohol consumption with stroke risk in a Korean population.SUBJECTS/METHODSWe conducted a prospective cohort study involving 8,465 men and women, aged 40-69 years and free of stroke between June, 2001 and January, 2003, and followed for the development of stroke. We identified new cases of stroke, which were self-reported or ascertained from vital registration data. Based on genome-wide association data, we selected a single-nucleotide polymorphism (rs2074356), which shows high linkage disequilibrium with the functional polymorphism of ALDH2. We conducted Cox proportional hazards regression analysis considering potential risk factors collected from a baseline questionnaire.RESULTSOver the median follow-up of 8 years, 121 cases of stroke were identified. Carrying the wild-type allele of the ALDH2 polymorphism increased stroke risk among men. The multivariate hazard ratio [95% confidence interval] of stroke was 2.02 [1.03-3.99] for the wild-type allele compared with the mutant alleles, but the association was attenuated after controlling for alcohol consumption. Combinations of the wild-type allele and other risk factors of stroke, such as old age, diabetes mellitus, and habitual snoring, synergistically increased the risk among men. Among women, however, the ALDH2 polymorphism was not associated with stroke risk.CONCLUSIONSThe prospective cohort study showed a significant association between a common ALDH2 polymorphism and stroke risk in Korean men, but not in Korean women, and also demonstrated that men with genetic disadvantages gain more risk when having risk factors of stroke. Thus, these men may need to make more concerted efforts to control modifiable risk factors of stroke.     

Prevalence and socioeconomic characteristics of alcohol disorders among men and women in the Eastern Cape Province,South Africa

There is growing concern about alcohol problems in low‐ and middle‐income countries. More research is required, particularly among the younger generation. The aim of this study was to investigate the prevalence of alcohol disorders and associated socioeconomic characteristics among young men and women living in the Eastern Cape Province, South Africa. This was a cross‐sectional population‐based study of 977 participants (52% male and 48% female) aged 18–40, the majority of whom lived in low‐income areas. Data collection was carried out in 2012 by trained fieldworkers. The Mini International Neuropsychiatric Interview (DSM‐IV) was used to investigate the prevalence of alcohol dependence (increased tolerance to alcohol, failed attempt to cut down, risk of physical and mental effects) and alcohol abuse (harmful use, consistent intoxication, risk behaviour, physically hazardous, social problems). A high 12‐month prevalence of alcohol dependence was found (26.5% in total; 39.0% among men and 19.1% among women) as well as of alcohol abuse (9% in total; 19.0% among men and 6.0% among women). Few socioeconomic differences emerged among the men, except older men (OR 1.94, CI 1.11–3.42) and those supported by social grants (OR 2.28, CI 1.06–4.93), who presented higher odd ratios for alcohol dependence than the reference groups. Among the women, more differences emerged: women who were widowed/single (OR 2.35, CI 1.20–4.62), had no education (OR 3.41, CI 1.04–11.21), had a low income (OR 3.26, CI 1.55–6.80) and had no social support from friends when ill presented higher odd ratios (OR 1.73, CI 1.07–2.80). In the adjusted model, marital status and low income remained statistically significant. With regard to alcohol abuse, fewer socioeconomic differences emerged. Interventions need to address the early onset of alcohol misuse in order to meet both current needs and long‐standing mental and physical illness.     

The psychosocial work environment and alcohol dependence: a prospective study

Aims: To examine whether a stressful psychosocial work environment predicts alcohol dependence.

Methods: Alcohol dependence of participants in the Whitehall II occupational cohort of London based civil servants (1985–88) was measured in 1991–93 using the CAGE questionnaire. The psychosocial work environment was measured by self report questions on the job demand-support-control model and on the model of effort-reward imbalance. Potential mediators including physical illness and poor mental health (GHQ) were measured at follow up in 1989.

Results: Effort-reward imbalance at work was associated with alcohol dependence in men after adjustment for employment grade and other baseline factors related to alcohol dependence. Although effort-reward imbalance predicted future longstanding illness, poor mental health and negative aspects of close relationships, the association between effort-reward imbalance and alcohol dependence in men was only partially mediated through these health and social support measures. In women, low decision latitude was related to alcohol dependence to some extent, but alcohol dependence among women was more prevalent in higher occupational grades. Men with high job demands or with low work social supports had a slightly reduced risk of alcohol dependence. No association was found between objectively assessed demands, job control, and alcohol dependence in either men or women.

Conclusion: A stressful psychosocial work environment in terms of effort-reward imbalance was found to be a risk factor for alcohol dependence in men. In view of the public health importance of alcohol dependence in working populations these findings call for more emphasis on psychosocial factors in occupational health research and prevention.

     

Detecting symptoms of alcohol abuse in primary care settings

BACKGROUND: Studies on alcohol abuse are frequently based on patients who meet minimum diagnostic criteria, thus ignoring patients with individual symptoms of harmful or hazardous use. Consequently, we are unable to characterize alcohol-abusing patients with sufficient clarity to effectively focus screening for primary prevention. OBJECTIVE: To determine the prevalence of harmful and hazardous use of alcohol, assess screening instruments for detecting alcohol abuse or dependence, and assess the impact of alcohol use on other diagnoses treated in outpatient settings. DESIGN: Survey (cross-sectional study). SETTING: Hospital-based outpatient clinic. PARTICIPANTS: Three hundred randomly selected adults (aged 18 years and older). MAIN OUTCOME MEASURE: Diagnosis of alcohol abuse or dependence based on the Diagnostic Interview Schedule (DIS). RESULTS: About 18% met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria of abuse or dependence while almost 50% had at least one symptom of harmful or hazardous use. The T-ACE questionnaire, a modified version of the CAGE questionnaire, was the most effective screening instrument for both men and women. Selected diagnoses, personal characteristics such as family history of alcohol abuse, and self-reported patterns of alcohol use could identify patients likely to meet diagnostic criteria. CONCLUSIONS: Many symptoms of substance use disorders are not adequately addressed in outpatient practice. Little is known about how alcohol use in varying quantities affects health care utilization and treatment of conditions commonly seen in outpatient medicine. Consequently, we lack a full appreciation of the burden of disease borne by alcohol use and have yet to achieve a universally accepted method of approaching primary and secondary prevention of alcohol-related problems.     

Adverse childhood exposures and alcohol dependence among seven Native American tribes

BACKGROUND: Alcohol abuse and alcoholism are leading causes of death among Native Americans. Little is known about the impact of negative childhood exposures, including parental alcoholism, childhood maltreatment, and out-of-home placement, on risk of lifetime DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) diagnosis of alcohol dependence in this population. METHODS: Face-to-face interviews were conducted with 1660 individuals from seven Native American tribes from 1998 to 2001. Logistic regression was used to estimate the impact of specific types and number of different adverse childhood experiences on alcohol dependence. Relationships between tribe-specific cultural characteristics and alcohol dependence were also examined. RESULTS: There were significant tribal differences in rates of alcohol dependence and several adverse childhood exposures. Lifetime prevalence of alcohol dependence was high among all tribes (men: 21%-56%, women: 17%-30%), but one (men: 1%, women: 2%). High prevalence rates were documented for one or more types of adverse childhood experiences (men: 74%-100%; women: 83%-93%). For men, combined physical and sexual abuse significantly increased the likelihood of subsequent alcohol dependence (odds ratio [OR]=1.58; 95% confidence interval [CI], 1.10-2.27). For women, sexual abuse (OR=1.79; 95% CI, 1.21-2.66) and boarding school attendance increased the odds of alcohol dependence (OR=1.57; 95% CI, 1.03-2.40). Two separate patterns of dose-response relationships were observed for men and women. Significant inter-tribal differences in rates of alcohol dependence remained after accounting for tribe-specific cultural factors and geographic region. CONCLUSIONS: Effects of childhood exposures on high-risk behaviors emphasize screening for violence in medical settings and development of social and educational programs for parents and children living on and near tribal reservations.     

Tobacco smoking and alcohol consumption as risk factors for glioma: a case-control study in Melbourne, Australia.

OBJECTIVE: To investigate possible associations between tobacco smoking and alcohol consumption and the risk of adult glioma. DESIGN: This was a population based, case-control study. Relative risks (RR) were estimated using logistic regression analysis. SETTING: Melbourne, Australia. PARTICIPANTS: These comprised 416 case subjects (166 women, 250 men), 66% of those eligible; and 422 control subjects (170 women, 252 men), 43.5% of those potentially eligible. RESULTS: There was no increase in risk of glioma with having ever smoked tobacco (RR 1.29, 95% CI 0.95, 1.75) for all subjects, adjusted for age, a reference date, and gender. There was a slight increase in risk for men (RR 1.64, 95% CI 1.1, 2.45), but not for women (RR 0.99, 95% CI 0.62, 1.62). For men, there was no increase in risk with increasing pack-years of cigarette smoking, but the risk was significantly increased in subjects who had smoked for less than 10 years. There was no increase in risk associated with having ever drunk alcohol for all subjects (RR 0.96, 95% CI 0.67, 1.37), women (RR 0.69, 95% CI 0.4, 1.15) or men (RR 1.40, 95% CI 0.81, 2.43). CONCLUSIONS: This study does not support an association between either tobacco smoking or alcohol consumption and glioma. The pattern of risk associated with tobacco smoking in men appears inconsistent with a causal role, and may be due to chance, response bias, or uncontrolled confounding.     

The use of audit to assess level of alcohol problems in rural Vietnam

AIMS: To assess the accuracy and performance of AUDIT in detecting alcohol problems, as defined by ICD-10 and DSM-IV, in a rural district in Vietnam. METHODS: The study was conducted in a rural district of Vietnam. Five hundred men and women aged 18-60 were randomly selected for interview with AUDIT and CIDI 2.1. The ICD-10 and DSM-IV criteria for harmful use/alcohol abuse and alcohol dependence were used to evaluate AUDIT. RESULTS: Due to few cases of alcohol problems observed among women (1/282), we could only evaluate the validity of AUDIT in men. At cut-off point 7/8, AUDIT had a sensitivity of 81.8% and a specificity of 76.1% for detecting at-risk drinking. At this cut-off point, using ICD-10 criteria, the sensitivity was 100% for harmful use and 93.8% for alcohol dependence; the specificity was 69.9% for harmful use and 87.4% for alcohol dependence. The area under the ROC curve was 0.91 (0.84-0.98) for harmful use and 0.84 (0.74-0.94) for alcohol dependence (ICD-10). The agreement between ICD-10 and DSM-IV was higher for diagnosing alcohol dependence than alcohol abuse (Kappa coefficient: 0.98 vs 0.68). CONCLUSION: We confirmed that AUDIT is feasible to use in a rural community in a developing country. Different cut-off points are appropriate for different purposes, but for general population screening of at-risk drinking we found a cut-off point 7/8 to be optimal.     

Web-based screening and brief intervention for the spectrum of alcohol problems

CONTEXT: Many persons who drink excessively remain unidentified and do not receive interventions. Screening and intervention using the World Wide Web could make such services more accessible and therefore more widely used. OBJECTIVE: To evaluate the use of a novel alcohol screening and brief intervention Web site. DESIGN: A Web site was developed, posted, and its use was evaluated. We analyzed a sample of visitors who completed alcohol screening over a 14-month period to describe their alcohol use, and their use of portions of the Web site that provide information and referral resources. SETTING: The Internet. PATIENTS OR OTHER PARTICIPANTS: Web site visitors, with a focus on visitors who completed an alcohol-screening questionnaire about their own drinking. INTERVENTION: Brief intervention via the Web site, consisting mainly of feedback, advice, and a menu of change options and referral information. MAIN OUTCOME MEASURES: Self-reported drinking amounts and alcohol screening test scores, and utilization of Web site components. RESULTS: Visitors completed online alcohol screening questionnaires at a rate of 50,711/year of 115,925 visitors/year. In a 14-month period, 39,842 adults completed the questionnaire about their own drinking habits; 66% were men, 90% reported drinking hazardous amounts (per occasion or typical weekly amounts), 88% reported binge (per occasion) drinking, and 55% reported typically exceeding weekly risky drinking limits. Most (65%) had alcohol screening test results (AUDIT > or = 8) consistent with alcohol abuse or dependence; similar proportions of women and men were hazardous drinkers. One-fifth of visitors visited portions of the Web site that provided additional information about alcohol use and referrals. Visitors with possible alcohol abuse or dependence were more likely than those without these disorders to visit a part of the Web site designed for those seeking additional help (33% vs. 8%, P < 0.0001). CONCLUSIONS: A well-publicized, easily accessible, research-based screening and intervention Web site can attract many users, most of whom are drinking excessively, and many of whom avail themselves of referral information after receiving individualized feedback.     

乙醇和乙醛脱氢酶基因多态与食道癌易感性

目的 研究乙醇脱氢酶2(ADH2)和乙醛脱氧酶2(ALDH2)基因多态与食道癌易感性.方法 对江苏省泰兴市221例食道癌新发病例和191名对照的饮酒习惯等因素进行调查,采用PCR和变性高效液相色谱法(DHPLC)检测ADH2和ALDH2基因型.结果 (1)与携带ALDH2 G/G基因型者相比,携带ALDH2A/A(OR=5.69,95%CI:2.51～12.18)和ALDH2 G/A(OR=1.70,95%CI:1.08～2.68)基因型者患食道癌危险性明显增加,以携带ALDH2A/A的饮酒者最为显著(OR=8.63,95%CI:2.07～35.95).(2)无论是否饮酒,携带不同ADH2基因型者之间患食道癌的风险差异均无统计学意义.(3)携带ALDH2 A/A或G/A基因型者,不论同时携带何种ADH2基因型患食道癌的风险均显著增加,且作用效应为ALDH2 A/A≥G/A.(4)与同时携带ALDH2 G/G和ADH2 A/A的不饮酒者相比,同时携带ALDH2 G/A或A/A和ADH2 G/A或G/G的饮酒者,患食道癌危险性OR值高达8.36(95%CI:2.98～23.46).结论 饮酒及醇醛脱氢酶基因多态与食道癌的联系主要与ALDH2有关;携带ALDH2A/A和G/A者减少酒精消耗量,有助于降低患食道癌危险性.     

Prevalence of alcohol use and associated factors in urban hospital outpatients in South Africa

The aim of this study was to assess the prevalence of alcohol use and associated factors among outpatients in an urban hospital in South Africa. The sample included 1,532 (56.4% men and women 43.6%) consecutively selected patients from different hospital outpatient departments. Results indicate that 41.2% of men and 18.3% of women were found to be hazardous drinkers, and 3.6% of men and 1.4% of women meet criteria for probable alcohol dependence or harmful drinking as defined by the Alcohol Use Disorder Identification Test (AUDIT). Two in five patients (40.5%) were hazardous or harmful drinkers and/or had anxiety or depression. Logistic multiple regression found that for men tobacco use and not having been diagnosed with diabetes and for women tobacco use and having been diagnosed with migraine headache was associated with hazardous and harmful drinking. Although the study is cross-sectional, it does identify groups that may be at high risk of alcohol misuse and for whom intervention is urgent. Because prevalence of hazardous and harmful alcohol use is high in this population, routine screening should be introduced in hospital out-patient settings.     

Pre- to post-immigration sexual risk behaviour and alcohol use among recent Latino immigrants in Miami

Retrospective pre-immigration data on sexual risk and alcohol use behaviours was collected from 527 recent Latino immigrants to the USA, aged 18–34. Two follow-up assessments (12 months apart) reported on post-immigration behaviours. Using a mixed model growth curve analysis, a six-level sexual risk change variable was constructed combining measures of sexual partners and condom use. The mixed model growth curve was also used to examine associations between changes in sexual risk behaviour and changes in alcohol use and for testing interaction effects of gender and documentation status. Results suggest that individuals with high sexual risk behaviour at pre-immigration converge to low/moderate risk post-immigration, and that those who were sexually inactive or had low sexual risk at pre-immigration increased their risk post-immigration. Individuals with moderately higher initial but decreasing sexual risk behaviour showed the steepest decline in alcohol use, but their drinking at Time 3 was still higher than individuals reporting low sexual risk at Time 1. On average, men drank more than women, except women in one of the highest sexual risk categories at Time 1 – who seemed to drink as much, if not more, than men. Undocumented men reported more frequent drinking than documented men. In contrast, undocumented women reported lower alcohol use than documented women.     

High-risk alcohol consumption and late-life alcohol use problems

OBJECTIVES: We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems. METHODS: A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later. RESULTS: Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals. CONCLUSION: Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.