Mortality attributable to drinking, drinking too much, or drinking too little: a comparison of methods

BACKGROUND: The existence of a U-shaped relationship between alcohol consumption and all-cause mortality complicates the calculation and interpretation of mortality attributable to alcohol consumption. METHODS: We used the relationships between all-cause mortality and alcohol consumption from four British cohort studies. For each study we defined a 'sensible drinking level' asthe level with lowest observed mortality. We estimated the fractions of deaths that were attributable to (1) any drinking (compared with not drinking), (2) drinking more than the 'sensible level', and (3) drinking less than the 'sensible level'. RESULTS: Data from the Doctors' study suggest that on balance 22.3 per cent of deaths are prevented by alcohol consumption, yet the fractions of deaths attributable to drinking more than 8-14 units per week and less than 8-14 units per week are nearly equal (6.5 per cent and 6.4 per cent, respectively). In a sensitivity analysis we show that it is possible for alcohol consumption to prevent deaths overall yet for more deaths to be attributable to drinking above a sensible level than are attributable to drinking below the sensible level. CONCLUSIONS: The balance of deaths attributable to or prevented by alcohol consumption provides no information about the deaths attributable to drinking above or below sensible levels. Using all-cause data in this way is likely to exaggerate the protective effect of alcohol consumption, so our results are only illustrative.     

Parenthood, drinking locations and heavy drinking

This study tests the hypothesis that the relationship between parenthood and heavy drinking is mediated by drinking locations. The analysis is based on a random sample of 4180 female and 3630 male Canadian drinkers aged between 18 and 55 years old. A multiple mediator model is tested. Results show that the parental role may be associated with variation in where people drink, and where people drink may be associated with variation in heavy drinking. For women, parenthood is related to a reduction in heavy drinking associated with a reduction of drinking occasions that occur at bars, offset to some extent by the fact that drinking in restaurants is also less common among mothers than non-mothers. For men, parenthood is related to a reduction in heavy drinking partly because fathers more often drink at friends' homes and the proportion of drinking occasions that occur at bars is smaller among fathers than non-fathers. The results of this study correspond with a refined version of the opportunity perspective. Given the nature of the processes by which parenthood is related to heavy drinking, alcohol consumption needs to be understood through a perspective that includes both individual and contextual factors.     

Work experience and drinking behavior: alienation, occupational status, workplace drinking subculture and problem drinking

This study explored the association between alienating job conditions and problem drinking within the context of occupational status and workplace drinking subculture. From December 1994 to March 1995, a questionnaire survey was implemented in the manufactory sector in southern Taiwan. Within the questionnaire, any perceived self-estrangement, powerlessness and social isolation that the individual experienced in his work were measured as the alienating job conditions, and any negative physical, psychological and social consequences the individual experienced during the previous month were considered as affecting problem drinking. Of the 1117 subjects, 668 (61.8%) reported imbibing one or more drinks during the preceding month; the average daily alcohol consumption being 0.2+/-0.9 drinks. In addition, 188 (16.8%) subjects reported having experienced drinking-related problems in the preceding month. Workers with low occupational status were more likely to become problem drinkers when they felt comparatively self-estranged in their work. Further, those with a family history including any habitual drinker or those under more encouraging workplace drinking subculture were more likely to have drinking-related problems. For the prevention of problem-related drinking behavior, the workplace should be considered as the focus of our future intervention and management program.     

Relationship of fluoride in drinking water to other drinking water parameters

Fluoride in drinking water and 32 other drinking water variables were evaluated in an epidemiologic study of 158 municipalities in the State of Iowa. The study included three study groups: two for controlled fluoridation and one for natural fluoride. Previous epidemiologic studies of fluoride in drinking water have rarely addressed other drinking water parameters. The results indicated that controlled fluoridation municipalities were more likely to have initiated other treatment practices such as chlorination. Natural fluoride drinking water concentrations were positively correlated with water source depth, and thereby related to other depth-associated variables such as radium 226, strontium, and nitrogen. Future epidemiologic studies evaluating the safety of fluoride in drinking water should address the potential for confounding by other water variables and treatment processes.     

Employment, unemployment, and problem drinking

The misuse of alcohol is estimated to result in enormous economic costs, composed largely of reduced labor market productivity. However, there has been debate on this issue. The purpose of this paper is to help to resolve this debate by presenting sound structural estimates of the relationship between measures of problem drinking and of employment and unemployment. The analysis is based on the 1988 Alcohol Supplement of the National Health Interview Survey. We find that for both men and women, problem drinking results in reduced employment and increased unemployment.     

Correlates of stages in the progression from everyday drinking to problem drinking

Data is presented on the following related problems: (1) social characteristic associated with differences in drinking style; (2) variables correlated with intensified consumption; (3) variables, other than consumption level, correlated with harmful effects of alcohol. The concepts of status role, positional role and situation role were used to develop hypotheses. Drinking alcoholic beverages is considered as an element of situation roles in which drinking alcohol is considered meaningful and appropriate. The hypotheses are that status groups tend to differ in drinking style (problem 1) and because of these differences, differ also in the degree to which drinking is associated with harmful effects (problem 3). The three positional roles: living with a partner, care for children at home, and employment were combined to indicate the structure of everyday life. The hypotheses were that people with a less structured everyday life are inclined to intensify their consumption (problem 2); and are more vulnerable to harmful effects (problem 3). Most of these hypotheses were confirmed. Gender and the integration of alcohol use appear to be intervening variables concerning the effect of the structure of everyday life on intensified consumption and on harmful effects.     

Longitudinal investigation of exposure to arsenic, cadmium, and lead in drinking water

Arsenic, cadmium, and lead have been associated with various forms of cancer, nephrotoxicity, central nervous system effects, and cardiovascular disease in humans. Drinking water is a well-recognized pathway of exposure to these metals. To improve understanding of the temporal dimension of exposure to As, Cd, and Pb in drinking water, we obtained 381 samples of tap and/or tap/filtered water and self-reported rates of drinking water consumption from 73 members of a stratified random sample in Maryland. Data were collected at approximately 2-month intervals from September 1995 through September 1996. Concentrations of As (range < 0.2-13.8 microg/L) and Pb (< 0.1-13.4 microg/L) were within the ranges reported for the United States, as were the rates of drinking water consumption (median < 0.1-4.1 L/day). Cd was present at a detectable level in only 8.1% of the water samples. Mean log-transformed concentrations and exposures for As and Pb varied significantly among sampling cycles and among respondents, as did rates of drinking water consumption, according to a generalized linear model that accounted for potential correlation among repeated measures from the same respondent. We used the intraclass correlation coefficient of reliability to attribute the total variance observed for each exposure metric to between-person and within-person variability. Between-person variability was estimated to account for 67, 81, and 55% of the total variance in drinking water consumption, As exposure (micrograms per day), and Pb exposure (micrograms per day), respectively. We discuss these results with respect to their implications for future exposure assessment research, quantitative risk assessment, and environmental epidemiology.     

Filamentous fungi in drinking water, particularly in relation to biofilm formation

The presence of filamentous fungi in drinking water has become an area worthy of investigation with various studies now being published. The problems associated with fungi include blockage of water pipes, organoleptic deterioration, pathogenic fungi and mycotoxins. Fungal biofilm formation is a less developed field of study. This paper updates the topic and introduces novel methods on fungal biofilm analysis, particularly from work based in Brazil. Further recommendations for standard methodology are provided.     

Doctors' drinking and fitness to practise

Rosta and Aasland's paper (2005) ‘Female surgeons’alcohol use: A Study of a Nation-wide Sample of Norwegian Doctorsadds to the evidence that doctors are at increased risk of becomingdependent at some point in their career. The finding that detrimental drinking by surgeons was more prevalentthan might be expected may point to important fitness-to-practiseconsiderations. The questions ‘Who cares about doctors as individuals?’and ‘Who cares for doctors apart from family and friends?’seem still to be difficult to answer. A doctor's independence and ability to become immersed in apatient's plight are key components for     

Heavy drinking, but not moderate or intermediate drinking, increases the risk of intracerebral hemorrhage

An increased risk of intracerebral hemorrhage among heavy consumers of alcohol has been demonstrated in several epidemiologic studies. The effect of moderate or intermediate intakes is, however, unclear. Although several studies provide evidence for a protective effect, this conclusion may be spurious, resulting from the inclusion, within the zero intake (reference) group, of past drinkers who have recently abstained for health reasons. The present study describes the relation between alcohol consumption and intracerebral hemorrhage among 331 case-control pairs recruited in Melbourne, Australia. Heavy drinking was associated with an increased risk of intracerebral hemorrhage (odds ratio (OR) 3.4, 95% confidence interval (CI) = 1.4-8.4). The odds ratio of intracerebral hemorrhage with moderate drinking, when compared with never drinkers, was 0.7, (95% CI = 0.4-1.2) and was 0.6 (95% CI = 0.4-1.0) when compared with nondrinkers (never drinkers plus past drinkers). Wine drinkers were apparently protected from intracerebral hemorrhage (OR 0.5, 95% CI = 0.2-0.9). These results are consistent with the possibility that moderate drinking may confer protection from intracerebral hemorrhage, but this protection may be less than that previously reported.     

From the second European drinking water guideline to the new drinking water regulations

The new drinking water regulations, effective 1.1.2003, introduced several new and hygienically important changes. The term "drinking water" has changed to "water for human consumption". The change of the term gives a remarkable extension of the scope of the drinking water regulations. One of the consequences is that the water in buildings in which the water is delivered to the public has now to be controlled as well. The planned measures may help to promote good consequences in case of accidents. The need for treatment makes it necessary to control raw water to a higher degree than before. In case of microbial contamination the water has to be treated by filtration. Disinfection may no longer be the only treatment to ensure a safe drinking water supply. The adherence to the technical rules demanded by the new drinking water regulations may convey much additional security to water supply.     

Copper in drinking water, Nebraska, 1994

In 1993, the levels of copper (Cu) in much of Nebraska's drinking water exceeded the U.S. Environmental Protection Agency's (EPA) action level of 1.3 mg/L. To determine the association of copper with gastrointestinal (GI) illness in August 1994 the authors interviewed persons living in households with 1993 Cu levels > 3 mg/L (51 households), 2-3 mg/L (54 households), and < 1.3 mg/L (43 households). Cases were defined as persons who had experienced the rapid onset of vomiting or nausea with abdominal pain during the preceding two weeks. To validate their exposure index, the authors immediately resampled drinking water in the households of 25 cases and 27 controls matched for age. Reassessment in December 1994 of the exposure and case status of the original cohort showed no association between copper in drinking water in 1993 and case status in 1994. The risk of GI illness seemed no greater with Cu > 3 mg/L (RR = 1.03; 95% CI = 0.43, 2.49) or 2-3 mg/L (RR = 0.50; 95% CI = 0.18, 1.41) than with Cu < 1.3 mg/L. The 1993 Cu concentrations could not be reproduced in August 1994; resampling in December 1994 again showed no association between GI illness and Cu exposure (RR > 1.3-2.9 mg/L, < or = 1.3 mg/L = 0.25, 95% CI = 0.10, 0.64, and RR > or = 3.0 mg/L, < or = 1.3 mg/L = 0.36, 95% CI = 0.09, 1.49).     

涉水产品中铬的石墨炉原子吸收法测定条件的探讨

目的：探讨石墨炉原子吸收光谱法测定涉水产品中铬的试验条件。方法：涉水产品经过前处理后，用石墨炉原子吸收光谱法测定其铬的含量并找出最佳试验条件。结果：最佳灰化温度1300℃、原子化温度2300℃。方法的线性范围0～8.0μg/L，相关系数r=0.9996。RSD为1．34％～3．19％，回收率为90．4％～108．9％。结论：在方法的最佳试验条件下测定涉水产品中的铬可以得到满意的结果。     

男性饮酒行为与吸烟行为及戒烟意愿的关系

目的探讨男性饮酒与吸烟行为及戒烟意愿之间的关系。方法按多阶段分层整群随机抽样方法,在江苏省14个慢病监测点,抽取≥18岁男性常住居民进行问卷调查,采用非条件logistic回归方法,分析饮酒与吸烟、戒烟意愿之间的关系。结果男性成人现在吸烟率和饮酒率分别为56.90%、60.16%。饮酒者现在吸烟率为66.54%,饮酒者现在吸烟的比例高于不饮酒者(OR=2.77,95%CI:2.40~3.19),且随饮酒频率和饮酒量的增加而显著增加。现在吸烟者中,打算戒烟比例为26.56%,饮酒频率越高者打算戒烟的比例越低(P=0.023)。结论饮酒会促进吸烟行为的发生,并降低吸烟者的戒烟意愿。     

The sociodemographic patterning of drinking and binge drinking in Estonia,Latvia, Lithuania and Finland, 1994–2002

Background  

Despite the relatively low recorded alcohol consumption level, the Baltic countries (Estonia, Latvia and Lithuania) and neighbouring Finland suffer from similar harmful consequences related to the use of alcoholic beverages, including socio-economic inequalities in alcohol related mortality. Comparative evidence is needed to understand harmful drinking patterns and to implement preventive alcohol policies also in the Baltic countries. This study compared heavy and binge drinking by sex, age, education, urbanisation and marital status in the Baltic countries and Finland.     

Infectious disease outbreaks related to drinking water in Canada, 1974-2001

BACKGROUND: Recent public attention on drinking water supplies in the aftermath of waterborne infection outbreaks in Walkerton and North Battleford raises questions about safety. We analyzed information on waterborne outbreaks occurring between 1974 and 2001 in order to identify apparent trends, review the current status of monitoring and reporting, and gain a better understanding of the impact of drinking water quality on public health and disease burden. METHODS: Data from outbreak investigations, published and unpublished, were categorized by the type of drinking water provider and were assessed to be definitely, probably or possibly waterborne in nature. RESULTS: The final data set consisted of 288 outbreaks of disease linked to a drinking water source. There were 99 outbreaks in public water systems, 138 outbreaks in semi-public systems and 51 outbreaks in private systems. The main known causative agents of waterborne disease outbreaks were (in descending frequency of occurrence) Giardia, Campylobacter, Cryptosporidium, Norwalk-like viruses, Salmonella and hepatitis A virus. SUMMARY: We found that severe weather, close proximity to animal populations, treatment system malfunctions, poor maintenance and treatment practices were associated with the reported disease outbreaks resulting from drinking water supplies. However, issues related to the accuracy, co-ordination, compatibility and detail of data exist. A systematic and coordinated national surveillance system for comparison purposes, trend identification and policy development is needed so that future waterborne disease outbreaks can be avoided.     

Phenol poisoning due to contaminated drinking water

Accidental spillage of 37,900 1 of 100% phenol (carbolic acid) in July 1974 caused chemical contamination of wells in a rural area of southern Wisconsin. Human illness characterized by diarrhea, mouth sores, dark urine, and burning of the mouth was subsequently reported by seventeen individuals who consumed the contaminated water; their estimated intake of phenol was 10 to 240 mg/person/day. Clustering of the illnesses in time and place, as well as the similarity of these cases to previously documented cases of phenol poisoning, suggest that phenol in water caused the illness. Physical and laboratory examinations 6 months after the exposure revealed no residual abnormality in exposed persons. Water testing and geologic evaluations indicate that contamination of the underground water system may persist for many years.     

Exposure to alcohol advertising and teen drinking

Objective

Assessing the association between alcohol ad exposure and alcohol use in German adolescents, controlling for general ad exposure.

Method

Cross-sectional survey of 3415 sixth to eighth graders (mean 12.5 years) from 29 schools in three German states (June 2008). Exposure to 9 alcohol and 8 non-alcohol advertisements was measured with masked ad images; students indicated contact frequency and brand recall. Main outcomes were ever drinking, current drinking, binge drinking, alcohol use intentions and outcome expectancies.

Results

There was a bivariate association between both exposures (alcohol and non-alcohol ads) and all alcohol use measures. After adjustment for confounding, only alcohol ad exposure retained a significant association with outcomes. Multi-level logistic regressions revealed that compared with quartile one alcohol ad exposure, the adjusted odds ratios for quartile four were 2.4 (95% confidence interval 1.7-3.4) for trying drinking, 2.7 (1.8-3.9) for current drinking and 2.3 (1.6-3.5) for ever binge drinking. There was also an independent association between alcohol ad exposure and alcohol-related attitudes among never drinkers.

Conclusion

This study demonstrates a positive association between exposure to alcohol advertising and multiple youth drinking outcomes, showing that the association is content-specific, not just a function of general ad exposure.