Consistency of reported alcohol use by pregnant women: anonymous versus confidential questionnaires with item nonresponse differences

BACKGROUND: Self-report is the best method to attain information about moderate alcohol consumption. However, reported alcohol consumption before and during pregnancy is sensitive to response bias. METHODS: We compared identical questionnaires completed either confidentially or anonymously by pregnant women. A representative half of the pregnant women in Oslo attending ultrasound screening between June 2000 and May 2001 were invited to join a confidential questionnaire study. Another group of pregnant women, selected in the identical manner, were asked to answer the same questionnaire anonymously during the summer of 2001. The questionnaire was completed by 1749 confidentially and 191 anonymously (response rate 93.4% vs 84.4%). For the current study, only women with Scandinavian ethnicity were included: 1707 and 178, respectively. Measures were T-ACE (screening measure for pregnancy risk drinking), reported frequency of alcohol use, Standard Units (SU) per occasion (po), SU per week, and binge drinking (>or=5 SU po), before and during pregnancy. RESULTS: There were no significant differences in reported alcohol consumption between the confidential and the anonymous group for the sample as a whole. Any alcohol consumption was reported by 22.6% and 23.3% during pregnancy week 7-12 and 13+ (confidential group) versus 22.5% and 25.8% (anonymous group). Differences between the groups tended to be larger for SU per week (p=0.07 both before pregnancy and after week 12 of pregnancy) than for the indirect alcohol (T-ACE) and the binge drinking questions. In the confidential group, the women with lower education had close to twice as high item nonresponse on the direct alcohol questions during pregnancy compared with those with higher education. This difference was smaller in the anonymous group. The rate of smoking was not reported differently in the anonymous group. CONCLUSIONS: Among pregnant women, there was no significant difference in self-reported alcohol consumption obtained by confidential or anonymous questionnaires.     

Is Pregnancy the Time to Change Alcohol Consumption Habits in France?

Background:  Although it is well known that France has a cultural history of alcohol use, no recent French data on alcohol consumption during pregnancy in a large sample are available.
Methods:  To determine the alcohol consumption patterns among pregnant women in France, we analyzed data from a 1-year multicenter self-survey. Sociodemographic profile, obstetrical history, neonatal data, and a self-report for assessing drinking patterns during pregnancy including AUDIT were recorded from women who delivered recently. Cases of fetal alcohol syndrome (FAS) were also reported.
Results:  A total of 837 pregnant women have described all parameters. The mean age at delivery of our sample was 29.7 years (SD = 4.8 years). A total of 52.2% of women indicated that they had consumed alcohol at least once during their pregnancy, and among abstainers 54.5% had a positive AUDIT score. Of the pregnant women who consumed alcohol, 13.7% reported at least one binge drinking episode (5 or more drinks on 1 occasion) during pregnancy. Binge drinking is significantly more frequent than regular alcohol consumption (at least 1 drink more than 1 time per week) during pregnancy. A prevalence rate of FAS of 1.8 per 1,000 live births was observed.
Conclusions:  There is a large population of women who still drink alcohol during pregnancy, particularly in binge drinking episodes. This underlines the need to clearly inform women of childbearing age about the dangers of alcohol during pregnancy as related to all types of consumption. Moreover, acting to prevent alcohol consumption prior to pregnancy may also greatly influence prenatal drinking.     

Women's alcohol consumption and risk for alcohol-exposed pregnancies in Russia

Aims Alcohol‐exposed pregnancies (AEP) are the direct cause of fetal alcohol spectrum disorders (FASD). This study examines drinking patterns among pregnant and non‐pregnant women of childbearing age in Russia, a country with one of the highest levels of alcohol consumption in the world. Design Cross‐sectional survey. Setting Seven public women's clinics in two locations: St Petersburg (SPB) and the Nizhny Novgorod region (NNR). Participants A total of 648 pregnant and non‐pregnant childbearing‐age women. Measurements A face‐to‐face structured interview assessed alcohol consumption, pregnancy status/possibility of becoming pregnant and consumption before and after pregnancy recognition. Findings Eighty‐nine per cent of non‐pregnant women reported consuming alcohol and 65% reported binge drinking in the past 3 months; 47% in NNR and 28% in SPB reported binges at least monthly. Women who might become pregnant consumed alcohol similarly to women who were not likely to become pregnant, and 32% of women in SPB and 54% in NNR were categorized as at risk for AEP. There was a significant decline in drinking after pregnancy identification. Twenty per cent of pregnant women reported consuming alcohol and 6% in SBP (none in NNR) reported binge drinking; however, a high prevalence of binge drinking was found among women who might become pregnant or who were trying to conceive. Conclusions Russian women substantially reduce drinking after pregnancy recognition compared to pre‐pregnancy levels. No reductions were found prior to pregnancy recognition, either when a woman might become pregnant or when she was trying to conceive. The pre‐conception period presents a risk window and, therefore, a prevention opportunity.     

Perception of Pregnancy and Social Support as Predictors of Alcohol Consumption during Pregnancy

Although an association between alcohol consumption during pregnancy and adverse fetal outcomes has been well documented, variables related to alcohol consumption during pregnancy have remained neglected. Since pregnancy has been considered a time of crisis and stress for pregnant women, this study sought to determine the association of perceptions of pregnancy and social support to alcohol consumption during pregnancy. The 311 Southern metropolitan prenatal patients sampled were interviewed twice during pregnancy. Perception of pregnancy was not found to be correlated with either social support or alcohol consumption during pregnancy. Social support was significantly associated with decreased alcohol consumption during pregnancy. Using standard multiple regressions, two components of social support, general support and pregnancy support, were found to be working in opposite directions prior to pregnancy, with general support showing a positive association with alcohol consumption. Only pregnancy support continued to account for a significant amount of the variance in alcohol consumption during the first 4 months of pregnancy. Pregnancy support, additionally, showed a significant negative association with high maximum drinking (consuming five or more drinks on occasion) prior to pregnancy. These findings suggest that social support may be an important predictor of alcohol consumption both prior to and during pregnancy and merits further investigation.     

Do attitudes and knowledge predict at-risk drinking among Russian women?

ABSTRACT

Background: Drinking patterns among Russian women indicate substantial risk for alcohol-exposed pregnancies. Data about women’s knowledge and attitudes related to alcohol consumption during pregnancy and the extent to which women’s knowledge and attitudes affect their alcohol use remain limited. Objectives: To describe Russian women’s knowledge and attitudes and assess whether women’s knowledge and attitudes were associated with their risky drinking. Methods: A cross-sectional survey was administered to women of childbearing age (n = 648). Participants were recruited at women’s health clinics and asked about their alcohol consumption, pregnancy status, attitudes, and knowledge about effects of alcohol and Fetal Alcohol Syndrome (FAS). Results: 40% of the women surveyed believed or were uncertain whether alcohol consumption during pregnancy was acceptable. Although 34% had heard of FAS, only 8% possessed accurate knowledge. Correct knowledge was associated with decreased alcohol consumption among pregnant women, but there was no association between knowledge and risky drinking in nonpregnant women, including those who were at risk for an unplanned pregnancy or were trying to conceive. However attitudes were strongly associated with risky drinking by nonpregnant women across levels of knowledge about FAS and any alcohol use by pregnant women. Conclusions: Russian women had limited knowledge and several misconceptions about the effects of alcohol on the fetus, and risky alcohol consumption was strongly associated with women’s attitudes and knowledge. The study provides strong evidence to support continuing public health education about effects of alcohol use during pregnancy. Correcting specific misconceptions and targeting the preconceptional period in health communications are necessary to reduce at-risk drinking and the risk for alcohol-exposed pregnancies.     

Beliefs about fetal alcohol spectrum disorder among men and women at alcohol serving establishments in South Africa

Background: South Africa has one of the highest rates of fetal alcohol spectrum disorder (FASD) in the world. However, little is known about what men and women who attend alcohol serving establishments believe about alcohol use during pregnancy and how these beliefs may be related to alcohol use. Objectives: To understand FASD beliefs and related behaviors among men and women attending alcohol-serving establishments. Methods: We surveyed 1047 men (n?=?565) and women (n?=?482) -including pregnant women and men with pregnant partners- attending alcohol serving establishments in a township located in Cape Town, South Africa. Results: Among both pregnant (n?=?53) and non-pregnant (n?=?429) women, 54% reported drinking alcohol at least 2–4 times per month, and 57% reported having at least 3–4 alcohol drinks during a typical drinking session. Pregnant women were less likely to believe that they should not drink alcohol and that alcohol can harm a fetus when compared to non-pregnant women. Similar findings were observed between men with pregnant partners compared to men without pregnant partners. Among women, beliefs about how much alcohol pregnant women can safely drink were associated with self-reported alcohol use. Conclusions: Efforts to address FASD need to focus on understanding how men and women perceive alcohol use during pregnancy and situational factors that contribute to alcohol consumption among pregnant women attending alcohol serving establishments. Structural and individual-level interventions targeting women at alcohol serving establishments should be prioritized to mitigate alcohol use during pregnancy.     

Alcohol consumption among low-income pregnant Latinas

BACKGROUND: Due to changing cultural norms, Latinas of childbearing age residing in the U.S. may be at increasing risk of drinking harmful levels of alcohol during pregnancy, and may also be unaware of the risks for Fetal Alcohol Spectrum Disorders associated with this behavior. We assessed the prevalence of alcohol consumption in a sample of low-income pregnant Latinas and examined risk factors for alcohol use in the periconceptional period. METHODS: As part of a larger intervention trial, a cross-sectional in-home interview study was conducted among a sample of 100 pregnant low-income Latinas receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in San Diego County, California. RESULTS: Fifty-seven percent of respondents indicated they were either life-time abstainers or had not consumed any alcohol in the periconceptional period. Forty-three percent reported some alcohol use in the three months prior to recognition of the current pregnancy, and 20% reported at least one binge episode of four or more standard drinks during that time frame. Five percent reported drinking seven or more drinks per week, and 8% continued drinking alcohol after recognition of pregnancy. Significant predictors of any alcohol use in the periconceptional period included English language/higher level of acculturation, younger maternal age, lower parity, higher level of education, younger age at first drink, and having ever smoked. Women who were aware of alcohol warning messages and /or had more knowledge of the Fetal Alcohol Syndrome (FAS) were significantly more likely to have consumed alcohol in the periconceptional period. Frequency of periconceptional use of alcohol did not differ between women who planned or did not plan the pregnancy. CONCLUSION: The prevalence and pattern of early pregnancy alcohol consumption in this sample of Latinas is similar to patterns noted in other race/ethnic groups in the U.S. Level of knowledge about FAS and awareness of warning messages was not protective for early pregnancy alcohol consumption, suggesting that specific knowledge was insufficient to prevent exposure or that other factors reinforce maintenance of alcohol consumption in early pregnancy. Selective interventions in low-income Latinas are warranted, and should be focused on women of reproductive age who are binge or frequent drinkers and who are at risk of becoming pregnant.     

Rates and correlates of alcohol use among pregnant women in obstetrics clinics

BACKGROUND: The purpose of this study was to demonstrate feasibility of screening and to identify rates and correlates of alcohol use in a large, demographically representative sample of pregnant women across a number of obstetrics clinics, extending previous studies of single or high-risk settings. Identification of harmful alcohol use during pregnancy and of associated factors is critical for the design and implementation of secondary prevention strategies. METHODS: A total of 1131 pregnant women age 18 and older were screened in the waiting areas of eight obstetrics clinics in Southeastern Michigan using a brief (10 min) screening questionnaire. This survey consisted of direct and indirect (TWEAK) measures of alcohol use, as well items assessing demographic characteristics, use of tobacco, and whether participants' physicians discussed alcohol use behavior with them. Women ranged in age from 18 to 46, with a mean age of 28.7 (SD = 5.3). The racial/ethnic distribution of our sample suitably reflects the various racial segments of the Michigan population. RESULTS: We found that 15.1% of the total sample (n = 169) reported any alcohol use during pregnancy, with the majority of those women reporting relatively low levels of alcohol use. One hundred and forty-seven women (13%) scored above the cutoff on the TWEAK (i.e., above a score of 2). Based on multivariate analyses, higher risk alcohol use (defined as binge drinking or greater than one standard drink per week) during pregnancy was predicted by smoking and earlier stage of pregnancy. Caucasian race, smoking, psychological distress, and greater number of drinks during pregnancy predicted scores above a cutoff of 2 on the TWEAK. CONCLUSION: This study demonstrated that screening in busy obstetrics clinics is feasible and acceptable to women and that it may be optimal to use both indirect and direct measures of alcohol use. In addition, brief assessments should be conducted throughout pregnancy and may be targeted or intensified for smokers and for women earlier in their pregnancy.     

Alcohol use in pregnant and nonpregnant Russian women

BACKGROUND: Alcohol consumption in Russia is reportedly high for both men and women; most studies of Russian drinking have used questionnaires not designed specifically to measure alcohol consumption or to interview women. This study was designed specifically to measure drinking patterns among pregnant and nonpregnant Russian women. METHODS: Eight hundred ninety-nine women of child-bearing age in St. Petersburg, Russia, were interviewed in employment centers, educational centers, and at obstetric and gynecologic (OB/GYN) clinics and hospitals. Measurement of drinking used several types of drinking questions and time frames. RESULTS: Nearly all nonpregnant Russian women (95.9%) reported consuming alcohol in the last 12 months. Among nonpregnant women drinkers, 7.6% reported drinking heavily (29.58 mL or more ethanol/d), and 18.4% reported drinking >or=5 on at least 1 occasion. Contrary to expectations of Russian obstetricians, pregnant Russian women readily answered detailed questions about their drinking behavior during pregnancy. Nearly all pregnant women drank in the year before they became pregnant; of these, 60.0% reported drinking when they knew they were pregnant, and 34.9% drank in the past 30 days. Among pregnant women who drank in the past 30 days, 7.4% reporting having >or=5 drinks on at least 1 occasion. Nevertheless, more than 90% of pregnant and nonpregnant Russian women believed that alcohol has a detrimental effect on pregnancy outcomes. CONCLUSIONS: Pregnant and nonpregnant Russian women were willing to answer detailed questions about their drinking behavior. Although most pregnant women studied reduced their drinking during pregnancy, one-third of the pregnant women did not stop drinking. It is important to find out what enabled two-thirds of the pregnant women to stop drinking before or during their pregnancy.     

Understanding drinking during pregnancy among urban American Indians and African Americans: health messages, risk beliefs, and how we measure consumption

BACKGROUND: Little is known about urban American Indian and African American women's drinking during pregnancy, or their beliefs about the risk of doing so. However, rates of fetal alcohol syndrome (FAS) are believed to be highest among those ethnic groups. METHODS: The Developing Effective Educational Resources (DEER) project recruited pregnant American Indian, African American, and white women from urban California areas (n = 321), to develop culturally appropriate consumption measures, to gather epidemiological data about drinking during pregnancy, and to assess exposure and reactions to health warnings intended to encourage abstinence during pregnancy. RESULTS: The study found high levels of exposure to health warnings among all ethnic groups, but many women were unclear about the actual consequences of FAS, about the risk of drinking even beer or wine or wine coolers, or about the value of reducing intake at any time during pregnancy. The majority of the women who drank malt liquor, fortified wine, wine, and spirits reported having larger than standard drinks, and daily drinkers had the highest levels of reporting error. When drink size was considered in the calculation of alcohol volume, average daily volume of consumption during pregnancy increased to the FAS risk level (average daily volume > or = 1) in the overall sample and among the African American and white subjects. CONCLUSIONS: Because some women, especially heavy drinkers, will continue drinking despite exposure to abstention-oriented health messages, it may be prudent to develop campaigns and interventions that provide factual information to help at-risk women reduce their drinking during pregnancy. Women could be advised of beverage equivalency, of standard drink sizes, and of how their own drinks compare with standard ones. Reliance on standard drink sizes in research can result in significant underreporting of consumption, especially among pregnant risk drinkers.     

Estimated Prevalence of Harmful Alcohol Consumption in Pregnant and Nonpregnant Women in Saxony-Anhalt (NorthEast Germany) Using Biomarkers

Background

Alcohol consumption is commonly accepted in Western societies and is a known risk factor in pregnancy, which could lead to fetal alcohol spectrum disorders (FASDs). Prevalence of alcohol consumption during pregnancy is mostly unknown. Prevalence estimates in publications based on questionnaires are limited by possible underreporting due to social stigmatization. The aim of this study was to estimate the prevalence of harmful alcohol consumption in a large cohort of pregnant women using different biomarkers related to alcohol consumption and compare the findings with those of non-pregnant women

Methods

Routine parameters known to be influenced by alcohol consumption (γ-glutamyltransferase, GGT; carbohydrate-deficient transferrin, CDT/%CDT; mean corpuscular/cell volume, MCV; combined parameter of GGT and %CDT, GGT-CDT) were analyzed in serum samples of 2,182 pregnant women and 743 non-pregnant, age-matched females. Data were tested for (i) differences between pregnant and non-pregnant women and (ii) changes across the 3 trimesters of pregnancy.

Results

Prevalence rates differ greatly according to the parameter and cutoff, which reflects the limitations of assessing alcohol consumption with biomarkers. The prevalence of harmful alcohol consumption on the basis of a single or several elevated parameters was 13.8% (95% CI: 12.4 to 15.2) in pregnant women and 18.6% (95% CI: 15.8 to 21.4) in non-pregnant women, though 85.0% of the elevated measurements were attributable to an isolated elevation in %CDT only. Using GGT-CDT as the parameter with the highest specificity according to the literature, the estimated prevalence of harmful alcohol consumption in pregnancy is 0.5% (95% CI: 0.2 to 0.7).

Conclusion

Estimated prevalence rates differ greatly with respect to the biomarkers and cutoffs used. The use of CDT/%CDT alone appears to overestimate harmful alcohol consumption during pregnancy.

     

Apolipoprotein E alleles in women with intrahepatic cholestasis of pregnancy

OBJECTIVE: To investigate the frequency of apolipoprotein E (apoE) alleles among women with intrahepatic cholestasis of pregnancy. METHODS: The presence of the three most common apoE alleles (epsilon2, epsilon3, epsilon4) was determined by polymerase chain reaction-restriction fragment length polymorphism in two groups of women: healthy pregnant women (n = 47) and pregnant women with a diagnosis of intrahepatic cholestasis of pregnancy (n = 44). In addition, the frequencies of the alleles in the general population in our area are presented for comparison. RESULTS: The frequency of the apo epsilon4 allele was 21.6% among women with intrahepatic cholestasis and it was 16.0% among healthy pregnant women (Fisher exact test; P= 0.216), which is close to the rate in the general population in our area (19%). None of the apoE genotypes was significantly over-represented, and homozygous genotype epsilon4 was not associated with more severe clinical disease than other genotypes. CONCLUSION: The observed profiles of allele and genotype frequencies confirm the equilibrium state between apoE polymorphism and obstetric cholestasis and suggest that apoE does not play a major role in the development of intrahepatic cholestasis of pregnancy.     

The effects of social support on alcohol consumption during pregnancy: situational and ethnic/cultural considerations

While the effects of alcohol consumption during pregnancy have been well documented, variables associated with drinking during pregnancy have received little attention. This study sought to determine the importance of situational and ethnic/cultural-specific support on alcohol consumption during pregnancy among Black and White women in a U.S. southern urban prenatal population. A consecutive sample of 311 prenatal patients were interviewed during both the fourth month and the eighth month of pregnancy. Using standard regressions, the two components of expressive support--general support and pregnancy support--were found to be working in opposite directions, with pregnancy support showing a negative association with alcohol consumption during pregnancy. Pregnancy support was found to contribute significantly to the variance in alcohol consumption among Whites but was not found to be a significant contributor among Blacks. These findings suggest that social support, specifically pregnancy support, is a significant variable in accounting for alcohol consumption during pregnancy, but this association may not be consistent across ethnic groups.     

Phosphatidylethanol as Blood Biomarker of Alcohol Consumption in Early Pregnancy: An Observational Study in 4,067 Pregnant Women

Background

The teratogenic effects of alcohol are well documented, but there is a lack of screening methods to detect alcohol use during pregnancy. Phosphatidylethanol 16:0/18:1 (PEth) is a specific and sensitive biomarker reflecting alcohol intake up to several weeks after consumption. The aim of this study was to investigate the prevalence of positive PEth values as an indicator of early prenatal alcohol exposure in a general population of pregnant women.

Methods

Rhesus typing is routinely performed in Norway in all pregnancies around gestational week 12. Rhesus-negative women have an additional test taken around week 24. Blood samples submitted to St. Olav University Hospital in Trøndelag, Norway, for Rhesus typing during the period September 2017 to October 2018 were collected. A total of 4,533 whole blood samples from 4,067 women were analyzed for PEth (limit of quantification of 0.003 µM).

Results

Fifty-eight women had a positive PEth sample. Of these, 50 women were positive around gestational week 12, 3 women were positive around week 24, and in 5 cases, the timing was unknown. There were no significant differences in proportions of women with positive PEth values related to age, or rural versus urban residency.

Conclusion

In an unselected pregnant population in Norway, 1.4% had a positive PEth sample around gestational week 12, whereas 0.4% had a positive sample around week 24. The use of PEth as an alcohol biomarker should be further investigated as a diagnostic tool in the antenatal setting.

     

Beverage choice among native american and african american urban women

BACKGROUND: Little is known about beverage preference, especially among understudied urban minority populations. Also, most studies do not differentiate between beer and malt liquor or among wine, wine coolers, and fortified wine. This article examines whether ethnicity or drinking frequency are associated with beverage choice, considering six types of alcoholic beverages: beer, wine, spirits, malt liquor, fortified wine, and wine coolers. METHODS: Data were analyzed from Native American (n = 70) and African American (n = 129) urban pregnant women who reported drinking in the 12 months before an index pregnancy. A small comparison group of white women (n = 22) was included. Women were queried about their consumption of each of six beverage types during the 12 months before pregnancy. RESULTS: The alcoholic beverage most often used, adjusted for other beverages consumed, was beer, followed in order by spirits, wine coolers, malt liquor, wine, and fortified wine. The Native American women preferred beer, which accounted for one third of total intake. In contrast, malt liquor and spirits each accounted for approximately a quarter of intake among African Americans. Compared with other drinkers, women who drank daily were significantly more likely to choose the beer and wine products with a higher alcohol content. In general, these bivariate results were borne out by multivariate analyses that controlled for age, marital status, and education. CONCLUSIONS: These findings suggest that when accuracy is desired, alcohol studies focusing on urban African American samples (and, to a lesser degree, Native American respondents) should consider not just beer, wine, and spirits consumption, but also stronger beer products, such as malt liquor; stronger wine products, such as fortified wine; and sweeter products, such as wine coolers.     

Drinking during pregnancy: attitudes and knowledge among pregnant Danish women, 1998

BACKGROUND: During the 1990s, most Western countries officially recommended that pregnant women abstain from alcohol. However, information about the potentially harmful effects of alcohol during pregnancy does not necessarily equate to understanding, and information and knowledge may not be associated with pregnant women's own attitudes toward drinking. METHODS: From October to December 1998, we interviewed 439 Danish-speaking pregnant women who were referred for routine antenatal care at their first visit at 15 to 16 weeks of gestation. The women were interviewed about their attitudes toward and beliefs and knowledge about drinking during pregnancy. Questions were also asked about information on alcohol provided to the women. RESULTS: Seventy-six percent of the women considered some alcohol intake during pregnancy to be acceptable, mostly on a weekly level. Binge drinking, however, was considered to be harmful by 85%. These attitudes were not associated with knowledge about the official recommendation or whether the woman had talked to her general practitioner or midwife about alcohol during pregnancy. Most of the women had received information on alcohol from the mass media or relatives, but most women believed that information about alcohol during pregnancy could best be communicated to them by health personnel. Only 21% were aware of the official recommendation from the Danish National Board of Health. One third had discussed alcohol with their general practitioner or midwife, but these women had mostly been advised that some alcohol intake was acceptable. CONCLUSIONS: Most of the women considered some alcohol intake during pregnancy to be acceptable, mostly on a weekly level, and their attitudes were independent of their knowledge about the subject. Most of the women had not been informed about alcohol during pregnancy.     

Alcohol Consumption in Emergency Room Patients and the General Population: A Population-Based Study

Our purpose was to obtain epidemiological measures of the association between habitual alcohol consumption, alcohol consumption before the event and alcohol abuse/dependence, and emergency room (ER) attendance compared to the general population in Pachuca-Hidalgo, a city located in the central area of Mexico. The study was a population based case-control design. Data consisted of breath samples to estimated blood alcohol concentration, as well as an interviewer-administered questionnaire, collected on a 24-hr basis, during the entire week, in each of the three main ERs of Pa-chuca. Cases were all patients who visited the three main hospitals ERs during the study period, classified according to their status as an injured or noninjured (medically ill) patient ( n = 1511). The general population sample (n = 920) serves as a comparison group for both types of patients. Injured patients in the ER sample were significantly more likely to report high frequency/high quantity of drinking during the last 12 months than the general population [odds ratio and 95% confidence intervals = 5.55 (1.72–17.97)] and to report drinking within 6 hr before the injury. These relationships did not hold for noninjured patients. Both types of patients were more likely to report high frequency of drunkenness during the preceding 12 months, to be positive for alcohol dependence and to report drug use. We found in the city of Pachuca, a large relationship between habitual alcohol consumption and ER injuries. These findings support associations of alcohol consumption and admission to an emergency room found in ER and general population studies in other countries. Due to the increases in the risk found for abuse/dependent in both injured and noninjured patients, they both would benefit with a brief intervention strategy for reducing their alcohol consumption.     

Alcohol and casualties: comparison of county-wide emergency room data with the county general population

A representative sample of patients in hospital emergency rooms (ERs) in a Northern California county (n = 3731) were compared with a household probability sample of those living in the same county (n = 2101). The injured in the ER sample were more likely to be black and under 30 than those in the general population sample who reported an injury during the last year which was treated in the ER. ER injured were more likely to be abstainers than injured in the general population and among drinkers, they were also more likely to report social consequences of drinking, but were no more likely to report experiences associated with alcohol dependence. Similar differences were found between the injured and the non-injured in the two samples, with the injured more likely to be male, younger, never married and to report heavy drinking, drunkenness, social consequences of drinking and alcohol dependence experiences. The data suggest that associations of alcohol and injury found in representative samples of the ER population may be generalizable to the injured in the general population from which these patients come, with differences which do exist most likely attributable to characteristics associated with emergency room usage.     

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.