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1.  Adult outcomes of binge drinking in adolescence: findings from a UK national birth cohort 
The aim of the study was to determine outcomes in adult life of binge drinking in adolescence in a national birth cohort.
Design and setting
Longitudinal birth cohort: 1970 British Birth Cohort Study surveys at 16 years (1986) and 30 years (2000).
A total of 11 622 subjects participated at age 16 years and 11 261 subjects participated at age 30 years.
At the age of 16 years, data on binge drinking (defined as two or more episodes of drinking four or more drinks in a row in the previous 2 weeks) and frequency of habitual drinking in the previous year were collected. Thirty‐year outcomes recorded were alcohol dependence/abuse (CAGE questionnaire), regular weekly alcohol consumption (number of units), illicit drug use, psychological morbidity (Malaise Inventory) and educational, vocational and social history.
17.7% of participants reported binge drinking in the previous 2 weeks at the age of 16 years. Adolescent binge drinking predicted an increased risk of adult alcohol dependence (OR 1.6, 95% CI 1.3 to 2.0), excessive regular consumption (OR 1.7, 95% CI 1.4 to 2.1), illicit drug use (OR 1.4, 95% CI 1.1 to 1.8), psychiatric morbidity (OR 1.4, 95% CI 1.1 to 1.9), homelessness (OR 1.6, 95% CI 1.1 to 2.4), convictions (1.9, 95% CI 1.4 to 2.5), school exclusion (OR 3.9, 95% CI 1.9 to 8.2), lack of qualifications (OR 1.3, 95% CI 1.1 to 1.6), accidents (OR 1.4, 95% CI 1.1 to 1.6) and lower adult social class, after adjustment for adolescent socioeconomic status and adolescent baseline status of the outcome under study. These findings were largely unchanged in models including both adolescent binge drinking and habitual frequent drinking as main effects.
Adolescent binge drinking is a risk behaviour associated with significant later adversity and social exclusion. These associations appear to be distinct from those associated with habitual frequent alcohol use. Binge drinking may contribute to the development of health and social inequalities during the transition from adolescence to adulthood.
PMCID: PMC2652971  PMID: 17873228
2.  Adult Consequences of Late Adolescent Alcohol Consumption: A Systematic Review of Cohort Studies 
PLoS Medicine  2011;8(2):e1000413.
In a systematic review of cohort studies of adolescent drinking and later outcomes, Jim McCambridge and colleagues show that although studies suggest links to worse adult physical and mental health and social consequences, existing evidence is of poor quality.
Although important to public policy, there have been no rigorous evidence syntheses of the long-term consequences of late adolescent drinking.
Methods and Findings
This systematic review summarises evidence from general population cohort studies of drinking between 15–19 years old and any subsequent outcomes aged 20 or greater, with at least 3 years of follow-up study. Fifty-four studies were included, of which 35 were assessed to be vulnerable to bias and/or confounding. The principal findings are: (1) There is consistent evidence that higher alcohol consumption in late adolescence continues into adulthood and is also associated with alcohol problems including dependence; (2) Although a number of studies suggest links to adult physical and mental health and social consequences, existing evidence is of insufficient quality to warrant causal inferences at this stage.
There is an urgent need for high quality long-term prospective cohort studies in order to better understand the public health burden that is consequent on late adolescent drinking, both in relation to adult drinking and more broadly. Reducing drinking during late adolescence is likely to be important for preventing long-term adverse consequences as well as protecting against more immediate harms.
Please see later in the article for the Editors' Summary
Editors' Summary
The effects of alcohol intoxication (drunkenness), dependence (habitual, compulsive, and long-term drinking), and the associated biochemical changes, have wide-ranging health and social consequences, some of which can be lethal. Worldwide, alcohol causes 2.5 million deaths (3.8% of total) and 69.4 million (4.5% of total) of disability-adjusted life years (DALYs). Unintentional injuries alone account for about one-third of the 2.5 million deaths, whereas neuro-psychiatric conditions account for almost 40%. There is also a causal relationship between alcohol consumption and more than 60 types of disease and injury; worldwide, alcohol is estimated to cause about 20%–30% cases of esophageal cancer, liver cancer, cirrhosis of the liver, homicide, epilepsy, and motor vehicle crashes. There is increasing evidence that, in addition to the volume of alcohol consumed, the pattern of drinking has an effect on health outcomes, with binge drinking found to be particularly harmful. As the majority of people who binge drink are teenagers, this group may be particularly vulnerable to the damaging health effects of alcohol, leading to global concern about the drinking trends and patterns among young people.
Why Was This Study Done?
Although there have been many published cohort studies reporting the longer term harms associated with adolescent drinking, the strength of this evidence remains unclear, which has implications for the objectives of interventions. For example, if adolescent drinking does not cause later difficulties, early intervention on, and management of, the acute consequences of alcohol consumption, such as antisocial behaviour and unintentional injuries, may be the most appropriate community safety and public health responses. However, if there is a causal relationship, there needs to be an additional approach that addresses the cumulative harmful effects of alcohol. The researchers conducted this systematic review of cohort studies, as this method provides the strongest observational study design to evaluate evidence of causality.
What Did the Researchers Do and Find?
The researchers conducted a comprehensive literature review to identify relevant studies that met their inclusion criteria, which were: (1) data collection from at least two points in time, at least 3 years apart, from the same cohort; (2) data collection regarding alcohol consumption between the ages of 15 and 19 years old; and (3) inclusion of a report of at least one quantitative measure of effect, such as an odds ratio, between alcohol involvement and any later outcome assessed at age 20 or greater. The majority of these studies were multiple reports from ten cohorts and approximately half were from the US. The researchers then evaluated the strength of causal inference possible in these studies by assessing whether all possible contributing factors(confounders) had been taken into account, identifying studies that had follow-up rates of 80% or greater, and which had sample sizes of 1,000 participants or more.
Using these methods, the researchers found that, overall, there is consistent evidence that higher alcohol consumption in late adolescence continues into adulthood and is also associated with alcohol problems, including dependence. For example, one population-based cohort showed that late adolescent drinking can cause early death among men, mainly through car crashes and suicides, and there was a large evidence base supporting the ongoing impacts of late adolescent drinking on adult drinking behaviours—although most of these studies could not strongly support causal inferences because of their weak designs. The researchers also concluded that although a number of studies suggested links with late adolescent drinking to adult physical and mental health and social consequences, this evidence is generally of poor quality and insufficient to infer causality.
What Do These Findings Mean?
The results of this study show that that the evidence-base on the long-term consequences of late adolescent drinking is not as extensive or compelling as it needs to be. The researchers stress that there is an urgent need for high quality long-term prospective cohort studies in order to better understand the public health burden associated with adolescent drinking in general and in relation to adult drinking. However, there is sufficient evidence to suggest that reducing drinking during late adolescence is likely to be important for preventing long-term adverse consequences as well as protecting against more immediate harmful consequences harms.
Additional Information
Please access these Web sites via the online version of this summary at
The World Health Organization has information about the global incidence of alcohol consumption
The US-based Marin Institute has information about alcohol and young people
The BBC also has a site on late adolescent drinking
PMCID: PMC3035611  PMID: 21346802
3.  Women's childhood and adult adverse experiences, mental health, and binge drinking: The California Women's Health Survey 
This study examined sociodemographic, physical and mental health, and adult and childhood adverse experiences associated with binge drinking in a representative sample of women in the State of California.
Materials and methods
Data were from the 2003 to 2004 (response rates of 72% and 74%, respectively) California Women's Health Survey (CWHS), a population-based, random-digit-dial annual probability survey sponsored by the California Department of Health Services. The sample was 6,942 women aged 18 years or older.
The prevalence of binge drinking was 9.3%. Poor physical health, and poorer mental health (i.e., symptoms of PTSD, anxiety, and depression, feeling overwhelmed by stress), were associated with binge drinking when demographics were controlled, as were adverse experiences in adulthood (intimate partner violence, having been physically or sexually assaulted, or having experienced the death of someone close) and in childhood (living with someone abusing substances or mentally ill, or with a mother vicimized by violence, or having been physically or sexually assaulted). When adult mental health and adverse experiences were also controlled, having lived as a child with someone who abused substances or was mentally ill was associated with binge drinking. Associations between childhood adverse experiences and binge drinking could not be explained by women's poorer mental health status in adulthood.
Identifying characteristics of women who engage in binge drinking is a key step in prevention and intervention efforts. Binge drinking programs should consider comprehensive approaches that address women's mental health symptoms as well as circumstances in the childhood home.
PMCID: PMC2447829  PMID: 18538028
4.  Self-esteem and Mortality: Prospective Evidence from a Population-based Study 
Annals of epidemiology  2004;14(1):58-65.
Self-esteem is considered to be importantly associated with both psychosocial states such as depression as well as physical health. There are no population-based studies that examine the association between self-esteem and mortality. The objective of this study was to assess whether low self-esteem was prospectively associated with increased risk of death in a population-based sample of Finnish men.
A sample of 2682 male residents of Kuopio, Finland were interviewed and followed prospectively as part of the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Characteristics of the KIHD sample at baseline included self-esteem, measured by the Rosenberg ten-item scale, socioeconomic factors, behavioral risk factors, other psychosocial characteristics, and prevalent diseases. Mortality was ascertained through linkage to the Finnish national death registry. We assessed the relationship between self-esteem and all-cause mortality using Cox proportional hazards models.
Low self-esteem was associated with a two-fold [hazard ratio (HR) = 2.0, 95% confidence interval (CI) = 1.3–3.2] increase in age-adjusted mortality. This relationship was partially explained by behavioral and socioeconomic factors, and prevalent diseases, and fully explained by other psychosocial characteristics (hopelessness, depression, cynical hostility, and sullenness). When adjusted for hopelessness alone there was no increased risk associated with low self-esteem (HR = 1.3, 95% CI = 0.8–2.2).
This study found no association between self-esteem and all-cause mortality after adjustment for other psychosocial characteristics, primarily hopelessness. Our understanding of the observed relationships between some psychosocial factors and mortality may be improved by simultaneous measurement of multiple psychosocial domains, thus diminishing the potential for residual confounding.
PMCID: PMC3173508  PMID: 14664781
Self-esteem; Mortality; Psychosocial Factors; Socioeconomic Factors
5.  Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors: a prospective cohort study with 17-years of follow up 
BMC Public Health  2012;12:1045.
The mechanisms underlying socioeconomic inequalities in mortality from cardiovascular diseases (CVD) are largely unknown. We studied the contribution of childhood socioeconomic conditions and adulthood risk factors to inequalities in CVD mortality in adulthood.
The prospective GLOBE study was carried out in the Netherlands, with baseline data from 1991, and linked with the cause of death register in 2007. At baseline, participants reported on adulthood socioeconomic position (SEP) (own educational level), childhood socioeconomic conditions (occupational level of respondent’s father), and a broad range of adulthood risk factors (health behaviours, material circumstances, psychosocial factors). This present study is based on 5,395 men and 6,306 women, and the data were analysed using Cox regression models and hazard ratios (HR).
A low adulthood SEP was associated with increased CVD mortality for men (HR 1.84; 95% CI: 1.41-2.39) and women (HR 1.80; 95%CI: 1.04-3.10). Those with poorer childhood socioeconomic conditions were more likely to die from CVD in adulthood, but this reached statistical significance only among men with the poorest childhood socioeconomic circumstances. About half of the investigated adulthood risk factors showed significant associations with CVD mortality among both men and women, namely renting a house, experiencing financial problems, smoking, physical activity and marital status. Alcohol consumption and BMI showed a U-shaped relationship with CVD mortality among women, with the risk being significantly greater for both abstainers and heavy drinkers, and among women who were underweight or obese. Among men, being single or divorced and using sleep/anxiety drugs increased the risk of CVD mortality. In explanatory models, the largest contributor to adulthood CVD inequalities were material conditions for men (42%; 95% CI: −73 to −20) and behavioural factors for women (55%; 95% CI: -191 to −28). Simultaneous adjustment for adulthood risk factors and childhood socioeconomic conditions attenuated the HR for the lowest adulthood SEP to 1.34 (95% CI: 0.99-1.82) for men and 1.19 (95% CI: 0.65-2.15) for women.
Adulthood material, behavioural and psychosocial factors played a major role in the explanation of adulthood SEP inequalities in CVD mortality. Childhood socioeconomic circumstances made a modest contribution, mainly via their association with adulthood risk factors. Policies and interventions to reduce health inequalities are likely to be most effective when considering the influence of socioeconomic circumstances across the entire life course and in particular, poor material conditions and unhealthy behaviours in adulthood.
PMCID: PMC3539932  PMID: 23217053
Cardiovascular diseases; Socioeconomic status; Health behaviour; Life course epidemiology; Mortality determinants
6.  Effects of childhood socioeconomic position on subjective health and health behaviours in adulthood: how much is mediated by adult socioeconomic position? 
BMC Public Health  2011;11:269.
Adult socioeconomic position (SEP) is one of the most frequently hypothesised indirect pathways between childhood SEP and adult health. However, few studies that explore the indirect associations between childhood SEP and adult health systematically investigate the mediating role of multiple individual measures of adult SEP for different health outcomes. We examine the potential mediating role of individual measures of adult SEP in the associations of childhood SEP with self-rated health, self-reported mental health, current smoking status and binge drinking in adulthood.
Data came from 10,010 adults aged 25-64 years at Wave 3 of the Survey of Family, Income and Employment in New Zealand. The associations between childhood SEP (assessed using retrospective information on parental occupation) and self-rated health, self-reported psychological distress, current smoking status and binge drinking were determined using logistic regression. Models were adjusted individually for the mediating effects of education, household income, labour market activity and area deprivation.
Respondents from a lower childhood SEP had a greater odds of being a current smoker (OR 1.70 95% CI 1.42-2.03), reporting poorer health (OR 1.82 95% CI 1.39-2.38) or higher psychological distress (OR 1.60 95% CI 1.20-2.14) compared to those from a higher childhood SEP. Two-thirds to three quarters of the association of childhood SEP with current smoking (78%), and psychological distress (66%) and over half the association with poor self-rated health (55%) was explained by educational attainment. Other adult socioeconomic measures had much smaller mediating effects.
This study suggests that the association between childhood SEP and self-rated health, psychological distress and current smoking in adulthood is largely explained through an indirect socioeconomic pathway involving education. However, household income, area deprivation and labour market activity are still likely to be important as they are intermediaries in turn, in the socioeconomic pathway between education and health.
PMCID: PMC3110570  PMID: 21527039
7.  Childhood Psychosocial Cumulative Risks and Carotid Intima-Media Thickness in Adulthood: The Cardiovascular Risk in Young Finns Study 
Psychosomatic medicine  2016;78(2):171-181.
Adverse experiences in childhood may influence cardiovascular risk in adulthood. We examined the prospective associations between types of psychosocial adversity as well as having multiple adversities (e.g., cumulative risk) with carotid intima-media thickness (IMT) and its progression among young adults. Higher cumulative risk score in childhood was expected to be associated with higher IMT and its progression.
Participants were 2265 men and women (age range: 24-39 years in 2001) from the on-going Cardiovascular Risk in Young Finns study whose carotid IMT were measured in 2001 and 2007. A cumulative psychosocial risk score, assessed at the study baseline in 1980, was derived from four separate aspects of the childhood environment that may impose risk (childhood stressful life-events, parental health behavior family, socioeconomic status, and childhood emotional environment).
The cumulative risk score was associated with higher IMT in 2007 (b=.004; se=.001; p<.001) and increased IMT progression from 2001 to 2007 (b=.003; se=.001; p=.001). The associations were robust to adjustment for conventional cardiovascular risk factors in childhood and adulthood, including adulthood health behavior, adulthood socioeconomic status and depressive symptoms. Among the individual childhood psychosocial risk categories, having more stressful life-events was associated with higher IMT in 2001 (b=.007; se=.003; p=.016) and poorer parental health behavior predicted higher IMT in 2007 (b=.004; se=.002; p=.031) after adjustment for age, sex and childhood cardiovascular risk factors.
Early life psychosocial environment influences cardiovascular risk later in life and considering cumulative childhood risk factors may be more informative than individual factors in predicting progression of preclinical atherosclerosis in adulthood.
PMCID: PMC4739501  PMID: 26809108
cardiovascular diseases; cumulative risk score; psychosocial
8.  Pathways from Childhood Abuse and Other Adversities to Adult Health Risks: The Role of Adult Socioeconomic Conditions 
Child abuse & neglect  2015;51:390-399.
Adverse Childhood Experiences (ACEs), including child abuse, have been linked with poor health outcomes in adulthood. The mechanisms that explain these relations are less understood. This study assesses whether associations of ACEs and health risks are mediated by adult socioeconomic conditions, and whether these pathways are different for maltreatment than for other types of adversities.
Using the Behavioral Risk Factor Surveillance System 2012 survey (N=29,229), we employ structural equation modeling to (1) estimate associations of the number and type of ACEs with five health risks – depression, obesity, tobacco use, binge drinking, and self-reported sub-optimal health; and (2) assess whether adult socioeconomic conditions— marriage, divorce and separation, educational attainment, income and insurance status—mediate those associations.
Findings suggest both direct and indirect associations between ACEs and health risks. At high numbers of ACEs, 15–20% of the association between number of ACEs and adult health risks was attributable to socioeconomic conditions. Associations of three ACEs (exposure to domestic violence, parental divorce, and residing with a person who was incarcerated) with health risks were nearly entirely explained by socioeconomic conditions in adulthood. However, child physical, emotional and sexual abuse were significantly associated with several adult health risks, beyond the effects of other adversities, and socioeconomic conditions explained only a small portion of these associations. These findings suggest that the pathways to poor adult health differ by types of ACEs, and that childhood abuse is more likely than other adversities to have a direct impact.
PMCID: PMC4670808  PMID: 26059537
health; mediation; adverse childhood experiences; socioeconomic status; abuse
9.  Binge Drinking among Men Who Have Sex with Men and Transgender Women in San Salvador: Correlates and Sexual Health Implications 
High rates of heavy alcohol use among men who have sex with men (MSM) and transgender women (TW) have been linked to increased vulnerability for HIV and poor mental health. While theories explaining elevated drinking levels among sexual minorities have been forwarded, few investigations have assessed the potential pathways using empirical data, particularly with an explicit focus on self-stigma and among MSM and TW in low- and middle-income countries. This study examined the relationship between stigma-related stress (specifically, self-stigma and concealment of one’s sexual orientation) and binge drinking in a sample of MSM and TW (n = 670) in San Salvador, El Salvador, recruited using respondent-driven sampling. Levels of alcohol consumption among participants were high: only 39 % of the sample did not drink alcohol or did not binge drink, while 34 % engaged in binge drinking at least weekly. Among MSM, high self-stigma was associated with binge drinking at least weekly (adjusted relative risk ratio (aRRR) = 2.1, p < 0.05). No such relationship was found with less than weekly binge drinking. Among both MSM and TW, having a female partner was associated with binge drinking less than weekly (aRRR = 3.3, p < 0.05) and binge drinking at least weekly (aRRR = 3.4, p < 0.05), while disclosure of sexual orientation to multiple types of people was associated with binge drinking less than weekly (aRRR = 2.9 for disclosure to one–two types of people, p < 0.01; aRRR = 4.0 for disclosure to three–nine types of people, p < 0.01). No such relationship was found with at least weekly binge drinking. Binge drinking at least weekly was marginally associated with a number of sexual health outcomes, including high number of lifetime partners (adjusted odds ratio (aOR) = 1.7, p < 0.10), inconsistent condom use with a non-regular partner (aOR = 0.5, p < 0.10), and decreased intention to test for HIV in the next 12 months (aOR = 0.6, p < 0.10). With the exception of inconsistent condom use with a non-regular partner (aOR = 0.4, p < 0.05), binge drinking less than weekly was not associated with increased sexual risk behavior and was actually associated with increased intention to test for HIV in the next 12 months (aOR = 2.8, p < 0.01). These findings support multiple pathways linking stigma-related stress to alcohol use. Specifically, those with high self-stigma and identity concealment may be using alcohol as a maladaptive coping and emotion regulation strategy, while those who have disclosed their sexual orientation to multiple types of people may be more engaged with the sexual minority community, likely in bars and other venues where permissive norms for alcohol use prevail. That this frequency of binge drinking does not appear to be associated with increased sexual risk behavior (and may even be associated with increased intention to test for HIV in the next 12 months) lends further support to the suggestion that these individuals with healthy concepts of the self (as indicated by high levels of disclosure and low levels of risky sexual behavior) may engage in binge drinking because of the influence of the social environment. Further research is needed to establish the pathways linking stigma-related stress to heavy alcohol use so that points of intervention can be identified.
PMCID: PMC4524843  PMID: 25591660
Substance use; Binge drinking; Sexual health; Internalized homonegativity; Sexual orientation disclosure; Men who have sex with men; Transgender women; El Salvador; Respondent driven sampling
10.  Association of Lifecourse Socioeconomic Status with Chronic Inflammation and Type 2 Diabetes Risk: The Whitehall II Prospective Cohort Study 
PLoS Medicine  2013;10(7):e1001479.
Silvia Stringhini and colleagues followed a group of British civil servants over 18 years to look for links between socioeconomic status and health.
Please see later in the article for the Editors' Summary
Socioeconomic adversity in early life has been hypothesized to “program” a vulnerable phenotype with exaggerated inflammatory responses, so increasing the risk of developing type 2 diabetes in adulthood. The aim of this study is to test this hypothesis by assessing the extent to which the association between lifecourse socioeconomic status and type 2 diabetes incidence is explained by chronic inflammation.
Methods and Findings
We use data from the British Whitehall II study, a prospective occupational cohort of adults established in 1985. The inflammatory markers C-reactive protein and interleukin-6 were measured repeatedly and type 2 diabetes incidence (new cases) was monitored over an 18-year follow-up (from 1991–1993 until 2007–2009). Our analytical sample consisted of 6,387 non-diabetic participants (1,818 women), of whom 731 (207 women) developed type 2 diabetes over the follow-up. Cumulative exposure to low socioeconomic status from childhood to middle age was associated with an increased risk of developing type 2 diabetes in adulthood (hazard ratio [HR] = 1.96, 95% confidence interval: 1.48–2.58 for low cumulative lifecourse socioeconomic score and HR = 1.55, 95% confidence interval: 1.26–1.91 for low-low socioeconomic trajectory). 25% of the excess risk associated with cumulative socioeconomic adversity across the lifecourse and 32% of the excess risk associated with low-low socioeconomic trajectory was attributable to chronically elevated inflammation (95% confidence intervals 16%–58%).
In the present study, chronic inflammation explained a substantial part of the association between lifecourse socioeconomic disadvantage and type 2 diabetes. Further studies should be performed to confirm these findings in population-based samples, as the Whitehall II cohort is not representative of the general population, and to examine the extent to which social inequalities attributable to chronic inflammation are reversible.
Please see later in the article for the Editors' Summary
Editors' Summary
Worldwide, more than 350 million people have diabetes, a metabolic disorder characterized by high amounts of glucose (sugar) in the blood. Blood sugar levels are normally controlled by insulin, a hormone released by the pancreas after meals (digestion of food produces glucose). In people with type 2 diabetes (the commonest form of diabetes) blood sugar control fails because the fat and muscle cells that normally respond to insulin by removing sugar from the blood become insulin resistant. Type 2 diabetes, which was previously called adult-onset diabetes, can be controlled with diet and exercise, and with drugs that help the pancreas make more insulin or that make cells more sensitive to insulin. However, as the disease progresses, the pancreatic beta cells, which make insulin, become impaired and patients may eventually need insulin injections. Long-term complications, which include an increased risk of heart disease and stroke, reduce the life expectancy of people with diabetes by about 10 years compared to people without diabetes.
Why Was This Study Done?
Socioeconomic adversity in childhood seems to increase the risk of developing type 2 diabetes but why? One possibility is that chronic inflammation mediates the association between socioeconomic adversity and type 2 diabetes. Inflammation, which is the body's normal response to injury and disease, affects insulin signaling and increases beta-cell death, and markers of inflammation such as raised blood levels of C-reactive protein and interleukin 6 are associated with future diabetes risk. Notably, socioeconomic adversity in early life leads to exaggerated inflammatory responses later in life and people exposed to social adversity in adulthood show greater levels of inflammation than people with a higher socioeconomic status. In this prospective cohort study (an investigation that records the baseline characteristics of a group of people and then follows them to see who develops specific conditions), the researchers test the hypothesis that chronically increased inflammatory activity in individuals exposed to socioeconomic adversity over their lifetime may partly mediate the association between socioeconomic status over the lifecourse and future type 2 diabetes risk.
What Did the Researchers Do and Find?
To assess the extent to which chronic inflammation explains the association between lifecourse socioeconomic status and type 2 diabetes incidence (new cases), the researchers used data from the Whitehall II study, a prospective occupational cohort study initiated in 1985 to investigate the mechanisms underlying previously observed socioeconomic inequalities in disease. Whitehall II enrolled more than 10,000 London-based government employees ranging from clerical/support staff to administrative officials and monitored inflammatory marker levels and type 2 diabetes incidence in the study participants from 1991–1993 until 2007–2009. Of 6,387 participants who were not diabetic in 1991–1993, 731 developed diabetes during the 18-year follow-up. Compared to participants with the highest cumulative lifecourse socioeconomic score (calculated using information on father's occupational position and the participant's educational attainment and occupational position), participants with the lowest score had almost double the risk of developing diabetes during follow-up. Low lifetime socioeconomic status trajectories (being socially downwardly mobile or starting and ending with a low socioeconomic status) were also associated with an increased risk of developing diabetes in adulthood. A quarter of the excess risk associated with cumulative socioeconomic adversity and nearly a third of the excess risk associated with low socioeconomic trajectory was attributable to chronically increased inflammation.
What Do These Findings Mean?
These findings show a robust association between adverse socioeconomic circumstances over the lifecourse of the Whitehall II study participants and the risk of type 2 diabetes and suggest that chronic inflammation explains up to a third of this association. The accuracy of these findings may be affected by the measures of socioeconomic status used in the study. Moreover, because the study participants were from an occupational cohort, these findings need to be confirmed in a general population. Studies are also needed to examine the extent to which social inequalities in diabetes risk that are attributable to chronic inflammation are reversible. Importantly, if future studies confirm and extend the findings reported here, it might be possible to reduce the social inequalities in type 2 diabetes by promoting interventions designed to reduce inflammation, including weight management, physical activity, and smoking cessation programs and the use of anti-inflammatory drugs, among socially disadvantaged groups.
Additional Information
Please access these Web sites via the online version of this summary at
The US National Diabetes Information Clearinghouse provides information about diabetes for patients, health-care professionals, and the general public, including information on diabetes prevention (in English and Spanish)
The UK National Health Service Choices website provides information for patients and carers about type 2 diabetes; it includes peoples stories about diabetes
The nonprofit Diabetes UK also provides detailed information about diabetes for patients and carers, including information on healthy lifestyles for people with diabetes, and has a further selection of stories from people with diabetes; the nonprofit Healthtalkonline has interviews with people about their experiences of diabetes
MedlinePlus provides links to further resources and advice about diabetes (in English and Spanish)
Information about the Whitehall II study is available
PMCID: PMC3699448  PMID: 23843750
11.  Binge Drinking Intensity and Health-Related Quality of Life Among US Adult Binge Drinkers 
Binge drinking (men, ≥5 drinks, women, ≥4 on an occasion) accounts for more than half of the 79,000 annual deaths due to excessive alcohol use in the United States. The frequency of binge drinking is associated with poor health-related quality of life (HRQOL), but the association between binge drinking intensity and HRQOL is unknown. Our objective was to examine this association.
We used 2008-2010 Behavioral Risk Factor Surveillance System data and multivariate linear regression models to examine the association between binge drinking intensity (largest number of drinks consumed on any occasion) among US adult binge drinkers and 2 HRQOL indicators: number of physically and mentally unhealthy days.
Among binge drinkers, the highest-intensity binge drinkers (women consuming ≥7 drinks and men consuming ≥8 drinks on any occasion) were more likely to report poor HRQOL than binge drinkers who reported lower levels of intensity (women who consumed 4 drinks and men who consumed 5 drinks on any occasion). On average, female binge drinkers reported more physically and mentally unhealthy days (2.8 d and 5.1 d, respectively) than male binge drinkers (2.5 d and 3.6 d, respectively). After adjustment for confounding factors, women who consumed ≥7 drinks on any occasion reported more mentally unhealthy days (6.3 d) than women who consumed 4 drinks (4.6 d). Compared with male binge drinkers across the age groups, female binge drinkers had a significantly higher mean number of mentally unhealthy days.
Our findings underscore the importance of implementing effective population-level strategies to prevent binge drinking and improve HRQOL.
PMCID: PMC3396549  PMID: 22498037
12.  The persistence of adolescent binge drinking into adulthood: findings from a 15-year prospective cohort study 
BMJ Open  2013;3(8):e003015.
To examine the prevalence of binge drinking in adolescence and its persistence into adulthood in an Australian cohort.
15-year prospective cohort study.
Victoria, Australia.
1943 adolescents were recruited from secondary schools at age 14–15 years.
Primary outcome measures
Levels of past-week ‘binge’ drinking (5+ standard drinks on a day, each 10 g alcohol) and ‘heavy binge’ drinking (20+ standard drinks on a day for males, 11+ for females) were assessed during six adolescent waves, and across three adult waves up to age 29 years.
Half of the males (52%) and a third of the females (34%) reported past-week adolescent binge drinking. 90% of male and 70% of female adolescent-onset binge drinkers continued to binge in young adulthood; 70% of males and 48% of females who were not adolescent-onset binge drinkers reported young adult binge drinking. Past-week heavy bingeing was less common in adolescence than adulthood. Overall, 35% of the sample (95% CI 33% to 38%) reported past-week binge drinking in adolescence and young adulthood and one-third (33%; 30% to 35%) first reported binge drinking in young adulthood; only 7% of the sample (6–8%) had binge drinking in adolescence but not young adulthood. ‘Heavy binge’ drinking occurred in adolescence and young adulthood for 9% (8% to 10%); 8% (7% to 10%) reported it in adolescence but no longer in young adulthood; and 24% (22% to 26%) began ‘heavy binge’ drinking in young adulthood. Among adolescent binge drinkers (n=821), young adult binge and heavy binge drinking were predicted by being male, adolescent antisocial behaviour and adverse consequences of drinking in adolescence.
Binge alcohol use is common and persistent among young Australians. Efforts to prevent the onset of binge drinking during adolescence may substantially reduce harmful patterns of alcohol use in young adulthood.
PMCID: PMC3753516  PMID: 23959750
Public Health; Epidemiology
13.  Childhood adversities as a predictor of disability retirement 
There is a large body of research on adulthood risk factors for retirement due to disability, but studies on the effect of adverse childhood experiences are scarce.
To examine whether adverse childhood experiences predict disability retirement.
Data were derived from the Health and Social Support Study. The information was gathered from postal surveys in 1998 (baseline) and in 2003 (follow‐up questionnaire). The analysed data consisted of 8817 non‐retired respondents aged 40–54 years (5149 women, 3668 men). Negative childhood experiences, such as financial difficulties, serious conflicts and alcohol‐related problems, were assessed at baseline and disability retirement at follow‐up.
The risk of disability retirement increased in a dose–response manner with increasing number of childhood adversities. Respondents who had experienced multiple childhood adversities had a 3.46‐fold increased risk (95% CI 2.09 to 5.71) of disability retirement compared with those who reported no such adversities. Low socioeconomic status, depression (Beck Depression Inventory‐21), use of drugs for somatic diseases as well as health‐related risk behaviour, such as smoking, heavy alcohol consumption and obesity, were also predictors of disability retirement. After simultaneous adjustments for all these risk factors, the association between childhood adversities and the risk of disability retirement attenuated, but remained significant (OR 1.90, 95% CI 1.07 to 3.37).
Information on childhood conditions may increase our understanding of the determinants of early retirement, especially due to mental disorders. Childhood adversities should be taken into account when considering determinants of disability retirement and identifying groups at risk.
PMCID: PMC2465717  PMID: 17496255
14.  Multi-Exposure and Clustering of Adverse Childhood Experiences, Socioeconomic Differences and Psychotropic Medication in Young Adults 
PLoS ONE  2013;8(1):e53551.
Stressful childhood experiences have negative long-term health consequences. The present study examines the association between adverse childhood experiences, socioeconomic position, and risk of psychotropic medication in young adulthood.
This register-based cohort study comprises the birth cohorts between 1985 and 1988 in Sweden. We followed 362 663 individuals for use of psychotropic medication from January 2006 until December 2008. Adverse childhood experiences were severe criminality among parents, parental alcohol or drug abuse, social assistance recipiency, parental separation or single household, child welfare intervention before the age of 12, mentally ill or suicidal parents, familial death, and number of changes in place of residency. Estimates of risk of psychotropic medication were calculated as odds ratio (OR) with 95% confidence intervals (CIs) using logistic regression analysis.
Adverse childhood experiences were associated with increased risks of psychotropic medication. The OR for more than three adverse childhood experiences and risk of psychotropic medication was for women 2.4 (95% CI 2.3–2.5) and for men 3.1 (95% CI 2.9–3.2). The risk of psychotropic medication increased with a higher rate of adverse childhood experiences, a relationship similar in all socioeconomic groups.
Accumulation of adverse childhood experiences increases the risk of psychotropic medication in young adults. Parental educational level is of less importance when adjusting for adverse childhood experiences. The higher risk for future mental health problems among children from lower socioeconomic groups, compared to peers from more advantaged backgrounds, seems to be linked to a higher rate of exposure to adverse childhood experiences.
PMCID: PMC3547022  PMID: 23341951
15.  Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study 
BMJ : British Medical Journal  1998;316(7145):1631-1635.
Objective: To investigate the association between social circumstances in childhood and mortality from various causes of death in adulthood.
Design: Prospective observational study.
Setting: 27 workplaces in the west of Scotland.
Subjects: 5645 men aged 35-64 years at the time of examination.
Main outcome measures: Death from various causes.
Results: Men whose fathers had manual occupations when they were children were more likely as adults to have manual jobs and be living in deprived areas. Gradients in mortality from coronary heart disease, stroke, lung cancer, stomach cancer, and respiratory disease were seen (all P<0.05), generally increasing from men whose fathers had professional and managerial occupations (social class I and II) to those whose fathers had semiskilled and unskilled manual occupations (social class IV and V). Relative rates of mortality adjusted for age for men with fathers in manual versus non-manual occupations were 1.52 (95% confidence interval 1.24 to 1.87) for coronary heart disease, 1.83 (1.13 to 2.94) for stroke, 1.65 (1.12 to 2.43) for lung cancer, 2.06 (0.93 to 4.57) for stomach cancer, and 2.01 (1.17 to 3.48) for respiratory disease. Mortality from other cancers and accidental and violent death showed no association with fathers’ social class. Adjustment for adult socioeconomic circumstances and risk factors did not alter results for mortality from stroke and stomach cancer, attenuated the increased risk of coronary heart disease and respiratory disease, and essentially eliminated the association with lung cancer.
Conclusions: Adverse socioeconomic circumstances in childhood have a specific influence on mortality from stroke and stomach cancer in adulthood, which is not due to the continuity of social disadvantage throughout life. Deprivation in childhood influences risk of mortality from coronary heart disease and respiratory disease in adulthood, although an additive influence of adulthood circumstances is seen in these cases. Mortality from lung cancer, other cancer, and accidents and violence is predominantly influenced by risk factors that are related to social circumstances in adulthood.
Key messages Adverse socioeconomic conditions in childhood are associated with mortality in later life Mortality from stroke and stomach cancer is particularly dependent on social circumstances in childhood Mortality from coronary heart disease and respiratory disease is dependent on social circumstances in both adulthood and childhood Mortality from accidents and violence and from lung cancer is mainly dependent on factors acting in adulthood The increases in child poverty seen in Britain and elsewhere over the past 20 years may herald unfavourable future trends in adult health
PMCID: PMC28561  PMID: 9603744
16.  Is there an association between seeing incidents of alcohol or drug use in films and young Scottish adults' own alcohol or drug use? A cross sectional study 
BMC Public Health  2011;11:259.
As the promotion of alcohol and tobacco to young people through direct advertising has become increasingly restricted, there has been greater interest in whether images of certain behaviours in films are associated with uptake of those behaviours in young people. Associations have been reported between exposure to smoking images in films and smoking initiation, and between exposure to film alcohol images and initiation of alcohol consumption, in younger adolescents in the USA and Germany. To date no studies have reported on film images of recreational drug use and young people's own drug use.
Cross sectional multivariable logistic regression analysis of data collected at age 19 (2002-4) from a cohort of young people (502 boys, 500 girls) previously surveyed at ages 11 (in 1994-5), 13 and 15 in schools in the West of Scotland. Outcome measures at age 19 were: exceeding the 'sensible drinking' guidelines ('heavy drinkers') and binge drinking (based on alcohol consumption reported in last week), and ever use of cannabis and of 'hard' drugs. The principle predictor variables were an estimate of exposure to images of alcohol, and of drug use, in films, controlling for factors related to the uptake of substance use in young people.
A third of these young adults (33%) were classed as 'heavy drinkers' and half (47%) as 'binge drinkers' on the basis of their previous week's consumption. Over half (56%) reported ever use of cannabis and 13% ever use of one or more of the 'hard' drugs listed. There were linear trends in the percentage of heavy drinkers (p = .018) and binge drinkers (p = 0.012) by film alcohol exposure quartiles, and for ever use of cannabis by film drug exposure (p = .000), and for ever use of 'hard' drugs (p = .033). The odds ratios for heavy drinking (1.56, 95% CI 1.06-2.29 comparing highest with lowest quartile of film alcohol exposure) and binge drinking (1.59, 95% CI 1.10-2.30) were attenuated by adjustment for gender, social class, family background (parental structure, parental care and parental control), attitudes to risk-taking and rule-breaking, and qualifications (OR heavy drinking 1.42, 95% CI 0.95-2.13 and binge drinking 1.49, 95% CI 1.01-2.19), and further so when adjusting for friends' drinking status (when the odds ratios were no longer significant). A similar pattern was seen for ever use of cannabis and 'hard' drugs (unadjusted OR 1.80, 95% CI 1.24-2.62 and 1.57, 95% CI 0.91-2.69 respectively, 'fully' adjusted OR 1.41 (0.90-2.22 and 1.28 (0.66-2.47) respectively).
Despite some limitations, which are discussed, these cross-sectional results add to a body of work which suggests that it is important to design good longitudinal studies which can determine whether exposure to images of potentially health-damaging behaviours lead to uptake of these behaviours during adolescence and early adulthood, and to examine factors that might mediate this relationship.
PMCID: PMC3123204  PMID: 21513542
alcohol; drugs; films; movies; adolescents
17.  Commentary on Day and colleagues (2013): The association between prenatal alcohol exposure and behavior at 22 years of age—Adverse effects of risky patterns of drinking among low to moderate alcohol-using pregnant women 
Day and colleagues have presented the first data showing that the behavioral effects of low to moderate prenatal alcohol exposure seen in childhood and adolescence persist into adulthood. Using the Achenbach Adult Self Report, they found dose-dependent effects of prenatal exposure on Internalizing, Externalizing, and Attention problems that persist in young adults and, thus, appear to be permanent. To date, few studies have attempted to identify thresholds at which prenatal alcohol exposure is harmful, although the animal literature suggests that even 1–2 binge episodes can result in adverse effects in the offspring. Four prospective longitudinal studies have reported adverse effects at what can be characterized as moderate exposure levels based on NIAAA criteria, but moderate drinking women often concentrate their alcohol use on 1–2 days per week, thereby engaging in binge drinking. In this study binge drinking was not a strong predictor of adverse outcome when average daily dose was held constant, a conclusion that the authors note runs “counter to studies that have reported that binge drinking has a greater effect.” This inconsistency may be due to the difficulty of allocating variance that is shared (overlapping) between average daily dose and binge drinking (i.e., dose/occasion). Data from laboratory animal studies, in which dosage can be manipulated experimentally, demonstrate that a higher dose per occasion, the key feature of binge drinking, leads to more severe adverse effects. Day et al.’s findings of adverse effects at low levels of exposure provides clear evidence that there is no safe level of drinking during pregnancy and that, even at low levels, drinking results in irreversible behavioral impairment. On the other hand, given the evidence from the animal and most human studies, it is important for all women who drink during pregnancy, even at light to moderate levels, to recognize that minimizing their intake per occasion and refraining from binge drinking can reduce risk to the fetus.
PMCID: PMC3703854  PMID: 23822873
light to moderate prenatal alcohol exposure; fetal alcohol spectrum disorders; binge drinking; adult behavior; prospective longitudinal studies; internalizing and externalizing behavior; attention
18.  When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood 
STUDY OBJECTIVES: To compare associations of childhood and adult socioeconomic position with cardiovascular risk factors measured in adulthood. To estimate the effects of adult socioeconomic position after adjustment for childhood circumstances. DESIGN: Cross sectional survey, using the relative index of inequality method to compare socioeconomic differences at different life stages. SETTING: The Whitehall II longitudinal study of men and women employed in London offices of the Civil Service at study baseline in 1985-88. PARTICIPANTS: 4774 men and 2206 women born in the period 1930-53 who were administered questions on early socioeconomic circumstances. MAIN RESULTS: Adult occupational position (employment grade) was inversely associated (high status-low risk) with current smoking and leisure time physical inactivity, with waist/height, and with metabolic risk factors HDL cholesterol, triglycerides, post-load glucose and fibrinogen. Associations of these variables with childhood socioeconomic position (father's Registrar General Social Class) were weaker or absent, with the exception of smoking in women. Childhood social position was associated with adult weight in both sexes and with current smoking, waist/height, HDL cholesterol and fibrinogen in women. Height, a measure of health capital or constitution, was weakly linked with father's social class and more strongly linked with own employment grade. The combination of childhood disadvantage (low father's class) together with a low status clerical occupation in men was particularly associated with higher body mass index as an adult (interaction test p < 0.001). Adjustment for earlier socioeconomic position--using father's class and own education level simultaneously--did not weaken the effects of adult socioeconomic position, except in the case of smoking in women, when the grade effect was reduced by 59 per cent. CONCLUSIONS: Cardiovascular risk factors in adulthood were in general more strongly related to adult than to childhood socioeconomic position. Among women but not men there was a strong but unexplained link between father's class and adult smoking habit. In both sexes degree of obesity was associated with both childhood and adulthood social position. These findings suggest that the socially patterned accumulation of health capital and cardiovascular risk begins in childhood and continues, according to socioeconomic position, during adulthood.
PMCID: PMC1756821  PMID: 10656084
19.  Self-reported drunkenness among adolescents in four sub-Saharan African countries: associations with adverse childhood experiences 
Consumption of alcohol is associated with acute and chronic adverse health outcomes. There is a paucity of studies that explore the determinants of alcohol use among adolescents in sub-Saharan Africa and, in particular, that examine the effects of adverse childhood experiences on alcohol use.
The paper draws on nationally-representative data from 9,819 adolescents aged 12-19 years from Burkina Faso, Ghana, Malawi, and Uganda. Logistic regression models were employed to identify correlates of self-reported past-year drunkenness. Exposure to four adverse childhood experiences comprised the primary independent variables: living in a food-insecure household, living with a problem drinker, having been physically abused, and having been coerced into having sex. We controlled for age, religiosity, current schooling status, the household head's sex, living arrangements, place of residence, marital status, and country of survey. All analyses were conducted separately for males and females.
At the bivariate level, all independent variables (except for coerced sex among males) were associated with the outcome variable. Overall, 9% of adolescents reported that they had been drunk in the 12 months preceding the survey. In general, respondents who had experienced an adverse event during childhood were more likely to report drunkenness. In the multivariate analysis, only two adverse childhood events emerged as significant predictors of self-reported past-year drunkenness among males: living in a household with a problem drinker before age 10, and being physically abused before age 10. For females, exposure to family-alcoholism, experience of physical abuse, and coerced sex increased the likelihood of reporting drunkenness in the last 12 months. The association between adverse events and reported drunkenness was more pronounced for females. For both males and females there was a graded relationship between the number of adverse events experienced and the proportion reporting drunkenness.
We find an association between experience of adverse childhood events and drunkenness among adolescents in four sub-Saharan African countries. The complex impacts of adverse childhood experiences on young people's development and behavior may have an important bearing on the effectiveness of interventions geared at reducing alcohol dependence among the youth.
PMCID: PMC2904276  PMID: 20569490
20.  Are adolescents with high socioeconomic status more likely to engage in alcohol and illicit drug use in early adulthood? 
Previous literature has shown a divergence by age in the relationship between socioeconomic status (SES) and substance use: adolescents with low SES are more likely to engage in substance use, as are adults with high SES. However, there is growing evidence that adolescents with high SES are also at high risk for substance abuse. The objective of this study is to examine this relationship longitudinally, that is, whether wealthier adolescents are more likely than those with lower SES to engage in substance use in early adulthood.
The study analyzed data from the National Longitudinal Survey of Adolescent Health (AddHealth), a longitudinal, nationally-representative survey of secondary school students in the United States. Logistic regression models were analyzed examining the relationship between adolescent SES (measured by parental education and income) and substance use in adulthood, controlling for substance use in adolescence and other covariates.
Higher parental education is associated with higher rates of binge drinking, marijuana and cocaine use in early adulthood. Higher parental income is associated with higher rates of binge drinking and marijuana use. No statistically significant results are found for crystal methamphetamine or other drug use. Results are not sensitive to the inclusion of college attendance by young adulthood as a sensitivity analysis. However, when stratifying by race, results are consistent for white non-Hispanics, but no statistically significant results are found for non-whites. This may be a reflection of the smaller sample size of non-whites, but may also reflect that these trends are driven primarily by white non-Hispanics.
Previous research shows numerous problems associated with substance use in young adults, including problems in school, decreased employment, increases in convictions of driving under the influence (DUI) and accidental deaths. Much of the previous literature is focused on lower SES populations. Therefore, it is possible that teachers, parents and school administrators in wealthier schools may not perceive as great to address substance abuse treatment in their schools. This study can inform teachers, parents, school administrators and program officials of the need for addressing drug abuse prevention activities to this population of students.
PMCID: PMC2924306  PMID: 20687935
21.  Social gradients in binge drinking and abstaining: trends in a cohort of British adults 
To investigate (1) social gradients in non‐drinking and binge drinking, and (2) changes in social gradients in drinking with increasing age.
British men and women born during the same week in March 1958 were prospectively followed up to adulthood. The frequency and amount of alcohol use were recorded at age 23, 33 and 42 years. Abstainers “never” drank, binge drinkers consumed ⩾10 units (men) and ⩾7 units (women) per occasion. Educational qualifications and occupation were reported at age 23 and 33 years. Logistic and repeated‐measures models were used to investigate associations between social position and drinking status at single and multiple ages in adulthood.
Less educated men and women had greater odds of being non‐drinkers at each age in adulthood, with similar gradients at ages 23–42 years. At 23 years of age, men without qualifications had 2.94 times greater odds of non‐drinking than men with higher qualifications. Less educated men had greater odds of binge drinking, and gradients did not change at ages 23–42 years. At age 23 years, less educated women had lower odds of binge drinking (odds ratio (OR) 0.67 for women with no qualifications) than women with higher qualifications. By age 42 years, the gradient reversed, and less educated women had higher odds of binge drinking (OR 2.68).
Stable gradients in non‐drinking and trends in gradients in binge drinking may reinforce alcohol‐related health inequalities over time.
PMCID: PMC2465651  PMID: 17234875
22.  Associations of childhood adversity and adulthood trauma with C-reactive protein: a cross-sectional population-based study 
Brain, behavior, and immunity  2015;53:105-112.
Mounting evidence highlights specific forms of psychological stress as risk factors for ill health. Particularly strong evidence indicates that childhood adversity and adulthood trauma exposure increase risk for physical and psychiatric disorders, and there is emerging evidence that inflammation may play a key role in these relationships. In a population-based sample from the Health and Retirement Study (n = 11,198, mean age 69 ± 10), we examine whether childhood adversity, adulthood trauma, and the interaction between them are associated with elevated levels of the systemic inflammatory marker high sensitivity C-reactive protein (hsCRP). All models were adjusted for age, gender, race, education, and year of data collection, as well as other possible confounds in follow-up sensitivity analyses. In our sample, 67% of individuals had experienced at least one traumatic event during adulthood, and those with childhood adversity were almost three times as likely to have experienced trauma as an adult. Childhood adversities and adulthood traumas were independently associated with elevated levels of hsCRP (β = 0.03, p = 0.01 and β = 0.05, p < 0.001, respectively). Those who had experienced both types of stress had higher levels of hsCRP than those with adulthood trauma alone, Estimate = −0.06, 95% CI [−0.003, −0.12], p = 0.04, but not compared to those with childhood adversity alone, Estimate = −0.06, 95% CI [0.03, −0.16], p = 0.19. There was no interaction between childhood and adulthood trauma exposure. To our knowledge, this is the first study to examine adulthood trauma exposure and inflammation in a large population-based sample, and the first to explore the interaction of childhood adversity and adulthood trauma with inflammation. Our study demonstrates the prevalence of trauma-related inflammation in the general population and suggests that childhood adversity and adulthood trauma are independently associated with elevated inflammation.
PMCID: PMC5189980  PMID: 26616398
childhood adversity; adulthood trauma; C-reactive protein; immune system; inflammation
23.  Binge Drinking and Its Relation to Metabolic Syndrome in Korean Adult Men 
Korean Journal of Family Medicine  2014;35(4):173-181.
It is reported that heavy drinking increases the risk of metabolic syndrome. But there have been few studies on the relationship between the intensity of drinking and metabolic syndrome when drinking the same amount of alcohol. This study aimed to assess the relationship between the frequency of binge drinking and metabolic syndrome in Korean adult men.
From the database of the 4th and 5th Korea National Health and Nutrition Examination Survey conducted in 2007-2010, data of 8,305 adult men (≥19 years of age) was included in this analysis. Cross-sectional relationship between the frequency of binge drinking and metabolic syndrome was investigated adjusting for pure alcohol consumed per day.
Adjusting for various confounders including pure alcohol consumed per day, the adjusted odds ratio for metabolic syndrome in those in higher frequency (more than 1/wk) binge drinking group was 1.62 (95% confidence interval, 1.30 to 2.03; P for trend = <0.001) compared to those in the non-binge drinking group. Through analysis of the relationship between pure alcohol consumed per day and metabolic syndrome, it was found that pure alcohol consumed per day had a positive relation to metabolic syndrome in the higher frequency binge drinking group (P for trend = 0.041). The relationship was inverse in the non-binge drinking group (P for trend = 0.002).
Our study found a positive relationship between frequency of binge drinking and metabolic syndrome in adult men. And the effect of drinking on metabolic syndrome may depend on the frequency of binge drinking. Further studies are required to confirm this association.
PMCID: PMC4129244  PMID: 25120888
Binge Drinking; Metabolic Syndrome; Asian Continental Ancestry Group; Men
24.  Childhood Environment and Mental Wellbeing at Age 60-64 Years: Prospective Evidence from the MRC National Survey of Health and Development 
PLoS ONE  2015;10(6):e0126683.
Mental wellbeing, conceptualised as positive affect, life satisfaction and realisation of needs that contribute to psychological growth, captures more than the absence of mental ill health. Several nations now aim to monitor and improve mental wellbeing. Whilst many studies document associations between adverse childhood experiences and mental disorders in adulthood, possible links between childhood experiences and adult mental wellbeing have so far received less attention.
Using data from 1976 men and women in the MRC National Survey for Health and Development, we investigated prospective associations between childhood socioeconomic and psychosocial environments and the Warwick Edinburgh Mental Wellbeing Scale, designed to capture both hedonic and eudaimonic facets of wellbeing, at age 60-64.
Whilst there was no evidence that childhood socioeconomic circumstances were related to later wellbeing independently of other childhood experiences, elements of childrearing and parenting, parental health and adjustment, and childhood illness were related. More advantaged socioeconomic position was associated with greater wellbeing but this did not explain the links between these childhood exposures and adult wellbeing, suggesting alternative explanatory pathways should be considered.
Childhood illness and family psychosocial environment are associated with mental wellbeing in early older age, with effects sizes that are larger or comparable to socioeconomic circumstances in adulthood. Initiatives to improve the nation’s mental wellbeing that include programmes targeted to supporting families and children may additionally have benefits that continue into older age.
PMCID: PMC4451971  PMID: 26030929
25.  Inequalities in Alcohol-Related Mortality in 17 European Countries: A Retrospective Analysis of Mortality Registers 
PLoS Medicine  2015;12(12):e1001909.
Socioeconomic inequalities in alcohol-related mortality have been documented in several European countries, but it is unknown whether the magnitude of these inequalities differs between countries and whether these inequalities increase or decrease over time.
Methods and Findings
We collected and harmonized data on mortality from four alcohol-related causes (alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental poisoning by alcohol) by age, sex, education level, and occupational class in 20 European populations from 17 different countries, both for a recent period and for previous points in time, using data from mortality registers. Mortality was age-standardized using the European Standard Population, and measures for both relative and absolute inequality between low and high socioeconomic groups (as measured by educational level and occupational class) were calculated.
Rates of alcohol-related mortality are higher in lower educational and occupational groups in all countries. Both relative and absolute inequalities are largest in Eastern Europe, and Finland and Denmark also have very large absolute inequalities in alcohol-related mortality. For example, for educational inequality among Finnish men, the relative index of inequality is 3.6 (95% CI 3.3–4.0) and the slope index of inequality is 112.5 (95% CI 106.2–118.8) deaths per 100,000 person-years. Over time, the relative inequality in alcohol-related mortality has increased in many countries, but the main change is a strong rise of absolute inequality in several countries in Eastern Europe (Hungary, Lithuania, Estonia) and Northern Europe (Finland, Denmark) because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries, alcohol-related causes now account for 10% or more of the socioeconomic inequality in total mortality.
Because our study relies on routinely collected underlying causes of death, it is likely that our results underestimate the true extent of the problem.
Alcohol-related conditions play an important role in generating inequalities in total mortality in many European countries. Countering increases in alcohol-related mortality in lower socioeconomic groups is essential for reducing inequalities in mortality. Studies of why such increases have not occurred in countries like France, Switzerland, Spain, and Italy can help in developing evidence-based policies in other European countries.
In a harmonized analysis of regional data, Johan Mackenbach and colleagues characterize three decades of alcohol-related mortality across socioeconomic groups in Europe.
Editors' Summary
People have consumed alcoholic beverages throughout history, but, globally, about three million people die from alcohol-related causes every year. Alcohol consumption, particularly in higher amounts, is a risk factor for cardiovascular disease (diseases of the heart and/or blood vessels), liver cirrhosis (scarring of the liver), injuries, and many other fatal and nonfatal health problems. Alcohol also affects the well-being and health of people around those who drink, through alcohol-related crime and road traffic crashes. The impact of alcohol use on health depends on the amount of alcohol consumed and on the pattern of drinking. Most guidelines on alcohol consumption recommend that men should regularly consume no more than two alcoholic drinks per day and that women should regularly consume no more than one drink per day (a “drink” is, roughly speaking, a can of beer or a small glass of wine). The guidelines also advise people to avoid binge drinking—the consumption of five or more drinks on a single occasion for men or four or more drinks on a single occasion for women.
Why Was This Study Done?
Like many other behaviors that affect health, alcohol consumption is affected by socioeconomic status (an individual’s economic and social position in relation to others based on income, level of education, and occupation). Thus, in many European countries, the frequency of drinking and the levels of alcohol consumption are greater in higher socioeconomic groups than in lower socioeconomic groups, whereas binge drinking and other problematic forms of alcohol consumption occur more frequently in lower socioeconomic groups. Importantly, higher levels of mortality (death) from alcohol-related conditions have been documented in lower socioeconomic groups than in higher socioeconomic groups in several European countries. Here, the researchers analyze mortality registers to find out whether the magnitude of socioeconomic inequalities in alcohol-related mortality differs among European countries and whether these inequalities have changed over time. Documenting these differences and changes is important because it may help to explain socioeconomic inequalities in alcohol-related mortality and thus inform policies and interventions designed to reduce alcohol-related harm and socioeconomic inequalities in mortality.
What Did the Researchers Do and Find?
The researchers obtained data on deaths from alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy (a type of heart disease); alcoholic liver cirrhosis; and accidental alcohol poisoning from the mortality registers of 17 European countries. Using available data on educational level and occupational class, they calculated relative and absolute socioeconomic inequalities in alcohol-related mortality (relative inequality reflects mortality differences between socioeconomic groups in terms of a proportion or percentage; absolute inequality reflects mortality differences between groups in terms of deaths per 100,000 person-years). Rates of alcohol-related mortality were higher in individuals with less education or with manual (as opposed to non-manual) occupations in all 17 countries. Both relative and absolute inequalities were largest in Eastern Europe but Finland and Denmark also had very large absolute inequalities in alcohol-related mortality. For example, among Finnish men, those with the lowest level of education were 3.6 times more likely to die from an alcohol-related cause than those with the highest level of education, and there were 112.5 more deaths per 100,000 person-years among those with the lowest level of education than among those with the highest level of education. The relative inequality in alcohol-related mortality increased over time in many countries. Moreover, the absolute inequality increased markedly in Hungary, Lithuania, Estonia, Finland, and Denmark because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. By contrast, mortality from alcohol-related causes among lower educated men was stable in France, Switzerland, Spain, and Italy.
What Do These Findings Mean?
These findings suggest that alcohol-related conditions are an important contributing factor to the socioeconomic inequality in total mortality in many European countries. Indeed, in some countries (for example, Finland), alcohol-related causes account for 10% or more of the socioeconomic inequality in total mortality among men. The accuracy of these findings is likely to be affected by the use of routinely collected underlying causes of death and by other aspects of the study design. Importantly, however, these findings indicate that to reduce socioeconomic inequalities in mortality, health professionals and governments need to introduce interventions and policies designed to counter recent increases in alcohol-related mortality in lower socioeconomic groups. Further investigation of why such increases have not occurred in some countries may help in the design of these important public health initiatives.
Additional Information
This list of resources contains links that can be accessed when viewing the PDF on a device or via the online version of the article at
The World Health Organization provides detailed information about alcohol, including a fact sheet on the harmful use of alcohol; its Global Status Report on Alcohol and Health 2014 provides country profiles for alcohol consumption, information on the impact of alcohol use on health, and policy responses; the Global Information System on Alcohol and Health provides further information about alcohol, including information on control policies around the world
The US National Institute on Alcohol Abuse and Alcoholism has information about alcohol and its effects on health; it provides interactive worksheets to help people evaluate their drinking and decide whether and how to make a change
The US Centers for Disease Control and Prevention provides information on alcohol and public health
The UK National Health Service Choices website provides detailed information about drinking and alcohol, including information on the risks of drinking too much, tools for calculating alcohol consumption, and personal stories about alcohol use problems
MedlinePlus provides links to many other resources on alcohol
PMCID: PMC4666661  PMID: 26625134

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