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1.  The Risks Associated With Alcohol Use and Alcoholism 
Alcohol consumption, particularly heavier drinking, is an important risk factor for many health problems and, thus, is a major contributor to the global burden of disease. In fact, alcohol is a necessary underlying cause for more than 30 conditions and a contributing factor to many more. The most common disease categories that are entirely or partly caused by alcohol consumption include infectious diseases, cancer, diabetes, neuropsychiatric diseases (including alcohol use disorders), cardiovascular disease, liver and pancreas disease, and unintentional and intentional injury. Knowledge of these disease risks has helped in the development of low-risk drinking guidelines. In addition to these disease risks that affect the drinker, alcohol consumption also can affect the health of others and cause social harm both to the drinker and to others, adding to the overall cost associated with alcohol consumption. These findings underscore the need to develop effective prevention efforts to reduce the pain and suffering, and the associated costs, resulting from excessive alcohol use.
PMCID: PMC3307043  PMID: 22330211
alcohol and other drug (AOD) use; alcohol use disorders; alcoholism; heavy drinking; AOD induced risk; AOD effects and consequences; health; disease cause; disease factor; disease risk and protective factors; burden of disease; health care costs; injury; social harm; drinking guidelines; prevention
2.  The Risks Associated With Alcohol Use and Alcoholism 
Alcohol Research & Health  2011;34(2):135-143.
Alcohol consumption, particularly heavier drinking, is an important risk factor for many health problems and, thus, is a major contributor to the global burden of disease. In fact, alcohol is a necessary underlying cause for more than 30 conditions and a contributing factor to many more. The most common disease categories that are entirely or partly caused by alcohol consumption include infectious diseases, cancer, diabetes, neuropsychiatric diseases (including alcohol use disorders), cardiovascular disease, liver and pancreas disease, and unintentional and intentional injury. Knowledge of these disease risks has helped in the development of low-risk drinking guidelines. In addition to these disease risks that affect the drinker, alcohol consumption also can affect the health of others and cause social harm both to the drinker and to others, adding to the overall cost associated with alcohol consumption. These findings underscore the need to develop effective prevention efforts to reduce the pain and suffering, and the associated costs, resulting from excessive alcohol use.
PMCID: PMC3307043  PMID: 22330211
alcohol and other drug (AOD) use; alcohol use disorders; alcoholism; heavy drinking; AOD induced risk; AOD effects and consequences; health; disease cause; disease factor; disease risk and protective factors; burden of disease; health care costs; injury; social harm; drinking guidelines; prevention
3.  Understanding standard drinks and drinking guidelines 
Drug and Alcohol Review  2011;31(2):200-205.
Introduction and Aims
For consumers to follow drinking guidelines and limit their risk of negative consequences they need to track their ethanol consumption. This paper reviews published research on the ability of consumers to utilise information about the alcohol content of beverages when expressed in different forms e.g. in standard drinks or units versus percentage alcohol content..
Design and Methods
A review of the literature on standard drink definitions and consumer understanding of these, actual drink pouring, use of standard drinks in guidelines and consumer understanding and use of these.
Results
Standard drink definitions vary across countries and typically contain less alcohol than actual drinks. Drinkers have difficulty defining and pouring standard drinks with over-pouring being the norm such that intake volume is typically underestimated. Drinkers have difficulty using percentage alcohol by volume and pour size information in calculating intake but can effectively utilise standard drink labeling to track intake.
Discussion and Conclusions
Standard drink labeling is an effective but little used strategy for enabling drinkers to track their alcohol intake and potentially conform to safe or low risk drinking guidelines.
doi:10.1111/j.1465-3362.2011.00374.x
PMCID: PMC3276704  PMID: 22050262
guidelines; standard drink; labeling; measurement
4.  Carotenoids and alcoholic liver disease 
Chronic and excessive consumption of alcohol leads to the development of alcoholic liver disease. The depletion of vitamin A is a well-known consequence of alcohol consumption, and may be associated with the observed alcohol-induced hepatic injury. The provitamin A carotenoid β-carotene has been demonstrated to increase alcohol-induced hepatic injury when given in high doses, while low dose supplementation provides protection against hepatic injury. However, it is unknown if the hepatoprotective effects of low dose β-carotene are due to the protective actions of β-carotene itself or if the alterations are due to restored vitamin A levels. Future studies are needed to provide further insight into the specific mechanisms by which β-carotene exerts its protective effect. Further, supplementation studies utilizing high doses of β-carotene in the presence of alcohol must be done with caution.
doi:10.3978/j.issn.2304-3881.2013.10.01
PMCID: PMC3924697  PMID: 24570953
Carotenoids; β-carotene; vitamin A; alcoholic liver disease; hepatic injury
5.  Impact of a Brief Training on Medical Resident Screening for Alcohol Misuse and Illicit Drug Use 
Educational initiatives are needed to improve primary care substance use screening. This study assesses the impact on 24 medical residents of a 2.5-day curriculum combining experiential and manual-based training on screening for alcohol misuse and illicit drug use. A retrospective chart review of new primary care outpatients demonstrated that nearly all were asked about current alcohol use before and after curriculum participation. Adherence to national screening guidelines on quantification of alcohol consumption modestly improved (p < .05), as did inquiry about current illicit drug use (p < .05). Continued efforts are needed to enhance educational initiatives for primary care physicians.
doi:10.1080/10550490701861144
PMCID: PMC3146173  PMID: 18393059
6.  Protein biomarkers of alcohol abuse 
Expert review of proteomics  2012;9(4):425-436.
Alcohol abuse can lead to a number of health and social issues. Our current inability to accurately assess long-term drinking behaviors is an important obstacle to its diagnosis and treatment. Biomarkers for chronic alcohol consumption have made a number of important advances but have yet to become highly accurate and as accepted as objective tests for other diseases. Thus, there is a crucial need for the development of more sensitive and specific markers of alcohol abuse. Recent advancements in proteomic technologies have greatly increased the potential for alcohol abuse biomarker discovery. Here, the authors review established and novel protein biomarkers for long-term alcohol consumption and the proteomic technologies that have been used in their study.
doi:10.1586/epr.12.38
PMCID: PMC3535006  PMID: 22967079
alcohol abuse and dependence; biomarkers; DIGE; ethanol; mass spectrometry; proteomics
7.  Mortality and potential years of life lost attributable to alcohol consumption in Canada in 2005 
BMC Public Health  2012;12:91.
Background
Alcohol is a substantial risk factor for mortality according to the recent 2010 World Health Assembly strategy to reduce the harmful use of alcohol which outlined the need to characterize and monitor this burden. Accordingly, using new methodology we estimated 1) the number of deaths caused and prevented by alcohol consumption, and 2) the potential years of life lost (PYLLs) attributable to alcohol consumption in Canada in 2005.
Methods
Mortality attributable to alcohol consumption was estimated by calculating Alcohol-Attributable Fractions (AAFs) (defined as the proportion of mortality that would be eliminated if the exposure was eliminated) using data from various sources. Indicators for alcohol consumption were obtained from the Canadian Alcohol and Drug Use Monitoring Survey 2008 and corrected for adult per capita recorded and unrecorded alcohol consumption. Risk relations were taken from the Comparative Risk Assessment within the current Global Burden of Disease (GBD) study. Due to concerns about the reliability of information specifying causes of death for people aged 65 or older, our analysis was limited to individuals aged 0 to 64 years. Calculation of the 95% confidence intervals (CIs) for the AAFs was performed using Monte Carlo random sampling. Information on mortality was obtained from Statistics Canada. A sensitivity analysis was performed comparing the mortality results obtained using our study methods to results obtained using previous methodologies.
Results
In 2005, 3,970 (95% CI: 810 to 7,170) deaths (4,390 caused and 420 prevented) and 134,555 (95% CI: 36,690 to 236,376) PYLLs were attributable to alcohol consumption for individuals aged 0 to 64 years. These figures represent 7.7% (95% CI: 1.6% to 13.9%) of all deaths and 8.0% (95% CI: 2.2% to 14.1%) of all PYLLs for individuals aged 0 to 64 years. The sensitivity analysis showed that the number of deaths as measured by this new methodology is greater than that if mortality was estimated using previous methodologies.
Conclusions
The mortality burden attributable to alcohol consumption for Canada is large, unnecessary, and could be substantially reduced in a short period of time if effective public health policies were implemented. A monitoring system on alcohol consumption is imperative and would greatly assist in planning and evaluating future Canadian public health policies related to alcohol consumption.
doi:10.1186/1471-2458-12-91
PMCID: PMC3305515  PMID: 22293064
Alcohol consumption; Mortality; Potential years of life lost; Relative risk; Canada
8.  A STUDY OF ALCOHOL RELATED PHYSICAL DISEASES IN GENERAL HOSPITAL PATIENTS 
Indian Journal of Psychiatry  2000;42(3):247-252.
We studied the prevalence of harmful use of alcohol and alcohol related diseases in newly admitted patients in a general hospital. Two hundred and ninety seven patients were screened for alcohol use with Alcohol Use Disorders Identification Test (AUDIT). Sixty one subjects (21%) had harmful pattern of alcohol consumption. Of these twenty eight patients (9.4%) had alcohol-related diseases, while in 33 patients (11.1%) we did not find any association between alcohol use and hospital diagnoses. Physicians′ referral rate for problem drinking was low. The findings indicate the need for an active consultation service to address the specific issue of harmful drinking among patients admitted in general hospitals.
PMCID: PMC2958346  PMID: 21407951
Alcohol abuse; general hospital; alcohol-related diseases
9.  Work and High-Risk Alcohol Consumption in the Canadian Workforce 
This study examined the associations between occupational groups; work-organization conditions based on task design; demands, social relations, and gratifications; and weekly high-risk alcohol consumption among Canadian workers. A secondary data analysis was performed on Cycle 2.1 of the Canadian Community Health Survey conducted by Statistics Canada in 2003. The sample consisted of 76,136 employees 15 years of age and older nested in 2,451 neighbourhoods. High-risk alcohol consumption is defined in accordance with Canadian guidelines for weekly low-risk alcohol consumption. The prevalence of weekly high-risk alcohol consumption is estimated to be 8.1% among workers. The results obtained using multilevel logistic regression analysis suggest that increased work hours and job insecurity are associated with elevated odds of high-risk alcohol consumption. Gender female, older age, being in couple and living with children associated with lower odds of high-risk drinking, while increased education, smoking, physical activities, and, and economic status were associated with higher odds. High-risk drinking varied between neighbourhoods, and gender moderates the contribution of physical demands. The results suggest that work made a limited contribution and non-work factors a greater contribution to weekly high-risk alcohol consumption. Limits and implications of these results are discussed.
doi:10.3390/ijerph8072692
PMCID: PMC3155324  PMID: 21845153
alcohol misuse; occupational groups; work-organization conditions; multilevel models; longitudinal design
10.  Alcohol Policy Support Among Mandated College Students 
Addictive behaviors  2011;36(10):1015-1018.
Background
Alcohol consumption on college campuses is high, and often dangerous. College administrators have created policies to control alcohol consumption, but student body support or opposition of specific policies has been relatively unexplored.
Method
The current study examined the relations of alcohol policy support with gender and alcohol consumption. Mandated students (N = 229; 44% women) completed self-report assessments of alcohol policy support and alcohol consumption.
Results
Women supported policies to a greater extent than did men, as did lighter drinkers relative to heavier drinkers. Drinks per drinking day fully mediated the relation between gender and alcohol policy support.
Conclusion
While alcohol policy support differs by gender, this covariation is explained by differences in alcohol consumption. Findings have implications for addressing alcohol policy support among mandated college students.
doi:10.1016/j.addbeh.2011.05.011
PMCID: PMC3149856  PMID: 21665372
alcohol policy; college drinking; gender; mandated students
11.  Alcohol consumption screening of newly-registered patients in primary care: a cross-sectional analysis 
The British Journal of General Practice  2013;63(615):e706-e712.
Background
Although screening and brief intervention is effective at reducing alcohol consumption in primary care and is recommended by guidelines, there are numerous barriers to its delivery. Screening newly-registered patients for alcohol-use disorders provides an opportunity for systematic collection of alcohol consumption data.
Aim
To examine how alcohol screening data are recorded in primary care, the extent to which they are recorded, and whether reported levels of consumption differ from general population data.
Design and setting
Cross-sectional analysis, with data collected from patients in the year after registration.
Method
Data on alcohol consumption were collected from The Health Improvement Network (THIN) primary care database from patients aged ≥18 years, newly registered with a general practice in 2007 to 2009, and compared with the Office for National Statistics Opinions (ONS Omnibus) survey.
Results
A total of 292 376 (76%) of the 382 609 newly-registered patients had entries for alcohol consumption (units a week, Read Codes for level of consumption, and/or screening test). Only 25 975 (9%) were recorded as completing a validated screening test, most commonly AUDIT/AUDIT-C (16 004, 5%) or FAST (9419, 3%). Alcohol-use disorders are underreported in primary care (for example, higher risk drinking 1% males, 0.5% females) in comparison with the Opinions survey (8% males, 7% females).
Conclusion
Alcohol screening data are collected from most patients within 1 year of registration with a GP practice; however, use of a validated screening test is rarely documented and alcohol-use disorders are underreported. Further efforts are needed to encourage or incentivise the use of validated tests to improve the quality of data collected.
doi:10.3399/bjgp13X673720
PMCID: PMC3782804  PMID: 24152486
alcohol drinking; cross-sectional studies; ONS Opinions (Omnibus) survey; primary health care; The Health Improvement Network (THIN)
12.  Alcohol consumption in tertiary education students 
BMC Public Health  2011;11:545.
Background
Heavy alcohol consumption among adolescents and young adults is an issue of significant public concern. With approximately 50% of young people aged 18-24 attending tertiary education, there is an opportunity within these settings to implement programs that target risky drinking. The aim of the current study was to survey students and staff within a tertiary education institution to investigate patterns of alcohol use, alcohol-related problems, knowledge of current National Health and Medical Research Council (NHMRC) guidelines for alcohol consumption and intentions to seek help for alcohol problems.
Methods
Students of an Australian metropolitan university (with staff as a comparison group) participated in a telephone interview. Questions related to knowledge of NHMRC guidelines, drinking behaviour, alcohol-related problems and help-seeking intentions for alcohol problems. Level of psychological distress was also assessed.
Results
Of the completed interviews, 774 (65%) were students and 422 (35%) were staff. While staff were more likely to drink regularly, students were more likely to drink heavily. Alcohol consumption was significantly higher in students, in males and in those with a history of earlier onset drinking. In most cases, alcohol-related problems were more likely to occur in students. The majority of students and staff had accurate knowledge of the current NHMRC guidelines, but this was not associated with lower levels of risky drinking. Psychological distress was associated with patterns of risky drinking in students.
Conclusions
Our findings are consistent with previous studies of tertiary student populations, and highlight the disconnect between knowledge of relevant guidelines and actual behaviour. There is a clear need for interventions within tertiary education institutions that promote more effective means of coping with psychological distress and improve help-seeking for alcohol problems, particularly among young men.
doi:10.1186/1471-2458-11-545
PMCID: PMC3223920  PMID: 21740593
13.  Older Adults’ Alcohol Consumption and Late-Life Drinking Problems: A 20-Year Perspective 
Addiction (Abingdon, England)  2009;104(8):1293-1302.
Aims
The aim was to identify changes in patterns of alcohol consumption over a 20-year interval among older women and men, and to examine the associations between guideline-defined excessive drinking and late-life drinking problems.
Design, Participants, and Measures
A community sample of 719 adults between 55 and 65 years of age who consumed alcohol at or prior to baseline participated in a survey of alcohol consumption and drinking problems and was followed 10 years and 20 years later.
Findings
The likelihood of excessive drinking declined over the 20-year interval as adults matured into their 70s and 80s. However, at ages 75–85, 27% of women and 49% of men consumed more than 2 drinks per day or 7 drinks per week. At comparable guideline levels of alcohol consumption, older men were more likely to have drinking problems than were older women. Consumption of more than 2 drinks per day or 7 drinks per week was identified as a potential conservative guideline for identifying excessive drinking associated with an elevated likelihood of drinking problems.
Conclusions
A substantial percentage of older adults who consume alcohol engage in guideline-defined excessive drinking and incur drinking problems. The finding that older men may be more likely than older women to experience problems when they drink beyond guideline levels suggests that alcohol guidelines for men should not be set higher than those for women.
doi:10.1111/j.1360-0443.2009.02604.x
PMCID: PMC2714873  PMID: 19438836
Alcohol; aging; drinking problems; gender differences
14.  Excess mortality associated with alcohol consumption. 
BMJ : British Medical Journal  1988;297(6652):824-826.
To estimate the excess mortality due to alcohol in England and Wales death rates specific to alcohol consumption that had been derived from five longitudinal studies were applied to the current population divided into categories of alcohol consumption. Because of the J shaped relation between alcohol consumption and death the excess mortality used as a baseline was an alcohol consumption of 1-10 units/week and an adjustment was made for the slight excess mortality of abstainers. The number of excess deaths was obtained by subtracting the number of deaths expected if all the population had the consumption of the lowest risk group; correction for the total observed mortality in the population was made. This resulted in an estimate of 28,000 deaths each year in England and Wales as the excess mortality among people aged 15-74 associated with alcohol consumption.
PMCID: PMC1834583  PMID: 3140936
15.  Alcohol consumption and household expenditure on alcohol in a rural district in Vietnam 
Global Health Action  2013;6:10.3402/gha.v6i0.18937.
Introduction
Alcohol use and alcohol-related problems are on the rise in low- and middle-income countries. Expenditure on alcohol is an important problem for families and communities and needs to be assessed.
Aim
This study examines level of alcohol consumption and expenditure on alcohol in a district in Vietnam.
Methods
A cross-sectional survey was conducted in a rural district in northern Vietnam. Multi-stage sampling was employed to randomly select participants from 20 communities and a town in the same district. One thousand five hundred and sixty-four adults (765 males and 799 females) aged 18–60 years were interviewed. Information about alcohol use as well as expenditure on alcohol consumption four weeks prior to the interview was gathered. Non-parametric tests and log-linear regression were employed to compare expenditure on alcohol consumption across socioeconomic groups.
Results
The prevalence of alcohol use one month prior to interview was 35% (66% among men and 5% among women). The median alcohol consumption among those who reported use of alcohol in the week prior to the interview was 7.9 standard drinks. Excessive drinking (more than 14 standard drinks per week for men and more than seven standard drinks per week for women) occurred among 35% of those who used alcohol. Median expenditure for alcohol consumption during one month by those who drank alcohol was USD 3.5, accounting for 4.6% of household food expenditure, 2.7% of total household expenditure, and 1.8% of household income. The differences in alcohol consumption and expenditure between sexes and between socioeconomic groups are also presented.
Conclusion
Our study confirms that alcohol consumption and alcohol-related problems are common among men in Vietnam. The share of alcohol expenditure in total household expenditure is substantial, especially among poor households. This should be considered an important public health issue, which needs to be taken into account in the alcohol policy debate.
doi:10.3402/gha.v6i0.18937
PMCID: PMC3557352  PMID: 23364099
alcohol consumption; alcohol problems; alcohol expenditure; Vietnam
16.  Patterns and Predictors of Late-Life Drinking Trajectories: A 10-Year Longitudinal Study 
This study examines the extent of group-level and intra-individual decline in alcohol consumption among adults as they traverse a 10-year interval spanning late-middle to early-old age. Further, it identifies key baseline predictors of these adults' 10-year drinking trajectories. Community residents (n=1,291; age 55 to 65 at baseline) were assessed at 4 points over a 10-year interval on demographic and health characteristics, coping responses, social context, and alcohol consumption. Descriptive cross-wave statistics, and multilevel regression analyses, indicated that in the sample overall, participants' 10-year patterns of alcohol consumption were relatively stable. However, men's patterns, and those of individuals drinking beyond recommended alcohol consumption guidelines at baseline, were more variable and showed steeper rates of decline, than did those of women and individuals drinking within recommended levels. Contrary to expectation, baseline use of substances to reduce tension and heavier reliance on avoidance coping predicted faster rate of decline in alcohol consumption. Post-hoc prospective mediation analyses suggested that this may have occurred because these and other baseline predictors heighten risk of developing new health problems which, in turn, motivate reduced alcohol consumption.
doi:10.1037/a0018592
PMCID: PMC2891546  PMID: 20565151
older adults; alcohol; drinking trajectories
17.  A Study on the Prevalence of Alcohol Consumption, Tobacco Use and Sexual Behaviour among Adolescents in Urban Areas of the Udupi District, Karnataka, India 
Objectives:
The aim of this study was to assess the prevalence of alcohol consumption, tobacco use and risky sexual behaviour among adolescents, and to evaluate the socioeconomic factors potentially influencing these behaviours.
Methods:
This cross-sectional study was conducted from January to April 2011 among 376 adolescents (15–19 years old) studying in different schools and colleges in Udupi, India. The Youth Risk Behavior Survey questionnaire and guidelines were followed for data collection. Participants’ alcohol consumption, smoking habits and sexual behaviour patterns were explored. Univariate analysis followed by multivariate logistic regression was done.
Results:
The prevalence of alcohol consumption, tobacco use and sexual activity was found to occur in 5.7%, 7.2% and 5.5% of participants, respectively. The mean age of the participants’ first sexual activity, consumption of alcohol and tobacco use was reported to be approximately 16.8 years. Multivariate analysis showed that males were more likely to have used alcohol and tobacco. Other factors, such as religion and tobacco use among family members, were found to be influential.
Conclusion:
The potential coexistence of multiple risk behaviours in a student demands an integrated approach. Emphasis should be placed on health education in schools and an increased awareness among parents in order to prevent adolescents’ behaviours from becoming a risk to their health.
PMCID: PMC3916261  PMID: 24516739
Adolescents; Risk Behaviors; Tobacco; Alcoholic Beverages; Sexual Behavior; India
18.  Alcohol consumption and rectal tumor mutations and epigenetic changes 
Diseases of the colon and rectum  2010;53(8):1182-1189.
Purpose
An association between alcohol and rectal cancer has been reported in the epidemiological literature. In this study we further explore the association by examining specific tumor markers with alcohol consumption as well as types of alcoholic beverages consumed.
Methods
We assessed alcohol consumption with CpG Island Methylator Phenotype, TP53 and KRAS2 mutations in incident rectal cancer cases and compared them to population-based controls. We evaluated type, long-term, and recent alcohol consumption.
Results
We observed a trend toward increasing risk of CpG Island Methylator Phenotype positive tumors and long-term alcohol consumption. In contrast, after adjusting for recent total alcohol intake, recent high beer consumption significantly increased the odds of having a TP53 mutation compared to those who did not drink beer (Odds Ratios 2.19 95% Confidence Interval 1.34, 3.57). We observed a non-statistically significant reduced risk of a TP53 mutation among those who drank wine (particularly red wine) versus non-consumers of wine. The association between TP53 mutations and recent beer consumption was strongest for transversion mutations.
Conclusions
These data suggest that both alcohol and specific constituents of alcoholic beverages contribute to rectal cancer risk among unique disease pathways.
doi:10.1007/DCR.0b013e3181d325db
PMCID: PMC2907183  PMID: 20628283
TP53; KRAS2; CpG Island Methylator Phenotype; rectal cancer; alcohol; beer; wine
19.  Can Preoccupation with Alcohol Override the Protective Properties of Mindful Awareness on Problematic Drinking? 
Objectives
To assess the mediating role of drinking restraint— specifically preoccupation with drinking— on the associations between mindful awareness and alcohol consumption and alcohol-related problems.
Methods
390 heavy-drinking, undergraduate, college students (52% male) were assessed on measures of mindfulness, drinking restraint, alcohol consumption (prior 90-days), and alcohol-related problems via self-report surveys.
Results
Mindfulness was negatively associated with alcohol consumption, problems, and both factors of drinking restraint (emotional preoccupation and behavioral constraint). Emotional preoccupation, but not behavioral constraint, statistically mediated these relationships and demonstrated positive associations with both alcohol consumption and related problems.
Conclusions
Results replicate previous findings documenting a negative association between mindfulness and alcohol consumption and problems. Statistical mediation models suggest that preoccupation with drinking may be a risk factor that over-rides the health-promoting effects of mindfulness.
doi:10.1097/ADT.0b013e31824c886b
PMCID: PMC3693770  PMID: 23814503
college students; drinking restraint; mindfulness; preoccupation; temptation
20.  A Syndemic Analysis of Alcohol Use and Sexual Risk Behavior Among Tourism Employees in Sosúa, Dominican Republic 
Qualitative Health Research  2011;22(1):89-102.
The Dominican Republic has high rates of HIV infection and alcohol consumption. Unfortunately, little research has been focused on the broader sources of the synergy between these two health outcomes. We draw on syndemic theory to argue that alcohol consumption and sexual risk behavior are best analyzed within the context of culture and economy in Caribbean tourism spaces, which produce a synergy between apparently independent outcomes. We sampled 32 men and women working in the tourism industry at alcohol-serving establishments in Sosúa, Dominican Republic. Interviewees described alcohol consumption as an implicit requirement of tourism work, tourism industry business practices that foster alcohol consumption, and an intertwining relationship between alcohol and sexual commerce. The need to establish relationships with tourists, combined with the overconsumption of alcohol, contributed to a perceived loss of sexual control, which participants felt could impede condom use. Interventions should incorporate knowledge of the social context of tourism areas to mitigate the contextual factors that contribute to HIV infection and alcohol consumption among locals.
doi:10.1177/1049732311419865
PMCID: PMC3322414  PMID: 21859907
alcohol / alcoholism; Caribbean people / cultures; ethnography; HIV/AIDS; sex workers
21.  Communicating about Alcohol Consumption to Nonharmful Drinkers with Hepatitis C: Patient and Provider Perspectives 
Background
Abstaining from alcohol consumption is generally recommended for patients with Hepatitis C (HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not be a problem in the absence of their HCV diagnosis.
Objective
This study explores what healthcare providers advise their HCV patients who are drinking alcohol at nonharmful levels about alcohol use and what these patients actually hear.
Design
We conducted separate focus groups and interviews about alcohol use and HCV with nonharmful drinkers with HCV (N = 50) and healthcare providers (N = 14) at a metropolitan teaching hospital. All focus groups and interviews were audio-taped, transcribed, and analyzed using NVivo, a qualitative data management and analysis program.
Results
We found similar themes about HCV and alcohol consumption (stop completely, occasional drink is ok, cut down, and provision of mixed/ambiguous messages), reported by both providers and patients. Patient respondents who reported hearing “stop completely” were more likely to have had their last medical visit at the gastroenterology (GI) clinic as opposed to the internal medicine (IM) clinic. Furthermore, IM providers were more likely to give their recommendations in “medical language” than were GI providers.
Conclusions
To make the best health-related decisions about their disease, HCV patients need consistent information about alcohol consumption. Departments of Internal Medicine can increase provider knowledge about HCV and alcohol use by providing more education and training on HCV.
doi:10.1007/s11606-007-0483-y
PMCID: PMC2359467  PMID: 18172739
Hepatitis C; alcohol consumption; patient-provider communication
22.  Communicating About Alcohol Consumption to Nonharmful Drinkers with Hepatitis C: Patient and Provider Perspectives 
Journal of General Internal Medicine  2008;23(8):1290-1295.
Background
Abstaining from alcohol consumption is generally recommended for patients with Hepatitis C (HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not be a problem in the absence of their HCV diagnosis.
Objective
This study explores what healthcare providers advise their HCV patients who are drinking alcohol at nonharmful levels about alcohol use and what these patients actually hear.
Design
We conducted separate focus groups and interviews about alcohol use and HCV with nonharmful drinkers with HCV (N = 50) and healthcare providers (N = 14) at a metropolitan teaching hospital. All focus groups and interviews were audio-taped, transcribed, and analyzed using NVivo, a qualitative data management and analysis program.
Results
We found similar themes about HCV and alcohol consumption (stop completely, occasional drink is ok, cut down, and provision of mixed/ambiguous messages), reported by both providers and patients. Patient respondents who reported hearing “stop completely” were more likely to have had their last medical visit at the gastroenterology (GI) clinic as opposed to the internal medicine (IM) clinic. Furthermore, IM providers were more likely to give their recommendations in “medical language” than were GI providers.
Conclusions
To make the best health-related decisions about their disease, HCV patients need consistent information about alcohol consumption. Departments of Internal Medicine can increase provider knowledge about HCV and alcohol use by providing more education and training on HCV.
doi:10.1007/s11606-008-0649-2
PMCID: PMC2517959  PMID: 22135843
Hepatitis C; alcohol consumption; patient–provider communication
23.  Alcohol consumption, blood alcohol concentration level and guideline compliance in hospital referred patients with minimal, mild and moderate head injuries 
Background
In 2000 the Scandinavian Neurotrauma Committee published guidelines for safe and cost-effective management of minimal, mild and moderate head injured patients.
The aims of this study were to investigate to what extent the head injury population is under the influence of alcohol, and to evaluate whether the physicians' compliance to the guidelines is affected when patients are influenced by alcohol.
Methods
This study included adult patients (≥15 years) referred to a Norwegian University Hospital with minimal, mild and moderate head injuries classified according to the Head Injury Severity Scale (HISS). Information on alcohol consumption was recorded, and in most of these patients blood alcohol concentration (BAC) was measured. Compliance with the abovementioned guidelines was registered.
Results
The study includes 860 patients. 35.8% of the patients had consumed alcohol, and 92.1% of these patients had a BAC ≥ 1.00‰. Young age, male gender, trauma occurring during the weekends, mild and moderate head injuries were independent factors significantly associated with being under the influence of alcohol. Guideline compliance was 60.5%, and over-triage was the main violation. The guideline compliance showed no significant correlation to alcohol consumption or to BAC-level.
Conclusions
This study confirms that alcohol consumption is common among patients with head injuries. The physicians' guideline compliance was not affected by the patients' alcohol consumption, and alcohol influence could therefore not explain the low guideline compliance.
doi:10.1186/1757-7241-19-25
PMCID: PMC3101126  PMID: 21496318
24.  The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) – A randomised control trial protocol 
Background
There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption. In older populations excessive alcohol consumption is associated with increased risk of coronary heart disease, hypertension, stroke and a range of cancers. Alcohol consumption is also associated with an increased risk of falls, early onset of dementia and other cognitive deficits. Physiological changes that occur as part of the ageing process mean that older people experience alcohol related problems at lower consumption levels. There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol consumption in populations identified opportunistically in primary care settings. Stepped care interventions involve the delivery of more intensive interventions only to those in the population who fail to respond to less intensive interventions and provide a potentially resource efficient means of meeting the needs of this population.
Methods/design
The study design is a pragmatic prospective multi-centre two arm randomised controlled trial. The primary hypothesis is that stepped care interventions for older hazardous alcohol users reduce alcohol consumption compared with a minimal intervention at 12 months post randomisation. Potential participants are identified using the AUDIT questionnaire. Eligible and consenting participants are randomised with equal probability to either a minimal intervention or a three step treatment approach. The step treatment approach incorporates as step 1 behavioural change counselling, step 2 three sessions of motivational enhancement therapy and step 3 referral to specialist services. The primary outcome is measured using average standard drinks per day and secondary outcome measures include the Drinking Problems Index, health related quality of life and health utility. The study incorporates a comprehensive economic analysis to assess the relative cost-effectiveness of the interventions.
Discussion
The paper presents a protocol for the first pragmatic randomised controlled trial evaluating the effectiveness and cost-effectiveness of stepped care interventions for older hazardous alcohol users in primary care.
Trial registration
ISRCTN52557360
doi:10.1186/1472-6963-8-129
PMCID: PMC2442836  PMID: 18549492
25.  Alcohol Consumption and Mortality in the Korean Multi-center Cancer Cohort Study 
Objectives
To examine the association between alcohol consumption habit, types of beverages, alcohol consumption quantity, and overall and cancer-specific mortality among Korean adults.
Methods
The alcohol consumption information of a total of 16 320 participants who were 20 years or older from the Korean Multi-center Cancer Cohort were analyzed to examine the association between alcohol consumption habit and mortality (median follow-up of 9.3 years). The Cox proportional hazard model was used to estimate the hazard ratio (HR) of alcohol consumption to mortality adjusting for age, sex, geographic areas, education, smoking status, and body mass index.
Results
Alcohol drinkers showed an increased risk for total mortality compared with never drinkers (HR, 1.72; 95% confidence interval [CI], 1.38 to 2.14 for past drinkers; HR, 1.21; 95% CI, 1.06 to 1.39 for current drinkers), while past drinkers only were associated with higher risk for cancer deaths (HR, 1.84; 95% CI, 1.34 to 2.53). The quantity of alcohol consumed per week showed a J-shaped association with risk of mortality. Relative to light drinkers (0.01 to 90 g/wk), never drinkers and heavy drinkers (>504 g/wk) had an increased risk for all-cause and cancer deaths: (HR, 1.18; 95% CI, 0.96 to 1.45) and (HR, 1.39; 95% CI, 1.05 to 1.83) for all-cause mortality; and (HR, 1.55; 95% CI, 1.15 to 2.11) and (HR, 2.07; 95% CI, 1.39 to 3.09) for all cancer mortality, respectively. Heavy drinkers (>504 g/wk) showed an elevated risk for death from stomach and liver cancers.
Conclusions
The present study supports the existence of a J-shaped association between alcohol consumption quantity and the risk of all-cause and cancer deaths. Heavy drinkers had an increased risk of death from cancer overall and liver and stomach cancer.
doi:10.3961/jpmph.2012.45.5.301
PMCID: PMC3469812  PMID: 23091655
Alcohol drinking; Mortality; Korean Multi-center Cancer Cohort; Korea

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