Serving Substance Abuse Professionals Since 1993

Last Update: 30.05.09

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Per Capita Consumption (Alcohol)

87 citations. January 2003 to present

Prepared: June 2009

Academy of Medical Sciences. Calling Time: The Nation's Drinking as a Major Health Issue. London: Academy of Medical Sciences (UK), 2004. (91 refs.)

In the UK, the per capita level of alcohol consumption has risen by 50% since 1970. The focus of this report is the relationship of population drinking levels and levels of alcohol-related harm, and the implications for social and public health policy. Compelling evidence supports previous findings of a strong correlation between mean or median alcohol consumption and heavy or "problem" drinking. The scientific evidence indicates that for the health of the public, action is required to reduce the consumption of alcohol at a population level. Four recommendations are outlined, along with the supporting scientific evidence: (1) Per capita consumption should be a pillar of any comprehensive government initiatives, policy options include increasing taxes, reducing traveller's allowances in the EU (the current allowance is a 272 day supply of wines and spirits; and review the advertising and promotion of alcoholic beverages to young people; (2) Initiate discussion and debate in the general public on the need for reducing general consumption. (3) Reduce the statutory BAC for drivers from 80 mg to 50 mg, and establish a zero statutory blood alcohol level for drivers up at age 21. (4) Initiate an interdepartmental alcohol policy research programme.

Ahlstrom SK; Osterberg EL. International perspectives on adolescent and young adult drinking. Alcohol Research & Health 28(4): 258-268, 2004. (41 refs.)

Alcohol consumption by adolescents and young adults varies greatly in different countries and cultures, in different population groups within a country, and over time. Analyses of per capita consumption in different countries provide some information on drinking patterns of young people in various countries. School-based surveys conducted in a variety of European countries and in the United States offer more specific insight into the drinking behavior of this age group. Such surveys have analyzed variables such as age of onset of drinking; lifetime frequency of drinking; drinking to intoxication; frequency, amount, and timing of current drinking; and drinking consequences. These studies have demonstrated that drinking patterns of young people in, for example, Scandinavian, Anglo-Saxon, and Mediterranean countries vary greatly. Further analyses have explored the influence of social norms and related factors as well as alcohol availability and pricing on alcohol consumption among adolescents and young adults. The generalizability of the findings is limited, however, by the fact that most studies have been conducted in the United States and Europe.

Public Domain

Alcohol Epidemiologic Data System; Lakins NE; Williams GD/Yi H-Y. Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, 1977-2004. Surveillance Report No. 78. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2006. (20 refs.)

This surveillance report on 1977-2004 apparent per capita alcohol consumption in the US is the 20th in a series produced by the NIAAA. The following are highlights from the current report on consumption trends through 2004. In the country, per capita consumptio of alcohol from all kinds of beverages combined was 2.23 gallons, representing a 0.5 increase over 2003. This increase is attributable to an increase in wine and spirits, and a decline in beer. Between 2003 and 2004, there were increases in 35 states and a decrease in 15. In terms of regions of the country, there was a 1.4% increase in the Northeast, a 0.9% increase in the West, a 0.5% increase in the South and a 0.9 percent decrease in the Midwest. There has been an increasing trend in alcohol consumption since 1999.I For the country to meet the Health People 2010 objectives, or per capita consumption will be no more than 1.96 gallons of ethanol, there will need to be about a 2 percent decrease from 2005 through 2010. Data is presented in 21 tables, figures and tables.

Alcohol Epidemiologic Data System; Nephew TM; Williams GD; Yi H-y; Hoy AK; Stinson FS; Dufour MC. Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, 1977-2000. Surveillance Report No. 62. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2003. (37 refs.)

This surveillance report on apparent per capita alcohol consumption in the United States is the 17th in a series of consumption reports produced annually by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Findings are based on alcoholic beverage sales data, either collected directly by the Alcohol Epidemiologic Data System (AEDS) from States or provided by beverage industry sources. Population data provided by the U.S. Census Bureau are used to calculate per capita rates. The following are highlights from the current report which updates consumption trends through 2000: After a 0.9 percent increase in 1999, per capita consumption of ethanol from all alcoholic beverages combined increased by 0.9 percent again in 2000 (from 2.16 to 2.18 gallons ethanol). The increase between 1999 and 2000 is mainly due to the increase in per capita consumption of spirits (from 0.63 to 0.65 gallons ethanol), while per capita consumption remained unchanged for wine (0.31 gallons ethanol) and declined for beer (from 1.23 to 1.22 gallons ethanol). Changes in overall per capita alcohol consumption among the States and the District of Columbia between 1999 and 2000 included increases in 29 States and the District of Columbia and decreases or no change in 21 States. This continued the trend observed in 1999 when overall per capita consumption increased in 41 States and decreased or remained unchanged in 9 States and the District of Columbia. Analysis of overall per capita alcohol consumption by census region between 1999 and 2000 indicated an overall per capita increase in all of the four regions: 1.9 percent in the Northeast, 0.5 percent in the Midwest, 0.5 percent in the South, and 0.9 percent in the West. The Healthy People Year 2000 national objective of reducing per capita consumption to no more than 2 gallons ethanol was not attained. To meet the Year 2010 objective (set to the same value of 2 gallons ethanol), total per capita ethanol consumption must decrease by 0.8 percent per year.

Public Domain

Anderson P; Baumberg B. Alcohol in Europe - Public Health Perspective: Report summary. Drugs: Education, Prevention and Policy 13(6): 483-488, 2006. (0 refs.)

"Alcohol in Europe" was an analysis of the health, social and economic impact of alcohol in Europe, undertaken by the European Commission. The main findings of the Report are reprinted here. The major sections include (1) Alcohol and the economy of Europe; (2) the use of alcohol in Europe; (3) the impact of alcohol on Europe; (4) the impact of alcohol policy options; (5) European and global alcohol policy; and (6) member state alcohol policy. Among the key findings are that alcohol is a central element in the economy accounting for EU9 billion for the European Union. The EU is the heaviest drinking region of the world, although per capita consumption has been declining. Binge drinking is common and the level equivalent to one in three persons binge-drinking at least once per month. It is estimated that 23 million European are alcohol dependent. In terms of the impact alcohol is responsible for 12% or male and 2% of female premature death per year. One in three road fatalities are alcohol related; 10% of youth female morality is alcohol related and 25% of male youth mortality. Not all the harm falls to the drinker; alcohol is associated with 60,000 underweight births, 16% of case of child abuse and 7 million children live in families adversely impacted by alcohol. The drinking -driving policies are seen as highly effective, including random breath testing, lowered BAC levels, license suspension and lower BAC for young drivers. Efforts judged to have a low impact include designated driver, training and public awareness. There is also strong evidence of polices that regulate the market, via alcohol taxes. However, one of the proble3ms is that member states have to abide by the trade law of the EU, thus restricting the ability to have advertising bans in some areas, or to raise taxes independently.

Andreasson S; Holder HD; Norstrom T; Osterberg E; Rossow I. Estimates of harm associated with changes in Swedish alcohol policy: Results from past and present estimates. Addiction 101(8): 1096-1105, 2006. (21 refs.)

(i) To compare actual developments of alcohol-related harm in Sweden with estimates derived prior to major policy changes in 1995 and (ii) to estimate the effects on consumption and alcohol-related harm of reducing alcohol prices in Sweden. Design Alcohol effect parameters expressing the strength of the relationship between overall alcohol consumption and different alcohol-related harms were obtained from ARIMA ( Auto Regressive Integrated Moving Average) time-series analyses. Measurements Measures of Swedish alcohol-related mortality ( liver cirrhosis, alcoholic psychosis, alcoholism and alcohol poisoning), accident mortality, suicide, homicide, assaults and sickness absence from 1950 to 1995. Findings: Previous estimates of alcohol-related harm based on changes in alcohol consumption for the period 1994 - 2002 for Sweden were, in some cases ( e. g. violent assaults and accidents), relatively close to the actual harm levels, whereas in other cases ( e. g. homicides, alcohol-related mortality and suicide) they diverged from observed harm levels. A tax cut by 40% on spirits and by 15% on wine is estimated to increase total per capita alcohol consumption by 0.35 litre. This increase is estimated to cause 289 additional deaths, 1627 additional assaults and 1.6 million additional sickness absence days. Conclusions: The estimates of future changes in harm based upon even relatively modest increases in alcohol consumption produce considerable negative effects, with large economic consequences for the Swedish economy. The additional alcohol-related deaths, for instance, amount to more than half the number of yearly traffic fatalities in Sweden.

Asbridge M; Mann RE; Flam-Zalcman R; Stoduto G. The criminalization of impaired driving in Canada: Assessing the deterrent impact of Canada's first per se law. Journal of Studies on Alcohol 65(4): 450-459, 2004. (55 refs.)

Objective: The goal of this article is to assess the effectiveness of Canada's first per se law criminalizing driving with a blood alcohol concentration of over 0.08%, the Breathalyser Law introduced in 1969, in reducing drinking-driver-related fatalities. We also examine the long-term deterrent effect of this law on driver fatality rates. In the analyses we include such potentially confounding influences on drinking-driver fatality rates as the founding of Mothers Against Drunk Driving (MADD), Canada; the introduction of Ontario's mandatory seatbelt law; per capita alcohol consumption; the unemployment rate; vehicles registered per capita; and precipitation rates. Method: Interrupted time series analysis with auto-regressive integrated moving average modeling was applied to the annual number of motor vehicle driver fatalities in Ontario for the period 1962-1996 to examine drinking- and nondrinking-driver fatalities. Results: A significant intervention effect was found for the Breathalyser Law in Ontario, which was associated with an estimated reduction of 18% in the number of fatally injured drinking drivers. No corresponding effect was observed for nondrinking-driver fatalities. Per capita alcohol consumption was positively associated with drinking-driver fatalities; Ontario's mandatory seatbelt law was linked to nondrinking-driver fatalities; and the formation of MADD, Canada, was strongly associated with drinking- and nondrinking-driver fatalities. Conclusions: These data provide evidence that Canada's per se law had a specific deterrent effect that resulted in a reduction in drinking-driver fatalities. A long-term deterrent effect was also observed, which is in contrast to the early policy literature on impaired driving.

Babor T; Caetano P; Casswell S; Edwards G; Giesbrecht N; Graham K et al. Alcohol consumption trends and patterns of drinking. IN: Babor T; Caetano P; Casswell S; Edwards G; Giesbrecht N; Graham K et al. Alcohol: No Ordinary Commodity. Oxford: Oxford University Press, 2003. pp. 31-56. (74 refs.)

This chapter descries alcohol consumption trends and patterns of drinking in a global perspective. The usual frequency of drinking and amount per occasion vary widely, among regions, within countries, over time, and between population groups. This chapter explores how these variations affects rates of alcohol-related problems, and the implications for alcohol policy. Two aspects of consumption are viewed as particularly significant across populations and across time: the proportion of drinkers and per capita consumption among drinkers, and the ways in which alcohol is consumed. In the discussion it is noted that market economies have had a slight overall decrease in alcohol consumption in recent years, as well as a converging of trends between high and low consumption countries. Much of the variation world wide is attributable to the proportions of adults who abstain from drinking. There are also differences between regions in the frequency and nature of intoxication. There are also differences in the nature and rate of social and health problems from drinking.

BAC; Room R; Selin KH. Problems from women's and men's drinking in eight developing countries. IN: Obot IS; Room R, eds. Alcohol, Gender and Drinking Problems: Perspectives from Low and Middle Income Countries. Geneva: World Health Organization, 2005. pp. 209-220. (11 refs.)

This chapter endeavors to summarize the data presented in the previous chapters within common frameworks. Among the findings is that there is no straigh forward relationship between level of development and per capita adult consumption. The two countries with the highest levels of consumption are Argentina and Uganda. Data is summarized and discussed in respect to levels of harazdous drinking, and current drinking by gender and age, as well as data on problems, and guilt over problems.

Bloomfield K; Stockwel T; Gmel G; Rehn N. International comparisons of alcohol consumption. Alcohol Research & Health 27(1): 95-109, 2003. (54 refs.)

International comparisons of alcohol consumption and its consequences can serve multiple purposes. For example, despite differences among countries in drinking cultures, drink sizes and strengths, and methods of measuring alcohol consumption, international survey research has provided a substantial amount of information on the rates of abstinence or current drinking, the frequency of drinking or binge drinking, and the mean consumption among both adults and youths in many countries. Other studies using aggregate-level data have analyzed per capita alcohol consumption in various countries. These studies can be used to relate per capita consumption to certain alcohol-related outcomes and to evaluate changes of both consumption and different outcomes within a country or across countries over time. Some problems associated with international research, however, such as issues of comparability of surveys, still need to be resolved.

Public Domain

Bokhari F; Mayes R; Scheffler RM. An analysis of the significant variation in psychostimulant use across the US. Pharmacoepidemiology and Drug Safety 14(4): 267-275, 2005. (30 refs.)

Objective: To provide a national profile of the area variation in per-capita psychostimulant consumption in the U.S. Methods: We separated 3030 U.S. counties into two categories of 'low' and 'high' per-capita use of attention deficit hyperactivity disorder (ADHD) drugs (based on data from the Drug Enforcement Administration), and then analyzed them on the basis of their socio-demographic, economic, educational and medical characteristics. Results: We found significant differences and similarities in the profile of counties in the U.S. that are above and below the national median rate of per-capita psychostimulant use (defined as g/per 100K population). Compared to counties below the median level, counties above the median level have: significantly greater population, higher per-capita income, lower unemployment rates, greater HMO penetration, more physicians per capita, a higher ratio of young-to-old physicians and a slightly higher students-to-teacher ratio. Conclusions: Our analysis of the DEA's ARCOS data shows that most of the significant variables correlated with 'higher' per-capita use of ADHD drugs serve as a proxy for county affluence. To provide a more complex, multivariate analysis of the area variation in psychostimulant use across the U.S.-which is the logical next step-requires obtaining price data to match the DEAs quantity data.

Bye EK. Alcohol and violence: Use of possible confounders in a time-series analysis. Addiction 102(3): 369-376, 2007. (50 refs.)

Aim: To assess the aggregate association between alcohol consumption and violence, while controlling for potential confounders. Design and measurements: The data comprise aggregate time-series for Norway in the period 1880-2003 and 1911-2003 on criminal violence rates and per capita alcohol consumption. Possible confounders comprise annual rates of unemployment, divorce, marriage, total fertility rate, gross national product, public assistance/social care and the proportion of the population aged between 15 and 25. Autoregressive integrated moving average (ARIMA) analyses were performed on differenced data. Both semilogarithmic and linear models were estimated. Findings: Alcohol consumption was associated significantly with violence, and an increase in alcohol consumption of 1 litre per year per inhabitant predicted a change of approximately 8% in the violence rate. The parameter estimate for the alcohol variable remained unaltered after including the covariates both in the semilogarithmic and the linear models. Of the seven covariates included in the models, only divorce was associated significantly with violence rate. Conclusions: The results suggest that alcohol consumption has an independent effect on violence rates when other factors are controlled for. The results support the assumption of a causal effect of alcohol consumption on violence, and it appears that alcohol consumption is an important factor when we wish to explain changes in violence rates over time.

Cherpitel CJ; Ye Y; Bond J; Rehm J; Poznyak V; Macdonald S et al. Multi-level analysis of alcohol-related injury among emergency department patients: A cross-national study. Addiction 100(12): 1840-1850, 2005. (27 refs.)

Aim: The aim of this analysis was to examine the average rate and variation of alcohol-related injury across emergency department (ED) studies, the effect of usual drinking on likelihood of alcohol-related injury, whether cross-study variation in rate of alcohol-related injury can be explained by between-study difference in usual consumption and whether social-cultural contextual variables help explain cross-study variations, after between-study difference in usual consumption has been controlled. Design: Data were merged from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the WHO Collaborative Study on Alcohol and Injuries, together representing 28 studies in 16 countries, and include 8423 (drinking) injury patients who arrived in the ED within 6 hours after injury. Alcohol-related injury was based, separately, on a positive blood alcohol concentration (BAC) and self-reported drinking within 6 hours prior to injury. A multi-level design and hierarchical generalized linear models were used for analysis in which patients were nested within studies. Findings: Overall prevalence of alcohol-related injury was 24% and 29% for positive BAC and self-report, respectively. At the patient level, log-transformed alcohol consumption in the last 12 months was a significant predictor of alcohol-related injury. At the study level significant variation in rates of alcohol-related injury was observed; studies with higher overall average consumption reported a higher rate of alcohol-related injury. When volume was controlled, societies with higher detrimental drinking pattern and higher legal level for intoxication while driving were more likely to have an increased rate of alcohol-related injury. Conclusion: Alcohol-related injury varies across EDs and countries. While it is associated with an individual's usual alcohol consumption, it is also affected by a number of societal drinking characteristics including the aggregate volume of consumption, overall drinking pattern and legislative policies to control drinking and related harms.

Chesson HW; Harrison P; Stall R. Changes in alcohol consumption and in sexually transmitted disease incidence rates in the United States: 1983-1998. Journal of Studies on Alcohol 64(5): 623-630, 2003. (47 refs.)

Objective: A substantial research literature has documented an association between alcohol consumption and risky sexual behavior at the level of the individual. We explored the association between changes in alcohol consumption and sexually transmitted disease (STD) incidence rates at the level of the 50 U.S. states and the District of Columbia. Method: We used multivariate analyses to examine state-level changes in STD rates (gonorrhea and syphilis) and state-level changes in alcohol consumption, controlling for changes in state-level characteristics (e.g., poverty, age distribution of population) and for national trends in factors that affect STD rates. Results: From 1983 to 1998, changes in alcohol consumption were significantly associated with changes in gonorrhea and syphilis rates. Each 1% increase in per capita alcohol consumption was associated with increases of about 0.4% to 0.7% in reported gonorrhea incidence rates and 1.8% to 3.6% in reported syphilis incidence rates. Conclusions: The association between alcohol and risky sex, well documented at the level of the individual, might hold at the population level as well.

Cochrane J; Chen H; Conigrave KM; Hao W. Alcohol use in China. Alcohol and Alcoholism 38(6): 537-542, 2003. (48 refs.)

Aims: Over recent decades there has been a striking increase in alcohol consumption and related problems in China. As China holds over 22% of the world's population this has a significant potential impact on world health. Here we review English- and Chinese-language publications on the prevalence of alcohol consumption and related problems in China, and treatment and control measures to reduce these. Methods: Medline search 1976-2002 and search of the China National Knowledge Infrastructure database 1996-2002. Results: While alcohol is a traditional part of Chinese life, commercial alcohol production in China has increased more than 50-fold per capita since 1952. In parallel there is evidence of a marked increase in prevalence of alcohol dependence, which has moved from the ninth to the third most prevalent mental illness. The public health response to increase in alcohol-related disorders has commenced but is in need of further development. Conclusions: There is a need for increased policies and public health programmes to reduce alcohol related harm, and evaluation of outpatient treatment potential.

Cook PJ; Ostermann J; Sloan FA. The net effect of an alcohol tax increase on death rates in middle age. American Economic Review 95(2): 278-281, 2005. (16 refs.)

Alcohol excise taxes increases prices and reduce per capita consumption. in principle, a tax-induced reduction in per capita consumption has the result of both a reduction in the prevalence of alcohol abuse and the prevalence of moderate drinking, with opposite effects on mortality rates. The net effect on morality could be either positive or negative and has not been established empirically. Moderate alcohol consumption has been shown to have a cardiovascular protective effects. Increase in excise taxes may reduce mortality if it lowers risky drinking and lowers the prevalence of chronic heavy drinking; it may raise mortality rates in older people drink" to little". This report combines new estimates on the effect of per capita consumption on drinking patterns. It reports that a reduction of 1 percent in per capita consumption would have little effect on mortality in middle age. As there is no health benefit from drinking for younger people, but are considerable risks, it is concluded that the public-health case for increased alcohol taxation is strong.

Elster J; Gjelsvik O; Hylland A; Moene K, eds. Understanding Choice, Explaining Behavior: Essays in Honour of Ole-Jorgen Skog. Oslo, Norway: Oslo Academic Press, 2007. (Chapter refs.)

This edited work of essays with 17 contributors honours the work of Ole-Jorgen Skog, a scholar in the substance abuse field, who though a sociologist by training, had a wide range of interests. These invited essays include a review of Skog's work and contributions to the alcohol field. The essays address alcohol policy, the relationship of drinking patterns and per capita consumption and mortality, the significance (or lack thereof) of the age of first consumption in respect to prevention efforts. Beyond those essays dealing with alcohol per se are those which related Skog's work to larger methodological and conceptual concerns including, the role of choice as a function of future incentives, the weakness of the will, and the role of generative models in understanding macro-level social dynamics.

Fagerstrom K. The nicotine market: An attempt to estimate the nicotine intake from various sources and the total nicotine consumption in some countries. Nicotine & Tobacco Research 7(3): 343-350, 2005. (37 refs.)

Tobacco particularly smoked products-has been associated with great harm and growing public disapproval and can be expected to suffer in the marketplace. This situation has created opportunities for other less harmful nicotine-containing products such as smokeless tobacco and nicotine replacement products, which are gaining public support. Little is known about the level of nicotine intake in our society. Tobacco sales are known, but how much nicotine is extracted and actually absorbed by users is largely unknown. The present study is a first attempt to estimate uptake of nicotine from tobacco and nicotine replacement products and to map nicotine consumption in a few countries, with special emphasis on Sweden. Relevant pharmacokinetic studies for three types of nicotine containing products (cigarettes, smokeless tobacco, and nicotine replacement products) were analyzed for bioavailable nicotine. Estimates of nicotine intake from each category were made. These were then multiplied by the amount consumed in the respective countries. Tobacco consumption statistics were usually from official records of taxed sales. In Sweden about 54% of all nicotine intake comes from smoked sources, 45% from nonsmoked tobacco, and 1.3% from nicotine replacement products. For men, 63% of the nicotine consumed comes from nonsmoked tobacco. Per-capita nicotine intake per year for adults aged 15 years or older is 3,321 mg for Austria, 3,043 mg for Sweden, 3,014 mg for Denmark, 2,955 mg for the United States, 2,244 mg for Norway, and 2,023 mg for Finland. Compared with cigarette smokers, snus users seem to have a somewhat higher daily intake (34 mg vs. 25 mg). The cleanest nicotine products, nicotine replacement products, represent a negligible part (about 1%) of the total nicotine consumption in most countries.

Fogarty J. The nature of the demand for alcohol: Understanding elasticity. British Food Journal 108(4): 316-332, 2006. (66 refs.)

Purpose - The demand for alcohol is a well-researched topic, yet the published literature regarding consumer responses to changes in the price of alcohol includes many conflicting and inconsistent results. This paper seeks to present an analysis of known own-price elasticity estimates, and to attempt to understand why reported results differ. Design/methodology/approach - The approach taken to analysing the data is the meta-regression approach. Specifically, the meta-regression considers 150 beers, spirits, and wines, own price elasticity point estimates, which have been drawn from studies that consider demand responses to changes in the price of alcohol in 18 different countries. Findings - The results of the empirical work reported in this paper suggest that the year of the study, the length of study, the per capita level of alcohol consumption, and the relative ethanol share of a beverage are important factors when explaining variations in consumer demand responses to changes in the price of alcohol. Interestingly, the study also suggests that country-specific and beverage-specific effects are not important. Originality/value - The paper is valuable as it uses the meta-regression framework to control for study design characteristics and, once these characteristics are controlled for, it becomes possible to identify the underlying trend in the demand for alcohol. Specifically, the trend was shown to be one where the demand for alcoholic beverages became increasingly inelastic up to 1969 and decreasingly inelastic thereafter.

Gilpin EA; Messer K; White MM; Pierce JP. What contributed to the major decline in per capita cigarette consumption during California's comprehensive tobacco control programme? Tobacco Control 15(4): article 308, 2006. (46 refs.)

Objectives: California experienced a notable decline in per capita cigarette consumption during its comprehensive tobacco control programme. This study examines what proportion of the decline occurred from: ( 1) fewer ever smokers in the population, ( 2) more ever smokers quitting, and ( 3) current smokers smoking less. Design, subjects: Per capita cigarette consumption computed from cigarette sales and from adult respondents to the large, cross-sectional, population-based California Tobacco Surveys of 1990 (n = 24 296), 1996 ( n = 18 616) and 2002 ( n = 20 525) were examined for similar trends. Main outcome measure: Changes (period 1: 1990-1996; period 2: 1996-2002) in per capita cigarette consumption from self-reported survey data were partitioned for the entire population and for demographic subgroups into the three components mentioned above. Results: In periods 1 and 2, most of the decline in per capita cigarette consumption for the population as a whole was from current smokers smoking less followed by a reduction in ever smokers. The decline from smokers smoking less was particularly evident among young adults (18-29 years) in period 1. While the portion of the decline due to quitting in the entire population in period 1 was negligible, in period 2 it accounted for 22% of the total per capita decline. The decline from quitting in period 2 was mostly observed among women. Conclusions: Rather than near-term benefits from smokers quitting, population health benefits from reduced per capita cigarette consumption will likely occur over the longer term from fewer people becoming ever smokers, and more less-addicted smokers eventually quitting successfully.

Giovino GA. The tobacco epidemic in the United States. (review). American Journal of Preventive Medicine 33(6, Supplement S): S318-S326, 2007. (124 refs.)

Tobacco use, primarily in the form of cigarettes and exposure to tobacco smoke pollution, has caused the premature deaths of more than 14 million Americans since 1964. The major diseases caused by tobacco and tobacco smoke include lung cancer, other cancers, coronary heart disease, other cardiovascular diseases, chronic respiratory diseases, pregnancy complications, and respiratory diseases in children. Per capita consumption of various tobacco products has declined substantially since 1950, with current consumption at approximately 3.7 pounds per capita. Whereas approximately two in five adults smoked cigarettes in 1965, approximately one in five did so in 2005. Several factors can influence initiation and cessation, including product factors (e.g., ventilation holes, additives, and flavorings); host factors (intention to use, level of dependence); tobacco company activities (e.g., marketing strategies, efforts to undermine public health activities); and environmental factors (e.g., peer and parental smoking, smoke-free air laws and policies). Efforts to prevent initiation, promote quitting, and protect nonsmokers should reduce exposure to pro-tobacco marketing and increase (1) the price of tobacco products, (2) protection from tobacco smoke pollution, (3) effective mass media strategies, (4) provision of effective cessation support, (5) effective regulation, and (6) litigation that holds the industry responsible for its misdeeds. Adequate implementation of effective tobacco-control strategies and useful scientific advances will help to ensure that per capita consumption decreases to the lowest level possible. The economic benefits of tobacco in our society are replaceable and they pale in comparison to the extent of human life lost.

Grigg D. Wine, spirits and beer: World patterns of consumption. Geography 89(Part 2): 99-110, 2004. (44 refs.)

World patterns of the consumption of wine, spirits and beer can be obtained using data collected by the Food and Agriculture Organization [sic]. About half the worlds consumption of absolute alcohol comes from spirits, one third from beer, the rest from wine. Spirits are the leading drink in Eastern Europe, the former Soviet Union, Central and Northern. America and most of Asia; wine in southern Europe, parts of South America mid Central Asia, beer in northern Europe, North America and Australasia. The production of grapes from which wine is made is climatically limited and consumption is high only in the regions of production, i.e. mainly areas of Mediterranean-type climate. Beer production is much more widely distributed, and only a very small amount is exported. Spirits, unlike beer and wine. can be made from a wide variety of plants, and so their consumption is not limited to areas of production. Income per capita, religion, migration and several other factors influence the relative importance of the beverages in different parts of the world.

Hanewinkel R; Radden C; Rosenkranz T. Price increase causes fewer sales of factory-made cigarettes and higher sales of cheaper loose tobacco in Germany. Human Economics 17(6): 683-693, 2008. (63 refs.)

Aim of this study is the analysis of the price responsiveness of demand for cigarettes and loose tobacco in Germany over the period 1991-2006. In this period the average consumption of all kinds of cigarettes per capita (German population >= 15 years) declined from 634 pieces/quarter to 457pieces/quarter (-28%). Consumption of factory-made cigarettes decreased from about 545 pieces/quarter to 330 pieces/quarter in 2006 (-39%). In the same time consumption of self-made cigarettes increased from 89 pieces/quarter to 127 pieces/quarter (+42%). A one Euro Cent increase in price is associated with 28 cigarettes of all kinds consumed less per quarter. Data indicate that the different types of cigarettes are substitutes, e.g. there is evidence for a positive relationship between the price of factory-made cigarettes and the consumption of hand-made cigarettes. Thus, the increase in such consumption is rather driven by a positive cross-price effect of 17.01. Data indicate additionally an overall decrease in the cigarette consumption and a partial switch to cheaper loose tobacco. The availability of low-taxed loose tobacco may undermine the public health benefits of higher cigarette prices. Price differentials between tobacco products should be reduced in order to maximize the public health benefits of high cigarette prices.

Hao W; Su Z; Liu B; Zhang K; Yang H; Chen S; Biao M; Cui C. Drinking and drinking patterns and health status in the general population of five areas of China. Alcohol and Alcoholism 39(1): 43-52, 2004. (22 refs.)

Aims: To understand drinking patterns, health status related to drinking and the level of unrecorded alcoholic beverage consumption for the general population living in five areas of China in 2001. Methods: By cluster sampling, 24,992 community residents aged 15 years or older were interviewed by trained psychiatrists using structured questionnaires provided by WHO. Results: The 1-year drinking rate was 59.0%, and the point prevalence rate of dependence was 3.8%. The average annual consumption of pure alcohol was 4.47 l. The 1-year morbidity from gastritis/ulcer in the whole sample was 7.9%, which associated nonlinearly to alcohol intake, and heart disease and cerebral infarction/cerebral haemorrhage showed V-shaped curve relationships. Conclusions: The rate of alcohol use was higher in men than in women, and the annual alcohol consumption per capita was higher than that in the 1990s in the selected areas. Alcohol consumption plays a role in the development of alcohol-related physical diseases.

Haw C; Hawton K; Casey D; Bale E; Shepherd A. Alcohol dependence, excessive drinking and deliberate self-harm. Social Psychiatry and Psychiatric Epidemiology 40(12): 964-971, 2005. (23 refs.)

Background: Problems relating to alcohol use are very common among deliberate self-harm (DSH) patients, and alcohol abuse increases the risk of both DSH and suicide. In the UK, per capita consumption of alcohol has risen by 50% since 1970. The proportion of women (but not men) drinking in excess of government-recommended limits has also increased. We investigate trends, by gender and age group, in alcohol problems and usage among DSH patients. Method Data collected by the Oxford Monitoring Systemem for Attempted Suicide were used to examine trends in alcohol disorders and alcohol consumption shortly before, or at, the time of self-harm by patients aged 15 years or over between 1989 and 2002. Results Data were available on 10,414 patients who were involved in 17,511 episodes of DSH. The annual numbers of both male and female DSH patients rose progressively over the study period. Although rates of alcohol disorders and consumption remained higher in males than females, substantial increases were seen in females of all ages in rates of alcohol problems, excessive drinking and consumption of alcohol within 6 h of DSH and as part of the act of DSH. Rates for males largely remained unchanged. Conclusions: There has been a significant increase in excessive drinking and consumption of alcohol around the time of DSH by females but not males. These changes may relate to increases in the affordability and availability of alcohol and to social changes in drinking patterns. They have implications for services for DSH patients and may have an impact on future patterns of suicidal behaviour.

Herttua K; Makela P; Martikainen P. Differential trends in alcohol-related mortality: A register-based follow-up study in Finland in 1987-2003. Alcohol and Alcoholism 42(5): 456-464, 2007. (46 refs.)

Aims: To assess to what extent alcohol-related mortality has changed by age, sex and education in Finland in 1987-2003, a period which saw two periods of economic growth, separated by a severe depression (1991-1995). Methods: A register-based follow-up study of all over 15-year-old Finnish men and women. Age, sex and education of the participants were measured at the time of the 1985, 1990, 1995 and 2000 censuses. Follow-up for mortality was for 1987--2003. The outcome measure was alcohol-related mortality, which was defined using information on the underlying and contributory causes of death. Results: Among men and women aged 45 years and over, the trends in alcohol-related mortality were associated with economic cycles. Among those aged less than 45 years, alcohol-related mortality decreased from the early 1990s, but intoxication-related accidents and violence still contributed largely to premature mortality. The unfavourable trend for older men resulted from an increase in mortality due to directly alcohol-attributable diseases, alcohol-related diseases of the circulatory system and accidents and violence, and for older women from an increase due to intoxication-related accidents and violence, and alcohol-attributable diseases. Alcohol-related mortality was higher in lower educational groups, and among women the educational gap widened towards the end of the study period. Conclusion: This study shows that trends in both economic conditions and per capita consumption of alcohol are not associated with trends in alcohol-related mortality in all population subgroups. In health policy more attention should be paid to divergent trends in gender, age and education specific alcohol-related mortality.

Higuchi S; Matsushita S; Osaki Y. Drinking practices, alcohol policy and prevention programmes in Japan. International Journal of Drug Policy 17(4, Special Issue): 358-366, 2006. (38 refs.)

The purpose of this article is to outline alcohol consumption patterns and related problems, alcohol control policy and prevention programmes in Japan, which are not well-known in other countries. In Japan, per capita alcohol consumption is no longer increasing and has even started to decrease. At the same time, diversification of drinking populations has made a rapid progress. For the last several decades, alcohol consumption in non-traditional drinking populations, such as women and young people, has been on a steep rise. Consequently, in addition to traditional drinking problems observed among adult males, the magnitude of problems among these non-traditional populations has expanded. Alcohol policy and prevention programmes, however, have not developed to adequately control these problems. Availability of alcoholic beverages, including to underage populations, remains very high. Legislation related to alcohol control has not been well enforced, with the exception of the Road Traffic Law. Tax systems on alcoholic beverages are not relevant to the suppression of alcohol consumption. Moreover, there are virtually no restrictions on advertising or sponsorship and no provisions concerning an alcohol-free environment. Prevention programmes and activities to reduce harm from drinking have been carried out, especially for underage drinking, but they are insufficient to tackle the existing problems. Comprehensive discussions on alcohol policy and implementation of effective prevention programmes with participation of all sectors concerned are necessary, in parallel with actions taken by the WHO and other organisations.

Higuchi S; Matsushita S; Maesato H; Osaki Y. Japan: Alcohol today. (review). Addiction 102(12): 1849-1862, 2007. (86 refs.)

Aims: The purpose of this paper is to outline alcohol availability, alcohol consumption and related harm, alcohol control policy and prevention programmes in Japan, few of which have been discussed in either the Japanese or English literature. Methods: Data were collected primarily from the following two sources: statistics and survey results issued by the national government, including surveys funded by the government; and papers published since 2000, identified by searching the MEDLINE and Igaku-Chuo-Zasshi databases. These data were assessed regarding their quality and summarized. Some data presented here were produced specifically for this review. Results: Although per capita alcohol consumption has tended to decline for more than 10 years, it has remained at a high level. Diversification of the drinking population has progressed rapidly, specifically in women, among whom alcohol consumption has increased sharply. Cross-sectional data suggest that alcohol consumption is associated with serious health and social consequences. Existing longitudinal data suggest that alcohol-related problems, especially health problems, have increased steadily over the past several decades, with few exceptions, including alcohol-related fatal road traffic accidents. Alcohol policy and prevention programmes have not developed to a level that can control these problems adequately. Specifically, the high availability of alcoholic beverages, including the lack of restrictions on sales and advertising and decreasing prices, are noted. Conclusions This review provides basic information regarding alcohol availability and alcohol consumption and related harm that may facilitate the improvement of existing alcohol control measures in Japan and encourage the development of new alcohol control measures. This research revealed the scarcity of longitudinal data regarding alcohol consumption and its consequences, and the lack of several important variables, such as disability adjusted life years, for improving our understanding of the comprehensive status of alcohol in Japan.

Holder H. Population drinking and alcohol harm: What these Canadian analyses tell us. (commentary). Addiction 98(7): 865-866, 2003. (5 refs.)

The author makes the case that the time-series analyses over almost 50 years of all Canadian provinces (article by Skog) again demonstrates a strong relationship between per capita consumption and alcohol trauma. The same relationship has been found in Europe during the same period. The commentator notes that this provides clear support for paying attention to population levels of alcohol consumption as a part of public health initiatives.

Huessy F; Perrine B. Economic factors in identifying best practices for reducing road traffic crashes by drinking drivers. Glasgow: ICADTS, 2004. (9 refs.)

It is noted that the decline is fatalities attributable to alcohol is in part an artifact of where the accident takes places. For example, investments and improvement in road safety are widely recognized to have contributed to the decline in the number of fatal and serious injury crashes involving impaired driving in developed countries. these measures include better-engineered roadways, installation of air bags, use of seat belts. (Note: Not to mention improved emergency medical care.) Nonetheless, some developed countries continue to report relatively high fatality rates, such that on road safety varies widely across Europe, the US, Canada, Australia and New Zealand. In emerging economies, "road traffic fatalities" typically mean pedestrian and bicyclist deaths. Road traffic deaths in developing countries account for 90% of the annual 1.2 million road fatalities worldwide. This paper seeks to provide a model for extending traditional road safety research considerations to include important cross-national economic factors such as the role of per capita gross domestic product in road fatality rates. For example, are disparities in road fatality rates among developed countries an economic problem or a reporting problem, or both? Data is provided in tables showing comparative per capita GDP, the GDP in US $, the number killed for 1 billion vehicle-kilometers, and the road fatality ranking. Also examined is the relationship between fatality rate and legal BAC for the country. Also, the problems inherent in comparing data from different countries are discussed. There is an accompanying PowerPoint presentation with 15 slides.

Ibanga AJ; Adetula AV; Dogona Z; Karick H; Ojiji O. The contexts of alcohol consumption by men and women in Nigeria. IN: Obot IS; Room R, eds. Alcohol, Gender and Drinking Problems: Perspectives from Low and Middle Income Countries. Geneva: World Health Organization, 2005. pp. 143-166. (45 refs.)

Nigeria has been independent from Britain since 1960, but been under military rule for much of that time. There is a high rate of illiteracy and tremendous poverty, with per capita annual income of $300, and 70% of the population live on less than $1 per day. 15% of children die before age 5. The chapter reviews the history of alcohol consumption, and its role in all cultural groups. It is consumed in the form of traditional beverages, or as western lager beer, wine or liquor. Historically alcohol consumption has been tied to rituals, ceremonies, and celebrations and drinking patterns prescribed. Alcohol abuse per se only became common in the 1960s and 1970s, with the increasing widespread use of western beverages. The alcohol beverage industry is described, the rise of national breweries, and the advent of marketing and promotion. There are virtually no surveys of drinking patterns. One study of 1,052 heads of households form 53% describing themselves as drinkers. A high proportion, 39% drank some form of alcohol daily. While limited surveys of health care, suggest a disproportionate level of admissions linked to alcohol misuse. A study reviewed here describes current alcohol consumption and insights into gender differences. Among the highlights is that 41% of men and 22% reported to be drinkers. Drinking is more common among rural residents, highest among the divorced and separated, and highest among those 45 and above. Gender is a predictive factor for drinking location, with more women drinking at home than do men. Bars are largely a male venue, but among women who go to bars it is with a frequency similar to that of men. There is a relationship of drinking to religion, the introduction of Sharia law in some states results in punitive measures.

Jepsen P; Vilstrup H; Sorensen HT. Alcoholic cirrhosis in Denmark - population-based incidence, prevalence, and hospitalization rates between 1988 and 2005: A descriptive cohort study. BMC Gastroenterology 8(e-article 3), 2008. (23 refs.)

Background: Denmark has one of the highest alcohol consumption rates in Northern Europe. The overall per capita alcohol consumption has been stable in recent decades, but surveys have indicated that consumption has decreased in the young and increased in the old. However, there is no recent information on the epidemiology of alcoholic cirrhosis. We examined time trends in incidence, prevalence, and hospitalization rates of alcoholic cirrhosis in Denmark between 1988 and 2005. Methods: We used data from a nationwide population-based hospital registry to identify all Danish citizens with a hospital diagnosis of alcoholic cirrhosis. We computed standardized incidence rates, prevalence and hospitalization rates of alcoholic cirrhosis within the Danish population. We also computed the number of hospitalizations per alcoholic cirrhosis patient per year. Results: From 1988 to 1993, incidence rates for men and women of any age showed no clear trend, and after a 32 percent increase in 1994, rates were stable throughout 2005. In 2001-2005, the incidence rates were 265 and 118 per 1,000,000 per year for men and women, respectively, and the prevalence rates were 1,326 and 701 per 1,000,000. From 1994, incidence, prevalence, and hospitalization rates decreased for men and women younger than 45 years and increased in the older population, although the latter finding might be partly explained by changes in coding practice. Men and women born around 1960 or later had progressively lower age-specific alcoholic cirrhosis incidence rates than the generations before them. From 1996 to 2005, the number of hospitalizations per alcoholic cirrhosis patient per year increased from 1.3 to 1.5 for men and from 1.1 to 1.2 for women. Conclusion: From 1988 to 2005, alcoholic cirrhosis put an increasing burden on the Danish healthcare system. However, the decreasing incidence rate in the population younger than 45 years from 1994 indicated that men and women born around 1960 or later had progressively lower incidence rates than the generations before them. Therefore, we expect the overall incidence and prevalence rates of alcoholic cirrhosis to decrease in the future.

Johansson E; Bockerman P; Uutela A. Alcohol consumption and sickness absence: Evidence from microdata. European Journal of Public Health 19(1): 19-22, 2009. (20 refs.)

Background: Aggregate time-series evidence has shown that overall per capita alcohol consumption is associated with sickness absence. This study re-examines the relationship between alcohol consumption and sickness absence by using individual-level microdata and methods that yield results which are less likely to be due to spurious correlations. Methods: Data on sickness absence and alcohol consumption for 18 Finnish regions over the period 19932005 was used. Sickness absence was measured as the number of sickness absence days during 1 year. Alcohol consumption was measured as the number of alcohol drinks consumed per week. The individual-level relationship between alcohol consumption and sickness absence was estimated by using Poisson regression models. Unobserved determinants of lifestyle behaviours associated with the region and survey year were controlled for. Personal characteristics as well as the clustering of observations by regions were also taken into account. Results: The estimates show that alcohol consumption is associated with sickness absence. The positive relationship between alcohol consumption and sickness absence is particularly pronounced for low-educated males. Conclusions: Aggregate time-series evidence for the relationship between alcohol consumption and sickness absence is confirmed by using individual-level microdata. The policy lesson is that it is important to take into account the effects of alcohol consumption on the prevalence of sickness absence (i.e. labour supply on an intensive margin) when one is considering the level of taxation of alcoholic beverages.

Kerr WC. Pancreatitis mortality and population level alcohol consumption: Taking the science a step forward. (editorial). Addiction 99(10): 1231-1232, 2004. (7 refs.)

Kerr WC; Ye Y. Population-level relationships between alcohol consumption measures and ischemic heart disease mortality in US time-series. Alcoholism: Clinical and Experimental Research 31(11): 1913-1919, 2007. (42 refs.)

Background: Individual-level studies indicate the possibility of both protective and harmful effects of alcohol consumption on Ischemic Heart Disease (IHD) mortality depending on the pattern of consumption. Population-level relationships could be in either direction and previous studies have found mixed results. Methods: Population-level relationships between IHD mortality rates and per capita consumption of alcoholic beverages, cirrhosis mortality rates, cigarettes, and sugar sweetened soda for the period from 1950 to 2002 are modeled using autoregressive integrated moving average (ARIMA) and vector error correction methods. Results: In multivariate ARIMA models controlling for accumulated heavy drinking as represented by cirrhosis mortality, a protective effect of 4%/l was found for total alcohol consumption while cirrhosis mortality rates had significant positive effects on IHD rates. Beverage-specific models found no effect for wine, positive risks for spirits, and significant protective effects for beer. The protective effects for both total alcohol and beer were also found in vector error correction models. Significant positive effects of cigarette sales on IHD rates were also found in both types of models. Conclusions: The complexity of alcohol's relationship with IHD is highlighted. Aspects of pattern represented by beverage-specific consumption and cirrhosis mortality indicate potential protective effects from moderate drinking and harmful effects from heavy drinking in accord with individual-level findings.

Kubicka L. Alcohol use in the country with the world's highest per capita beer consumption: The Czech Republic. (commentary). Addiction 101(10): 1396-1398, 2006. (30 refs.)

Lakins NE; Williams GD; Yi H-y. Surveillance Report #82. Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, 1977-2005. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2007. (22 refs.)

This report examines trends in the consumption of alcohol in the United States. Findings are based on alcoholic beverage sales data, either collected by the Alcohol Epidemiologic Data System (AEDS) from States or provided by beverage industry sources. Population data from the U.S. Bureau of the Census were used to calculate rates. The report provides data on national consumption of beer, wine, and distilled spirits as well as for all alcoholic beverages combined; consumption trends for each State for the same beverage categories; and consumption trends for each type of beverage and all beverages combined for U.S. regions. The following are highlights from the current report, which updates consumption trends through 2005: United States per capita consumption of ethanol from all alcoholic beverages combined in 2005 was 2.24 gallons, representing a 0.4 percent increase from 2.23 gallons in 2004. The increase is due to the increase in per capita consumption of wine (from 0.35 to 0.36 gallons ethanol) and spirits (from 0.68 to 0.70 gallons ethanol). However, per capita consumption of beer decreased (from 1.21 to 1.19 gallons ethanol). Between 2004 and 2005, changes in overall per capita consumption of ethanol included increases in 29 states, decreases in 20 states and the District of Columbia, and no change in two states. Analysis of overall per capita alcohol consumption by census region between 2004 and 2005 indicated increases in the Northeast (0.4 percent), the West (0.4 percent), and the Midwest (1.8 percent), and a decrease in the South (0.5 percent). Healthy People 2010 has set the national objective for reducing per capita alcohol consumption to no more than 1.96 gallons ethanol. However, there has been an increasing trend in per capita consumption since 1999. To meet the 2010 objective, per capita alcohol consumption will need to decrease by 12.5 percent, or about 3 percent per year from 2006 through 2010.Data is presented in 12 figures and tables.

Public Domain

Landberg J. Alcohol and suicide in eastern Europe. Drug and Alcohol Review 27(4): 361-373, 2008. (42 refs.)

Introduction and Aims. The aim of this paper was to estimate how suicide rates in seven eastern European countries are affected by changes in population drinking and to put the results into a comparative perspective. Design and Methods. The analysis included data on annual suicide mortality rates and per capita consumption for the post-war period from: Russia, Belarus, Poland, Hungary, Bulgaria, the former Czechoslovakia and the former German Democratic Republic (GDR). Overall and gender-specific models were estimated using the Box-Jenkins technique for time-series analysis. The estimates were pooled into two groups, i.e. spirits countries (Russia, Belarus and Poland) and non-spirits countries (Hungary, Bulgaria, former Czechoslovakia and former GDR). Results. All countries obtained positive alcohol effect estimates. The effects on the overall population were largest in the spirits countries, where a 1-litre increase in per capita consumption was associated with an increase in overall suicide rates of 5.7-7.5%. The effects were somewhat smaller in the non-spirits countries, 2.7-4.7%. The estimates for males were larger, but showed the same national variations as the overall population estimates. The female estimates were generally smaller than for men and did not differ between the two country groups. Discussion and Conclusions. The results suggest that per capita consumption matters for suicide mortality in these eastern European countries, but that the strength of the relationship is contingent upon the drinking culture, so that it tends to be stronger in countries with detrimental drinking patterns.

Lee JM; Liao DS; Ye CY; Liao WZ. Effect of cigarette tax increase on cigarette consumption in Taiwan. Tobacco Control 14(Supplement 1): I71-I75, 2005. (23 refs.)

Objectives: This study evaluates the effect of a 5 New Taiwan Dollar (NT$5) Health and Welfare Tax increase on the consumption of domestic and imported cigarettes and cigars. Methods: Using statistics published annually from 1971 through 2000, we set up a model based on the Central Bureau of Statistics (CBS) demand model to estimate price and expenditure elasticity coefficients of cigarettes and cigars. Results: Our results showed that the price elasticity coefficients for domestic and imported cigarettes were -0.644 and -0.822. The consumption of imported cigarettes was reduced by 7.51 packs per capita, and the consumption of domestic cigarettes was reduced by 15.21 packs per capita. Total per capita consumption of cigarettes was reduced by 22.72 packs (18%). Conclusions: From the public health and financial perspectives, the increase in this excise tax on tobacco to the Taiwan government will have significant effect in reducing cigarette consumption; it will also generate additional tax revenues.

Leon DA; McCambridge J. Liver cirrhosis mortality rates in Britain from 1950 to 2002: An analysis of routine data. Lancet 367(9504): 52-56, 2006. (30 refs.)

Background: Rates of mortality due to cirrhosis of the liver are an important indicator of population levels of alcohol harm. Total recorded alcohol consumption in Britain doubled between 1960 and 2002, giving rise to a need to examine and assess cirrhosis mortality trends. Methods Mortality rates were calculated for all ages and for specific age-groups (15-44 years and 45-64 years) for cirrhosis of the liver. Rates were directly age-standardised to the European standard population and compared with rates from 12 western European countries for the period 1955-2001. Findings Cirrhosis mortality rates increased steeply in Britain during the 1990s. Between the periods 1987-1991, and 1997-2001, cirrhosis mortality in men in Scotland more than doubled (104% increase) and in England and Wales rose by over two-thirds (69%). Mortality in women increased by almost half (46% in Scotland and 44% in England and Wales). These relative increases are the steepest in western Europe, and contrast with the declines apparent in most other countries examined, particularly those of southern Europe. Cirrhosis mortality rates in Scotland are now one of the highest in western Europe, in 2002 being 45.2 per 100 000 in men and 19.9 in women. Interpretation: Current alcohol policies in Britain should be assessed by the extent to which they can successfully halt the adverse trends in liver cirrhosis mortality. The situation in Scotland warrants particular attention.

Makela P. Impact of correcting for nonresponse by weighting on estimates of alcohol consumption. Journal of Studies on Alcohol 64(4): 589-596, 2003. (13 refs.)

Objective: This study describes the characteristics of nonrespondents and assesses the impact of unit nonresponse on estimates of central alcohol consumption variables by examining the impact of corrective weighting. Method: The data came from a Finnish general population random sample of 1,932 respondents (987 women) (response rate: 78.1%). The survey was carried out in the year 2000 using face-to-face interviews. The impact of unit nonresponse was assessed by comparing results using (1) no weighting; (2) poststratified weights adjusted for age, gender and region; (3) weights obtained from a statistical model predicting response propensity; and (4) weights from the model, adjusted to match the population distribution for age, gender and region. Extensive auxiliary information used to predict response propensity came from administrative registers. Results: Compared with respondents, both male and female nonrespondents had fewer children, lived in urban areas and lived in southern Finland. Male nonrespondents were also older; female nonrespondents more often had only a basic education and were less often in the second-highest income quartile. The change in alcohol variables resulting from the adjustment for nonresponse was small, however, and the difference between the different weighting schemes was even smaller. Conclusions: If nonrespondents' drinking differs considerably from that of respondents, this difference cannot be captured even by using extensive auxiliary information and an elaborate model predicting propensity of nonresponse.

Mann RE; Smart RG; Rush BR; Zalcman RF; Suurvali H. Cirrhosis mortality in Ontario: Effects of alcohol consumption and Alcoholics Anonymous participation. Addiction 100(11): 1669-1679, 2005. (62 refs.)

We test the hypotheses that cirrhosis mortality rates are positively associated with per capita alcohol consumption and negatively associated with Alcoholics Anonymous (AA) membership rates. The impact of alcohol consumption levels and AA membership rates on cirrhosis mortality rates in Ontario from 1968 to 1989 were examined. Time-series analyses with ARIMA modelling were applied to male and female cirrhosis mortality rates in three age groups: 15-44, 45-64 and 65 + years. Missing AA membership data were interpolated using two methods: linear splines and cubic splines. In general, cirrhosis mortality rates were positively associated with alcohol consumption and negatively associated with AA membership. For some age and gender combinations, these effects were not statistically significant. The limits of this study include restrictions in the length of series available and in the ability to infer causality. Despite these limitations, these findings are consistent with previous research demonstrating that per capita consumption is a strong determinant of cirrhosis mortality rates, and also that higher levels of AA membership can reduce cirrhosis mortality rates.

Mann RE; Zalcman RF; Smart RG; Rush BR; Suurvali H. Alcohol consumption, Alcoholics Anonymous membership, and suicide mortality rates, Ontario, 1968-1991. Journal of Studies on Alcohol 67(3): 445-453, 2006. (46 refs.)

Objective: The goal of this study is to identify alcohol-related factors that influence mortality rates from suicide. Specifically, we examine the impact of per capita consumption of total alcohol, distilled spirits, and beer and wine; unemployment rate; and Alcoholics Anonymous (AA) membership rate on total and male and female suicide mortality rates in Ontario between 1968 and 1991. Method: We studied the impact of alcohol consumption levels, AA membership rates, and unemployment rates on suicide mortality rates in Ontario from 1968 to 1991. Time series analyses with Auto Regressive Integrated Moving Average (ARIMA) modeling were applied to total and male and female suicide rates. The analyses performed included total alcohol consumption, distilled spirits consumption, beer consumption, and wine consumption. Missing AA membership data were interpolated with cubic splines. Results: Total alcohol consumption and consumption of each of beer, distilled spirits, and wine were significantly and positively related to total and female suicide mortality rates. AA membership rates were negatively related to total and female suicide rates. Although data for males did not reach significance (except for the relationship between wine consumption and suicide rate), the direction of effects was consistent with that observed for female and total suicide rates. Unemployment rates were positively related to male and total suicide rates in some models. Conclusions: These data confirm the important relationships between per capita consumption measures and suicide mortality rates seen by previous investigators. Additionally, the results for AA membership rates are consistent with the hypothesis that AA membership and treatment for misuse of alcohol can exert beneficial effects observable at the population level.

Mann RE; Zalcman RF; Smart RG; Rush BR; Suurvali H. Alcohol consumption, Alcoholics Anonymous membership, and homicide mortality rates in Ontario 1968 to 1991. Alcoholism: Clinical and Experimental Research 30(10): 1743-1751, 2006. (51 refs.)

Background: Research has shown a strong link between alcohol use and a variety of problems, including violence. Parker and colleagues have presented a selective disinhibition theory for the link between alcohol use and homicide (and other violence) that posits a causal relationship that is also influenced by other situational and contextual factors. This model is particularly well suited for aggregate-level investigations. In this study, we examine the impact of alcohol factors, including consumption measures and Alcoholics Anonymous (AA) membership rates, on homicide mortality rates in Ontario, and test predictions derived from the selective disinhibition model. Methods: Time series analyses with ARIMA modeling were applied to total, male, and female homicide rates in Ontario between 1968 and 1991. The analyses performed included total alcohol consumption, spirits consumption, beer consumption, and wine consumption. Missing AA membership data were interpolated with cubic splines. Results: For the total population and males, homicide rates were significantly and positively related to total alcohol consumption and to the consumption of beer and spirits. They were also negatively related to AA membership rates in the analyses involving spirits and wine and positively related to unemployment rates in the analyses involving beer, wine, and total alcohol. Among females, none of the measures were significant predictors of homicide mortality rates. Conclusions: These data provide important support for the selective disinhibition model and confirm important relationships between per capita consumption measures and homicide mortality rates, especially among males, seen in other studies. Additionally, the results for AA membership rates are consistent with the hypothesis that AA membership and treatment for misuse of alcohol can exert beneficial effects observable at the population level.

Mann RE; Zalcman RF; Asbridge M; Suurvali H; Giesbrecht N. Drinking-driving fatalities and consumption of beer, wine and spirits. Drug and Alcohol Review 25(4): 321-325, 2006. (38 refs.)

Drinking-driving is a leading cause of preventable morbidity and mortality in Canada. The purpose of this paper was to examine factors that influenced drinking driver deaths in Ontario. We examined the impact of per capita consumption of total alcohol, and of beer, wine and spirits separately, on drinking-driving deaths in Ontario from 1962 to 1996, as well as the impact of the introduction of Canada's per se law and the founding of People to Reduce Impaired Driving Everywhere -Mothers Against Drunk Driving (PRIDE-MADD) Canada. We utilised time-series analyses with autoregressive integrated moving average (ARIMA) modelling. As total alcohol consumption increased, drinking driving fatalities increased. The introduction of Canada's per se law, and of PRIDE-MADD Canada, acted to reduce drinking driving death rates. Among the specific beverage types, only consumption of beer had a significant impact on drinking driver deaths. Several factors were identified that acted to increase and decrease drinking driver death rates. Of particular interest was the observation of the impact of beer consumption on these death rates. In North America, beer is taxed at a lower rate than other alcoholic beverages. The role of taxation policies as determinants of drinking-driving deaths is discussed.

Martin AL. Fetal alcohol syndrome in Europe, 1300-1700: A review of data on alcohol consumption and a hypothesis. Food and Foodways 11: 1-26, 2003. (162 refs.)

Alcohol consumption and fetal alcohol syndrome (FAS) in Europe during the period 1300 to 1700 is discussed, with an effort to integrate four separate bodies of knowledge: modern medical understanding of the effects of alcohol on the unborn fetus; the work of historical demographers that demonstrates a high level of infant mortality in pre-industrial Europe; evidence that demonstrates women consuming large amounts of alcohol in pre-industrial Europe; and contemporary beliefs about the effects of alcohol on the unborn. Section headings in this review of the literature include: (1) infant and child mortality in pre-industrial Europe; (2) fetal alcohol syndrome; (3) the role of alcohol in pre-industrial Europe; (4) data on traditional alcohol consumption; (5) binge drinking, or the life cycle and rituals of excess; and (6) alcohol and medical opinion. Annual per capita consumption of wine in Italy, France, and England from the 1200s to 1700 is presented in table format.

McKinney A; Kieran C. Alcohol hangover effects on measures of affect the morning after a normal night's drinking. Alcohol and Alcoholism 41(1): 54-60, 2006. (32 refs.)

Aim: To investigate the effects of students' usual levels of alcohol consumption on aspects of mood and anxiety the following morning. Methods: Students were recruited who consumed their usual quantity of any type of alcoholic beverage in their chosen company and then completed assessments of the effects the following day. The timing of drinking was restricted to the period between 22:00 and 02:00 h the night before testing as these are the most popular hours for consuming alcohol in the population under investigation. The testing included an assessment of mood and anxiety; testing was also performed after an evening of abstinence (no hangover condition), following a counterbalanced repeated measure design, with time of testing and order of testing as `between participant' factors. Forty-eight student social drinkers (33 women, 15 men) aged between 18 and 43 years were tested, with a 1 week interval between test sessions. Results: Males reported consuming on average 14.7 units and females 10.5 units the night before testing. On the morning after alcohol consumption, ratings of alertness and tranquility were lower than the ratings the morning following an evening of abstinence at both 11:00 and 13:00 h and the post intoxication physical symptoms, emotional symptoms and symptoms of fatigue persisted throughout the morning. Conclusion: Heavy alcohol consumption lowers mood, disrupts sleep, increases anxiety and produces physical symptoms, emotional symptoms and symptoms of fatigue throughout the next morning

Moorhead JH. The alcoholic republic: Temperance in the United States. Our documentary heritage (Letters, photographs, books, pamphlets, and archival material held in the Presbyterian Historical Society). Journal of Presbyterian History 81(1): 60-63, 2003. (1 refs.)

Materials in the archives of the Presbyterian Historical Society provide a rich record of the history and culture, as well as social issues confronting the nation. this article considers material related to temperance and alcohol prohibition attitudes and efforts. It begins with information on the use and role of alcohol and distilled spirits trade in the early American economy. By the 1830s per capita consumption was estimated to be 7.1 gallons of alcohol per year, all the more remarkable inasmuch as children, women, slaves, did not consume this amount. This type of drinking labeled the United States the "alcoholic republic." In response to this thee was a rise in temperance societies throughout the country. The literature of these movements is described and depicted, including "pledge" cards." church school educational materials, and temperance hymns.

Mustonen H; Makela P; Huhtanen P. People are buying and importing more alcohol than ever before. Where is it all going? Drugs: Education, Prevention and Policy 14(6): 513-527, 2007. (15 refs.)

Aims: Removal of import quotas for alcoholic beverages from other EU countries and cuts on alcohol taxes by one third on average resulted in approximately a 10% increase in per capita alcohol consumption in 2004, and a further 3% in 2005. Our aim was to study which population groups accounted for this increase, and what happened to self-reported alcohol-related harm. Methods: A panel survey with a general population random sample was carried out. The current data are the first and third waves of the panel. A questionnaire was sent in autumn 2003 to 4000 Finns aged 15 to 69. In 2005, the questinnaire was mailed to 1209 persons who responded both in 2003 and in 2004 and who agreed to participate in the follow-up. Findings: The respondents themselves reported no increase in either their own consumption or in alcohol-related harm from 2003 to 2005, and there were few changes by subgroup of the population either. Conclusions: The survey data did not capture the increase in consumption that has been observed in per capita consumption. The permanent consequences of the changes in the alcohol situation in 2004 remain to be seen in future statistics and studies.

Naimi TS; Brewer RD; Mokdad A; Denny C; Serdula MK; Marks JS. Binge drinking among US adults. Journal of the American Medical Association 289(1): 70-75, 2003. (53 refs.)

Context: Binge drinking (consuming greater than or equal to 5 alcoholic drinks on 1 occasion) generally results in acute impairment and has numerous adverse health consequences. Reports indicate that binge drinking may be increasing in the United States. Objectives: To quantify episodes of binge drinking among US adults in 1993-2001, to characterize adults who engage in binge drinking, and to describe state and regional differences in binge drinking. Design, Setting, and Participants: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey of adults aged 18 years or older that is conducted annually in all states. The sample size ranged from 102263 in 1993 to 212 510 in 2001. Main Outcome Measures Binge-drinking prevalence, episodes, and episodes per person per year. Results: Between 1993 and 2001, the total number of binge-drinking episodes among US adults increased from approximately 1.2 billion to 1.5 billion; during this time, binge-drinking episodes per person per year increased by 17% (from 6.3 to 7.4, P for trend = .03). Between 1995 and 2001, binge-drinking episodes per person per year increased by 35% (P for trend = .005). Men accounted for 81% of binge-drinking episodes in the study years. Although rates of binge-drinking episodes were highest among those aged 18 to 25 years, 69% of binge- drinking episodes during the study period occurred among those aged 26 years or older. Overall, 47% of binge-drinking episodes occurred among otherwise moderate (i.e., non-heavy) drinkers, and 73% of all binge drinkers were moderate drinkers. Binge drinkers were 14 times more likely to drive while impaired by alcohol compared with non- binge drinkers. There were substantial state and regional differences in per capita binge-drinking episodes. Conclusions: Binge drinking is common among most strata of US adults, including among those aged 26 years or older. Per capita binge- drinking episodes have increased, particularly since 1995. Binge drinking is strongly associated with alcohol-impaired driving. Effective interventions to prevent the mortality and morbidity associated with binge drinking should be widely adopted, including screening patients for alcohol abuse in accordance with national guidelines.

Nemtsov A. Suicides and alcohol consumption in Russia, 1965-1999. Drug and Alcohol Dependence 71(2): 161-168, 2003. (45 refs.)

Background: Abrupt changes in the alcohol consumption level and the suicide rate associated with the anti-alcohol campaign of 1985-1991 and the market reforms of 1992. Methods: Epidemiological investigation of total Russian suicide rate and per capita alcohol consumption utilizing the Box-Jenkins technique and regression analysis. Results: The decrease of per capita consumption from 14.2 to 10.5 l in 1985-1987 and the growth of this index after 1987 (14.6 l in 1994) saw a respective decline and increase of suicides per litre of alcohol: eight males and one female per 100,000 of the corresponding population (13 or 6% of male or female suicides and 12% total suicides). The maximum suicide rate was reached in 1994 (41.8 per 100,000 population, in 1981-1994 r=0.91). In 1984-1986 and 1991-1994 the distribution of suicides' age was close to that of the age distribution from fatal alcohol poisoning. Changes in the level of BAC-positive suicides are closely correlated with changes in the alcohol consumption level (r=0.98), whereas changes in the number of BAC-negative suicides were not related to changes in consumption. Conclusion: Alcohol consumption level plays a considerable role in the suicide rate, especially for male suicides. The rate of alcohol-related suicides is very high in Russia, owing to the very high alcohol consumption rate in the country.

Norstrom T. Per capita alcohol consumption and all-cause mortality in Canada,1950-98. Addiction 99(10): 1274-1278, 2004. (35 refs.)

Aims: To estimate the relationship between per capita alcohol consumption and male all-cause mortality in Canada. Data and method: The outcome measure comprised annual data on male all-cause mortality for the period 1950-98. Alcohol sales (in litres 100% alcohol) were used as proxy for per capita consumption. The data were analysed using the Box-Jenkins technique. Two models were estimated, one including only female mortality as control, the other in addition cigarette sales. Results: The first model yielded a significant alcohol effect that implied a 2.9% [standadrd error (SE) = 0.6%] increase in mortality given a I-litre increase in consumption. This estimate coincides with that obtained for northern Europe in previous research. When cigarette sales were included in the model the alcohol effect was still statistically significant but markedly reduced, to 1.7% (SE = 0.6%). Conclusions: Total mortality is a classic indicator of the general health status of the population. its relationship with per capita consumption of alcohol supports the view that total consumption is a concern for public health.

Norstrom T; Ramstedt M. Mortality and population drinking: A review of the literature. Drug and Alcohol Review 24(6): 537-547, 2005. (69 refs.)

The aim of this review was to review research addressing the relationship between population drinking and health, particularly mortality. The review is based primarily on articles published in international journals after 1994 to February 2005, identified via Medline. The method used in most studies is time- series analysis based on autoregressive intergrated moving average (ARIMA) modelling. The outcome measures covered included the following mortality indicators: mortality from liver cirrhosis and other alcohol-related diseases, accident mortality, suicide, homicide, ischaemic heart disease ( IHD) mortality and all- cause mortality. The study countries included most of the EU member states as of 1995 ( 14 countries), Canada and the United States. For Eastern Europe there was only scanty evidence. The study period was in most cases the post-war period. There was a statistically significant relationship between per capita consumption and mortality from liver cirrhosis and other alcohol-related diseases in all countries. In about half the countries, there was a significant relationship between consumption, on one hand, and mortality from accidents and homicide as well as all- cause mortality on the other hand. A link between alcohol and suicide was found in all regions except for mid- and southern Europe. There was no systematic link between consumption and IHD mortality. Overall, a 1-litre increase in per capita consumption was associated with a stronger effect in northern Europe and Canada than in mid- and southern Europe. Research during the past decade has strengthened the notion of a relationship between population drinking and alcohol- related harm. At the same time, the marked regional variation in the magnitude of this relationship suggests the importance of drinking patterns for modifying the impact of alcohol. By and large, there was little evidence for any cardioprotective effect at the population level. It is a challenge for future research to reconcile this outcome with the findings from observational studies, most of which suggest a protective effect of moderate drinking.

O'Farrell A; Allwright S; Toomey D; Bedford D; Conlon K. Hospital admission for acute pancreatitis in the Irish population, 1997-2004: Could the increase be due to an increase in alcohol-related pancreatitis? Journal of Public Health 29(4): 398-404, 2007. (21 refs.)

To investigate trends in the incidence of acute pancreatitis by examining emergency admissions to acute public hospitals over an 8-year period; to compare trends for alcohol-related pancreatitis admissions with biliary tract-related admissions and to profile the patients admitted with an acute pancreatitis diagnosis. All in-patient emergency admissions for which an acute pancreatitis diagnosis (ICD-9-CM Code 577.0) was recorded as principal diagnosis were identified for years 1997-2004 inclusive. Alcohol-related acute pancreatitis admissions (i.e. had alcohol misuse recorded as co-morbidity) were identified using ICD-9-CM-codes 303 and 305. Biliary tract disease-related admissions (i.e. had biliary tract disease recorded as co-morbidity) were identified using ICD-9-CM codes 574.0-576.0 inclusive. Pearson's chi(2)-test was used to compare proportions in groups of categorical data and chi(2)-tests for trend were used to identify linear trends. There were 6291 emergency admissions with a principal diagnosis of acute pancreatitis during the 8 year study period, with 622 admissions in 1997 compared to 959 admissions in 2004, an increase of 54.1%. Age standardized rates rose significantly from 17.5 per 100 000 population in 1997 to 23.6 per 100 000 in 2004, (P < 0.01 for linear trend). There were 1205 admissions with alcohol misuse recorded as a co-morbidity increasing from 13.9% (87/622) of acute pancreatitis admissions in 1997 to 23.2% (223/959) in 2004. This increase was significantly greater than the increase observed for biliary tract disease-related admissions, 19.6% (122/622) in 1997 to 23.5% (225/959) in 2004. Rates for total acute pancreatitis admissions were highest in those aged 70 years and over; the majority (3563, 56.6%) of the admissions were male with a mean age of 51.1 years (SD 19.9); the mean age for male admissions was significantly younger than for female admissions (49.1 versus 53.6 years, P < 0.001). However, for alcohol-related admissions, rates were highest in those aged 30-49 years and patients admitted with alcohol misuse recorded were significantly younger than those who did not have alcohol misuse recorded (42.0 versus 53.2 years, P < 0.001). Median length of stay was 7 days. Hospital admissions for acute pancreatitis rose from 17.5 per 100 000 population in 1997 to 23.6 per 100 000 in 2004. The proportion of admissions that had alcohol misuse recorded as a co-morbidity rose more markedly than those with biliary tract disease and the rise was more pronounced in younger age groups. The increasing trend in alcohol-related acute pancreatitis parallels the rise in per capita alcohol consumption. Given the continuing rise in binge drinking, particularly among young people, this is a cause for concern.

Office of Applied Studies; Wright D. State Estimates of Subtance Use from the 2001 National Household Survey on Drug Abuse. Volume 1. Findings. NSDUH Series H-19. Rockville MD: Substance Abuse and Mental Health Administration, Office of Applied Studies, 2003. (28 refs.)

Based on national data from the National Household Survey on Drug Abuse estimates are provided for levels of drug use are presented for the states. Nineteen measures are provided. Data is presented in 106 tables and figures. Among the findings were that reflecting national increases in use, 38 states had higher rates of prevalence in 2000-2001, compared to the prior year. Of these only 6 states had a statistically significant increase, and the bulk of the increase were in the 18-25 year age group. the Northeastern states and western states have the highest estimated rate of past month use of any illicit drugs. Marijuana is the most commonly used illicit substance. For alcohol use, nine states had an increase in past month use. The percentage of adolescents age 12 or older with past month use ranges from 29% to 62%. Southern states have the highest rate of tobacco use. In terms of dependence, the rates of alcohol dependence range from 4% to 8.5%.

Office of Applied Studies; Brown JM; Council CL; Penne MA; Gfroerer JC. Immigrants and Substance Use: Findings from the 1999-2001 National Surveys on Drug Use and Health. Analytic Series A-23. Rockville MD: Office of Applied Studies, SAMHSA, 2005. (35 refs.)

This report is organized into 4 chapters and three appendices. It provides information on alcohol, tobacco, and illicit drug use among immigrants aged 18 or older in the United States during 1999-2001. The data are based on the National Survey on Drug Use and Health (NSDUH), an annual survey conducted by NIDA since 1971. Among the findings are that [1] The rates of alcohol use were lower among immigrants than among U.S.-born adults. This was true for past year use (54.3 vs. 67.8 percent), past month use (39.5 vs. 52.4 percent), past month binge use (16.9 vs. 22.3 percent), past month heavy use (3.0 vs. 6.5 percent), and the average number of drinks per week among current drinkers (6.3 vs. 8.3). [2] Among adult immigrants who were current drinkers, per capita alcohol consumption in the country of birth was associated with the current weekly alcohol consumption. [3] Rates of tobacco use were lower among immigrants than among U.S.-born adults. This was true for past year use (24.8 vs. 38.2 percent) and past month use (20.4 vs. 32.8 percent). [4] Rates of illicit drug use were lower among immigrants than among U.S.-born adults. This was true for past year marijuana use (3.5 vs. 8.8 percent), past month marijuana use (1.7 vs. 5.1 percent), past year any illicit drug use (6.0 vs. 11.5 percent), and past month any illicit drug use (2.9 vs. 6.6 percent). [5] Rates of substance use were associated with the length of time immigrants had been in the United States, those in the U.S. for 5 or more years were more likely to be drinkers, to use marijuana, an illicit drug, or tobacco. [6] The substance use patterns of immigrants from 16 selected countries showed wide variations. It demonstrated that comparisons of broad regions, e.g. Asia or Central America is likely to mask differences within the region. [7] Past month alcohol use rates among immigrants from the United Kingdom (67.5 percent) and Canada (64.5 percent) were significantly higher than the rate among U.S.-born adults (52.4 percent). Immigrants born in the Philippines (24.1 percent), Vietnam (26.4 percent), India (26.6 percent), and China (28.4%) had rates significantly below rates among immigrants from other selected Asian countries (Japan, 62.1 percent; Korea, 53.2%) and among U.S.-born adults. [8] None of the 16 countries studied showed adult immigrant populations with past month tobacco use rates higher than the U.S. rate (32.8%). Among the Latin American countries studied, rates ranged from 12.1% among immigrants from Jamaica to 31.0% among immigrants from Puerto Rico. Similarly, there was wide variation among Asian countries, with Korean-born immigrants having a rate of 30.2%, while the lowest rates were found among those born in China (10.1%), India (10.2%), and the Philippines (13.5%). [9] Immigrants from several countries had rates of past month illicit drug use that were similar to the U.S.-born rate of 6.6%. These included Japan, Puerto Rico, Korea, Jamaica, Poland, Germany, and the United Kingdom. Low rates of illicit drug use were found among immigrants from China, Cuba, the Philippines, and India. The data is presented in 17 figures and 20 tables.

Petti S; Scully C. Oral cancer: The association between nation-based alcohol-drinking profiles and oral cancer mortality. Oral Oncology 41(8): 828-834, 2005. (36 refs.)

The unclear association between different nation-based alcohol-drinking profiles and oral cancer mortality was investigated using, as observational units, 20 countries from Europe, Northern America, Far Eastern Asia, with cross-nationally comparable data. Stepwise multiple regression analyses were run with mate age-standardised, mortality rate (ASMR) as explanatory variable and annual adult alcohol consumption, adult smoking prevalence, life expectancy, as explanatory. Large between-country differences in ASMR (range, 0.88-6.87 per 100,000) were found, but the mean value was similar to the global estimate (3.31 vs. 3.09 per 100,000). Differences in alcohol consumption (2.06-21.03 annual litres per capita) and in distribution between beverages were reported. Wine was the most prevalent alcoholic beverage in 45% of cases. Significant increases in ASMR for every litre of pure ethanol (0.15 per 100,000; 95 Cl, 0.01-0.29) and spirits (0.26 per 100,000; 95 CI, 0.03-0.49), non-significant effects for beer and wine were estimated. The impact of alcohol on oral cancer deaths would be higher than expected and the drinking profile could affect cancer mortality, probably because of the different drinking pattern of spirit drinkers, usually consuming huge alcohol quantities on single occasions, and the different concentrations of ethanol and cancer-preventing compounds such as polyphenols, in the various beverages.

Price JH; Thompson AJ; Dake JA. Factors associated with state variations in homicide, suicide, and unintentional firearm deaths. Journal of Community Health 29(4): 271-283, 2004. (43 refs.)

This study examined the relationship of 16 variables with homicide, suicide, and unintentional firearm deaths. This cross-sectional analysis, using adjusted partial correlation coefficients, found that state-level firearm homicide rates significantly varied by the prevalence of firearms and by percent of the population which was African American. Whereas, state-level variations in firearm suicide mortality significantly varied by firearm prevalence, per capita alcohol consumption, percent of the population which was African American, and level of urbanization. None of the variables were significantly (p less than or equal to.05) related to state-level variations in unintentional firearm mortality. Furthermore, state gun laws had only a limited effect on firearm-related homicide deaths. Although the current study cannot determine causation, firearm mortality in its various forms is most commonly related to the prevalence of firearms and the percent of the population that is African American.

Raistrick D. The United Kingdom: Alcohol today. (commentary). Addiction 100(9): 1212-1214, 2005. (19 refs.)

The United Kingdom is ninth of 14 leading European Union countries in the per capita consumption league table but second only to Germany as a producer of beers. Some 1.47 million people are employed in licensed retailing and related industries. The number of fully licensed premises, public houses and hotels has remained fairly steady in recent years at around 88 000 . The public enjoy eating out and drinking as a prime leisure activity and in 2003 spent �74,766 on alcohol every minute of the year, generating �13,477 million in revenue, 4.5% of the total, for the Treasury. The per capita consumption of alcohol in the United Kingdom has increased from 6.6 l per head in 1973 to 9.1 l in 2003 , which is reflected in the 2002 General Household Survey as 27% of men and 17% of women drinking over safer weekly limits (21 and 14 units) and 7% and 3% drinking over dangerous limits (50 and 35 units). Best estimates for England and Wales are of at least 7 million hazardous or harmful and at least 1 million dependent drinkers. The cost of alcohol-related harm has been estimated at up to �1.7 billion to the health service, accounting for between 11 300 and 17 900 deaths due to chronic disease, up to �7.3 billion attributable to crime and public disorder and up to �6.4 billion in costs to the economy. There are other costs that are difficult to quantify, notably the impact on children, the dysfunction of families and the despair experienced by individuals. The total costs may reach �20 billion or, viewed another way, �6 billion more than income. This editorial discusses the tensions in the United Kingdom in the creation of alcohol policy, differences across the UK, the role of the Portman Group (an industry advocate) as a key player, and the tendency to discount experiences of other countries.

Ramstedt M. Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol-the case of Canada. Addiction 98(9): 1267-1276, 2003. (27 refs.)

Aims: To analyse post-war variations in per capita alcohol consumption in relation to gender-specific liver cirrhosis mortality in Canadian provinces and to assess the extent to which alcohol bears a different relation to cirrhosis deaths with mention of alcohol (alcoholic cirrhosis) compared to cirrhosis deaths without mention of alcohol (non-alcoholic cirrhosis). Data and method: Annual liver cirrhosis mortality rates by 5-year age groups were converted into gender-specific and age-adjusted mortality rates. Outcome measures included total cirrhosis-the conventional measure of liver cirrhosis-alcoholic cirrhosis and non-alcoholic cirrhosis. Per capita alcohol consumption was measured by alcohol sales and weighted with a 10-year distributed lag model. A graphical analysis was used to examine the regional relationship and the Box-Jenkins technique for time-series analysis was used to estimate the temporal relationship. Findings: Geographical variations in alcohol consumption corresponded to variations in total liver cirrhosis and particularly alcoholic cirrhosis, whereas non-alcoholic cirrhosis rates were not associated geographically with alcohol consumption. In general, for all provinces, time-series analyses revealed positive and statistically significant effects of changes in alcohol consumption on cirrhosis mortality. In Canada at large, a 1-litre increase in per capita consumption was associated with a 17% increase in male total cirrhosis rates and a 13% increase in female total cirrhosis rates. Alcohol consumption had a stronger impact on alcoholic cirrhosis, which increased by fully 30% per litre increase in alcohol per capita for men and women. Although the effect on the non-alcoholic cirrhosis rate was weaker (12% for men and 7% for women) it was nevertheless statistically significant and suggests that a large proportion of these deaths may actually be alcohol-related. Conclusions: Some well-established findings in alcohol research were confirmed by the Canadian experience: per capita alcohol consumption is related closely to death rates from liver cirrhosis and alcohol-related deaths tend to be under-reported in mortality statistics.

Ramstedt M. Alcohol consumption and alcohol-related mortality in Canada 1950-2000. Canadian Journal of Public Health 95(2): 121-126, 2004. (11 refs.)

Objective: To describe trends in overall alcohol consumption and alcohol-related mortality in Canada, and to test regional associations between per capita alcohol consumption and alcohol-related mortality. Method: Alcohol sales for 1950-2000 were used to measure total alcohol consumption; alcohol-related mortality consisted of nine different alcohol-related causes of death for 1950-1998. Alcohol consumption and alcohol-related mortality were described for 1950-2000, and measures of dispersion were calculated to assess the homogeneity across regions. Findings: Both alcohol consumption and alcohol-related mortality increased in all regions up to 1975-80 and then underwent a decline until the 1990s. Since 1996, consumption began to increase. Beer represented more than half of the total consumption throughout the study period, although overall, the share of wine increased, particularly in the larger provinces. Over time there have been fewer differences in per capita consumption and alcohol-related mortality rates across the regions. A strong positive cross-regional relationship was observed between explicitly alcohol-related mortality and per capita consumption, whereas cirrhosis showed only a weak geographical association with consumption. Conclusions: Since 1950, there has been a general trend toward national homogenization, especially with respect to drinking levels but also to alcohol-related mortality. A strikingly close regional relationship between alcohol consumption and alcohol-related mortality suggests that consumption is an important marker of alcohol-related harm in Canada.

Ramstedt M. Alcohol and pancreatitis mortality at the population level: Experiences from 14 western countries. Addiction 99(10): 1255-1261, 2004. (29 refs.)

Aims: To test if there is relationship between alcohol consumption and pancreatitis mortality at the population level. Data and methods: Annual pancreatitis death rates for 1950-95 were converted into age-adjusted mortality rates per 100 000 inhabitants. Per capita alcohol consumption was measured by alcohol sales. The relationship was estimated with time-series analysis on data from 14 western countries. Several models were tested with different assumptions about risk function and lag structure. Results: According to the assumed most appropriate model, a positive relationship was found in each country, and statistical significance was reached in all countries except from Finland, Italy and Canada. The magnitude of the association was fairly consistent across countries, with the alcohol effect parameters ranging between 0.05 and 0.14. However, Sweden and Norway deviated from this pattern with estimates between 0.30 and 0.40. Conclusions: Pancreatitis joins a wide range of causes of death where the mortality rate is influenced by per capita alcohol consumption, and more so in northern Europe. It is suggested that pancreatitis mortality is an important indicator of alcohol-related harm, not least because a large amount of morbidity is likely to be connected to the mortality rate.

Ramstedt M. Is alcohol good or bad for Canadian hearts? A time-series analysis of the link between alcohol consumption and IHD mortality. Drug and Alcohol Review 25(4): 315-320, 2006. (30 refs.)

The objective of this study was to analyse the population level association between alcohol consumption and ischaemic heart disease (IHD) mortality in Canada. Yearly changes in IHD mortality rates from 1950 to 1998 were analysed in relation to yearly changes in alcohol consumption, employing the Box & Jenkins technique for time-series analyses. All models controlled for cigarette smoking and one analysis with focus on men also included female IHD mortality as an indicator of other risk factors for IHD. A 1-litre increase in per capita alcohol consumption was associated with an increase in overall IHD mortality as well as among men and women with fully 1%, but no estimate reached statistical significance. A positive and significant relationship between smoking and IHD mortality was demonstrated in all models. According to the model with focus on male IHD mortality, an increase in per capita consumption by 1 litre was related significantly to a 1% increase in male IHD mortality. No significant effects were found in different male age groups. The idea that alcohol saves more IHD deaths than it causes in Canada is not in accordance with these findings. An increase in overall alcohol consumption is more likely to cause an increase in IHD mortality than to lower the number of IHD deaths, at least among men.

Ramstedt M. Population drinking and liver cirrhosis mortality: is there a link in eastern Europe? Addiction 102(8): 1212-1223, 2007. (35 refs.)

Aims: To analyse the relationship between population drinking and liver cirrhosis mortality in eastern European countries and compare it with similar findings from western Europe. Design and measurements Yearly data, from the approximate period 1960-2002, on liver cirrhosis mortality in total and by gender were analysed in relation to per capita alcohol consumption in nine eastern European countries divided into 'spirits countries' and 'non-spirits countries'. The Box-Jenkins technique for time-series analysis was used to estimate the impact on liver cirrhosis resulting from a 1-litre increase in per capita consumption in terms of relative (%) and absolute effects (number of cirrhosis deaths). Findings Cirrhosis mortality rates were related significantly to population drinking in eight of nine eastern European countries and both relative and absolute alcohol effects laid within the range of previous western European estimates. A 1-litre increase in per capita consumption was on average estimated to cause three to four additional cirrhosis deaths per 100,000 for men and one additional death for women. The absolute effects for men were relatively high in a European perspective: stronger than in mid- and northern Europe and only marginally weaker in comparison with southern Europe. Conclusions: A reduction in per capita alcohol consumption would prevent many cirrhosis deaths in eastern Europe, particularly for men. It is suggested that further studies of the extent other forms of alcohol-related mortality respond to changes in population drinking in eastern Europe would be valuable.

Razvodovsky YE. Association between distilled spirits consumption and violent mortality rate. Drugs: Education, Prevention and Policy 10(3): 235-250, 2003. (41 refs.)

The association between alcohol and violent mortality is well documented. Considerably less is known about the beverage-specific effect of alcohol on mortality rate. The role of drinking patterns in the alcohol-violent mortality association is a very important issue today. Aim: To estimate the beverage-specific effect of alcohol on violent mortality rate. Measurement. Trends in different types of violent mortality rate (mortality due to accidents and injuries, mortality due to suicide and homicide, mortality due to motor-traffic accidents) from 1970-1999 in Belarus were analyzed in relation to trends in the level of different types of alcoholic beverage consumption per capita applying time series, factor and cluster analyses. Results: The results of this study demonstrated a positive and statistically significant effect of changes in strong spirits per capita consumption on violent mortality rate. At the same time, the relationship between the total level of alcohol consumption and different types of violent mortality rates is far below statistical significance. The analysis suggest that a 10% increase in spirits consumption per capita would result in a 7.5% increase in accidents and injuries mortality rate, in a 5% increase in suicide rate, in an 11.4% increase in homicide rate, in a 1% increase in fatal traffic accidents rate. Conclusion: The results of this study support the idea that violent mortality rate tends to be more responsive to changes in distilled spirits consumption per capita than in total level of alcohol consumption. The main evidence for this conclusion is that a positive and statistically significant relationship between violent mortality rate and the level of vodka consumption per capita was revealed. The level of strong spirits consumption per capita is most strongly associated with such indexes as mortality due to homicides, suicides, accidents and injuries, and to a lesser degree with mortality due to road accidents. This study supports the idea that violent, mortality and alcohol are more closely connected in culture with prevailing intoxication-oriented drinking patterns and adds to the growing body of evidence that a substantial proportion of violent mortality in Belarus is due to the acute effect of binge drinking.

Rehm J; Monga N; Adlaf E; Taylor B; Bondy SJ; Fallu JS. School matters: Drinking dimensions and their effects on alcohol-related problems among Ontario secondary school students. Alcohol and Alcoholism 40(6): 569-574, 2005. (52 refs.)

Aims: To test the hypotheses that average volume of alcohol consumption and patterns of drinking, each influence alcohol-related problems and that both act at individual and aggregate levels. Methods: The 2003 cycle of the Ontario Student Drug Use Survey obtained self-administered questionnaires from a representative classroom-based survey of 2455 Ontario secondary school students (grades 9-12) from 74 schools, with a student completion rate of 72%. Average volume of alcohol consumption was assessed using a quantity-frequency measure. Heavy drinking occasions were operationalized by four dummy variables indicating less than monthly, monthly, weekly and daily consumption of five or more drinks per occasion, with never having a heavy drinking occasion serving as the reference group. Alcohol-related problems were measured by using seven items of the Alcohol Use Disorders Identification Test. Results: As hypothesized, both the average volume of alcohol consumption and patterns of drinking influenced alcohol-related problems at the student level, independently of each other. At the school level, both determinants significantly influenced the problems, but not when simultaneously entered into the equation. Conclusions: Future prevention of alcohol-related problems in adolescents should consider both the average volume and patterns of drinking. Both prevention and research should also try to include environmental determination of alcohol-related problems.

Rehm J; Patra J; Popova S. Alcohol-attributable mortality and potential years of life lost in Canada 2001: implications for prevention and policy. Addiction 101(3): 373-384, 2006. (56 refs.)

Alcohol is one of the most important risk factors for burden of disease. To estimate the number of deaths and the years of life lost attributable to alcohol for Canada 2001 using different ways to measure alcohol exposure. Distribution of exposure was taken from a major national survey of Canada, the Canadian Addiction Survey, and corrected for per capita consumption from production and sales. For chronic disease, risk relations were taken from the published literature and combined with exposure to calculate age- and sex-specific alcohol-attributable fractions (AAFs). For injury, AAFs were taken directly from available statistics. Information on mortality, with cause of death coded according to the International Classification of Diseases version 10 (ICD-10) was obtained from Statistics Canada. For Canada in 2001, 4010 of all deaths in the group below 70 years of age were attributable to alcohol, 3132 in men and 877 in women. This constituted 6.0% of all deaths in Canada in this age group, 7.6% for men, and 3.5% for women. The 4010 deaths are a net figure, already taking into account the deaths prevented by moderate consumption of alcohol. Main causes of alcohol-attributable death were unintentional injuries, malignant neoplasms and digestive diseases. Ischaemic heart disease (IHD) was the biggest cause of death prevented by alcohol, with 78.7% of all alcohol-attributable prevented deaths in the age groups of 70 years and above. A total of 144 143 years of life were lost prematurely in Canada in that year, 113 079 years in men and 31 063 years in women. Regardless of the assumptions made, alcohol is a major contributor to mortality in Canada. The impact of alcohol on social life is not confined to mortality, as other studies indicated that alcohol is linked even more strongly to disability and social harm. Alcohol-attributable harm could be substantially reduced, however, if known effective policies were introduced.

Rehm J; Patra J; Taylor B. Harm, benefits, and net effects on mortality of moderate drinking of alcohol among adults in Canada in 2002. Annals of Epidemiology 17(5, Supplement S): S81-S86, 2007. (28 refs.)

Alcohol is an important risk factor contributing to the burden of chronic diseases and injuries, but is also associated with some health benefits. This study estimates risks and benefits associated with moderate consumption of alcohol in terms of mortality for Canada in 2002 by age and sex. Distribution of exposure was taken from a Canadian survey and corrected for per capita consumption from production and sales data; risk relationships were taken from published literature to calculate alcohol-attributable fractions for moderate consumption. If moderate consumption is based on average volume alone, 866 net deaths in 2002 among those younger than 70 years of age were due to moderate consumption of alcohol (1.3% of all the deaths in this age group, consisting of 1653 deaths caused and 787 deaths prevented). When heavy drinking episodes were excluded, the net effect was beneficial (55 prevented deaths, 0.09% of all deaths); the net burden was higher for younger ages and the net benefits for older ages. The net impact of average moderate alcohol consumption on mortality depends on patterns of drinking. Beneficial net effects are seen only when heavy drinking occasions are excluded. Policies should strive to reduce the burden of moderate alcohol consumption while preserving the beneficial impacts.

Rehm J; Sulkowska U; Manczuk M; Boffetta P; Powles J; Popova S et al. Alcohol accounts for a high proportion of premature mortality in central and eastern Europe. International Journal of Epidemiology 36(2): 458-467, 2007. (56 refs.)

Background: There is a west-east mortality gradient in Europe, more pronounced in men. The objective of this article was to quantify the contribution of alcohol use to the gap in premature adult mortality between three old (France, Sweden and United Kingdom) and four new (Czech Republic, Hungary, Lithuania and Poland) European Union (EU) member states for the year 2002. Russia was added as an external comparator. Methods: Exposure data were taken from surveys and per capita consumption records from the World Health Organization (WHO) Global Alcohol Database. Mortality data were taken from the WHO databank. The risk relationships were taken from published meta-analyses and from the WHO Comparative Risk Assessment project. Alcohol exposure and relative risk information was combined to derive alcohol-attributable fractions for relevant causes of premature mortality. Results: Alcohol consumption was responsible for 14.6% of all premature adult mortality in the eight countries, 17.3% in men and 8.0% in women. This proportion was clearly higher in the new EU member states and Russia compared with the comparison countries from the old EU. For men, Russia with 29.0 alcoholattributable premature deaths per 10000 population had a more than 10-fold higher rate compared with Sweden (2.7 deaths/10000). For women, the ratio between Hungary (5.0 alcohol- attributable deaths/10000) and Russia (4.7 deaths/10000) compared with Sweden (0.5 deaths/10000) was almost as high, but the rates were much lower. The Czech Republic and Poland showed proportionally less alcohol-attributable premature mortality than the other new EU member states or Russia for both genders, which, however, was still higher than in any of the old EU member states. Conclusions: Alcohol is a strong contributor to the health gap between western and central and eastern Europe, with both average volume of consumption and patterns of drinking contributing to burden of disease and injury. Alcohol also contributes substantially to male-female differences in mortality and life expectancy. However, there are feasible and cost-effective measures to reduce alcohol-related burden that should be implemented in central and eastern Europe.

Rehm J; Taylor B; Roerecke M; Patra J. Alcohol consumption and alcohol-attributable burden of disease in Switzerland, 2002. International Journal of Public Health 52(6): 383-392, 2007. (47 refs.)

Objectives: This analysis estimated alcohol-attributable burden of disease for Switzerland. Methods: Exposure distributions were taken from the 2002 Swiss Health Survey and adjusted for per capita consumption. Risk relations were taken from meta-analyses. Mortality and burden of disease data were taken from the World Health Organization. Results: Overall consumption and alcohol-attributable mortality and burden of disease in Switzerland were high compared to European and global averages, especially among women. Overall in Switzerland in 2002, 2016 deaths (5.2% of all deaths in men, 1.4% in women), 28,939 years of life lost (men: 10.5%, women: 4.9%) and 70,256 disability adjusted life years (men: 12.9%, women: 4.2%) were attributable to alcohol. These numbers are net numbers already incorporating the cardio-protective and other beneficial effects of alcohol. Conclusions: Limitations of the approach used are discussed. In addition, questions of causality and confounding are addressed.

Rehn J; Taylor B; Patra J. Volume of alcohol consumption, patterns of drinking and burden of disease in the European region 2002. Addiction 101(8): 1086-1095, 2006. (45 refs.)

To describe the volume of alcohol consumption and patterns of drinking in the World Health Organization (WHO) European regions in 2002 and to estimate quantitatively the burden of disease attributable to alcohol in that year. Secondary data analysis. Exposure data were taken from the WHO Comparative Risk Assessment, outcome data from the WHO Measurement and Health Information department, and used to derive three outcome measures: deaths, years of life lost (YLL) and disability adjusted life years (DALY) for 2002. All calculations were conducted according to age, sex and region. Alcohol consumption in the WHO regions for Europe was high, with 12.1 litres pure alcohol per capita, on average more than 100% above the global consumption. Alcohol consumption caused a considerable disease burden: 6.1% of all the deaths, 12.3% of all YLL and 10.7% of all DALY in all European regions in 2002 could be attributed to this exposure. Intentional and unintentional injuries accounted for almost 50% of all alcohol-attributable deaths and almost 44% of alcohol-attributable disease burden. Young people and men were affected the most. Geographically, the most eastern region around Russia had the highest alcohol-attributable disease burden. Interventions should be implemented to reduce the high burden of alcohol-attributable disease in the European regions. Given the epidemiological structure of the burden, injury prevention, including but not restricted to the prevention of traffic injuries, and specific prevention for young people should play the most important role in a comprehensive plan to reduce alcohol-attributable burden.

Scuffham PA. Economic factors and traffic crashes in New Zealand. Applied Economics 35(2): 179-186, 2003. (34 refs.)

The aim of this study was to examine the changes in the trend and seasonal patterns of fatal crashes in New Zealand in relation to changes in economic conditions between 1970 and 1994. The Harvey (Harvey and Durbin, Journal of the Royal Statistical Society, 149(3), 187-227, 1986) Structural Time Series Model (STSM), an 'unobserved components' class of model, was used to estimate the quarterly number of fatal traffic crashes. Independent variables included distance travelled, the unemployment rate (UER), real gross domestic product per capita (RGDP), the proportion of motorcycles, the proportion of young males in the population, alcohol consumption per capita, the open road speed limit, and dummy variables for the 1973 and 1979 oil crises and seatbelt wearing laws. Distance travelled, RGDP, UER, and alcohol consumption per capita were significant factors in explaining the short-run dynamics of fatal crashes with the effect of RGDP greater than UER. Increases in either RGDP or UER were related with decreases in fatal crashes. The STSM is a feasible approach to modelling the effect of economic factors on traffic crashes whilst accounting for unobserved components.

Sesok J. Alcohol consumption and indicators of alcohol-related harm in Slovenia, 1981-2002. Croatian Medical Journal 45(4): 466-472, 2004. (27 refs.)

Aim. To document over-time per capita alcohol consumption and connection between per capita alcohol consumption and indicators of short and long term alcohol-related harm. Methods. Registered alcohol consumption was calculated from the data on production and trade of alcoholic beverages, using World Health Organization recommended methodology for the 1981-2002 period. The indicators of alcohol-related harm, alcohol-related mortality, and alcohol-related road-traffic accidents were calculated from mortality data and alcohol-related traffic accidents data for the 1986-2001 period. Results. Estimates of apparent per capita alcohol consumption in Slovenia over the past 20 years indicate a decrease in alcohol consumption, beginning in 1982 and continuing with some fluctuations in subsequent years through 2002. Per capita consumption of ethanol from all beverages combined decreased from 1981 to 2002 by 15.1%. The drop was substantial in the period from 1981 to 1991. On average, 32 people per 100,000 aged greater than or equal to15 years died annually from all alcohol-related causes. The number of years of potential life lost (YPLL) due to all alcohol related causes decreased by 21%, with a 40% decrease in YPLL due to premature deaths from alcoholic liver disease and 113% increase in YPLL due to premature deaths from mental and behavioral disorders due to use of alcohol. Conclusion. Indicators of alcohol-related harm reflect high per capita alcohol consumption. With a strong legislative and public health support the situation is expected to improve.

Sher L. Relation between rates of geriatric suicide and consumption of alcohol beverages in European countries. TheScientificWorldJOURNAL 6(March): 383-387, 2006. (17 refs.)

Among older adults, suicide is a significant and persistent health problem. The highest suicide rate is found among white men aged 65 years and older. The causes of elder suicide are multifaceted. Although no predominate factor precipitates or explains geriatric suicide, alcohol is strongly linked to suicide attempts and completions. This study examined the relationship between rates of suicide in 65- to 74-year-olds and per capita consumption of alcoholic beverages in European countries. Data on suicide rates in 65- to 74-year-olds and per capita consumption of alcoholic beverages were obtained from the World Health Organization databases. Correlations were computed to examine relationships between suicide rates in 65- to 74-year-old males and females and per capita consumption of beer, wine, and spirits in the general population in 34 European countries. There was a positive correlation between suicide rates in 65- to 74-year-old males and per capita consumption of spirits. No correlations between suicide rates in 65- to 74-year-old males and per capita consumption of beer or wine were found. We also found no correlations between rates of suicide in 65- to 74-year-old females and per capita consumption of beer, wine, or spirits. The results of this study are consistent with reports that consumption of spirits is associated with suicide events. It is to be hoped that this paper will stimulate further studies that are necessary to clarify the relation between suicide rates in different age groups and consumption of alcoholic beverages, and attract more attention to the problem of geriatric suicide.

Skog OJ. Alcohol consumption and fatal accidents in Canada, 1950-98. Addiction 98(7): 883-893, 2003. (30 refs.)

Aims To evaluate the effects of changes in aggregate alcohol consumption on overall fatal accidents, motor vehicle accidents, fatal falling accidents and drowning accidents in Canadian provinces after 1950. Design: Time-series analysis of annual mortality rates (15-69 years) in relation to per capita alcohol consumption, utilising the Box-Jenkins technique. All series were differenced to remove long-term trends. Measurements: Gender-specific and age-adjusted mortality rates for the age group 15-69 years were calculated on the basis of mortality data for 5-year age groups, using a standard population. Data on per capita alcohol consumption was converted to consumption per inhabitant 15 years and older. In the analysis of motor vehicle accidents, the number of motor vehicles was used as a control variable. Findings Statistically significant associations between alcohol consumption and overall fatal accident rates were uncovered in all provinces for males, and in all provinces except Ontario for females. For Canada at large, an increase in per capita alcohol consumption of I litre was accompanied by an increase in accident mortality of 5.9 among males and 1.9 among females per 100,000 inhabitants. Among males there was a significant association with alcohol for both falling accidents, motor vehicle accident and other accidents, but the association was insignificant for drowning accidents. Among females, the association with falling accidents and other accidents was significant. Conclusion: Changes in alcohol consumption have had substantial effects on most of the main types of fatal accidents in Canada during the second half of the 20th century. The size of the association is comparable to the one previously reported from Northern Europe.

Smith AJ; Tett SE. How do different age groups use benzodiazepines and antidepressants? Analysis of an Australian administrative database, 2003-6. Drugs & Aging 26(2): 113-122, 2009. (40 refs.)

Background: The use of antidepressants and benzodiazepines is increasing in Australia and worldwide, and it is thought that some of the prescribing of these classes of drugs may be inappropriate. However, the demographic characteristics of the subgroups of the population responsible for this increase remain unexplored. Objective: The aim of this study was to examine changes in the utilization of antidepressants and benzodiazepines between different age groups within Australia from 2003 to 2006. Methods: The Australian Pharmaceutical Benefits Scheme administrative database was used to obtain dispensing data for all antidepressants and Publicly subsidized benzodiazepines. Changes in utilization (amounts and patterns of use of different compounds) were compared between different age groups from 2003 to 2006. The WHO Anatomic Therapeutic Chemical/Defined Daily Dose system was used. Results: Use of antidepressants increased from 2003 to 2006, and in each year increased with age, with those >= 65 years having the greatest use. Differences were seen in the antidepressant most utilized, with the elderly using more tricyclic antidepressants than those who are younger. The utilization of benzodiazepines decreased from 2003 to 2006 in elderly individuals and those receiving social welfare benefits. Individuals aged >= 85 years had the highest use of benzodiazepines and used more long-acting benzodiazepines compared with those aged 35-44 years. Conclusion: The elderly still account for most use per capita of benzodiazepines. Some of this use may be inappropriate (e.g. use of long-acting benzodiazepines) and, hence, may represent a useful target for future educational intervention. The elderly also still account for the largest per capita use of antidepressants.

Stewart K; Fell J; Sweedler B. Trends in impaired driving in the United States: How to resume progress. Glasgow: ICADTS, 2004. (10 refs.)

After years of decline, alcohol-related crash rates have stopped dropping, and actually increased a bit. In 1982, there were 26,173 alcohol-related fatalities, 60% of all killed on US highways. By 1999, that percentage had fallen to 40%, and the number of alcohol-related fatalities dropped to 16,572. The prevalence of drinking drivers on the highways (BAC >.05% on Friday and Saturday nights was 13.7% in 1973, 8.4% in 1986, and in 1996 was 7.7%. This paper reviews the trends in light of the legal and social developments and suggests ways in which further progress might be accomplished. A number of factors probably contributed to the declines in the 1980s and 90s. These include lowering BAC levels, raising the drinking age to 21, increased public awareness and activism, along with reduction in per capita alcohol consumption. Some of these policy changes, such as lowering the BAC for drivers under 21, and increasing the legal drinking age to age 21, are changes which are unlikely to be duplicated. Nonetheless, there are major strategies that can further contribute to lowering alcohol-related fatalities. Drawing from a 2003 report by the National Highway Traffic Safety Administration these initiatives are categorized into four groups. Behavioral interventions include a screening and brief intervention programs for offenders, in light of the fact that many offenders are problem or addicted drinkers. Motor vehicle and environmental interventions is another area. This includes things such as roadway improvements such as "rumble strips: that can prevent single vehicle crashes, half of which are alcohol related. Strategies designed to deal with offenders include DWI courts to monitor offenders more closely, high visibility law enforcement, more vigorous enforcement laws against serving minors or those who are intoxicated, and promoting effective alternative sanctions such as house arrest or electronic monitoring, but limiting diversion programs that allow the offenders driving record to be expunged. Finally are efforts to adopt and effectively implement key laws at the state level. This includes zero tolerance for drivers under age 21, administrative license revocation, .08 BAC limits, open container laws, primary seatbelt law enforcement and more effective and easily enforced minimum purchase age laws. All of these have been implemented and shown to be effective. There is an accompanying PowerPoint presentation with 14 slides.

Stockwell T; Donath S; Cooper-Stanbury M; Chikritzhs T; Catalano P; Mateo C. Under-reporting of alcohol consumption in household surveys: A comparison of quantity-frequency, graduated-frequency and recent recall. Addiction 99(8): 1024-1033, 2004. (24 refs.)

Aim: To compare alternative survey methods for estimating (a) levels of at risk alcohol consumption and (b) total volume of alcohol consumed per capita in comparison with estimates from sales data and to investigate reasons for under-reporting. Setting: The homes of respondents who were eligible and willing to participate. Participants: A total of 2 16 74 Australians aged 14 years and older. Design A 2001 national household survey of drug use, experiences and attitudes with weights applied for age, sex, geographic location and day of week of interview. Measures Self-completion questionnaire using quantity-frequency (QF) and graduated-frequency (GF) methods plus two questions about consumption 'yesterday': one in standard drinks, another with empirically based estimates of drink size and strength. Results: The highest estimate of age 14 + per capita consumption of 7.001 of alcohol derived from recall of consumption 'yesterday' or 76.8% of the official estimate. The lowest was QF with 49.8%. When amount consumed 'yesterday' was recalled in standard drinks this estimate was 5.27 1. GF questions yielded higher estimates than did OF questions both for total volume (5.25 versus 4.541) and also for the proportion of the population at risk of long-term alcohol-related harm (10.61% versus 8.1%). With the detailed 'yesterday' method 61% of all consumption was on high risk drinking days. Conclusions: Questions about typical quantities of alcohol consumed can lead to underestimates, as do questions about drinking 'standard drinks' of alcohol. Recent recall methods encourage fuller reporting of volumes plus more accurate estimates of unrecorded consumption and the proportion of total alcohol consumption that places drinkers at risk of harm. However, they do not capture longer-term drinking patterns. It is recommended that both recent recall and measures of longer-term drinking patterns are included in national surveys.

Stoduto G; Asbridge M; Mann R. Short and long-term effects of drinking driving laws: An evaluation of Canada's per se Law. Glasgow: ICADTS, 2004. (26 refs.)

In 1969, Canada introduced a per se law making it a criminal offence to drive with a BAC over 80 mg%. It also made refusal to take a breath test a criminal offence. The earliest evaluation studies in the early 1970s showed a modest interest on fatalities. This paper looks at data from 1962 through 1996, considering driver fatalities and controlling for confounding factors (e.g., formation of MADD Canada, introduction of mandatory seatbelt laws, per capita alcohol consumption, and per capita vehicle registration.) The data analysis is described. The data indicates that the per se law has had a long-term impact on drinking driver fatalities, and was associated with an 18% decline. However, the per se law failed to influence non-drinking driver fatalities, suggesting a specific deterrent effect. Among the other findings were that MADD Canada founded in 1982 was associated with 18-23% decline in both drinking and non-drinking driver fatalities; a 1 litre increase in per capita alcohol consumption on the other hand produces an 8-14% increase in drinking driver fatalities. In addition, the mandatory seatbelt law (1976) produced a significant decrease (15%) in non-drinking driver fatalities. There is an accompanying PowerPoint presentation with 18 slides.

Swedish National Institute for Public Health. Nordic alcohol statistics 1993-2003. Nordic Studies on Alcohol and Drugs 21(English Supplement): 196-206, 2004

The Swedish National Institute for Public Health with the cooperation of the Finnish National Research and Development Centre has collected statistical data of alcohol, retail outlets, licensed premises, deaths caused by alcohol, and cases of drunken driving for the Nordic countries. Unregisted consumption is obviously excluded, but is estimated in Sweden and Finland to be between 15-30% of registered consumption. In terms of consumption, there is marked variaiton with Greenland the highest at a 12.3 litres per capita consumption for those age 15 and older, and Norway has the lowest at 5.89 litres per capita, age 15 and older. Over time, consumption remained stable in Denmark and Greenland between 1993 and 2002, however, theer was an increase in Finland, Iceland, Sweden and Norway. Data on consumption of different types of bevearges in each country are reported. In terms of cost, the price has declined in all countries, and state revenues from alcohol similarly decreased. In respect to morbidity and mortality, Finland has the highest number of deaths from alcohol poisoning (acute use) as well as with Denmark having the highest rate of deaths fromm cirrhosis. Data is presented in 11 figures and tables.

Swedish National Institute of Public Health. Nordic alcohol statistics 1993-2004. Nordic Studies on Alcohol and Drugs 22(English Supplement): 198-208, 2005. (0 refs.)

The Swedish National Institute for Public Health with the cooperation of the Finnish National Research and Development Centre has collected statistical data of alcohol, retail outlets, licensed premises, deaths caused by alcohol, and cases of drunken driving for the Nordic countries. In terms of consumption, there is marked variation with Finland having the highest level of consumption, 2.5 times the level of Norway the lowest level. Several countries have had increases in consumption levels (Finland, Denmark, and Norway) some have remained stable (Sweden) and Iceland has had a steady decrease since 1999. Data on consumption of different types of beverages in each country are reported. In all countries the real price of alcohol declined in the end of the reporting period. Correspondingly, the state revenues from alcohol similarly decreased. In respect to morbidity and mortality, Finland and Denmark have the highest number of deaths from all alcohol-related causes. Finland has the highest number of deaths from alcohol poisoning (acute use) as well as with Denmark having the highest rate of deaths from cirrhosis. Data is presented in 11 figures and tables.

Takahashi I; Matsuzaka M; Umeda T; Yamai K; Nishimura M; Danjo K et al. Differences in the influence of tobacco smoking on lung cancer between Japan and the USA: Possible explanations for the 'smoking paradox' in Japan. Public Health 122(9): 891-896, 2008. (34 refs.)

Objectives: The prevalence of cigarette smoking among Japanese men has been consistently high compared with males in Western countries over the past 30 years. However, during the same period, the incidence and mortality rates for lung cancer have been consistently lower in Japan than in Western countries, which has been termed the 'Japanese smoking paradox'. The odds ratio/relative risk of cigarette smoking for lung cancer mortality and incidence for the same number of cigarettes smoked per capita in Japan have been lower than those in Western countries. This difference in the odds ratio/relative risk is likely to be the main reason for the Japanese smoking paradox. The aim of this study was to clarify the reason for the difference in the odds ratio/relative risk between Japan and the USA. Study design: Literature review to compare environmental, hereditary and other factors that may be related to lung cancer in Japan and the USA. Results and conclusions: The main factors likely to have brought about the difference in the odds ratio/relative risk between Japan and the USA (and perhaps other Western countries as well) are: lower alcohol consumption by Japanese males; lower fat intake by Japanese males; higher efficiency of filters on Japanese cigarettes; lower levels of carcinogenic ingredients in Japanese cigarettes; and lung-cancer-resistant hereditary factors among Japanese males.

Tapilina VS. How much does Russia drink: Volume, dynamics and differentiation of alcohol consumption. Sotsiologicheskie Issledovaniya (2): 85+, 2006. (9 refs.)

"How much does Russia drink: volume, dynamics and differentiation of alcohol consumption" (by Vera Tapilina) investigated standards, dynamics, and differentiation in alcohol consumption, as well as social demographic aspects of excessive drinking in Russian Federation 1994 through 2002. The data originate in official statistics and the Russian longitudinal monitoring survey (RLMS). The RLMS original data were corrected by weighing it up. Following features of alcohol consumption have been ascertained as outstanding: high level of per capita alcohol consumption accompanied by its intensive growth. Composition of consumption is changing with regard to both strong and weak drinks. Alcohol consumers tend to increasingly differentiate by amount of consumption, and there is a steady and marked increase of excessive alcohol consumers.

Taylor B; Rehm J; Patra J; Popova S; Baliunas D. Alcohol-attributable morbidity and resulting health care costs in Canada in 2002: Recommendations for policy and prevention. Journal of Studies on Alcohol and Drugs 68(1): 36-47, 2007. (46 refs.)

Objective: Alcohol is one of the most important risk factors for burden of disease, particularly in high-income countries such as Canada. The purpose of this article was to estimate the number of hospitalizations, hospital days, and the resulting costs attributable to alcohol for Canada in 2002. Method: Exposure distribution was taken from the Canadian Addiction Survey and corrected for per capita consumption from production and sales. For chronic disease, risk relations were taken from the published literature and combined with exposure to calculate age- and gender-specific alcohol-attributable fractions. For injury, alcohol-attributable fractions were taken directly from available statistics. Data on the most responsible diagnosis, length of stay for hospitalizations, and costs were obtained from the national Canadian databases. Results: For Canada in 2002, there were 195,970 alcohol-related diagnoses among acute care hospitalizations, 2,058 alcohol-attributable psychiatric hospitalizations, and 183,589 alcohol-attributable admissions to specialized treatment centers. These accounted for 1,246,945 hospital days in acute care facilities, 54,114 hospital days in psychiatric hospitals, and 3,018,688 hospital days in specialized treatment centers (inpatient and outpatient). The main causes of alcohol-attributable morbidity were neuropsychiatric conditions, cardiovascular disease, and unintentional injuries. In total, Can. $2.29 billion were spent on alcohol-related health care. Conclusions: Alcohol poses a heavy burden of disease as well as a financial strain on Canadian society. However, there are evidence-based effective and cost-effective policy and legislative interventions as well as measures to better enforce these laws.

ter Bogt T; Schmid H; Nic Gabhainn S; Fotiou A; Vollebergh W. Economic and cultural correlates of cannabis use among mid-adolescents in 31 countries. Addiction 101(2): 241-251, 2006. (45 refs.)

Aims: To examine cannabis use among mid-adolescents in 31 countries and associations with per-capita personal consumer expenditure (PCE), unemployment, peer factors and national rates of cannabis use in 1999. Design, participants and measurement: Nationally representative, self-report, classroom survey with 22 223 male and 24 900 female 15-year-olds. Country characteristics were derived from publicly available economic databases and previously conducted cross-national surveys on substance use. Findings Cannabis use appears to be normative among mid-adolescents in North America and several countries in Europe. The life-time prevalence of cannabis use was 26% among males and 15% among females and was lowest for males and females in the former Yugoslav Republic (TFYR) of Macedonia: 2.5% and to 2.5%, respectively; and highest for males in Switzerland (49.1%) and in Greenland for females (47.0%). The highest prevalence of frequent cannabis use (more than 40 times in life-time) was seen in Canada for males (14.2%) and in the United States for females (5.5%). Overall, life-time prevalence and frequent use are associated with PCE, perceived availability of cannabis (peer culture) and the presence of communities of older cannabis users (drug climate). Conclusions: As PCE increases, cannabis use may be expected to increase and gender differences decease. Cross-national comparable policy measures should be developed and evaluated to examine which harm reduction strategies are most effective.

United Nations, Office on Drugs and Crime. Global Illicit Drug Trends 2003. New York: United Nations, 2003. (7 endnote refs.)

At the twentieth special session of the General Assembly in 1998, State Members agreed to make significant progress towards the control of supply and demand for illicit drugs by the year 2008. They noted that this objective could only be achieved by means of the 'balanced approach' (giving demand as much attention as supply), and on the basis of regular assessments of the drug problem. The aim of the present report is to contribute to such assessments by presenting supply and demand statistics and analysis on the evolution of the global illicit drug problem. It describes the main trends in the illicit drug markets, those for heroin, cocaine, cannabis, and amphetamine-type stimulants. There is also a review of trafficking. Of note the number of seizures declined by 23%, primarily due to decrease in opium production in Afghanistan in 2001. Seizures of ecstasy also declined. In terms of consumption, it is estimated that 200 million people consume illicit drugs worldwide. The greatest proportion are those who use marijuana, 163 million. As reflected by demand for treatment, opiates is the main drug problem, followed by cocaine. Globally, drug use continues to spread geographically, as more countries report increases rather than decreases in drug abuse. The strongest increase is for cannabis, followed by amphetamine-like stimulants. Data is summarized in multiple tables and charts.

Varnik, A.; Kolves, K.; Vali, M.; Tooding, LM; Wasserman, D. Do alcohol restrictions reduce suicide mortality? Addiction 102(2): 251-256, 2007. (28 refs.)

Aim: Blood alcohol concentration (BAC) at the time of suicide was examined in relation to the marked falls in suicide rates and per capita alcohol consumption in Estonia during the major Soviet anti-alcohol campaign from June 1985. Design and participants In all, 5054 suicide cases (76% males, 24% females) were examined with respect to the official autopsy reports of the Estonian Bureau of Forensic Medicine (autopsy rates: 95%, of males, 88% of females) before (1981-84), during (1986-88) and after (1989-92) the campaign. Cases were divided by gender and BAC level (0.5-1.49,1.5-2.49 and > 2.5 parts per thousand). Findings During the campaign, annual per capita alcohol consumption in Estonia fell from 10.9 to 6.61. Alcohol in blood was found in 47.9% before, 35.1% during and 40.90% after the campaign. During the intervention, BAC-positive, i.e. alcohol-positive, suicides decreased by 39.2% for males and 41.4%, for females, with the largest fall occurring at the BAC 2.5 parts per thousand + level for both sexes. Changes in BAC-negative suicides were modest. When the campaign ended suicide rates started to rise. Conclusions: Investigation on an individual level showed that alcohol consumption was a common precursor to suicide and that rigorous alcohol restrictions were accompanied particularly by a decrease in BAC-positive suicide mortality among both sexes. However, the 'natural experiment' does not, in terms of study design, demonstrate convincingly that the fall in the suicide rate was due specifically to the decrease in alcohol use as such.

World Health Organization, Department of Mental Health and Substance Abuse. WHO Global Status Report on Alcohol 2004. Geneva Switzerland: World Health Organization, 2004. (323 refs.)

The Global Status Report on Alcohol 2004 is the second global status report on alcohol published by WHO. This report provides an update on the global picture of the status of alcohol as a factor in world health and seeks to document what is known about alcohol consumption and drinking patterns among various population groups. The report consists of two parts. Part I consists of a description of alcohol consumption and beverage preferences, an overview of unrecorded alcohol consumption, traditional/local alcoholic beverages, and case examples. There is also data on drinking patterns, with the discussion of those who are abstainers, heavy drinkers, and youth drinkers. Another section deals with the consequences of alcohol use in terms of the health effects (direct biochemical effects, intoxication, alcohol dependence, wholly alcohol-attributable diseases, diseases with a contributory role, beneficial health effects of alcohol consumption, coronary heart disease as a chronic condition where alcohol has harmful and beneficial consequences, depression, diseases related mainly to chronic alcohol consumption, and acute phenomenon, traffic accidents, injuries, suicide, interpersonal violence) and the global burden of disease. The next portion addresses the consequences of alcohol use, including social problems associated with alcohol use, in respect to the workplace, family, poverty, domestic violence; and the consequences of alcohol use, in terms of both economic and social costs. Part II of the report consists individual country profiles for all Member States for which sufficient data were available. The profiles bring together information on each of these indicators: trends in adult per capita consumption as well as prevalence/drinking patterns data, information regarding traditional and/or locally brewed alcoholic beverages, unrecorded alcohol consumption, health and social problems, including morbidity and mortality from alcohol-related causes, and the social and economic costs of alcohol abuse.

Young DJ; Bielinska-Kwapisz A. Alcohol consumption, beverage prices and measurement error. Journal of Studies on Alcohol 64(2): 235-238, 2003. (24 refs.)

Objective: Alcohol price data collected by the American Chamber of Commerce Researchers Association (ACCRA) have been widely used in studies of alcohol consumption and related behaviors. A number of problems with these data suggest that they contain substantial measurement error, which biases conventional statistical estimators toward a finding of little or no effect of prices on behavior. We test for measurement error, assess the magnitude of the bias and provide an alternative estimator that is likely to be superior. Method: The study utilizes data on per capita alcohol consumption across US states and the years 1982-1997. State and federal alcohol taxes are used as instrumental variables for prices. Results: Formal tests strongly confirm the hypothesis of measurement error. Instrumental variable estimates of the price elasticity of demand range from -0.53 to -1.24. These estimates are substantially larger in absolute value than ordinary least squares estimates, which sometimes are not significantly different from zero or even positive. Conclusions: The ACCRA price data are substantially contaminated with measurement error, but using state and federal taxes as instrumental variables mitigates the problem.