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CORK Bibliography: Per Capita Consumption (Alcohol)

85 citations. January 2000 to present

Prepared: June 2008

Alcohol Epidemiologic Data System; Nephew TM; Williams GD; Stinson FS; Nguyen K; Dufour MC. Apparent Per Capita Consumption: National, State, and Regional Trends, 1977-1998. Surveillance Report No. 55. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2000. (37 refs.)

This surveillance report is the 15th in a series that examines apparent per capita alcohol consumption on a national, state, and regional basis. The present report data from 1977 to 1998. The findings are based on alcoholic beverage sales data, either collected directly from the Alcohol Epidemiologic Data System or by beverage industry sources. Population data are provided by the U.S. Census. The following are highlights from the current report: After a 0.5 percent increase in per capita consumption in 1997, consumption of ethanol from all beverages combined increased by 0.4 percent in 1997, 2.19 versus 2.18 gallons of ethanol. Despite this increase, per capita consumption in 1998 remains near the record low of 2.5 gallon in 1995. Between 1997 and 1998, consumption of wine (0.31 gallons) and spirits (0.63 gallon of ethanol) remained unchanged, consumption of beer increased. In terms of the States, where were increases in 36 States between 199 and 1998, and decreases in 14. In terms of regional differences, consumption dropped in the Northeast (0.2 percent) and west (1.2%) and increased in the mid-west (1.2 percent) and the south ((0.8%). The goal of reaching the Year 200 national objective of reducing per capita consumption to no more than 2 gallons of ethanol, does not appear promising. It would require an average drop of 4.3% for 1999 and 2000. Information is summarized in 9 figures and 4 tables, which include breakdowns by State and region.

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

Alcohol Epidemiologic Data System; Nephew TM; Willians GD; Yi H-y; Hoy AK; Sinson FS; Dufour MC. Apparent per Capita Alcohol Consumption: National, State, and Regional Trends, 1977-99. Surveillance Report No. 59. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2002. (36 refs.)

This surveillance report is the sixteenth in a series that examines apparent per capita alcohol consumption on a national, state, and regional basis. The present report data from 1977 to 1999. The findings are based on alcoholic beverage sales data, either collected directly from the Alcohol Epidemiologic Data System or by beverage industry sources. Population data are provided by the U.S. Census. The following are highlights from the current report: After a 0.5 percent increase in per capita consumption in 1998, consumption of ethanol from all beverages combined increased by 0.9 percent in 1999, 2.21 versus 2.19 gallons of ethanol. Consumption of beer remained unchanged but there was an increased in both the consumption of wine and spirits by 0.01 gal each. There were increases in 43 States, and either a decreases or no change in 7 States and the District of Columbia. Regional analysis shows that there were overall increase in consumption in all geographic regions. The lowest change was 1% in the Northeast and the highest increase occurred in the South and Midwest, (1.49%). Information is summarized in 9 figures and 4 tables, which include breakdowns by State and region.

Anonymous. Economic analysis aids alcohol research. Alcohol Research & Health 24(1): 62-71, 2000. (67 refs.)

Economic research contributes to our understanding of alcohol use and the prevention and treatment of alcohol-related problems in several ways. This article reviews three areas in which the fools of economic analysis have produced significant insights in recent years. First, economic researchers have analyzed the effects of beverage prices and taxation on alcohol consumption and on adverse consequences associated with alcohol use. Second, analyses of the costs and cost- effectiveness of treatment for alcohol use disorders have provided insight into the long-term costs and benefits of alternative approaches to alcoholism treatment. Finally, studies have incorporated economic techniques in estimating the overall magnitude of the burden placed on society by the misuse of alcoholic beverages.

Public Domain

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.

Baltagi BH; Griffin JM. Rational addiction to alcohol: Panel data analysis of liquor consumption. Health Economics 11(6): 485-491, 2002. (20 refs.)

Utilizing a panel data set of 42 states over the period 1959-1994, this paper estimates a rational addiction model for liquor consumption for the US. The empirical evidence is consistent with the rational addiction hypothesis proposed by Becker and Murphy. However, the results are sensitive to the assumption of homogeneity across states or over time.

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

Casswell S; Huckle T; Pledger M. Survey data need not underestimate alcohol consumption. Alcoholism: Clinical and Experimental Research 26(10): 1561-1567, 2002

Background: There are two main ways to assess alcohol consumption in a population: per capita estimates, usually derived from data on taxable alcohol available for consumption, and population-based surveys. Population-based survey estimates of alcohol consumption are often compared with estimates based on taxable alcohol available for consumption as a measure of validity. Discrepancies between these two measures occur, with the majority of population-based surveys substantially underestimating taxable alcohol available for consumption. Methods: This article argues, however, that high proportions of taxable alcohol available for consumption can be accounted for by population-based surveys and reports a method of data collection for a national alcohol survey that has accounted for 94% of the taxable alcohol in New Zealand. Results: The ability of the survey methodology to account for this proportion of taxable alcohol is likely due to the within-location beverage-specific alcohol consumption measures used in the survey, the process of recording the quantity of alcohol consumed, the use of a computer-assisted telephone interview system, and the population coverage achieved. Conclusions: Population-based surveys using the methodology outlined in this article may account for, if not exceed, the high proportions of taxable alcohol available for consumption estimates for some populations.

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.

Clough AR; Guyula T; Yunupingu M; Burns CB. Diversity of substance use in eastern Arnhem Land (Australia): Patterns and recent changes. Drug and Alcohol Review 21(4): 349-356, 2002. (39 refs.)

The objective of this study was to describe patterns of substance use among remote Aboriginal community populations. The setting was the eastern Arnhem Land ('Miwatj') region of the Northern Territory's (NT) 'Top End', with a population of 4217 Aboriginal people over 15 years of age using a cross-sectional description and comparison. Sample 1 (n = 689) from the region used data from health-worker consensus classification of kava, alcohol, tobacco, petrol and cannabis use. Sample 2 ( n = 101) from one community used self- reported use, age at commencement, duration, amounts consumed and expenditure. In 1999 (sample 1), 46% of males and 18% of females were kava users, alcohol: 53% males, 12% females, tobacco: 68% males, 65% females, and cannabis: 31% males, 8% females. Less than 5% sniffed petrol. In one community in 2000, 39% males and 20% females reported using cannabis during the previous month. In this community between 1999 and 2000, the proportion of current kava users among men declined (77-52%, p = 0.015) with a tendency in women for a decrease in the proportion of tobacco users (87-69%, p = 0.096). The increase in the proportion of cannabis users in men (21-39%, p = 0.068) was not statistically significant. However, in women the increase was significant (0-20%, p = 0.013). Gross expenditure on tobacco and kava were similar in 2000: both greater than cannabis and alcohol. Median years used ranged from 4 years for cannabis and 20 years for tobacco. The data supported anecdotes of a recent rise in cannabis use, especially in women. Kava use declined in men. Tobacco use patterns in women may have been changing. Average per capita consumption of alcohol was low compared with other 'Top End' areas. Such varied and dynamic substance use patterns pose challenges for research and policy.

Commission for Distilled Spirits. World Drink Trends 2003. Oxfordshire, UK: World Advertising Research Center, 2002

World Drink Trends is an annual publication that presents international drink alcohol consumption data concentrated into a convenient pocket sized format. Fully revised and updated, the new 2003 edition is a 184 page statistical compilation that covers 58 countries and 70% of the global population. The data contents are presented in the form of numerous charts and detailed statistical tables, compiled from more than 100 authoritative and fully attributed sources worldwide. The 2003 edition includes the latest available data for all the countries covered in detail. As well as a section on total liquid intake (including consumption of non-alcoholic beverages) for the EU and USA, the new edition also features information on excise duties and VAT rates for beer, wine and spirits in selected European countries, Canada, Australia and the USA. Data covers (1) total alcohol consumption by country, (2) summary of per capita consumption by beverage type, (3) spirits consumption by country, (4) beer consumption by country, (5) wine consumption by country, and (6) total alcohol consumption by world region. This pocket book is especially designed for those working in drink manufacturing, retailing, advertising, and marketing who need quick access to key data.

Public Domain

Corman H; Mocan HN. A time-series analysis of crime, deterrence, and drug abuse in New York City. American Economic Review 90(3): 584-604, 2000. (60 refs.)

The purpose of this study is to examine evidence of the crime-deterrence relationship, using a unique data set that consists of monthly observations for nearly 30 years for five different crimes, corresponding arrests, the size of the police force, and a poverty indicator, as well as drug use indicators. The analysis suggests that drug usage has only a small effect on some property crimes, and that local law enforcement has a stronger and more significant effect. There was a positive relationship between drug use and robberies and burglaries. There was no significant relationship between drug use and the violent crimes, of felonious assault or murder, nor was there a relationship of drug use levels and motor vehicle theft.

Edwards G; Holder HD. The alcohol supply: its importance to public health and safety, and essential research questions. Addiction 95(12 Supplement): S621-S627, 2000. (17 refs.)

This paper seeks to identify the main questions which have emerged from the preceding papers concerning the supply side of alcohol. On any rational analysis these issues are of thoroughly legitimate concern to public health researchers. We list them under seven headings: (1) what drives the alcohol supply side? (2) What is the impact of alcohol supply on demand? (3) What are the benefits and risks to health and safety stemming from deregulation and what are the possibilities to avoid negative effects? (4) What is the size and significance of the alcohol supply which may derive from other than the officially approved channels? (5) Who are the important actors in the alcohol supply system? (6) What are local influences on alcohol supply and its distribution throughout communities? (7) What is to be learned from tobacco and other risky commodities about the importance of supply? Finally, we outline a series of possible next steps for a supply side initiative.

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.

Giesbrecht N; Greenfield T; Lemmens P; Osterberg E. Estimating alcohol consumption: Measurement and policy issues related to legal and illegal sources of alcohol. Contemporary Drug Problems 27(2): 221-234, 2000. (20 refs.)

There are several challenges to obtaining an accurate estimate of alcohol consumption and per capita consumption in a jurisdiction. There are difficulties in estimating the extent of illegal production and fraudulent transportation activities. In some jurisdictions there is extensive home production, which is difficult to estimate. There are challenges to estimating the amount of alcohol that is brought into a country or is taken out, primarily by individuals. This includes "slippage" between official and unofficial production and weaker brands are marketed, the conventional conversion factors from beverage to absolute alcohol volumes need to be adjusted. Finally, in light of extensive international travel there are challenges in determining the appropriate denominators in calculating some rates of consumption or damage. The eight papers in this special issue of Contemporary Drug Problems address a number of the challenges related to measurement issues and to estimating "unrecorded" consumption, and they note the underlying social and political dynamics and the applications of estimates. They also point to the need for further research on the reasons for gaps between different estimation methods, consequences of high rates of smuggling or use of illegal alcohol, and impacts of various interventions to curtail illegal consumption

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.

Gmel G; Rehm J. The empirical testability of Skog's theory of collective drinking behaviour. Drug and Alcohol Review 19(4): 391-399, 2000. (63 refs.)

The objectives of this study were (1) to review systematically Skog's theory of collective drinking behaviour and its interpretations by alcohol researchers, and (2) to give examples of how Skog's theory and these different interpretations have been empirically tested and to indicate how they might be tested. Based on a computer-aided search of the literature, a reconstruction of the theory and possible alternative interpretations is provided. Different interpretations of Skog's theory are possible and can be found in the literature. Surprisingly, there is little empirical evidence, especially recent evidence, to support Skog's key assumptions. Suggestions for further research are given.

Greenfield TK; Midanik LT; Rogers JD. A 10-year national trend study of alcohol consumption, 1984-1995: Is the period of declining drinking over? American Journal of Public Health 90(1): 47-52, 2000. (29 refs.)

Objectives. Data from the 1984, 1990, and 1995 National Alcohol Surveys were used to investigate whether declines shown previously in drinking and heavy drinking across many demographic subgroups have continued. Methods. Three alcohol consumption indicators -- current drinking (vs abstaining), weekly drinking, and weekly heavy drinking (5 or more drinks in a day) -- were assessed for the total US population and for demographic subgroups. Results. Rates of current drinking, weekly drinking, and frequent heavy drinking, previously reported to have decreased between the 1984 and 1990 surveys, remained unchanged between 1990 and 1995. Separate analyses for each beverage type (beer, wine, and spirits) and most demographic subgroups revealed similar temporal patterns. Conclusions. Alcohol consumption levels, declining since the early 1980s, may reach a minimum by the 21st century. Consumption levels should be monitored carefully over the next few years in the event that long-term alcohol consumption trends may be shifting.

Heale P; Chikritzhs T; Jonas H; Stockwell T; Dietze P. Estimated alcohol-caused deaths in Australia, 1990-97. Drug and Alcohol Review 21(2): 121-129, 2002. (22 refs.)

The purpose of the study was to provide updated estimates of alcohol-caused mortality rates in Australia between 1990 and 1997, making adjustments for changes in the prevalence of high-risk alcohol use estimated on the basis of per capita alcohol consumption (PCAC). Deaths wholly and partially attributable to high-risk alcohol consumption were extracted from the Australian Bureau of Statistics Mortality Datafile (1990-1997) and multiplied by specific aetiological fractions, which in turn were adjusted by changes in the prevalence of high-risk alcohol use estimated on the basis of annual changes in PCAC. The yearly trends in age-standardized rates of estimated alcohol-caused deaths were compared with those using (i) aetiological fractions unadjusted for changes in PCAC, and (ii) wholly alcohol-caused conditions only (thus requiring no application of aetiological fractions). The age-standardized rates of all alcohol- caused deaths among males aged 15 + years declined from 1990 (4.01/10 000) to 1993 (3.19/ 10000) and decreased far more slowly up to 1997 (3.15/ 10000) -16% overall. For females, these rates declined steadily from 1990 (1.75/ 10000) to 1997 (1.33/ 10000) -19% overall. Similar patterns in time trends were noted for estimated alcohol- caused death rates calculated as in (i) and (ii). However, the proportional decreases in rates (21.6% for males; 24.0% for females) would have been underestimated by 16% (males) and 19% (females) if the alcohol aetiological fractions had not been adjusted to take account of the estimated annual changes in the prevalence of high- risk drinking. The declines in estimated alcohol-caused death rates were more pronounced than the 9% decline in PCAC, and were due mainly to decreasing death rates for stroke (men and women), alcoholic liver cirrhosis and road injuries (men only). When aetiological fractions are used to measure temporal trends in estimated alcohol-caused death rates from official mortality statistics, they should account for annual changes in the prevalence of high-risk drinking. Such changes in prevalence can be deduced from yearly fluctuations in PCAC.

Heather N; Peters TJ; Stockwell T, eds. International Handbook of Alcohol Dependence and Problems. Chichester, England: John Wiley & Sons, Ltd., 2001. (Chapter refs.)

This comprehensive volume, with 42 chapters and 62 contributors, is organized into six sections. Section I reviews the positive and negative aspects of drinking; social and political history of alcohol; dominant images in public discussion about problem drinking; and classification of alcohol use disorders. Section II reviews the metabolic consequences of ethanol metabolism; neuropharmacology; neurologic consequences; effects on the gastrointestinal tract, pancreas, and liver; alcoholic muscle, skin, and bone disease; nutrition and infections; cardiovascular system; and diagnostic and monitoring studies. Section III deals with genetic predisposition; classical conditioning; operant behavioral theories; social and cognitive learning processes; developmental processes; and individual differences. Section IV considers international trends in alcohol production and consumption; the relationship of consumption and problems at the population level; individual risk; crime; and the anthropology of drinking. Part V addresses treatment -- treatment effectiveness; brief interventions; withdrawal and detoxification; pharmacological interventions; cognitive-behavioral approaches; relapse prevention; motivational interviewing; comorbid psychiatric disorders; natural recovery; and Alcoholics Anonymous. Section VI deals with control policies and prevention - price and taxation; controls on physical availability; creating safer drinking environments; preventing alcohol-related road crashes; prevention at the local level; alcohol education in schools; mass media advocacy for harm reduction; and control of alcohol advertising and sponsorship.

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; 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.

Isacsson G. Suicide prevention: A medical breakthrough? Acta Psychiatrica Scandinavica 102(2): 113-117, 2000. (32 refs.)

Objective: The author hypothesized, based on research until 1991, that a five-fold increase in the use of antidepressants might reduce Swedish suicide rates by 25%. A subsequent 3.5-fold increase in the use of antidepressants provided a 'natural experimental situation' for prospectively testing this hypothesis. Method: Swedish statistics on suicide, use of antidepressants, unemployment and alcohol consumption were obtained for 1978-96. Time- series of the latter variables were compared with suicide rates. Demographic subgroups regarding age, gender and county were analysed. Suicide rates were also compared with the use of antidepressants in Denmark, Norway and Finland. Results: Suicide rates decreased in accordance with the a priori hypothesis. Alcohol consumption and unemployment rates did not correlate well with suicide rates. Conclusion: This naturalistic study is not conclusive. The increased use of antidepressants appears, however, to be one of the contributing factors to the decrease in the suicide rate. It is of great scientific and clinical importance that this be evaluated by further studies.

Kaestner R. A note on the effect of minimum drinking age laws on youth alcohol consumption. Contemporary Economic Policy 18(3): 315-325, 2000. (18 refs.)

This study uses data from the National Longitudinal Survey of Youth to investigate the effect of minimum drinking age laws (MDALs) on youth alcohol consumption. Two considerations motivated the analysis. First, results from previous studies provide conflicting evidence of the effect of MDALs on alcohol consumption. Second, all previous studies of the effects of MDALs on alcohol consumption have failed to control for unmeasured time-varying state effects. This study addresses this latter issue by using a difference-in-differences-in- differences (DDD) methodology. The results of this study were mixed. On the one hand, a preponderance of estimates of the effect of MDALs on alcohol consumption are negative, although many are not significantly different from zero. On the other hand, estimates of the effect of MDALs differ by gender and exhibit some variation across samples and methods. In the end, I believe the estimates presented in this article are not sufficient to draw a definitive conclusion and suggest the need for additional research

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; Fillmore KM; Bostrom A. Stability of alcohol consumption over time: Evidence from three longitudinal surveys from the United States. Journal of Studies on Alcohol 63(3): 325-333, 2002. (30 refs.)

Objective: To assess the stability of individual monthly alcohol consumption volume in three studies from the United States: The first National Health and Nutrition Examination Survey with three measurements; The Framingham Offspring and Spouse Cohort with four measurements; and the National Longitudinal Survey of Youth with six measurements. The results will aid in the interpretation of studies that assess consumption at one point only. Method: Five analyses measure (1) the amount of change between measurements, (2) the correlation between reported consumption, (3) patterns of later drinking by the baseline group, (4) mean consumption of abstainers when they drink and heavy drinkers when not drinking heavily and (5) the strength of past consumption in predicting present consumption. Results: Correlations between measurements are high for adult samples 5 years apart or less but low for longer follow-ups and younger samples. Heavy drinkers are much less stable than abstainers or moderate drinkers. Abstainers at one time, who drink at another time, drink much less than the mean. One time heavy drinkers are close to the consumption mean of the entire sample when not heavy but two or more time heavy drinkers drink more than the mean when not heavy. An autoregressive, rather than Markov, model of consumption change is supported. Conclusions: Aspects of both stability and change are found. Baseline measures of drinking groups are especially unreliable for younger samples, longer follow-ups and heavier drinkers. There appear to be important subgroups moving between abstention and light drinking and moderate and heavy drinking that can be identified only by multiple measurements or retrospective measures.

Koppes LLJ; Twisk JWR; Snel J; Kemper HCG. Concurrent validity of alcohol consumption measurement in a 'healthy' population: Quantity-frequency questionnaire v. dietary history interview. British Journal of Nutrition 88(4): 427-434, 2002. (19 refs.)

Self-reports of alcohol consumption account for approximately 50% of the reported sales of alcohol. In the absence of a gold standard, it is not known how accurately different methods of measurement reflect actual consumption and whether under-reporting varies among different populations. The objective of the present study was to compare the consumption reported by the widely used quantity-frequency questionnaire (QFQ) with that reported in a cross-check dietary history interview (DHI), which has higher face validity. In 171 male and 197 female subjects of the Amsterdam Growth and Health Longitudinal Study (mean age 36 years), alcohol consumption was assessed by both the QFQ and the DHI. Most subjects reported a moderate consumption of alcohol by both measures. Spearman correlation coefficients were high (0.77 and 0.87 in men and women respectively). Overall, greater alcohol consumption was reported using the DHI. The difference between the DHI and QFQ reports was usually greater for wine than for beer. Backward stepwise regression analysis showed that the difference in reporting was positively related to a more irregular drinking pattern, and in wine drinkers to the square of the QFQ report. Sex, drinking alone or with others and the CAGE (acronym for four questions on drinking behaviour) score were not related to the difference in reporting. The precision of DHI estimation from QFQ reports and other factors was low. Serious questions arise as to the validity and precision of alcohol consumption measurements based on the QFQ alone. QFQ information may be improved by incorporating questions on the type of beverage and drinking patterns.

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. Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, 1977-2004. Surveillance Report #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 Northcase, a 0.9% 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.

Lariviere R; Larue B; Chalfant J. Modeling the demand for alcoholic beverages and advertising specifications. Agricultural Economics 22(2): 147-162, 2000. (53 refs.)

In this paper, the demand for beer, wine, spirits and soft drinks in Ontario is modeled in two parts: an equation is specified to endogenize group expenditures and a demand system is set up to allocate budgeted group expenditures across types of beverages, Advertising is allowed to influence both the level of group expenditures and its allocation. Three popular advertising specifications are compared using the J-test and the likelihood dominance criterion. Even though all three specifications fitted well according to standard criteria, the calculated expenditure, price and advertising elasticities were sensitive to the manner with which advertising is specified. This clearly highlights the need to rely on a sound criterion to identify a dominant specification. From the identified dominant specification, we found that advertising has very subtle effects on expenditures on alcoholic beverages (group and individual beverages). Thus, advertising is not effective in enlarging markets and this suggests that firms (especially breweries) use advertising to compete in zero-sum market share games. From a public policy perspective, our results are comforting but future research should investigate whether the neutral effect of advertising on aggregated expenditures hide substantial offsetting changes in the drinking habits of individuals.

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

Leifman H. Estimations of unrecorded alcohol consumption levels and trends in 14 European countries. Nordic Studies on Alcohol and Drugs 18(English Supplement): 54-70, 2001. (36 refs.)

AIMS: To map the extent of unrecorded alcohol consumption in the countries within the EU, including point estimates of the quantity of unrecorded consumption and the development over time. Data and Methods: This study examines unrecorded alcohol consumption in the countries within the European Union (excluding Greece and Luxembourg; including Norway), including point estimates of the quantity of unrecorded consumption and the development over time. An indirect method was used to assess development of unrecorded consumption over time in each country by estimating the discrepancy between the observed development of alcohol-related mortality and the development that would be expected from changes in recorded consumption only. Findings: The unrecorded consumption is highest in the northern European countries, and has increased from about 1 liter in the 1980s to 2 liters per adult in the second half of the 1990s. The United Kingdom also shows clear signs of increased unrecorded alcohol consumption as of the mid-1980s. In the remaining countries, the changes in the unrecorded alcohol appear to have been more modest over time. The quantities of unrecorded consumption in the Mediterranean countries in the 1990s are roughly estimated at 1 liter pure alcohol per adult and show no signs of increases over time. The general population survey indicated low quantities of personal imports of alcohol in France and Italy (1 deciliter in France; < 0.5 deciliter in Italy - compared with about 1 liter or more in Finland, Sweden and the United Kingdom). The downward trend in recorded consumption in Mediterranean countries for the past 20-30 years is most likely a real decrease in alcohol consumption: the large drop in recorded alcohol consumption in these countries has not been accompanied by increases in unrecorded consumption. When the total consumption (recorded plus unrecorded) is taken into account, and not just the recorded alcohol, the higher unrecorded consumption in the 'low-consuming' countries appear slightly to narrow down the differences between the countries. However, despite differences in unrecorded alcohol, the relative position between the countries in their total consumption in the mid -1990s remains to a large extent unchanged.

Leifman H. Homogenisation in alcohol consumption in the European Union. Nordic Studies on Alcohol and Drugs 18(English Supplement): 15-30, 2001. (25 refs.)

This article examines the trends in aggregate alcohol consumption in 15 European countries (14 European Union or EU member states and Norway) from 1950-1995. One of the aims is to outline the general trends in total consumption and beverage preferences, focusing on the dispersion over time and between all the countries involved, another to look more closely behind these trends and to analyze the development for different groups of countries. Evidence points to a clear homogenization for the whole study period in qualitative terms, that is, in beverage preferences. In terms of quantity, the homogenization of the last 15-20 years is less distinct and can be explained mainly by a drastic reduction in wine consumption in the Mediterranean wine-drinking countries. As to the remaining countries (beer and former spirits-drinking countries), there has not been any quantitative homogenization from the mid-1970s onwards. The results are discussed in the light of the ongoing globalization of economy, politics and culture, not least between the EU member states.

Lemmens P. Unrecorded alcohol consumption in the Netherlands: Legal, semi-legal and illegal production and trade in alcoholic beverages. Contemporary Drug Problems 27(2): 301-314, 2000. (12 refs.)

Three sources of unrecorded alcohol consumption in the Netherlands are discussed. The first source, illegal alcohol production, pertains only to illicit distilling, which never accounted for more than 1% of the total spirits production and is currently almost non-existent. Of more importance could be the standard 1.5% of total production of distilled alcohol that goes untaxed, officially booked as production loss. Unknown is how realistic this projected loss is, and how much of this quantity is sold for domestic, yet untaxed and hence unrecorded, consumption. The second source, legitimate home production of beer and wine, is estimated not to amount to more than 1% of total beer and wine consumption. Since the establishment of a single European market in 1992, importing and exporting of alcoholic beverages for personal use is free. No exact data on the quantity of cross-border traffic are available, but it is believed not to be substantial. Duty-free import is also limited. Due to large differences in excise duties between the EU countries, illegal trade is a potential lucrative criminal business. There is, however, no systematic control of alcohol transported between the Netherlands and other member states, so no estimate of this can be given. All sources of unrecorded consumption summed up, it is concluded that the quantity of non-registered alcohol consumption in the Netherlands is relatively small; the validity of sales figures, as a base for per capita consumption estimates, is thus relatively high.

Lemmens PH. Relationship of alcohol consumption and alcohol problems at the population level. IN: Heather N; Peters TJ; Stockwell T, eds. International Handbook of Alcohol Dependence and Problems. Chichester, England: John Wiley and Sons, Ltd, 2001. pp. 395-411. (38 refs.)

This chapter discusses the relationship of alcohol consumption and alcohol problems at the population level. A positive relationship between mean alcohol consumption and the proportion of heavy drinkers in a society has been used as an argument for restricting availability to all drinkers as a prevention measure. The author argues that aggregate data should be regarded with caution. Chronicity of heavy drinking has been found to vary across (sub)populations and over time. Acceptability of intoxication varies by culture and seems quite unrelated to per capita consumption. The proportion of nondrinkers in a population has been found to be unrelated to both per capita consumption and average consumption per drinker. Part of the uncertainty surrounding this issue is due to the limited validity and reliability of distributions based on surveys of annual consumption. Estimates of distributional shape are particularly affected by measurement error in the tail end, i.e. the consumption of the relatively few excessive drinkers. For some alcohol-related outcomes, most of the problems occur among light and moderate drinkers (the "prevention paradox"), which argues for a prevention effort aimed at reduction in all drinkers. Recently, however, some authors have proposed that the paradox vanishes when frequency of intoxication, rather than average consumption, is considered. Others have suggested that research often fails to take into account the severity and frequency of the outcome measures.

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.

Lester D. Association of alcohol use and suicide in 27 nations of the world. Psychological Reports 88(3 Part 2): 1129-1129, 2001. (3 refs.)

In 27 nations of the world, alcohol consumption predicted suicide rates, but changes in alcohol consumption did not predict changes in suicide rates.

Lohiniva RJ. Nordic alcohol statistics 1995-1999. Nordic Studies on Alcohol and Drugs 19: 100-110, 2002. (6 refs.)

A general overview of registered alcohol consumption in the Nordic countries is presented. The Norwegian Institute for Alcohol and Drug Research (SIRUS) has collected statistical data on alcohol consumption, retail outlets, and licensed premises. Sales figures for 2000 for Denmark, Finland, Norway, Sweden and Iceland are presented. Other tables are given for the years 1995-1999. The discussion focuss on (1) alcohol consumption in Nordic countries; (2) registered and unregistered consumption; (3) sales of different types of alcohol (spirits, wine, long drinks, beer); (4) conditions related to the sale of alcohol in the Nordic countries; (5) alcohol and economy; (6) deaths caused by alcohol; and (7) driving under the influence. Seven tables are included that provide data on annual sale of alcohol; sales of alcohol per inhabitant; numbers of retail and licensed outlets; real price indices for alcohol beverages; consumer expenditure on alcohol and state revenues from alcohol in the currency of each country; and cases of drunken driving in the Nordic countries. The consumption of wine has risen over the period 1995-2000. However, beer still remains the dominant bverage in the Nordic countries. Pressures in the Nordic countries to cut prices and duties on alcohol and widen import quotas is growing.

MacDonald S. The temporal impact of the age distribution on per adult consumption in Ontario, Canada. Contemporary Drug Problems 27(2): 335-348, 2000. (17 refs.)

Temporal changes in per adult consumption of alcohol may be partially explained by changing age distributions. Data sources included official alcohol sales data, population data by age groups, and population surveys from five years in Ontario. Results showed that the population has been getting older since 1978 and that people drink less as they age. Age-standardized calculations showed that between 2.5% and 6% of the decline in per adult consumption from 1971 to 1994 was attributable to changes in age distribution. Actual per adult consumption declined by 35%, which suggests that about 7% to 17% of the observed decline was due to the changing age structure.

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.

Makela P. Whose drinking does the liberalization of alcohol policy increase? Change in alcohol consumption by the initial level in the Finnish panel survey in 1968 and 1969. Addiction 97(6): 701-706, 2002. (20 refs.)

Aims: To study how the annual volume of alcohol consumed changed among population groups in different categories of initial consumption in a situation where per capita consumption strongly increased due to a new alcohol law. Design A post-hoc quasi-experiment with a two-wave panel study The regression to the mean effect was accounted for by using reference data from two auxiliary panel studies. Setting: Finland in 1968 and 1969, when per capita consumption increased by 46% in a year. Reference data come from Norway in 1975 and 1976, and the United States in 1993 and 1994. Participants General population sample of 1720 (1292 men) aged 15-69 (response rate 91.4%). Reference data General population surveys in a Norwegian town (n = 254) and in the United States (n = 658). Measurements Annual volume of alcohol consumed. Findings: In Finland, the greatest change in observed consumption levels occurred among those with moderate consumption levels, but the same phenomenon was observed in the reference data. A comparison between the Finnish and the reference data indicated that in Finland consumption increased at all levels, and the higher the initial consumption level, the greater the increase. Conclusions: A best estimate for the differential impact of future increases in alcohol consumption is that moderate and particularly heavy drinkers will be affected to a greater extent than will light drinkers or abstainers.

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.

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.

Nemtsov AV. Estimates of total alcohol consumption in Russia, 1980-1994. Drug and Alcohol Dependence 58(1/2): 133-142, 2000. (16 refs.)

It is important to estimate real alcohol consumption in Russia in the past 15 years because large quantities, and in recent years the bulk, of consumed alcohol evades state registration. In this study, trends in total consumption are estimated indirectly using an indicator of alcohol-related harm derived from forensic reports on accidental and violent deaths (Nemtsov, A.V., 1998. Anti-alcohol campaign, consequences, and actual alcohol consumption in Moscow, Addiction, in press). Using blood alcohol coefficients (BAC), the regression coefficients are estimated using the ratio of BAC-positive and BAC negative accidental and violent deaths in 1983-1986 in connection with the Moscow anti-alcohol campaign; the coefficients are then used to estimate consumption as a total sum of legal sales of alcoholic beverages and illegal spirits made from sugar. Data were obtained of violent BAC-positive and BAC-negative deaths in 17-25 oblasts of Russia in 1981-1994. The derived estimates indicate that in 1984 consumption exceeded 14 1 per capita, per annum (10.5 registered +4.2 unregistered); that consumption fell to 10.8 1 in 1986 (during the anti-alcohol campaign), and that it then began to rise owing to a sharp increase in estimated unregistered alcohol consumption-climbing to 13.6 1 (5.0 + 8.6) in 1993, and followed by a slight decline to 13.3 in 1994. These estimates are broadly consistent with estimates that have been made using unrelated methods, thus allowing some confidence in the overall picture obtained. Russia probably remains one of the heaviest-drinking countries in Europe. The reasons why indicators of alcohol-related harm in the mid-1990s exceed those recorded before the anti-alcohol campaign remain to be clarified.

Nordlund S. Real consumption of alcohol: Methods and errors of estimation. Contemporary Drug Problems 27(2): 235-252, 2000. (8 refs.)

The real total consumption (recorded plus unrecorded) of beer, wine and spirits is usually unknown. Estimates based on surveys usually cover just a fraction of the real consumption. Exactly how large these fractions (the coverage rates) are is also unknown, since the real consumption is unknown. This article presents a method of estimating these coverage rates. The problem is to obtain enough data sets of the right type for this estimation. The method is applied on Norwegian data. The method provides satisfactory results for estimation of total consumption and thereby for total unrecorded consumption, but (so far) not for estimating the different parts of the unrecorded consumption.

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. Per capita alcohol consumption and all-cause mortality in 14 European countries. Addiction 96(Supplement): S113-S128, 2001. (37 refs.)

Aims. (1) To estimate the relationship between per capita alcohol consumption and male-all-cause mortality in 14 European countries. (2) To compare the estimates with predictions from the U-shaped curve at the aggregate level. Data and method. The outcome measures comprised annual data, after 1950, on male mortality (al-cause mortality and mortality from diseases) for the following age groups: 15+, 15-29, 30-49, 50-69 and 70+ years. Female mortality was included as a control variable. Alcohol sales were used as proxy for per capita consumption. The data were analysed using the Box-Jenkins technique. The estimated alcohol effects were pooled within low-, medium- and high-consumption countries. Results. For all-cause mortality (15+), the effect estimates were significantly positive in eight of the 14 countries (3% per litre) than in medium- and high-consumption countries (1%). This pattern deviates from that predicted from the U-shaped curve. No significant impact of alcohol was found in the youngest age group when mortality from diseases was used as the outcome. Conclusions. Increases in overall consumption seem to be associated with increases in total mortality. Differences in drinking patterns are discussed as a possible explanation for the variation between country groups in alcohol effect.

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.

Osterberg E. Unrecorded alcohol consumption in Finland in the 1990s. Contemporary Drug Problems 27(2): 271-300, 2000. (27 refs.)

This paper discusses different categories of unrecorded alcohol consumption and the data sources used in estimating their magnitude and developments. It also gives a brief overview of the developments and importance of different categories of unrecorded alcohol consumption in Finland in the post Second World War period until the 1990s, and a more detailed analysis of the developments in the 1990s. One of the main findings is that travelers' alcohol imports have gained in importance, especially during the 1990s. However, drinking of non-beverage alcohol or surrogates has almost disappeared on the Finnish alcohol scene. In the second half of the 1990s homemade alcohol was also on the decrease. At the end of the 1990s about one-fifth of all alcohol consumed was unrecorded alcohol. More than half of the unrecorded alcohol consisted of travelers' alcohol imports. The next important categories were consumption outside Finland, homemade alcohol, and smuggled alcohol.

Partanen J; Simpura J. International trends in alcohol production and consumption. IN: Heather N; Peters TJ; Stockwell T, eds. International Handbook of Alcohol Dependence and Problems. Chichester, England: John Wiley and Sons Ltd, 2001. pp. 379-394. (22 refs.)

This chapter discusses international trends in alcohol production and consumption. Industrialization in the 19th century transformed alcohol into a market commodity. Alcohol consumption was high in most Western countries in the early 19th century but started to decline towards the end of the century. Consumption increased from the late 1940s to the middle 1970 then leveled off and even declined in a number of countries during the last quarter of the 20th century. In East and Southeast Asia, alcohol consumption has grown rapidly since the 1960s. In Latin America and Africa, consumption increased until the mid-1970s and has been decreasing since then. These differences correspond roughly to different economic development of these regions. Producers and traders of alcohol in Eastern European countries, faced with stagnant or declining demand in their most important markets in affluent industrialized countries, have had to develop new strategies. As a result, the production and distribution of alcoholic beverages has become concentrated in fewer and bigger enterprises, the assortment of beverage types and brands has been expanded along vigorous efforts to market them, and new markets have been sought, especially in developing countries and the transitional societies of Eastern Europe. A relatively small number of big transnational companies dominate the field, often in alliance with each other. The most significant change in the global market for alcohol in the last 20-30 years is the increasing popularity of beer.

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.

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 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. 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. Per capita alcohol consumption and liver cirrhosis mortality in 14 European countries. Addiction 96(Supplement): S19-S33, 2001. (36 refs.)

Aim. To estimate the effects of changes in per capita alcohol consumption on liver cirrhosis mortality rates in various demographic groups across 14 western European countries. Method. Yearly changes in gender- and age-specific mortality rates from 1950 to 1995 were analysed in relation to corresponding yearly changes in per capita alcohol consumption, employing the Box-Jenkins technique for time series analysis. Country-specific estimates were pooled into three regions: northern, central and southern Europe. Measurements. Cirrhosis mortality data for 5-year age groups were converted into gender-specific mortality rates in the age groups 15+, 15-44, 45-64 and 65+ and expressed as the number of deaths per 100 000 inhabitants. Alcohol sales were used to measure aggregate consumption, which were calculated into consumption (litres 100% alcohol) per year per inhabitant over 14 years of age and weighted with a 10-year distributed lag model. Findings. The country-specific analyses demonstrated a positive and statistically significant effect of changes in per capita consumption on changes in cirrhosis mortality in 13 countries for males and in nine countries for females. The strongest alcohol effect was found in northern Europe, due mainly to a large effect in Sweden. Moreover, when different age groups were analysed significant estimates were obtained in 29 of 42 cases for males and in 20 of 42 cases for females. Most of the non-significant estimates were found in older age groups. Conclusions. The results suggest clearly that a change in the overall level of drinking as a general rule affect cirrhosis mortality in different drinking cultures as well as among different demographic groups. Moreover, the findings correspond with what is expected from the collectivity theory of drinking cultures.

Ramstedt R. Alcohol and suicide in 14 European countries. Addiction 96(Supplement): S59-S75, 2001. (44 refs.)

Aim. To test the hypothesis that a positive population-level relationship between alcohol and suicide is more likely to be found in dry drinking cultures (as indicated by consumption level) than in wet drinking cultures. Design. Gender- and age-specific suicide rates in 14 western European countries were analysed in relation to per capita alcohol consumption employing the Box-Jenkins technique for time series analysis. The country-specific estimates were pooled into low-, medium- and high-consumption countries. Measurements. Suicide mortality data for 5-year age groups were converted into gender- and age-specific mortality rates. Alcohol sales expressed as litres of 100% alcohol per year and inhabitants 15 years and older were used as a measure of alcohol consumption. Findings. A positive and significant relationship between per capita consumption and gender and age-specific suicide rates was revealed most often in northern Europe and found least often in southern Europe. A stronger absolute alcohol effect for men was found only in northern Europe. Also, the suicide rate in younger age groups was more often significantly related to per capita consumption than suicide among the elder in northern and central Europe but not in southern Europe. Conclusions. The population-level association between alcohol and suicide is conditioned by cultural factors. In general, the suicide rate tends to be more responsive to changes in alcohol consumption in drinking cultures characterized by a low post-war per capita consumption compared to drinking cultures with higher consumption levels. The findings give support to the hypothesis derived from previous theoretical and empirical work, suggesting that suicide and alcohol is more closely connected in dry cultures than in wet cultures.

Razvodovsky YE. Association between the level of alcohol consumption per capita and suicide rate: Results of time-series analysis. Alcoholism 37(1): 35-43, 2001. (16 refs.)

This article deals with the comparative analysis of dynamics of the level of alcohol consumption per capita and suicide rate in Belarus in 1970-1999. In general terms, the results of the research prove the existence of positive association between the common level of alcohol consumption and the suicide level. Moreover, the research findings show that the structure of alcohol consumption effects the suicide rate.

Rehm J; Eschmann S. Global monitoring of average volume of alcohol consumption. Sozial- und Praventivmedizin 47(1): 48-58, 2002. (30 refs.)

Objectives: To estimate the prevalence of different categories of average volume of alcohol consumption for World Health Organization (WHO) regions. To check how the monitored indicator of average volume relates to prevalence of alcohol dependence. To discuss conclusions for establishing a global monitoring system. Methods: Prevalence of different categories of average volume of alcohol consumption was estimated by a triangulation of survey results, production, and sales figures. The relation between average volume of consumption and prevalence of alcohol dependence was analysed by regression techniques. Results: Alcohol consumption varies widely by sex, age, and region. It can predict prevalence of dependence with about 74 % of the variation of the latter explained. Conclusions: With current data, global monitoring of alcohol is possible. However, more and better surveys are necessary for the future. They should include patterns of drinking to improve prediction of other health outcomes like coronary heart disease (CHD) and accidents.

Rehm J; Greenfield TK; Rogers JD. Average volume of alcohol consumption, patterns of drinking, and all-cause mortality: Results from the US National Alcohol Survey. American Journal of Epidemiology 153(1): 64-71, 2001. (52 refs.)

The objective of this study was to investigate the effects of an average volume of alcohol consumption and drinking patterns on all- cause mortality. The sample (n = 5,072) was drawn from the 1984 National Alcohol Survey, representative of the US population living in households. Follow-up time was until the end of 1995, with 532 people deceased during this period. The authors found a significant influence of drinking alcohol on mortality with a J-shaped association for mates and an insignificant relation of the same shape for females, When the largest categories of equivalent average Volume of consumption were divided into people with and without heavy drinking occasions, serving as an indicator of drinking pattern, this differentiation proved important in predicting mortality. Light to moderate drinkers had higher mortality risks when they reported heavy drinking occasions (defined by either eight drinks per occasion or getting drunk at least monthly). Similarly, when the category of exdrinkers was divided into people who did or did not report heavy drinking occasions in the past, people with heavy drinking occasions had a higher mortality risk. Finally, indicating alcohol problems in the past was related to higher mortality risk. Results emphasized the importance of routinely including measures of drinking patterns into future epidemiologic studies on alcohol-related mortality.

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.

Rogers J; Greenfield T. Are estimates of the concentration of alcohol consumption affected by undercoverage? Evidence from five pooled U.S. surveys. Contemporary Drug Problems 27(2): 367-381, 2000. (22 refs.)

Conclusions concerning the properties of alcohol consumption distributions are often based on surveys that underestimate the amount consumed by sampled populations. Relationships between underreporting of alcohol consumption and the concentration of heavy drinking could present problems for several important research findings. Using data from five US telephone surveys, we compared state-level survey estimates of alcohol consumption and concentration with published estimates based on sales and taxes. Demographic factors predicting undercoverage were assessed in a multilevel analysis. Concentration was not significantly related to coverage, but it was related to rates of any drinking. State-level undercoverage was predicted by the proportion of males, younger age, political conservatism, Hispanic ethnicity, and the proportion of ethanol sold as spirits. Additional research is needed to determine the consequences of the relationship between these factors and undercoverage, but national estimates of consumption distribution properties are unlikely to be affected greatly by low coverage rates.

Rossow I. The validity of political arguments in the Norwegian alcohol policy debate: Associations between availability of liquor and consumption of illegal spirits. Contemporary Drug Problems 27(2): 253-269, 2000. (21 refs.)

Unrecorded alcohol consumption in Norway contributes to around 25% of total consumption, and a large part of this consists of moonshine and smuggled spirits. It has been argued that this is due to the restrictive price and availability measures in Norwegian alcohol policy. At the aggregate level, a significant increase in smuggled spirits has been found concurrent with an increase in liquor outlets. This paper presents individual level analyses based on five national surveys over a two-decade period, from 1973 to 1994, and assesses whether liquor outlet availability has an impact on consumption of and demand for illegal spirits in Norway. It is demonstrated that self-reported consumption of moonshine has decreased over the years, whereas purchase of smuggled spirits has increased significantly. Consumption of moonshine was more prevalent in municipalities with liquor outlets, whereas purchase of smuggled spirits and willingness to purchase illegal spirits did not depend on liquor and outlet availability

Ruhm CJ; Black WE. Does drinking really decrease in bad times? Journal of Health Economics 21(4): 659-678, 2002. (46 refs.)

This paper investigates the relationship between macroeconomic conditions and drinking using individual-level data from 1987 to 1999 interview years of the "behavioral risk factor surveillance system" (BRFSS). We confirm the procyclical variation in overall drinking identified in previous research using aggregate sales data and show that this largely results from changes in consumption by existing drinkers, rather than movements into or out of drinking. Moreover, the decrease occurring during bad economic times is concentrated among heavy consumers, with light drinking actually rising. We also find no evidence that the decline in overall alcohol use masks a rise for persons becoming unemployed during contractions. These results suggest that any stress-induced increases in drinking during bad economic times are more than offset by declines resulting from changes in economic factors such as lower incomes.

Saffer H. Alcohol Consumption and Alcohol Advertising Bans. National Bureau of Economic Research. Working Paper No. w7758. Cambridge MA: National Bureau of Economic Research, 2000. (33 refs.)

The purpose of this paper is to empirically examine the relationship between alcohol advertising bans and alcohol consumption. Most prior studies have found no effect of advertising on total alcohol consumption. A simple economic model is provided which explains these prior results. The data set used in this study is a pooled time series of data from 20 countries over 26 years. The empirical model is a simultaneous equations system which treats both alcohol consumption and alcohol advertising bans as endogenous. The primary conclusions of this study are that alcohol advertising bans decrease alcohol consumption and that alcohol consumption has a positive effect on the legislation of advertising bans. The results indicate that an increase of one ban could reduce alcohol consumption by five to eight percent. The alcohol price elasticity is estimated at about .2. The results suggest that recent exogenous decreases in alcohol consumption will decrease the probability of enactment of new bans and undermine the continuance of existing bans. Canada, Denmark, New Zealand and Finland have recently rescinded alcohol advertising bans. Alcohol consumption in these countries may increase or decrease at a slower rate than would have occurred had advertising bans remained in place.

Saffer H. Alcohol advertising and youth. Journal of Studies on Alcohol (Supplement): 173-181, 2002. (49 refs.)

Objective: The question addressed in this review is whether aggregate alcohol advertising increases alcohol consumption among college students. Both the level of alcohol-related problems on college campuses and the level of alcohol advertising are high. Some researchers have concluded that the cultural myths and symbols used in alcohol advertisements have powerful meanings for college students and affect intentions to drink. There is. however, very little empirical evidence that alcohol advertising has any effect on actual alcohol consumption. Method: The methods used in this review include a theoretically framework for evaluating the effects of advertising. This theory suggests that the marginal effect of advertising diminishes at high levels of advertising. Many prior empirical studies measured the effect of advertising at high levels of advertising and found no effect. Those studies that measure advertising at lower. more disaggregated levels have found an effect on consumption, Results: The results of this review suggest that advertising does increase consumption. However. advertising cannot be reduced with limited bans, which are likely to result in substitution to other available media. Comprehensive bans on all forms of advertising and promotion can eliminate options for substitution and be potentially more effective in reducing consumption. In addition. there is an increasing body of literature that suggests that alcohol counteradvertising is effective e in reducing the alcohol consumption of teenagers and young adults. Conclusions: These findings indicate that increased counteradvertising. rather than new advertising bans appears to be the better choice for public policy. It is doubtful that the comprehensive advertising bans required to reduce advertising would ever receive much public support. New limited bans on alcohol advertising might also result in less alcohol counteradvertising. An important topic for future research is to identify the counteradvertising themes that are most effective with youth.

Saffer H; Dave D. Alcohol consumption and alcohol advertising bans. Applied Economics 34(11): 1325-1334, 2002. (45 refs.)

The purpose of this paper is to empirically examine the relationship between alcohol advertising bans and alcohol consumption. Most prior studies have found no effect of advertising on total alcohol consumption. A simple economic model is provided which explains these prior results. The data set used in this study is a pooled time series of data from 20 countries over 26 years. The empirical model is a simultaneous equations system which treats both alcohol consumption and alcohol advertising bans as endogenous. The primary conclusions of this study are that alcohol advertising bans decrease alcohol consumption and that alcohol consumption has a positive effect on the legislation of advertising bans. The results indicate that an increase of one ban could reduce alcohol consumption by 5% to 8%. The alcohol price elasticity is estimated at about 0.2. The results suggest that recent exogenous decreases in alcohol consumption will decrease the probability of enactment of new bans and undermine the continuance of existing bans. Canada, Denmark, New Zealand and Finland have recently rescinded alcohol advertising bans. Alcohol consumption in these countries may increase or decrease at a slower rate than would have occurred had advertising bans remained in place.

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.

Sieri S; Agudo A; Kesse E; Klipstein-Grobusch K; San-Jose B; Welch AA et al. Alcohol consumption in EPIC cohorts from ten European countries. IARC Scientific Publications 156: 173-176, 2002. (4 refs.)

Quantities of alcohol and types of alcoholic beverage consumed were compared in 27 centers in 10 European countries participating in the EPIC study. Twenty-four-hour dietary recalls were collected from a sample of 35,855 (13,301 male and 22,824 female) members of the EPIC cohort. Adjusted means of alcoholic beverage consumption were calculated. Individual alcohol consumption was calculated as the sum of ethanol content of all alcoholic beverages consumed. Among men, wine consumption was highest in Varese and Turin (northern Italy) and San Sebastian (Spain) and lowest in Umea (Sweden). Beer was mainly consumed by men in German, Dutch, and Danish centers. Consumption of spirits by men was high in the Spanish centers and the United Kingdom general population, and low in Italy. Among women, wine consumption was lower than men in Spain, Greece, and Italy. Wine consumption by females was highest in the Danish centers and lowest in Granada (Spain). Beer consumption was also lower in women, but was particularly high in Murcia (Spain) and Denmark and low in the Mediterranean countries. Consumption of spirits by women was generally very low. Total alcohol intake among men was high in northern Spanish centers and low in Umea (Sweden) and Ragusa (southern Italy). Among women, total alcohol consumption was highest in the Danish centers and lowest in the Mediterranean centers. Gender differences in total alcohol consumption were less marked in central and northern Europe than in Mediterranean countries.

Skog OJ. Alcohol consumption and overall accident mortality in 14 European countries. Addiction 96(Supplement): S35-S47, 2001. (25 refs.)

Aims. To evaluate the effects of changes in aggregate alcohol consumption on overall accident morality in 14 western European countries after 1950, and to compare traditional beer, wine, and spirits countries with respects to the impact of alcohol. Design, setting and participants. The countries were sorted into three groups-traditional spirits countries of northern Europe, traditional beer countries of central Europe and wine countries of southern Europe. Gender- and age-specific annual mortality rates were analysed in relation to per capita alcohol consumption, utilizing the Box-Jenkins technique for time series analysis. All series were differences to remove long-term trends. The results of the analyses in individual countries were pooled within each group of countries to increase the statical power. Measurements. Overall accident mortality data for 5-year age groups were converted to gender and age specific mortality rates in the age groups 15-29, 30-49 and 50-69 years. Rates were age adjusted within groups. Data on per capita alcohol consumption were converted to consumption per inhabitant 15 years and older. Findings. The analyses demonstrated a statistically significant and positive relationship between changes in aggregate alcohol consumption in all three groups of countries. The estimated effect parameter was larger in northern Europe than in central Europe, and smallest in southern Europe. Conclusion. The results are compatible with the hypothesis that accident mortality rates are influenced by per capita alcohol consumption in souther, central and northern Europe. However, alcohol appears to play a larger role in northern Europe than in southern Europe.

Skog OJ. An experimental study of a change from over-the-counter to self-service sales of alcoholic beverages in monopoly outlets. Journal of Studies on Alcohol 61(1): 95-100, 2000. (6 refs.)

Objective: To evaluate if a change from over-the-counter to self-service sales of alcoholic beverages in monopoly outlets has an impact on the sales volume, Method: Fourteen Swedish towns were selected, each having only one state-run monopoly shop selling alcoholic beverages. Seven pairs were formed by matching towns in terms of demographic and economic criteria, and according to sales of alcoholic beverages. Within each pair, one town continued with the traditional over-the-counter sales, while the other switched to self-service sales of beer, wine and spirits. This was decided by randomization. The effect of switching to self-service was evaluated by comparing monthly sales volume of experimental and control towns over an extended period of rime. In order to evaluate changes due to transfer of customers from neighboring towns, the sales statistics in these towns were analyzed. In two towns, this transfer was also evaluated with the aid of customer surveys before and after the change. Results: It was found that the change produced an increase in sales volume of 17%. The increase was permanent. Approximately one half of the increase could be explained by an inflow of new customers from neighboring towns. Conclusions: The self-service shops became quite popular among the customers, and sales volume increased substantially. About one half of the increase appears to be due to new customers from neighboring towns. The remaining increase may be due to increased consumption by the local residents. Thus, the results seem to confirm the hypothesis that the physical availability of alcoholic beverages may affect consumption levels.

Smart RG; Ogborne A. Drinking and heavy drinking by students in 18 countries. Drug and Alcohol Dependence 60(3): 315-318, 2000. (6 refs.)

This paper examines how levels of drinking, daily drinking and heavy drinking are related in 18 countries. There is wide national variation in consumption patterns. The proportions of students drinking and the proportion drinking at least six times in the past month correlated with per capita consumption in the total adult population. Some student drinking variables correlated with each other. Most countries (n = 14) could be classified into one of two distinct groups based on the percentage of students who reported drinking at least six times per month, the percentage reporting drinking at least five drinks per day at any time in the last month and per capita alcohol consumption. Some countries in these groups were geographically close but others were not. Further research is needed to understand differences and similarities among countries with respect to student drinking.

Smart RG; Suurvali HM; Mann RE. Do changes in per capita consumption mirror changes in drinking patterns? Journal of Studies on Alcohol 61(4): 622-625, 2000. (23 refs.)

Objective: The goal of this study was to examine how well per capita alcohol consumption figures derived from beverage sales data relate to changes over time in survey-based measures of drinking patterns, it was expected that strong associations would be found among these various measures of consumption. Method: Data from 12 household surveys conducted in Ontario between 1977 and 1997 provided information on: percentages of drinkers; daily drinkers; those drinking five or more drinks at a sitting weekly; those reporting two or more alcohol-related harms; and average number of drinks per week. These variables were then correlated with per capita consumption. Results: Significant correlations were found only between per capita consumption and percentage of daily drinkers, and between percentage of drinkers and average number of drinks per week. Conclusions: The relationship of per capita consumption to survey measures of drinking is weak. The absence of consistent associations over time between per capita consumption and survey measures may be attributable to the small number of available data points or to increases in unrecorded consumption. Further research is needed to verify and explain these results.

Smart RG; Suurvali HM; Mann RE. Do drinking surveys predict changes in population-based alcohol problem indicators? Alcohol and Alcoholism 35(3): 255-258, 2000. (20 refs.)

We examined per capita alcohol consumption and survey-based measures of alcohol use in Ontario in relation to indicators of alcohol problems for the period 1977-1997. Per capita consumption and percentage of daily drinkers were significantly related to problem indicators, but percentage of drinkers and percentage of heavy drinkers were not. Of the measures we examined, per capita consumption was the strongest indicator of alcohol problems.

Smith DE; Solgaard HS. Dynamics of shifts in European alcoholic drinks consumption. Journal of International Consumer Marketing 12(3): 85-109, 2000. (46 refs.)

Global convergence of consumer behavior patterns is occurring in industrialized societies with increasing internationalization and cultural interactions. This study examined shifts in consumption of alcoholic beverages in Europe over the past 50 years using univariate time series analysis. Statistical data were obtained for the 15 member countries of the European Union as of 1995. Findings indicate that although differences remain in consumption levels and types of beverages, countries in north and south Europe are becoming more similar in their consumption of total alcohol. Alcoholic beverage consumption increased rapidly during the 1950s through the mid-1960s in many countries, mostly attributable to recovery after World War II and an increase in potential drinkers entering the market. In a number of countries