Associations between socio-economic factors and alcohol consumption: A population survey of adults in England

Associations between interrelated dimensions of socio-economic status, higher risk drinking and mental health in South East London: A cross-sectional study

AIM

To examine patterns of hazardous, harmful and dependent drinking across different socio-economic groups, and how this relationship may be explained by common mental disorder.

METHODS AND FINDINGS

Between 2011-2013, 1,052 participants (age range 17-91, 53% female) were interviewed for Phase 2 of the South East London Community Health study. Latent class analysis was used to define six groups based on multiple indicators of socio-economic status in three domains. Alcohol use (low risk, hazardous, harmful/dependent) was measured using the Alcohol Use Disorders Identification Test and the presence of common mental disorder was measured using the revised Clinical Interview Schedule. Multinomial regression was used to explore associations with hazardous, harmful and dependent alcohol use, including after adjustment for common mental disorder. Harmful and dependent drinking was more common among people in Class 2 'economically inactive renters' (relative risk ratio (RRR) 3.05, 95% confidence interval (CI) 1.07-8.71), Class 3 'economically inactive homeowners' (RRR 4.11, 95% CI 1.19-14.20) and Class 6 'professional renters' (RRR 3.51, 95% CI 1.14-10.78) than in Class 1 'professional homeowners'. Prevalent common mental disorder explained some of the increased risk of harmful or dependent drinking in Class 2, but not Class 3 or 6.

CONCLUSIONS

Across distinct socio-economic groups in a large inner-city sample, we found important differences in harmful and dependent drinking, only some of which were explained by common mental disorder. The increased risk of harmful or dependent drinking across classes which are very distinct from each other suggests differing underlying drivers of drinking across these groups. A nuanced understanding of alcohol use and problems is necessary to understand the inequalities in alcohol harms.

Remission of Food Addiction Does Not Induce Cross-Addiction after Sleeve Gastrectomy and Gastric Bypass: A Prospective Cohort Study

BACKGROUND

The hypothesis of "cross-addiction" has never been validated, and numerous aspects speak against it.

OBJECTIVES

To compare the differences between sleeve gastrectomy (SG) and gastric bypass (GB) procedures concerning cross-addiction.

SETTING

Center for maximum care in Germany.

METHODS

We performed a prospective analysis of patients undergoing SG or GB as the first surgical treatment for severe obesity. All patients completed validated questionnaires to evaluate food intake (Yale Food Addiction Scale, YFAS), alcohol intake (Alcohol Use Disorders Identification Test), nicotine use (Fagerstrom Test for Nicotine Dependence), exercise (Exercise Addiction Inventory), drug addiction (20-item Drug Abuse Screening Test), and Internet use disorder (Internet Addiction Test) before the operation (T0) and 6 (T6) and 24 (T24) months postoperatively (ClinicalTrials.gov identifier: NCT02757716).

RESULTS

One hundred thirteen patients underwent SG (n = 68) or GB (n = 45). At the follow-up, 61% completed the questionnaires at T6 and 44% at T24. In the YFAS, the percentage of patients diagnosed with food addiction decreased from 69 to 10%, and the mean symptom count decreased from 3.52 ± 1.95 to 1.26 ± 0.99 at T24 (p < 0.0001); these values did not differ between the surgical groups (p = 0.784). No significant evidence of cross-addiction was observed for use of alcohol, nicotine, drugs, the Internet, or exercise in either surgical group. The percentage of patients with moderate nicotine dependence increased in the SG group (+8.9%) at T24, but this was not significant.

CONCLUSION

In this single-center cohort study, surgery for obesity caused significant addiction remission regarding food but without inducing cross-addiction after 2 years. Importantly, no significant differences were seen between the SG and GB procedures.

Trends in and factors associated with the adoption of digital aids for smoking cessation and alcohol reduction: A population survey in England

BACKGROUND

Digital smoking cessation and alcohol reduction aids are widely available in England. To estimate their public health impact, researchers need to consider their adoption in the target population. We assessed adoption rates, and characteristics of adopters, of digital smoking cessation and alcohol reduction aids in England.

METHODS

3655 smokers and 2998 high-risk drinkers (defined as a score of >4 on the Alcohol Use Disorders Identification Test-Consumption; AUDIT-C) who had made a past-year quit/reduction attempt were surveyed as part of the Smoking and Alcohol Toolkit Studies between January 2015-October 2018. Respondents provided information on socio-demographic characteristics and whether they had used a digital aid in a recent quit/reduction attempt.

RESULTS

2.7 % (95 % CI 2.2%-3.0%) of smokers and 3.6 % (95 % CI 2.9%-4.0%) of drinkers who had made a past-year quit/reduction attempt (26.9 % and 15.3 %, respectively) had used a digital aid. Survey year was not significantly associated with use in smokers or drinkers. None of the baseline characteristics were significantly associated with the use of a digital aid in smokers. Drinkers with high motivation to reduce alcohol consumption (ORadj = 2.49, 95 % CI 1.63-3.77, p <  .001) and higher AUDIT scores (ORadj = 1.07, 95 % CI 1.03-1.11, p < .001) had greater odds of adoption.

CONCLUSIONS

Digital smoking cessation and alcohol reduction aids are rarely used by smokers or high-risk drinkers attempting to quit/cut down in England, indicating that most of the target population is not being reached. Despite overall digital access improving, adoption rates remained similarly low between 2015-2018.

Sociodemographic characteristics associated with alcohol consumption and alcohol-related consequences, a latent class analysis of The Norwegian WIRUS screening study

BACKGROUND

For alcohol, the association with socioeconomic status (SES) is different than for other public health challenges - the associations are complex, and heterogeneous between socioeconomic groups. Specifically, the relationship between alcohol consumption per se and adverse health consequences seems to vary across SES. This observation is called the 'alcohol harm paradox'. This study aims to describe different patterns of alcohol use and potential problems. Next, the associations between sub-groups characterized by different patterns of alcohol use and potential problems, and age, gender, educational level, full-time employment, occupational level and income is analysed.

METHODS

Employing data from the ongoing cross-sectional WIRUS-study, N = 4311 participants were included in the present study. Individual response patterns of the ten-item Alcohol Use Disorders Identification Test (AUDIT) were analysed and latent class analysis (LCA) was used to identify latent groups. Next, the associations between the classes identified in the best fitting LCA-model and sociodemographic factors were analysed and presented.

RESULTS

We identified three classes based on the response patterns on AUDIT. Class 1 was characterised by low-level alcohol consumption and very low probability of negative alcohol-related consequences related to their alcohol consumption. Class 2 was characterised by a higher level of consumption, but despite this, class 2 also had a relatively low probability of reporting negative alcohol-related consequences. Class 3, however, was characterised by high levels of alcohol consumption, and a high probability of reporting negative consequences of their consumption. The classes identified were systematically differentially associated with the included measures of SES, with class 3 characterised by younger age, more males and lower educational attainment.

CONCLUSIONS

Our findings highlight the interconnectedness of alcohol consumption and alcohol-related consequences. Furthermore, the identified classes and SES yields further insights into to intricate relationship between various socioeconomic factors, alcohol use patterns and related negative consequences.

Socioeconomic status and alcohol use disorders across the lifespan: A co-relative control study

Objectives

Alcohol use disorders (AUD) is well known to aggregate in families and is associated with socioeconomic status (SES). The objective was to study the effect of education, income and neighborhood SES in adulthood on AUD, and to explore whether the potential associations were confounded by shared familial factors, by using a co-relative control design.

Methods

Data on AUD was drawn from the Swedish inpatient and outpatient care registers; prescription drug register; and crime data. Through national population registers we collected information on income, education and neighborhood SES at age 25, 30, 35 and 40 years in all individuals born in Sweden between 1950 and 1980. Each sex-specific stratum consisted of approximately 750,000–1,200,000 individuals, who were followed for AUD for a mean follow-up time ranging between 10 and 15 years until the end of 2013. Cox proportional hazards models were used to investigate the risk of AUD as a function of income, education and neighborhood SES in the general population and in pairs of first cousins and full siblings within the same sex, who differed in their exposure to the SES measure.

Results

Higher educational level, higher income and higher neighborhood SES were all associated with a reduced risk for AUD for both males and females in all ages. The potentially protective effect remained but was attenuated when comparing pairs of first cousins and full siblings.

Conclusions

High educational level and income in adulthood, as well as high neighborhood socioeconomic status, may represent protective factors against alcohol use disorders, even when shared familial factors, e.g. childhood socioeconomic status and genetic factors, have been taken into account.

Prevalence and correlates of long-term e-cigarette and nicotine replacement therapy use: a prospective study in England

OBJECTIVES

To examine the prevalence of, and sociodemographic and smoking-related characteristics associated with, long-term e-cigarette use compared with long-term nicotine replacement therapy (NRT) use.

DESIGN

Cross-sectional and prospective survey, the Smoking Toolkit Study, with baseline data collected between September 2014 and September 2016 and follow-ups at 6 and 12 months.

SETTING

England.

PARTICIPANTS

Population representative sample of 40 933 adults aged 16+ years.

MAIN OUTCOME MEASURES

Prevalence of long-term (≥12 months) use of e-cigarettes and NRT by retrospective self-report among baseline respondents (all adults, n=40 933; smokers, n=8406) and current use at baseline, 6 months and 12 months in a subsample of smokers who responded to follow-up (n=733).

RESULTS

Of baseline respondents, 1.5% (95% CI 1.4% to 1.6%, n=604) of adults and 3.9% (95% CI 3.5% to 4.3%, n=327) of smokers were long-term e-cigarette users and 0.5% (95% CI 0.4% to 0.6%, n=205) of adults and 1.3% (95% CI 1.1% to 1.5%, n=112) of smokers were long-term NRT users. Assessed prospectively, 13.4% (95% CI 10.9% to 15.9%, n=100) of smokers were long-term e-cigarette users and 1.9% (95% CI 0.9% to 2.9%, n=14) were long-term NRT users. Among all adults, long-term use by never smokers of either e-cigarettes (0.1%, n=27) or NRT (0.0%, n=7) was rare. Among past-year smokers, long-term e-cigarette and NRT use was higher among older smokers compared with those who were 16-34 years old (OR range=1.55-5.21). Long-term e-cigarette use only was lower in smokers who were less educated (OR=0.63, 95% CI 0.49 to 0.81), from social grades C2DE (OR=0.66, 95% CI 0.52 to 0.84) and with children in the household (OR=0.66, 95% CI 0.51 to 0.85). Long-term e-cigarette use and long-term NRT use were higher among smokers more motivated to quit (OR=2.05, 95% CI 1.63 to 2.60 and OR=2.33, 95% CI 1.57 to 3.46).

CONCLUSIONS

In the adult population in England, long-term use of e-cigarettes and long-term use of NRT are almost exclusively by current or ex-smokers. Only a minority of past-year smokers retrospectively report long-term e-cigarette or NRT use, but this figure may be an underestimate, especially for e-cigarette use, which is more than threefold higher when assessed prospectively.

Moderators of real-world effectiveness of smoking cessation aids: a population study

BACKGROUND AND AIMS

Understanding whether and how far smokers' characteristics influence the effectiveness of treatment may be important for tailoring recommendations on cessation aids to those most likely to help the user achieve abstinence. This study aimed to estimate the effectiveness of commonly used smoking cessation aids and test whether their effectiveness differs according to cigarette addiction, socio-economic status, age or sex.

DESIGN

Correlational design using cross-sectional survey data collected monthly between 2006 and 2018.

SETTING

England.

PARTICIPANTS

A total of 18 929 adults (aged ≥ 16 years, 52.0% female) who had smoked within the previous 12 months and had made at least one quit attempt during that period.

MEASUREMENTS

The outcome was self-reported abstinence from quit date to survey. Independent variables were self-reported use during the most recent quit attempt of: prescription nicotine replacement therapy (NRT), NRT over-the-counter, varenicline, bupropion, e-cigarettes, face-to-face behavioural support, telephone support, written self-help materials, websites and hypnotherapy. Moderators were cigarette addiction, social grade, age and sex.

FINDINGS

After adjustment for covariates and use of other cessation aids, users of e-cigarettes [odds ratio (OR) = 1.95, 95% confidence interval (CI) = 1.69-2.24] and varenicline (OR = 1.82, 95% CI = 1.51-2.21) had significantly higher odds of reporting abstinence than those who did not report use of these cessation aids. Use of prescription NRT was associated with increased abstinence in older (≥ 45 years) (OR = 1.58, 95% CI = 1.25-2.00) but not younger (< 45 years) smokers (OR = 1.09, 95% CI = 0.85-1.42). Use of websites was associated with increased abstinence in smokers from lower (OR = 2.20, 95% CI = 1.22-3.98) but not higher social grades (OR = 0.74, 95% CI = 0.40-1.38). There was little evidence of benefits of using other cessation aids.

CONCLUSIONS

Use of e-cigarettes and varenicline are associated with higher abstinence rates following a quit attempt in England. Use of prescription of nicotine replacement therapy is also associated with higher abstinence rates, but only in older smokers, and use of websites only in smokers from lower socio-economic status.

Correction: Associations between socio-economic factors and alcohol consumption: A population survey of adults in England

[This corrects the article DOI: 10.1371/journal.pone.0209442.].