Alcohol consumption, cigarette sales and mortality in the United Kingdom: an analysis of the period 1970-1985

Health Psychology and Public Health: Theoretical Possibilities

Public health has either implicitly or explicitly drawn upon a range of psychological theories. This paper identifies four areas where the application of such theory could be developed, health communication, environmental initiatives, the negotiation of behaviour and participation and empowerment. Recommendations are made regarding content, sources and recipient characteristics that can be used to develop targeted health communication campaigns. Psychology also has a role to play in informing structural approaches to prevention. To facilitate this, a framework which focuses on cues, reinforcer and barriers and an understanding of how behaviour is achieved through negotiation and interaction is outlined. Finally we highlight a role for psychology in approaches that focus on participation and empowerment in relation to health.

Cohort effects on gender differences in alcohol dependence

AIMS

The present study investigated the presence of cohort effects on gender differences in the course, severity and symptomatology of DSM-III-R alcohol dependence in a community-based sample.

DESIGN

A comparison of substance-related variables among men and women divided into two groups based on the median birth year of the sample was conducted.

PARTICIPANTS

Participants were 468 men and 132 women with life-time alcohol dependence, the vast majority of whom were born between 1941 and 1960.

MEASUREMENTS

Substance use and DSM-III-R substance use disorders were assessed by a structured interview administered in person.

FINDINGS

Individuals born after 1951 had higher rates of alcohol dependence. Among individuals with alcohol dependence, those born after 1951 had an earlier onset and longer duration of alcohol-related problems. Significant interactions indicated that these effects were stronger for women than men.

CONCLUSIONS

Risk for alcohol dependence appears to be rising in younger generations, and particularly for younger women, making them an important target group for prevention and treatment programs.

Long-term follow-up after liver transplantation for alcoholic liver disease under tacrolimus

BACKGROUND

Liver transplantation (LTx) for alcohol-related liver disease (ALD) is an accepted modality of treatment and is one of the most common indications for LTx in the United States. The present report examines the long-term patient survival, graft survival, rates of recidivism, and development of de novo cancers in this group, and compares these results with a contemporaneous group of patients who were transplanted for non-ALD indications.

METHODS

Between August 1989 and December 1992, 185 adults received LTx for ALD (group I). During the same time interval, 649 adults received LTx for non-ALD (group II). The mean follow-up time was 94+/-10.7 months for group I vs. 92+/-11 months for group II. Kaplan-Meier survival estimates and the incidence of cancers using Surveillance Epidemiologic End Result data were compared in both groups.

RESULTS

At 5 years after orthotopic LTx, the overall patient survival and graft survival for group I were 72.0% and 66.5% vs. 66.5% and 60.3% for group II, respectively. After 5 years, the patient survival and graft survival for the alcoholic group were significantly lower (P=0.001) compared to the non-alcoholic group. The rate of de novo oropharyngeal cancer and lung cancer was 25.5 times and 3.7 times higher, respectively, in ALD group compared with the general population matched for age, sex, and length of follow-up (P=0.001), whereas this was not higher in the non-ALD group. Prior pretransplant length of sobriety and alcohol rehabilitation was not associated with the rate of post-LTx rate of recidivism, which was 20%. Out of 79 deaths in group I, only 1 was attributed to recidivism and 3 to noncompliance with recidivism. The other deaths occurred from de novo cancer (n=13), posttransplant lymphoproliferative disorder (n=5), age-related complications (n=23), and other infection or miscellaneous causes (n=34).

CONCLUSIONS

Patient and graft survival past 5 years after orthotopic LTx is significantly lower for ALD for a variety of reasons (P=0.001). The rate of upper airway malignances was significantly higher in ALD patients than for non-ALD post-LTx patients and the general public. Graft loss/death related to recidivism or chronic rejection was extremely low. More attention is needed for early diagnosis of de novo cancer and prevention of cardiorespiratory and cerebrovascular complications.

Alcohol use among college students in Scotland compared with norms from the United States

Four hundred fifty-six undergraduates at a Scottish university completed the Core Alcohol and Drug Survey, an instrument widely used in the United States to examine the nature, scope, and consequences of alcohol and other drug use on college campuses. The Scottish students were found to drink more frequently, consume more alcohol, and engage in binge drinking more often than their American counterparts. The Scottish students also demonstrated higher rates of hangovers, missed classes, and blackouts than the Americans, but the percentage of American students who had driven while intoxicated was greater than that of the Scots. Focus groups of students in Scotland and interviews with student affairs personnel and local officials indicated that student drinking is not generally viewed as a problem because extensive alcohol use appears to be part of Scottish culture and is readily accepted. Students reported that their drinking, other than in pubs, was spread out over time and was associated with eating and social activities. At student social events where alcohol was served, there was little evidence of loud, inappropriate, aggressive, or otherwise rowdy behavior; drinking appeared to be handled in a more controlled, safe, and responsible way than among US college students.

International policies on alcohol-impaired driving: a review

A review is presented of policies to curb alcohol-impaired driving. The principal measure applied against drinking and driving in most industrial countries is the implementation of laws limiting the amount of alcohol which can be legally consumed by a person who subsequently takes charge of a motor vehicle on a public road. This strategy seems to have been the most effective to date, although national variations in legislation, rigor of application, and the extent of public knowledge are reflected in the range of outcomes reported. The effectiveness of "random breath testing" appears to be related to the degree to which drivers believe that the law is enforced. Other strategies aimed at the reduction of drinking and driving are education, publicity, and exhortation; the rehabilitation of convicted offenders; and restrictions on the availability of alcohol. However, due to factors such as the lack of evaluation, or limited scope, or nonspecificity to drinking and driving, these measures appear to have been less successful in curbing alcohol-impaired driving than the application of legal powers.