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Hardie I, Sasso A, Holmes J, Meier PS. Understanding changes in the locations of drinking occasions in Great Britain: An age-period-cohort analysis of repeat cross-sectional market research data, 2001-2019. Drug Alcohol Rev 2023; 42:105-118. [PMID: 36222548 PMCID: PMC10092301 DOI: 10.1111/dar.13562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The 21st century has seen wide-ranging changes in drinking locations in Great Britain, with on-trade alcohol sales decreasing and off-trade sales increasing. To better understand the underlying time-trends in consumer behaviour, we examine age-period-cohort (APC) effects related to changes in the share of individuals' drinking occasions taking place in: (i) on-trade versus off-trade locations; and (ii) specific on-trade or off-trade locations, that is traditional/community pubs, modern pubs/bars/café bars, nightclubs/late-night venues, restaurants/pub restaurants, social/working men's clubs, golf/other sports clubs/venues, at home (social setting) and at home (non-social setting). METHODS Repeat cross-sectional 1-week drinking diary data, collected 2001-2019. APC analysis via negative binomial regression models for each gender (N = 162,296 men, 138,452 women). RESULTS A smaller/declining proportion of occasions took place in on-trade compared to off-trade locations. Recent cohorts tended to have a larger share of on-trade occasions than previous cohorts, driven by their larger share of occasions in modern pubs/bars/café bars and nightclubs/late-night venues. Meanwhile, occasions in social/working men's clubs, golf/other sports clubs/venues and traditional/community pubs tended to be popular among older men, but have declined. Finally, the growth of off-trade drinking appears to be driven by a growth of off-trade drinking in non-social settings, in particular by older people/cohorts. DISCUSSION AND CONCLUSION Our findings highlight the declining prominence of certain on-trade locations, and increasing prominence of home drinking in non-social settings, within British drinking practices. While rising non-social home drinking is concerning, it is positive from a public health perspective that it does not appear to be shared by recent cohorts.
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Affiliation(s)
- Iain Hardie
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alessandro Sasso
- Sheffield Alcohol Research Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Holmes
- Sheffield Alcohol Research Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra S Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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O’Donnell R, Mohan A, Purves R, Maani N, Egan M, Fitzgerald N. How public health teams navigate their different roles in alcohol premises licensing: ExILEnS multistakeholder interview findings. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/xcuw1239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In England and Scotland, local governments regulate the sale of alcohol by awarding licences to premises to permit the sale of alcohol for consumption on or off the premises, under certain conditions; without such a licence, alcohol cannot be legally sold. In recent years, many local public health teams have become proactive in engaging with alcohol licensing, encouraging licensing authorities to act in ways intended to improve population health.
Objective
This research aimed to explore and understand the approaches and activities of public health stakeholders (i.e. NHS staff and other public health professionals) in seeking to influence local alcohol licensing policy and decisions, and the views of licensing stakeholders (i.e. licensing officers/managers, police staff with a licensing remit, elected members and licensing lawyers/clerks) on the acceptability and effectiveness of these approaches.
Participants
Local public health teams in England and Scotland were directly informed about this multisite study. Scoping calls were conducted with interested teams to explore their level of activity in alcohol licensing from 2012 across several categories. Twenty local authority areas with public health teams active in licensing matters were recruited purposively in England (n = 14) and Scotland (n = 6) to vary by region and rurality. Fifty-three in-depth telephone interviews (28 with public health stakeholders and 25 with licensing stakeholders outside health, such as local authority licensing teams/lawyers or police) were conducted. Interview transcripts were analysed thematically in NVivo 12 (QSR International, Warrington, UK) using inductive and deductive approaches.
Results
Public health stakeholders’ approaches to engagement varied, falling into three main (and sometimes overlapping) types. (1) Many public health stakeholders in England and all public health stakeholders in Scotland took a ‘challenging’ approach to influencing licensing decisions and policies. Reducing health harms was felt to necessitate a focus on reducing availability and generating longer-term culture change, citing international evidence on the links between availability and alcohol-related harms. Some of these stakeholders viewed this as being a narrow, ‘nanny state’ approach, whereas others welcomed public health expertise and its evidence-based approach and input. (2) Some public health stakeholders favoured a more passive, ‘supportive’ approach, with some reporting that reducing availability was unachievable. They reported that, within the constraints of current licensing systems, alcohol availability may be contained (at least in theory) but cannot be reduced, because existing businesses cannot be closed on availability grounds. In this ‘supportive’ approach, public health stakeholders supplied licensing teams with data on request or waited for guidance from licensing teams on when and how to get involved. Therefore, public health action supported the licensing team in their aim of promoting ‘safe’ and ‘responsible’ retailing of alcohol and/or focused on short-term outcomes other than health, such as crime. (3) Some public health stakeholders favoured a ‘collaborative’ approach in which they worked in close partnership with licensing teams; this could include a focus on containing availability or responsible retail of alcohol, or both.
Conclusions
In engaging with alcohol licensing, public health stakeholders adapted their approaches, sometimes resulting in a diminished focus on public health goals. Sampling did not include lower-activity areas, in which experiences might differ. The extent to which current licensing systems enable achievement of public health goals is questionable and the effectiveness of public health efforts merits quantitative evaluation.
Study registration
The study is registered with the Research Registry as researchregistry6162.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in Public Health Research. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rachel O’Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Andrea Mohan
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Richard Purves
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Nason Maani
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Matt Egan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Niamh Fitzgerald
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- SPECTRUM Consortium, Edinburgh, UK
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Walsh D, McCartney G, Minton J, Parkinson J, Shipton D, Whyte B. Deaths from 'diseases of despair' in Britain: comparing suicide, alcohol-related and drug-related mortality for birth cohorts in Scotland, England and Wales, and selected cities. J Epidemiol Community Health 2021; 75:1195-1201. [PMID: 34045325 PMCID: PMC8588300 DOI: 10.1136/jech-2020-216220] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/12/2021] [Indexed: 12/03/2022]
Abstract
Background The contribution of increasing numbers of deaths from suicide, alcohol-related and drug-related causes to changes in overall mortality rates has been highlighted in various countries. In Scotland, particular vulnerable cohorts have been shown to be most at risk; however, it is unclear to what extent this applies elsewhere in Britain. The aim here was to compare mortality rates for different birth cohorts between Scotland and England and Wales (E&W), including key cities. Methods Mortality and population data (1981–2017) for Scotland, E&W and 10 cities were obtained from national statistical agencies. Ten-year birth cohorts and cohort-specific mortality rates (by age of death, sex, cause) were derived and compared between countries and cities. Results Similarities were observed between countries and cities in terms of peak ages of death, and the cohorts with the highest death rates. However, cohort-specific rates were notably higher in Scotland, particularly for alcohol-related and drug-related deaths. Across countries and cities, those born in 1965–1974 and 1975–1984 had the highest drug-related mortality rates (peak age at death: 30–34 years); the 1965–1974 birth cohort also had the highest male suicide rate (peak age: 40–44 years). For alcohol-related causes, the highest rates were among earlier cohorts (1935–1944, 1945–1954, 1955–1964)—peak age 60–64 years. Conclusions The overall similarities suggest common underlying influences across Britain; however, their effects have been greatest in Scotland, confirming greater vulnerability among that population. In addressing the socioeconomic drivers of deaths from these causes, the cohorts identified here as being at greatest risk require particular attention.
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Affiliation(s)
- David Walsh
- Glasgow Centre for Population Health, Glasgow, UK
| | | | | | | | | | - Bruce Whyte
- Glasgow Centre for Population Health, Glasgow, UK
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Davidson SM, Connery HS, Greenfield SF, Hill KP. Teaching Residents to Treat Substance Use Disorders: Overcoming 10 Common Patient-Perceived Barriers to Outpatient Treatment Engagement. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:217-221. [PMID: 33442860 PMCID: PMC7806248 DOI: 10.1007/s40596-020-01383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Affiliation(s)
| | - Hilary S Connery
- McLean Hospita, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Shelly F Greenfield
- McLean Hospita, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin P Hill
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Walsh D, McCartney G, Minton J, Parkinson J, Shipton D, Whyte B. Changing mortality trends in countries and cities of the UK: a population-based trend analysis. BMJ Open 2020; 10:e038135. [PMID: 33154048 PMCID: PMC7646340 DOI: 10.1136/bmjopen-2020-038135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Previously improving life expectancy and all-cause mortality in the UK has stalled since the early 2010s. National analyses have demonstrated changes in mortality rates for most age groups and causes of death, and with deprived populations most affected. The aims here were to establish whether similar changes have occurred across different parts of the UK (countries, cities), and to examine cause-specific trends in more detail. DESIGN Population-based trend analysis. PARTICIPANTS/SETTING Whole populations of countries and selected cities of the UK. PRIMARY AND SECONDARY OUTCOME MEASURES European age-standardised mortality rates (calculated by cause of death, country, city, year (1981-2017), age group, sex and-for all countries and Scottish cities-deprivation quintiles); changes in rates between 5-year periods; summary measures of both relative (relative index of inequality) and absolute (slope index of inequality) inequalities. RESULTS Changes in mortality from around 2011/2013 were observed throughout the UK for all adult age groups. For example, all-age female rates decreased by approximately 4%-6% during the 1980s and 1990s, approximately 7%-9% during the 2000s, but by <1% between 2011/2013 and 2015/2017. Equivalent figures for men were 4%-7%, 8%-12% and 1%-3%, respectively. This later period saw increased mortality among the most deprived populations, something observed in all countries and cities analysed, and for most causes of death: absolute and relative inequalities therefore increased. Although similar trends were seen across all parts of the UK, particular issues apply in Scotland, for example, higher and increasing drug-related mortality (with the highest rates observed in Dundee and Glasgow). CONCLUSIONS The study presents further evidence of changing mortality in the UK. The timing, geography and socioeconomic gradients associated with the changes appear to support suggestions that they may result, at least in part, from UK Government 'austerity' measures which have disproportionately affected the poorest.
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Affiliation(s)
- David Walsh
- Glasgow Centre for Population Health, Glasgow, Scotland, UK
| | | | - Jon Minton
- Public Health Scotland, Glasgow, Scotland, UK
| | | | | | - Bruce Whyte
- Glasgow Centre for Population Health, Glasgow, Scotland, UK
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Anderson P, Jané-Llopis E, Hasan OSM, Rehm J. Changing Collective Social Norms in Favour of Reduced Harmful Use of Alcohol: A Review of Reviews. Alcohol Alcohol 2018; 53:326-332. [PMID: 29346480 DOI: 10.1093/alcalc/agx121] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/04/2018] [Indexed: 12/25/2022] Open
Abstract
Background Public sector bodies have called for policies and programmes to shift collective social norms in disfavour of the harmful use of alcohol. This article aims to identify and summarize the evidence and propose how policies and programmes to shift social norms could be implemented and evaluated. Design Review of reviews for all years to July 2017. Data sources Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Joanna Briggs Institute EBP, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register and Epub Ahead of Print databases. Eligibility All reviews, without language or date restrictions resulting from combining the terms ((review or literature review or review literature or data pooling or comparative study or systematic review or meta-analysis or pooled analysis) and (social norms or culture) and (alcohol drinking)). Results Two relevant reviews were identified. One review of community-based interventions found one study that demonstrated small changes in parental disapproval of under-age drinking. One review stressed that collective social norms about drinking are malleable and not uniform in any one country. Three factors are proposed to inform programmes: provide information about the consequences of the harmful use of alcohol, and their causes and distribution; act on groups, not individuals; and strengthen environmental laws, regulations and approaches. Conclusions Purposeful policies and programmes could be implemented to change collective social norms in disfavour of the harmful use of alcohol; they should be evidence-based and fully evaluated for their impact.
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Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.,Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, 6221 HA Maastricht, Netherlands
| | - Eva Jané-Llopis
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, Ontario, Canada M5S 2S1.,ESADE Business School, Ramon Llull University, Av. Esplugues 92-96, 08034 Barcelona, Spain
| | - Omer Syed Muhammad Hasan
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, Ontario, Canada M5S 2S1.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, Canada M5T 3M7
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, Ontario, Canada M5S 2S1.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, Canada M5T 3M7.,Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, Ontario, Canada M5T 1R8.,Institute of Medical Science (IMS), University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada M5S 1A8.,Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario, Canada M5T 1R8.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
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McCartney G, Popham F, Katikireddi SV, Walsh D, Schofield L. How do trends in mortality inequalities by deprivation and education in Scotland and England & Wales compare? A repeat cross-sectional study. BMJ Open 2017; 7:e017590. [PMID: 28733304 PMCID: PMC5642664 DOI: 10.1136/bmjopen-2017-017590] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/09/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare the trends in mortality inequalities by educational attainment with trends using area deprivation. SETTING Scotland and England & Wales (E&W). PARTICIPANTS All people resident in Scotland and E&W between 1981 and 2011 aged 35-79 years. PRIMARY OUTCOME MEASURES Absolute inequalities (measured using the Slope Index of Inequality (SII)) and relative inequalities (measured using the Relative Index of Inequality (RII)) in all-cause mortality. RESULTS Relative inequalities in mortality by area deprivation have consistently increased for men and women in Scotland and E&W between 1981-1983 and 2010-2012. Absolute inequalities increased for men and women in Scotland, and for women in E&W, between 1981-1983 and 2000-2002 before subsequently falling. For men in E&W, absolute inequalities were more stable until 2000-2002 before a subsequent decline. Both absolute and relative inequalities were consistently higher in men and in Scotland. These trends contrast markedly with the reported declines in mortality inequalities by educational attainment and apparent improvement of Scotland's inequalities with those in E&W. CONCLUSIONS Trends in health inequalities differ when assessed using different measures of socioeconomic status, reflecting either genuinely variable trends in relation to different aspects of social stratification or varying error or bias. There are particular issues with the educational attainment data in Great Britain prior to 2001 that make these education-based estimates less certain.
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Affiliation(s)
- Gerry McCartney
- Public Health Science Directorate, NHS Health Scotland, Glasgow, Scotland
| | - Frank Popham
- CSO/MRC Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Srinivasa Vittal Katikireddi
- CSO/MRC Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - David Walsh
- Glasgow Centre for Population Health, Glasgow, Scotland
| | - Lauren Schofield
- Public Health Intelligence, NHS National Services Scotland, Edinburgh, Scotland
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8
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Walsh D, McCartney G, Collins C, Taulbut M, Batty GD. History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow. Public Health 2017; 151:1-12. [PMID: 28697372 DOI: 10.1016/j.puhe.2017.05.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/24/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES High levels of excess mortality (i.e. that not explained by deprivation) have been observed for Scotland compared with England & Wales, and especially for Glasgow in comparison with similar post-industrial cities such as Liverpool and Manchester. Many potential explanations have been suggested. Based on an assessment of these, the aim was to develop an understanding of the most likely underlying causes. Note that this paper distils a larger research report, with the aim of reaching wider audiences beyond Scotland, as the important lessons learnt are relevant to other populations. STUDY DESIGN Review and dialectical synthesis of evidence. METHODS Forty hypotheses were examined, including those identified from a systematic review. The relevance of each was assessed by means of Bradford Hill's criteria for causality alongside-for hypotheses deemed causally linked to mortality-comparisons of exposures between Glasgow and Liverpool/Manchester, and between Scotland and the rest of Great Britain. Where gaps in the evidence base were identified, new research was undertaken. Causal chains of relevant hypotheses were created, each tested in terms of its ability to explain the many different aspects of excess mortality. The models were further tested with key informants from public health and other disciplines. RESULTS In Glasgow's case, the city was made more vulnerable to important socioeconomic (deprivation, deindustrialisation) and political (detrimental economic and social policies) exposures, resulting in worse outcomes. This vulnerability was generated by a series of historical factors, processes and decisions: the lagged effects of historical overcrowding; post-war regional policy including the socially selective relocation of population to outside the city; more detrimental processes of urban change which impacted on living conditions; and differences in local government responses to UK government policy in the 1980s which both impacted in negative terms in Glasgow and also conferred protective effects on comparator cities. Further resulting protective factors were identified (e.g. greater 'social capital' in Liverpool) which placed Glasgow at a further relative disadvantage. Other contributory factors were highlighted, including the inadequate measurement of deprivation. A similar 'explanatory model' resulted for Scotland as a whole. This included: the components of the Glasgow model, given their impact on nationally measured outcomes; inadequate measurement of deprivation; the lagged effects of deprivation (in particular higher levels of overcrowding historically); and additional key vulnerabilities. CONCLUSIONS The work has helped to further understanding of the underlying causes of Glasgow's and Scotland's high levels of excess mortality. The implications for policy include the need to address three issues simultaneously: to protect against key exposures (e.g. poverty) which impact detrimentally across all parts of the UK; to address the existing consequences of Glasgow's and Scotland's vulnerability; and to mitigate against the effects of future vulnerabilities which are likely to emerge from policy responses to contemporary problems which fail sufficiently to consider and to prevent long-term, unintended social consequences.
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Affiliation(s)
- D Walsh
- Glasgow Centre for Population Health, Olympia Building, 2-16 Orr Street, Bridgeton Cross, Glasgow G40 2QH, Scotland, UK.
| | | | - C Collins
- University of the West of Scotland, Paisley Campus, Scotland, UK
| | - M Taulbut
- NHS Health Scotland, Glasgow, Scotland, UK
| | - G D Batty
- University College London, London, UK
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Feng Y, Chen R, Li X, Mo X. Environmental factors in the etiology of isolated and nonisolated esophageal atresia in a Chinese population: A case-control study. ACTA ACUST UNITED AC 2016; 106:840-846. [PMID: 27494675 DOI: 10.1002/bdra.23550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Esophageal atresia (EA) is a common birth defect that occurs with tracheoesophageal fistula (TEF), although etiological studies on EA/TEF have produced inconsistent results. METHODS The aim of this study was to examine the association between environmental factors during pregnancy and the risk of EA/TEF in a Chinese population. Cases of isolated EA and nonisolated EA and unaffected controls were identified between July 2005 and November 2015, and face-to-face questionnaires concerning exposure to environmental factors were administered to the birth mothers of 130 cases and 400 controls. The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the association between environmental factors and the risk of EA/TEF. RESULTS The results of this case-control study suggest that lower maternal education (p < 0.0001), maternal binge drinking (OR = 2.63; 95% CI, 1.05-6.6) and pickled food consumption (OR = 2.04; 95% CI, 1.31-3.71) during pregnancy increase the risk of EA in offspring, while maternal folic acid supplementation (OR = 0.45; 95% CI, 0.29-0.71) is significantly associated with a decreased risk of EA. CONCLUSION These results suggest a role for environmental exposures in the etiology of EA/TEF; however, further studies are needed to replicate the observed associations. Birth Defects Research (Part A) 106:840-846, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yu Feng
- Department of Cardiothoracic Surgery, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Runsen Chen
- Department of Cardiothoracic Surgery, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaonan Li
- Children's Health Care, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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