Time for a regional alcohol policy – A literature review of the burden of normative alcohol use in the Caribbean

Prevalence and correlates of alcohol use among the elderly in the Eastern Caribbean Health Outcomes Research Network (ECHORN) cohort study

BACKGROUND

Alcohol use is pervasive in the Caribbean; however, the prevalence and correlates of alcohol use and drinking problems in the elderly have not been extensively studied.

METHODS

Data were obtained from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study, a cohort study of Caribbean people from Puerto Rico, Barbados, Trinidad, and Tobago, and the U.S. Virgin Islands, collected between 2013 and 2018 (baseline study sample, ages 60+, n = 811). Descriptive statistics were used to compare the differences in drinking status (current vs. former vs. never), alcohol problems (Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) scale score ≥2 vs. <2), and binge drinking days (0 days vs. 1-2 days vs. ≥3 days) across sample characteristics. Logistic regression analyses estimated the association of these alcohol measures with sociodemographic (e.g., sex), psychological (depression), and cultural (e.g., religion) correlates.

RESULTS

Thirty-six percent were 70 + years of age, 64 % were female, and 41 % had less than a high school education. Alcohol problems (≥2 CAGE score) was 21 %. Binge drinking ≥3 days was 30.6 %. Never attending religious services (vs. attending once a week or more) was associated with almost three times higher odds of alcohol problems (adjusted Odds Ratio: OR = 2.88, 95 % CI = 1.02, 8.15) four times higher odds of increasing binge drinking days (aOR = 4.04, 95 % CI = 1.11, 14.96). College education was protective against both the outcomes.

CONCLUSION

We provide current estimates of alcohol problems among elderly Eastern Caribbean people. Among the sociodemographic, psychological, and cultural correlates examined, religious attendance was significant. Replicate longitudinal studies using DSM-5 alcohol dependence are recommended.

Drunk driving: a secondary analysis of factors associated with driving under the influence of alcohol in Jamaica

OBJECTIVES

To determine the prevalence of alcohol use patterns, sociodemographic factors and risk of alcohol dependence among vehicle drivers in Jamaica.

DESIGN

A secondary data analysis.

SETTING

This study was conducted using the Jamaica National Drug Prevalence Survey 2016 dataset.

PARTICIPANTS

This included 1060 vehicle drivers derived from the population sample of 4623. The participants from each household were randomly selected as the respondent for the survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

Alcohol use and dependence were measured using the Alcohol Use Disorders Identification Test questionnaire. Driving under the influence of alcohol (DUIA) was assessed by questions regarding its use in the past 12 months. The analysis involved the use of Pearson's χ2 test and logistic regression.

RESULTS

75% of Jamaicans reported lifetime alcohol use. Approximately 65% of drivers indicated that they currently drink alcohol. 18% of drivers who currently drink alcohol admitted to DUIA. Reportedly, 54.5% of these drivers were alcohol binge drinkers, with 41.5% also driving under the influence of cannabis. The bivariate analysis demonstrated that DUIA was higher among Christian participants and those who worked in non-machine operator jobs (p=0.002 and p=0.008, respectively). Vehicle drivers altogether and drivers who drive under the influence of alcohol had significant associations with hazardous drinking (p=0.011 and p<0.001, respectively). Logistic regressions highlighted drivers 34 years and under (p=0.012), male drivers (p=0.002) and the head of the household (p=0.050) were 1.82, 3.30 and 1.86 times more likely, respectively, to report driving under the influence of alcohol in the past year.

CONCLUSIONS

The prevalence of alcohol use among Jamaica's population and vehicle drivers is high. That one in five drivers, who currently consume alcohol, also admits to driving under the influence suggests the urgent need for mitigation strategies and legislative action as part of a preventative effort to reduce drunk driving.

Prevalence and sociodemographic factors associated with polysubstance use: analysis of a population-based survey in Jamaica

BACKGROUND

In Latin America and the Caribbean, there is a dearth of research exploring polysubstance use. This study aims to determine the prevalence, varying combinations and associated sociodemographic characteristics of polysubstance use in Jamaica.

METHODS

This study involved a secondary data analysis of the Jamaica National Drug Prevalence Survey 2016 dataset where 4,623 participants between the age of 12 and 65 years from each household were randomly selected as respondents. Statistical analysis was performed to determine the prevalence and the sociodemographic correlates of polysubstance use among Jamaicans.

RESULTS

19.6% of respondents used two or more drugs in their lifetime. Of this amount 68.7% reported past year use and 61.9% reported past month use. Bivariate analyses reported polysubstance use was statistically significantly higher amongst males (U = 54,579, p = 0.000), those living in rural areas (U = 91,892, p = 0.003), non-Christian (U = 89,514, p = 0.014), and married persons (U = 74,672, p = 0.000). Past month polysubstance use was statistically significantly higher among employed persons than unemployed persons were (U = 81,342, p = 0.001). Surprisingly, there was a lack of significant differences between education level, household income and past month concurrent polysubstance use (p = 0.609; p = 0.115 respectively). Logistic regression model indicated males were 3.076 times more likely than females to report past month polysubstance use than females. Also, when compared to those 55-65 years old, participants 35-54 years were 2.922 times more likely and those 18-34 years were 4.914 times more likely to report past month polysubstance use. Additionally, those living in rural areas were 1.508 times more likely than participants living in urban areas to report past month polysubstance use. As it relates to occupational status, when compared to armed forces, skilled workers were 4.328 times more likely and unskilled workers were 7.146 times more likely to report past month polysubstance use.

CONCLUSIONS

One in five Jamaicans identified as polysubstance users, predominated by marijuana as the most common factor amongst the polysubstance combinations examined, signalling the need for early marijuana interventions.

Mortality in the Americas from 2013 to 2015 resulting from diseases, conditions and injuries which are 100% alcohol-attributable

AIMS

To describe mortality in the Americas from 2013 to 2015 inclusive resulting from diseases, conditions and injuries which are 100% attributable to alcohol consumption.

DESIGN AND SETTING

Mortality registry, population-based study. The data come from 30 of the 35 countries of the Americas for the triennium of 2013 to 2015.

PARTICIPANTS AND CASES

A total of 18 673 791 deaths coded by three-digit ICD-10 codes were analyzed.

MEASUREMENTS

Cause (underlying), and age-specific and age-adjusted mortality rates were calculated by sex and country.

FINDINGS

From 2013 to 2015 inclusive, among 30 of the 35 countries of the Americas, an average of 85 032 deaths per year were entirely attributable to alcohol. Men accounted for 83.1% of all 100% alcohol-attributable deaths, and death rates were higher for men than for women across all countries; however, the ratios of 100% alcohol-attributable deaths by sex varied by country. The majority of all 100% alcohol-attributable deaths occurred among those aged under 60 years (64.9%) and were due to liver disease (63.9%) followed by neuropsychiatric disorders (27.4%). Age-adjusted 100% alcohol-attributable mortality rates were highest in Nicaragua (23.2 per 100 000) and Guatemala (19.0 per 100 000), although the majority of all 100% alcohol-attributable deaths occurred in the United States 36.9%), Brazil (24.8%), and Mexico (18.4%).

CONCLUSIONS

From 2013 to 2015, more than 85 000 deaths in the Americas were 100% attributable to alcohol. Most of those occurred in people under 60 years and the highest mortality rates occurred in the United States, Brazil and Mexico.

Bartenders' and Rum Shopkeepers' Knowledge of and Attitudes Toward "Problem Drinking" in Saint Vincent and the Grenadines

Harmful alcohol use encompasses a spectrum of habits, including heavy episodic drinking (HED) which increases the risk of acute alcohol-related harms. The prevalence of HED in Saint Vincent and the Grenadines (SVG) is 5.7% among the overall population aged 15 years and older and 10.2% among drinkers. Responsible Beverage Service interventions train alcohol servers to limit levels of intoxication attained by customers and decrease acute alcohol-related harms. The objectives of this study were to determine bar tenders' and rum shopkeepers' knowledge of and attitudes toward problem drinking and willingness to participate in server training. Researchers used convenience and purposive sampling to recruit 30 participants from Barraouile, Kingstown, and Calliaqua to participate in semi-structured interviews designed to explore study objectives. Results and conclusions were derived from grounded theory analysis. Heavy episodic drinking is common but not stigmatized. Heavy drinking is considered a "problem" if the customer attains a level of disinhibition causing drunken and disruptive or injurious behavior. Bartenders and rum shopkeepers reported intervening with visibly intoxicated patrons and encouraging cessation of continued alcohol consumption. Participants cited economic incentives, prevention of alcohol-related harms, and personal morals as motivators to prevent drunkenness. Respondents acknowledged that encouraging responsible drinking was a legitimate part of their role and were favorable to server training. However, there were mixed opinions about the intervention's perceived efficacy given absent community-wide standards on preventing intoxication and limitations of existing alcohol policy. Given respondents' motivation and lack of standardized alcohol server training in SVG, mandated server training can be an effective strategy when promoted as one piece of a multi-component alcohol policy.

Intensity of Energy Drink Use Plus Alcohol Predict Risky Health Behaviours among University Students in the Caribbean

The relationship between energy drink (ED) use and risky behaviours has not been explored in the Caribbean, where youth risky behaviours are prevalent. This paper examines the relationship between ED use and risky behaviours and the moderating effect of gender among 1994 undergraduate students in Trinidad and Tobago. Analyses examined the association between ED use and risky behaviours, and the significant predictors of risky behaviours. Analysis of variance determined whether there were differences in risky behaviours between those who used only alcohol or EDs, both alcohol and EDs, alcohol mixed with EDs and neither alcohol nor EDs; and the difference between those with high and low intensity of ED use. In both males and females current use of energy drinks was positively associated with harmful substance use, risky sexual behaviours, and risky non-sexual behaviours, more strongly for males. The strongest predictor of risky behaviours was gender. Males consuming both alcohol and EDs, independently or mixed, were most likely to have risky behaviours. Consistent with previous reports, harmful alcohol use and other risk taking health behaviours appear to be predicted by a combination of high intensity use of EDs and alcohol. In countries like Trinidad and Tobago where violence, alcohol use disorders, STI/HIV infection and teenaged pregnancy are prevalent, the assessment of consumption of EDs and alcohol may be an important potential predictor of health compromising behaviours.

Lower Limbic Metabotropic Glutamate Receptor 5 Availability in Alcohol Dependence

Animal studies suggest an important role for the metabotropic glutamate receptor subtype 5 (mGlu5) in the pathophysiology of alcohol dependence, but direct human evidence is lacking. The goal of this study was to investigate cerebral mGlu5 availability in alcohol-dependent subjects versus controls using ¹⁸F-3-fluoro-5-[(pyridin-3-yl)ethynyl]benzonitrile (¹⁸F-FPEB) PET. Methods: Dynamic 90-min ¹⁸F-FPEB scans combined with arterial blood sampling were acquired for 16 recently abstinent alcohol-dependent subjects and 32 age-matched controls. Regional mGlu5 availability was quantified by the ¹⁸F-FPEB total distribution volume using both a voxel-by-voxel and a volume-of-interest analysis with partial-volume effect correction. Alcohol consumption within the last 3 mo was assessed by questionnaires and by hair ethyl glucuronide analysis. Craving was assessed using the Desire for Alcohol Questionnaire. Results: mGlu5 availability was lower in mainly limbic regions of alcohol-dependent subjects than in controls (P < 0.05, familywise error-corrected), ranging from 14% in the posterior cingulate cortex to 36% in the caudate nucleus. Lower mGlu5 availability was associated with higher hair ethyl glucuronide levels for most regions and was related to a lower level of craving specifically in the middle frontal gyrus, cingulate cortex, and inferolateral temporal lobe. Conclusion: These findings provide human in vivo evidence that limbic mGlu5 has a role in the pathophysiology of alcohol dependence, possibly involved in a compensatory mechanism helping to reduce craving during abstinence.

Type and Context of Alcohol-Related Injury among Patients Presenting to Emergency Departments in a Caribbean Country

There is an association between alcohol consumption and injuries in Latin America and the Caribbean. This cross-sectional study explores the socio-contextual factors of alcohol-related injuries in Trinidad and Tobago. Data on drinking patterns, injury type, drinking context prior to injury, and demographics were collected from patients presenting with injuries to the Emergency Departments (ED) of four hospitals. Findings show that 20.6% of patients had consumed alcohol, mainly beer, in the 6 h before injury. More than half were drinking at home (27%), or someone else’s home (27%). Injury most commonly occurred outdoors (36%) while in transit. Alcohol-related injuries occurred mainly because of falling or tripping (31.7%); these patients recorded the highest mean alcohol consumption prior to injury. Most persons who fell (50%) did so at home. Findings highlight the previously unreported significant risk of non-drivers sustaining injures through falling and tripping because of heavy alcohol use. Current interventions to reduce alcohol-related injury have focused on drink driving but there is a need for interventions targeting pedestrians and those who drink at home. A comprehensive multi-component approach including secondary prevention interventions in the medical setting, community educational interventions, enforcement of current legislative policies concerning the sale of alcohol, and policy initiatives surrounding road safety and alcohol outlet density should be implemented.

Social determinants of breast cancer in the Caribbean: a systematic review

BACKGROUND

Breast cancer is the leading cause of cancer deaths among women in the Caribbean and accounts for >1 million disability adjusted life years. Little is known about the social inequalities of this disease in the Caribbean. In support of the Rio Political Declaration on addressing health inequities, this article presents a systematic review of evidence on the distribution, by social determinants, of breast cancer risk factors, frequency, and adverse outcomes in Caribbean women.

METHODS

MEDLINE, EMBASE, SciELO, CINAHL, CUMED, LILACS, and IBECS were searched for observational studies reporting associations between social determinants and breast cancer risk factors, frequency, or outcomes. Based on the PROGRESS-plus checklist, we considered 8 social determinant groups for 14 breast cancer endpoints, which totalled to 189 possible ways ('relationship groups') to explore the role of social determinants on breast cancer. Studies with >50 participants conducted in Caribbean territories between 2004 and 2014 were eligible for inclusion. The review was conducted according to STROBE and PRISMA guidelines and results were planned as a narrative synthesis, with meta-analysis if possible.

RESULTS

Thirty-four articles were included from 5,190 screened citations. From these included studies, 75 inequality relationships were reported examining 30 distinct relationship groups, leaving 84% of relationship groups unexplored. Most inequality relationships were reported for risk factors, particularly alcohol and overweight/obesity which generally showed a positive relationship with indicators of lower socioeconomic position. Evidence for breast cancer frequency and outcomes was scarce. Unmarried women tended to have a higher likelihood of being diagnosed with breast cancer when compared to married women. While no association was observed between breast cancer frequency and ethnicity, mortality from breast cancer was shown to be slightly higher among Asian-Indian compared to African-descent populations in Trinidad (OR 1.2, 95% CI 1.1-1.4) and Guyana (OR 1.3, 95% CI 1.0-1.6).

CONCLUSION

Study quantity, quality, and variability in outcomes and reporting limited the synthesis of evidence on the role of social determinants on breast cancer in the Caribbean. This report represents important current evidence on the region, and can guide future research priorities for better describing and understanding of Caribbean breast cancer inequalities.