The drinking habits of Sikh, Hindu, Muslim and white men in the West Midlands: a community survey

'Reputation, reputation, reputation! Oh, I have lost my reputation!'; A literature review on alcohol addiction in the British Sikh and/or Punjabi community and the barriers to accessing support

AIMS

The literature review aimed to identify the barriers the Punjabi and/or Sikh community have in accessing support for alcohol addiction.

METHOD

A systematic review of the literature was undertaken of four scholarly databases, Google Scholar and grey literature on UK-based research conducted after 1980 into alcohol addiction in the Punjabi and/or Sikh community. Fourteen papers met the inclusion criteria outlined in the paper and were included in the review.

RESULTS

Ten main barriers to accessing support were found; stigma, religion, lack of understanding of addiction, over reliance on a medical model of treatment and disregard of therapy, cultural implications of being a member of the Punjabi and/or Sikh community and the addiction community, gender and generational differences and a lack of government commitment to alcohol support for BME communities with a lack of culturally specific services.

CONCLUSION

Despite the many barriers explored, the role of stigma remained a powerful theme throughout often underpinning other barriers. A key recommendation across many papers was the need for culturally sensitive support services. Several areas for future research were identified.

Natural Bioactive Compounds in the Management of Oral Diseases in Nephropathic Patients

Among the chronic non-communicable degenerative diseases (CDNCDs), chronic kidney disease (CKD) represents a global public health problem. Recent studies demonstrate a mutual cause–effect relationship between CKD and oral diseases, in which the presence of one induces the onset and faster progression of the other. In particular, the oral cavity alterations more frequent in CKD patients are: chronic periodontitis diseases, bone lesions, oral infections, and oral cancer lesions. Currently, a standardized therapy for the treatment of oral diseases is lacking. For this reason, natural bioactive compounds (NBCs), characterized by several health effects, such as antioxidant, antimicrobial, anti-inflammatory and anti-cancer actions, represent a new possible adjuvant therapy in the management of these pathological conditions. Among NBCs, polyphenols play a leading role due to positive modulation of oral microbiota, preventing and correcting oral dysbiosis. Moreover, these compounds exert anti-inflammatory effects, such as inhibiting the production of pro-inflammatory cytokines and the expression of cycloxigenase-2. In this light, the formulation of a new mouthwash/gel/gingival paste, with a high content of polyphenols in association with NBCs characterized by antimicrobial action, could represent a future therapy of oral disease in CKD patients.

Exploring views on alcohol consumption and digital support for alcohol reduction in UK-based Punjabi-Sikh men: A think aloud and interview study

INTRODUCTION AND AIMS

We aimed to explore UK-based Punjabi-Sikh men's views on: (i) alcohol consumption within the community; (ii) available support for alcohol reduction; and (iii) an evidence-informed alcohol reduction app.

DESIGN AND METHODS

Semi-structured interviews and a think aloud method were employed. Participants (n = 15) were male, aged 18-27 years, identified as Punjabi-Sikh, were hazardous or harmful drinkers (i.e. had an Alcohol Use Disorders Identification Test-Consumption score of ≥5) and interested in using an app to reduce drinking. Interviews were audio-recorded, transcribed verbatim and analysed with inductive thematic analysis.

RESULTS

Six themes were developed: (i) fear of drinking to cope; (ii) clash between religious and cultural norms (i.e. an internal conflict between important values); (iii) stigmatisation of mental health issues and lack of knowledge as barriers to help seeking; (iv) perceived usefulness of goal setting, monitoring and feedback (i.e. beliefs about the utility of the app's components for reducing drinking); (v) concerns about accessibility of the app within the Punjabi-Sikh community; and (vi) desire for human support for continued app engagement.

DISCUSSION AND CONCLUSIONS

Among UK-based, Punjabi-Sikh men, clashing religious and cultural norms give rise to internal conflict about drinking. Stigmatisation of mental health issues and lack of knowledge of available support leads to reduced help seeking. Respondents believed an evidence-informed alcohol reduction app could be useful, but were concerned about accessibility within the wider community and wanted an element of human support. The potential for a combination of digital and face-to-face support should be explored.

The association of religious affiliation with cholesterol levels among South Asians: the Mediators of Atherosclerosis in South Asians Living in America study

Background

South Asians have disproportionately high rates of cardiovascular disease. Dyslipidemia, a contributing factor, may be influenced by lifestyle, which can vary by religious beliefs. Little is known about South Asian religions and associations with dyslipidemia.

Methods

Cross-sectional analyses of the MASALA study (n = 889). We examined the associations between religious affiliation and cholesterol levels using multivariate linear regression models. We determined whether smoking, alcohol use, physical activity, and dietary pattern mediated these associations.

Results

Mean LDL was 112 ± 32 mg/dL, median HDL was 48 mg/dL (IQR:40–57), and median triglycerides was 118 mg/dL (IQR:88–157). Muslims had higher LDL and triglycerides, and lower HDL, while participants with no religious affiliation had lower LDL and higher HDL. The difference in HDL between Muslims and those with no religious affiliation was partly explained by alcohol consumption.

Conclusions

Religion-specific tailoring of interventions designed to promote healthy lifestyle to reduce cholesterol among South Asians may be useful.

Treatment of alcohol use disorder among people of South Asian ancestry in Canada and the United States: A narrative review

To explore access and treatment for alcohol use disorders (AUDs) among people of South Asian ancestry living in Canada or the United State, EQUATOR guidelines were applied to 34 manuscripts identified through an English language literature search (1946-2017) for this narrative review. The population studied has poor access to and engagement with treatment for AUD. Early evidence suggests benefit from adopting language-specific materials, offering South Asian-specific therapy groups, and incorporating traditional healers. Specific engagement and therapy considerations may increase AUD treatment access and effectiveness among South Asians living in Canada or the United States.

Understanding how Families Cope with Alcohol Problems in the UK West Midlands Sikh Community

Twenty-four British Sikh wives of men with identified alcohol problems, plus ten of their husbands and seven of their daughters, were interviewed using a semistructured procedure that focused upon the ways in which wives and daughters had attempted to cope with their husbands'/fathers’ excessive drinking. In addition each completed the Coping Questionnaire (CQ) which has the same focus (husbands were instructed to indicate ways in which their wives had coped). Interview data were analyzed according to the grounded theory approach, and a model was constructed depicting the ways in which wives and daughters accommodated over time to the drinking problem. The general pattern was for inactive resignation (approved of by husbands/fathers), replaced by a phase during which wives and daughters stood up to their husbands/fathers in various ways (disapproved of), followed by active resignation and partial independence (also disapproved of). Despite the success that the women had achieved in being active in the face of men's excessive drinking, there remained a commitment on the part of wives to continue to care domestically for their husbands (and a similar commitment on the part of daughters to support their mothers); and CQ scores showed wives to have higher engaged and tolerant coping scores than a comparison sample of white British wives. The results have implications for service providers—for example, in recognizing the oversimplicity of some stereotypes about how Sikh women cope with their menfolk's drinking.

The Association of Religious Affiliation with Overweight/Obesity Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

Religiosity has been associated with greater body weight. Less is known about South Asian religions and associations with weight. Cross-sectional analysis of the MASALA study (n = 906). We examined associations between religious affiliation and overweight/obesity after controlling for age, sex, years lived in the USA, marital status, education, insurance status, health status, and smoking. We determined whether traditional cultural beliefs, physical activity, and dietary pattern mediated this association. The mean BMI was 26 kg/m². Religious affiliation was associated with overweight/obesity for Hindus (OR 2.12; 95 % CI: 1.16, 3.89), Sikhs (OR 4.23; 95 % CI: 1.72, 10.38), and Muslims (OR 2.79; 95 % CI: 1.14, 6.80) compared with no religious affiliation. Traditional cultural beliefs (7 %), dietary pattern (1 %), and physical activity (1 %) mediated 9 % of the relationship. Interventions designed to promote healthy lifestyle changes to reduce the burden of overweight/obesity among South Asians need to be culturally and religiously tailored.

Alcohol use disorders in elderly people: fact or fiction?

The number of older people is increasing in populations throughout the world. Alcohol use disorders in elderly people are a common but underrecognised problem associated with major physical and psychological health problems. Owing to the negative attitudes and inadequate training of healthcare professionals, alcohol misuse is not always being detected or effectively treated. Current diagnostic criteria and common screening instruments for alcohol use disorders may not be appropriate for elderly people. Older people are as likely to benefit from treatment as younger people and the basic principles of treatment are much the same. Better integrated and outreach services are needed. Training of healthcare professionals in this area and pragmatic research should be prioritised to improve detection, treatment and service provision for this vulnerable and neglected population.

Alcoholic Liver Disease: High Risk or Low Risk for Developing Hepatocellular Carcinoma?

In this review we critically assess the literature to evaluate the level of risk posed by alcohol as both a primary etiology of hepatocellular carcinoma (HCC) and as a cofactor in its development. Although there have been conflicting findings, based on the body of evidence to date, it appears that the linkage between compensated alcoholic liver disease-associated cirrhosis and HCC is best characterized as medium-high risk, with the risk increasing with age and with quantity and duration of alcohol consumption and is more pronounced in females. While abstinence is the most effective way to reduce HCC risk, its effect seems largely dependent on the severity of liver damage at the point of cessation. Alcohol clearly interacts with other etiologies and conditions including viral hepatitis B and C, hereditary hemochromatosis, diabetes, and obesity to increase the risk for developing HCC, either synergistically or additively. Continued progress in genetics, especially through mechanistic-based and genome-wide association studies may ultimately identify which single nucleotide polymorphisms are risk factors for the onset of alcoholic liver disease and its progression to HCC and lead to the development of targeted therapeutics which may help providers better manage at-risk patients.

What Role Do Changes in the Demographic Composition Play in the Declining Trends in Alcohol Consumption and the Increase of Non-drinkers Among Swedish Youth? A Time-series Analysis of Trends in Non-drinking and Region of Origin 1971-2012

Aim

Non-drinkers among youth in Sweden have increased markedly during the last 15 years. The aim of this study is to investigate the temporal association between region of origin among Swedish youth and rates of non-drinking.

Data and method

Data on non-drinkers were obtained from The Swedish Council on Information and Other drugs (CAN) yearly school surveys among Swedish ninth-grade students over the period 1971–2013. Annual data of region of origin for 1968–2012 has been compiled from Statistics Sweden (SCB) and consists of all 15-year-olds in Sweden and their region of birth; Sweden, The Nordic Countries, Europe, The Middle East and the rest of the world. Autoregressive Integrated Moving Average (ARIMA) modelling was applied in order to estimate these associations.

Results

Descriptive results revealed a change in the demography of Swedish 15- to 16-year-olds. In the early 1990s 1% of Swedish 15- to 16–year-olds were born in a Middle East country, this proportion increased to 6% in 2012. Furthermore, those born in the rest of the world (non-European or non-Nordic countries) increased from 1% to almost 4%. Similarly, the trend of non-drinkers increased from about 20% to more than 40% among Swedish 15- to 16-year-olds during the same period. However, a more thorough analysis using ARIMA modelling revealed no significant association between rates of region of origin and non-drinking.

Conclusion

The marked increase in non-drinkers during the last 15 years is not associated to changes in the demographic composition, in terms of region of origin, among Swedish youth.

EPA Guidance Mental Health Care of Migrants

Migration is an increasingly commonplace phenomenon for a number of reasons. People migrate from rural to urban areas or across borders for reasons including economic, educational or political. There is increasing recent research evidence from many countries in Europe that indicates that migrants are more prone to certain psychiatric disorders. Because of their experiences of migration and settling down in the new countries, they may also have special needs such as lack of linguistic abilities which must be taken into account using a number of strategies at individual, local and national policy levels. In this guidance document, we briefly present the evidence and propose that specific measures must be taken to improve and manage psychiatric disorders experienced by migrants and their descendants. This improvement requires involvement at the highest level in governments. This is a guidance document and not a systematic review.

The association of religiosity with overweight/obese body mass index among Asian Indian immigrants in California

OBJECTIVE

The aim of this study was to examine the association between religiosity and overweight or obese body mass index among a multi-religious group of Asian Indian immigrants residing in California.

METHODS

We examined cross-sectional survey data obtained from in-language telephone interviews with 3228 mostly immigrant Asian Indians in the 2004 California Asian Indian Tobacco Survey using multivariate logistic regression.

RESULTS

High self-identified religiosity was significantly associated with higher BMI after adjusting for socio-demographic and acculturation measures. Highly religious Asian Indians had 1.53 greater odds (95% CI: 1.18, 2.00) of being overweight or obese than low religiosity immigrants, though this varied by religious affiliation. Religiosity was associated with greater odds of being overweight/obese for Hindus (OR 1.54; 95% CI: 1.08, 2.22) and Sikhs (OR 1.88; 95% CI: 1.07, 3.30), but not for Muslims (OR 0.69; 95% CI: 0.28, 1.70).

CONCLUSIONS

Religiosity in Hindus and Sikhs, but not immigrant Muslims, appears to be independently associated with greater body mass index among Asian Indians. If this finding is confirmed, future research should identify potentially mutable mechanisms by which religion-specific religiosity affects overweight/obesity risk.

Low level of alcohol drinking among two generations of non-Western immigrants in Oslo: a multi-ethnic comparison

Background

Alcohol drinking is a risk factor for harm and disease. A low level of drinking among non-Western immigrants may lead to less alcohol-related harm and disease. The first aim of this study was to describe frequency of drinking in two generations of immigrants in Oslo, contrasting the result to drinking frequency among ethnic Norwegians. The second aim was to study how frequency of drinking among adult immigrants was associated with social interaction with their own countrymen and ethnic Norwegians, acculturation, age, gender, socioeconomic factors and the Muslim faith.

Method

The Oslo Health Study (HUBRO) was conducted during the period 2000 to 2002 and consisted of three separate surveys: a youth study (15-16-year-olds, a total of 7343 respondents, response rate 88.3%); adult cohorts from 30 to 75 years old (18,770 respondents, response rate 46%); the five largest immigrant groups in Oslo (aged 20–60 years, a total of 3019 respondents, response rate 39.7%). Based on these three surveys, studies of frequency of drinking in the previous year (four categories) were conducted among 15-16-year-olds and their parents’ generation, 30-60-year-old Iranians, Pakistanis, Turks and ethnic Norwegians. A structural equation model with drinking frequency as outcome was established for the adult immigrants.

Results

Adults and youth of ethnic Norwegian background reported more frequent alcohol use than immigrants with backgrounds from Iran, Turkey and Pakistan. Iranians reported a higher drinking frequency than Turks and Pakistanis. In the structural equation model high drinking frequency was associated with high host culture competence and social interaction, while high own culture competence was associated with low drinking frequency. Adult first-generation immigrants with a longer stay in Norway, those of a higher age, and females drank alcohol less frequently, while those with a higher level of education and work participation drank more frequently. Muslim immigrants reported a significantly lower drinking frequency than non-Muslims, although this did not apply to Iranians.

Conclusions

The existence and growth in Western societies of immigrant groups with low-level alcohol consumption contributed to a lower level of consumption at the population level. This may imply reduced drinking and alcohol-related harm and disease even among ethnic Norwegians.

Gastroenterology and the provision of care to Panjabi patients in the UK

Panjabi is spoken by 1.3 million people in the UK. It is the second most common language used in the country and is the first choice of 75% of Panjabis. It is becoming more common. For many patients it forms part of the barrier which limits access to gastrointestinal services. The provision of appropriate support services is woeful and yet seldom leads to formal complaints. This review considers the impact of gastrointestinal disorders on the Panjabi community and assesses some of the interventions that could be developed to ensure equity of care.

Subgroup differences in psychosocial factors relating to coronary heart disease in the UK South Asian population

OBJECTIVES

To explore the differences in psychosocial risk factors related to coronary heart disease (CHD) between South Asian subgroups in the UK. South Asian people suffer significantly higher rates of CHD than other ethnic groups, but vulnerability varies between South Asian subgroups, in terms of both CHD rates and risk profiles. Psychosocial factors may contribute to the excess CHD propensity that is observed; however, subgroup heterogeneity in psychosocial disadvantage has not previously been systematically explored.

METHODS

With a cross-sectional design, 1065 healthy South Asian and 818 white men and women from West London, UK, completed psychosocial questionnaires. Psychosocial profiles were compared between South Asian religious groups and the white sample, using analyses of covariance and post hoc tests.

RESULTS

Of the South Asian sample, 50.5% was Sikh, 28.0% was Hindu, and 15.8% was Muslim. Muslim participants were more socioeconomically deprived and experienced higher levels of chronic stress, including financial strain, low social cohesion, and racial discrimination, compared with other South Asian religious groups. In terms of health behaviors, Muslim men smoked more than Sikhs and Hindus, and Muslims also reported lower alcohol consumption and were less physically active than other groups.

CONCLUSION

This study found that Muslims were exposed to more psychosocial and behavioral adversity than Sikhs and Hindus, and highlights the importance of investigating subgroup heterogeneity in South Asian CHD risk.

Masculinities, diet and senior Punjabi Sikh immigrant men: food for Western thought?

The high rates of diabetes and cardiovascular disease among Punjabi Sikh (PS) men are often linked to diet. Although some high fat and sugar foods in both traditional and Western foods negatively influence these illnesses, little is known about what underpins PS immigrant men's dietary practices. This article details the connections between masculinities and diet to reveal how varying gendered ideals can inform and influence the practices of senior PS Canadian immigrant men who attended community-based men's groups. Participants' masculine ideals and their alignment to those ideals were deeply rooted in spirituality and traditional cultures, which shaped the use of specific foods and beverages, yet there was also evidence that the availability and affordability of dairy products and alcohol in Canada strongly influenced men's diets. While the men's group leaders educated attendees about diet, ideologies reinforcing ties between femininities and the cooking of meals often prevailed. Linkages between participants' masculine ideals and dietary practices were both similar and discordant with the findings reported in studies of Western men. The findings drawn from this study may direct what, how and where dietary messages are targeted to senior PS Canadian immigrant men.

Negative emotions and alcohol dependence symptoms in British Indian and White college students

This study investigated cross-cultural differences in the association between negative emotions and alcohol dependence symptoms in British Indian and White college students. Based on a study of levels of alcohol consumption (Spada & Moneta, 2004), it was hypothesized that the association between negative emotions and alcohol dependence symptoms would be present only in British White students. A sample of 150 British Indian students and 150 British White students completed the Alcohol Use Disorders Identification Test (AUDIT) and the Hospital Anxiety and Depression Scale (HADS). Structural regression modeling indicated that negative emotions predict higher levels of alcohol dependence symptoms in British White students, and do not predict alcohol dependence symptoms in British Indian students. The implications of the findings are discussed.

Ramadan fasting triggering koro-like symptoms during acute alcohol withdrawal: a case report from Oman

This article describes a case of koro-like symptoms from Oman associated with alcohol withdrawal and illustrates how the socio-cultural practices of Ramadan-fasting affected the patterning and timing of presentation of severe alcohol withdrawal symptoms. The patient was severely distressed by the delusion that his penis had been amputated. The acute anxiety involving this delusion appears to be conceptually and phenomenologically similar to koro.

Religious and Spiritual Elements of Change in Sikh Men with Alcohol Problems

The research presented aimed to explore and elucidate religious and spiritual elements involved in the change process for South Asian men overcoming alcohol problems. In-depth interviews with 15 Sikh men who had either accessed counselling services, and/or used religious/spiritual strategies to overcome an alcohol problem were carried out. A grounded theory approach was used to analyse the data. Change was seen to occur within a holistic framework, impacting on many levels of the person and their context. A model of behaviour change was developed identifying 3 phases of change labelled as catalyst, commitment, and maintenance within which specific religious and spiritual change processes took place. The findings have important implications for the provision of culturally appropriate alcohol treatment services.

Drinking pattern among adolescents with immigrant and Norwegian backgrounds: a two-way influence?

AIMS

To assess the association between drinking behaviour among adolescents with both immigrant and native backgrounds with aspects of acculturation.

DESIGN

Cross-sectional school survey among 15-16 year olds.

SETTING AND PARTICIPANTS

All students, a total of 8361, in 10th grade during spring 2000 and 2001 in Oslo, Norway with response rate 88.3%. The sample consisted of 1213 students with an immigrant background and 4627 students with a Norwegian background.

MEASUREMENTS

Indicators of the length of the acculturation process were assessed as first versus second generation and in terms of length of stay in Norway. The proportion of Muslim students in school was an indicator of social environment 'dryness'. Drinking behaviour was assessed as drinking alcohol ever, drinking frequency and intoxication frequency.

FINDINGS

A smaller proportion of immigrant students were current drinkers, frequent drinkers and drank to intoxication compared with adolescents with a Norwegian background. Adjusted two-level analyses showed that alcohol drinking was less common among immigrant students with a short stay in Norway and with a large proportion of Muslim students in school. In those with a Norwegian background there was a larger proportion of abstainers, and those who drank did so less frequently and were less frequently intoxicated the larger the proportion of Muslim students there was in their school.

CONCLUSION

Drinking behaviour among adolescents in a multicultural and heterogeneous society seems to reflect a bi-directional acculturation process where the majority population tend to adapt to the behaviours of the immigrant population which in turn, to a varying degree, tends to adapt to the behaviour of the majority population.

Alcohol use by young people from different ethnic groups: consumption, intoxication and negative consequences

OBJECTIVE

To investigate alcohol consumption among mid-adolescents from different ethnic groups and explore overall and gender variations in drinking behaviours.

METHODS

A survey of alcohol use by 609 14-16 year olds recruited from three schools in an ethnically diverse area of London. Approximately 70% of the sample was of white English, white Irish, black Caribbean or black African ethnic origin. Self-report information was collected via a researcher-administered structured interview.

RESULTS

There was a significantly lower prevalence of lifetime alcohol use among black African respondents than among the other three ethnic groups. Black African males and males and females from the two white ethnic groups reported drinking above levels recommended by the English Department of Health. Among the recent drinkers, over half of the white Irish and white English groups and over a quarter of black Caribbean and black African groups had been intoxicated in the 90 days before interview. Approximately three quarters of the white English and white Irish recent drinkers, but only a half of black Caribbean and black African recent drinkers had experienced a negative drinking-related consequence during the last year.

CONCLUSIONS

The survey findings suggest that while young people of white English or white Irish ethnic origin from the populations studied are more likely to drink excessively and experience negative consequences from their drinking than black African and black Caribbean youth, a substantial minority of black African and black Caribbean youth also experience alcohol-related problems.

Review of prevalence data in, and evaluation of methods for cross cultural adaptation of, UK surveys on tobacco and alcohol in ethnic minority groups

OBJECTIVE

To assess the adequacy of cross cultural adaptations of survey questions on self reported tobacco and alcohol consumption in the United Kingdom.

DESIGN

Assessment of consistency of data between studies identified through literature review. Studies evaluated with 12 guidelines developed from the research literature on achieving cross cultural comparability.

RESULTS

The literature review identified 18 key studies, five of them on national samples. Survey instruments were obtained for 15 of these. The comparison of prevalence data in national surveys showed some important discrepancies, greater for tobacco than for alcohol. For example, prevalence of cigarette smoking in Bangladeshi women was 6% in a national survey in 1994 and 1% in a national survey in 1999; in Chinese men it was 31% in a survey in 1993-4 and 17% in one in 1999; in African-Caribbean men it was 29% in a 1992 survey and 42% in one in 1993-4. The most guidelines met by any study was three, although one study partly met a fourth. Two studies met no guidelines. Only four studies consulted with ethnic minority communities in developing the questionnaire, none checked each language version with all others, and two stated the questionnaire had not been validated.

CONCLUSIONS

Surveys have not followed best practice in relation to measurement of risk factors in cross cultural settings. There is inconsistency in the prevalence data on smoking provided by different major national UK studies. Users of such data should be aware of their limitations. Research is needed to help achieve linguistic equivalence of survey questions in cross cultural research.

Prevalence of alcohol use in Istanbul

The current research assessed the prevalence of alcohol use in Istanbul, Turkey along with characteristics and severity of related problems. The data were collected from structured interviews including the CAGE Questionnaire to eliminate the severity of alcohol-related problems of 1,550 residents (743 women, 807 men) of Istanbul, ages 12 to 65 years. Current alcohol use was 25.6% (397 persons, 118 women and 279 men), including 15.9% of the women and 34.5% of the men. 67% reported never having used alcohol. The rate of alcohol use was highest in the 40- to 49-yr. age group: the onset of use was reported as most common for the 16- to 19-yr.-olds. Prevalence of risky drinking was 6.8% (106 persons). Men were more likely to have an earlier initiation to alcohol use, to consume more [5.2 standard drinks (SD=3.4) vs 3.6 standard drinks (SD=2.5)] and be problem drinkers (31.5% vs 15.2%) than women. Prevalence of alcohol use seems to be relatively low in Istanbul. Data on characteristics of alcohol use are important in estimating groups at risk for problems and in planning prevention strategies.

Validation of the Cross-Cultural Alcoholism Screening Test (CCAST)

BACKGROUND

When screening instruments that are used in the assessment and diagnosis of alcoholism of individuals from different ethnicities, some cultural variables based on norms and societal acceptance of drinking behavior can play an important role in determining the outcome. The accepted diagnostic criteria of current market testing are based on Western standards.

METHODS

In this study, the Munich Alcoholism Test (31 items) was the base instrument applied to subjects from several Hispanic-American countries (Bolivia, Chile, Ecuador, Mexico, and Peru). After the sample was submitted to several statistical procedures, these 31 items were reduced to a culture-free, 31-item test named the Cross-Cultural Alcohol Screening Test (CCAST).

RESULTS

The results of this Hispanic-American sample (n = 2,107) empirically demonstrated that CCAST measures alcoholism with an adequate degree of accuracy when compared to other available cross-cultural tests.

CONCLUSIONS

CCAST is useful in the diagnosis of alcoholism in Spanish-speaking immigrants living in countries where English is spoken. CCAST can be used in general hospitals, psychiatric wards, emergency services and police stations. The test can be useful for other professionals, such as psychological consultants, researchers, and those conducting expertise appraisal.

Gender, perceptions of harm, and other social predictors of alcohol use in a Punjabi community in the Toronto area

Based on self-administered face-to-face interviews conducted in 1992-93 with 524 members of the Punjabi community in Peel, near Toronto, this study investigates the factors associated with alcohol use in the community. Results from alcohol and other drug surveys in Ontario are used for comparison between the two samples regarding drinking and sociodemographic characteristics. Bivariate analyses indicate a lower prevalence rate of drinking among the Punjabi sample than the Ontario population, especially among women. In spite of this, a majority of the Punjabi respondents perceive that alcohol problems are widespread in their community. Logistic regression results show that sex, importance of religion, perceived risk of alcohol, and opinion on alcohol price in the province are significantly associated with alcohol use. The effects of socioeconomic status, perception of public drunkenness, and levels of integration appear to be not significant. In light of these results, some implications for "alcohol abuse" prevention strategies are discussed.

Ethnic differences in substance use and alcohol-use-related mortality among first generation migrants to England and Wales

Epidemiological studies among migrant ethnic groups are potentially important as a way to provide insight into the relative importance of genetic, cultural, and socioeconomic factors in the etiology of substance use disorders. This paper summarizes prior United Kingdom studies of the prevalence of substance-use-associated problems in different ethnic groups before analyzing trends in recent mortality data by country of birth. On this evidence, rates of alcohol-related mortality may be marginally higher for those born in the Caribbean than for the native British, but are substantially raised for those born in Ireland and the Indian subcontinent. There is some indication that rates for the Caribbean and possibly the Irish groups have risen more rapidly than for the national population over a 12-year period. These differences in mortality rates seem to have arisen for complex reasons.

Setting up psychiatric services: cross-cultural issues in planning and delivery

There is convincing evidence that in the UK, various ethnic minorities are over-represented in psychiatric hospitals, prisons and special hospitals. Various explanations have been put forward for this picture. The expanding emphasis on community care means that models for looking after ethnic communities should be innovative and work from a bottom-up approach. Psychiatric emphasis on clinical diagnoses means that services are developed according to the diagnoses rather than needs.

Drinking patterns of black and white men in the west Midlands

The limited amount of evidence available from mortality statistics, mental hospital in-patient admission rates and community surveys appears to indicate that people of African-Caribbean origin resident in Britain have fewer alcohol-related problems than the white population. However, there are no systematic data on the normal drinking habits of random and representative samples of the black population of Britain, or the true extent of alcohol-related problems in the whole population. A survey of the drinking habits and alcohol-related problems of random samples of 200 black men and 170 white men from the Birmingham and Wolverhampton areas is reported. Black men were much less likely to report regular drinking and to report drinking large amounts of alcohol. They were far less likely to have got drunk in the past year, and scored lower on most items of an Alcohol Problems Scale. Age was the only demographic variable associated with drinking levels in both groups, and the link was more tenuous in the black than the white group. There were no generational differences found. Religious observance and belonging to a Pentecostal Church were found to be major differences between the black and white groups, and strongly associated with moderation in relation to alcohol.

Alcohol consumption and lifestyle in medical students

1st, 2nd, 3rd and 5th year medical students completed a questionnaire with 35 questions relating to diet, general health, exercise, smoking and drinking. Based on reported 'typical weekly intake' one-third of male non-Asian students in years 1-3, and 59% in year 5 were drinking above safe limits. 12-26% of non-Asian female students were drinking above safe limits. In all years most Asian students were drinking within safe limits. Non-Asians smoked more than Asians and males smoked more than females. A group of non-Asian male students with alcohol intake for the previous week > 35 units was compared with a group of safe drinkers (<25 > 0 units/week). Significantly more of the former group drank > 10 units per occasion, had been hurt as a result of someone's drinking, had caused physical harm and drank at lunch. Although 65% were aware their level of drinking was dangerous, only 7.5% wanted advice on safe drinking and only 5% wanted to drink less. The dangerous level drinkers ate less fruit and smoked more cigarettes than those drinking safely, but there were no other significant differences and there was no evidence for impaired academic performance.

Asian inpatients in a district psychiatric unit: an examination of presenting features and routes into care

The case notes of one hundred consecutive Asian admissions at first presentation to a distric psychiatric unit were examined. Asian admissions to Greenwich Hospital comprise a young, well educated group of predominantly Punjabi Sikhs. They present mostly through crisis services often following a domiciliary visit. General practitioners (GPs) were involved in only 34% of referrals although 54% of patients had Asian GPs. They are less likely to be compulsorily admitted than has previously been reported and very infrequently came into contact with police services. Alcoholism was found mostly in male married Sikhs. Psychotic illness accounted for 51% of presentations and neurotic depression for 18%, the latter being the largest single diagnostic category. This study raises questions regarding preferred routes into care for Asians and has service implications when considering establishment of accessible community services.