Gender-specific mortality associated with alcohol consumption in Poland in transition

The Relationship between Diet and the Occurrence of Depressive Symptoms in a Community Example with High Rates of Social Deprivation: A Cross-Sectional Study

Research suggests that various biological and psychosocial mechanisms are involved in the heterogeneous and complex relationship between dietary patterns and depressive symptoms. The occurrence of depressive symptoms is thought to be related to socioeconomic status (SES), with those with lower SES being more likely to experience persistent depression. The aim of the undertaken study was to investigate whether socioeconomic and health variables are associated with dietary assessment in a population with high rates of social deprivation and whether a relationship exists between dietary assessment and depressive symptoms (DS). The respondents' nutrition was evaluated through a qualitative method, using the Perinumeric Periodic Table questionnaire by Starzyńska. At the same time, the prevalence of DS was assessed employing the Patient Health Questionnaire-9 (PHQ-9). In the DS screening (PHQ-9 ≥ 10), in the entire study population, the risk of DS was 16.1% (n = 605). In our entire study population, up to 61.2% (n = 2297) of the respondents exhibited poor dietary patterns. In the multivariate model, women with almost adequate or poor dietary assessment were 1.62 and 2.18 times more likely to score at least 10 on the PHQ-9 questionnaire, as compared to women whose dietary assessment was good or adequate. In conclusion, it was determined that sociodemographic variables affect nutritional habits. Women who lived in rural areas limited to a vocational education had significantly poorer diets. Moreover, men, younger men, smokers, and those without chronic diseases were characterized by a poorer dietary assessment. Additionally, women who had a better dietary assessment were significantly more likely to have lower scores on the questionnaire assessing the occurrence of DS (PHQ-9 10).

Trends in Health Behavior of Polish Women in 1986-2021: The Importance of Socioeconomic Status

In the last 35 years Poland has undergone a series of fundamental economic, social, and biological transformations. With the transition from a centrally planned to a free-market economy, a period of economic and social transformation, Poland's accession to the European Union, and the COVID-19 coronavirus pandemic, living conditions in the country have seen dramatic changes. The aim of this study was to assess whether there were changes in the basic health behaviors of Polish women, and if so, in what directions and with what strength, and whether there were differences in these changes depending on the socioeconomic status. Information on basic lifestyle factors (drinking alcohol, smoking, coffee drinking, and physical activity) and socioeconomic status (level of education, Gini coefficient, Gender Inequality Index, women total employment, employed women being in managerial positions, women among scientists) of 5806 women aged 40-50 years were analyzed. During the 1986-2021 period, based on the same methodology, team of technicians and research tools, six birth cohorts of women were examined in 1986, 1991, 1996, 2006, 2019 and 2021. Highly statistically significant changes were found in the frequencies of declared health behaviors from 1986-2021, according to the order of significance in coffee and alcohol consumption, physical activity levels, and smoking and smoking intensity. In subsequent cohorts, there were fewer and fewer women who did not drink coffee and alcohol, while more drank more than two cups of coffee a day and drank alcohol more often than 2× a week. Furthermore, they were more likely to be physically active, and slightly fewer were smokers. The lifestyles of the women were less likely to depend on their socio-economic status than the cohorts. In 1991 and 1996, there was a marked intensification of unhealthy behavior. Changes in the analyzed health behaviors may have been caused by adaptation to the high level of psychosocial stress observed during the transition of the 1986-2021 period and may result in changes in the biological condition and quality and length of life of Polish women. Research on social differences in health behavior provides an opportunity to analyze the biological effects of changes in the living environment.

Is area-level socioeconomic deprivation associated with mortality due to circulatory system diseases in Poland?

BACKGROUND

Socioeconomic deprivation (SED) is known to influence cardiovascular health. However, studies analyzing the relationship between deprivation and circulatory system diseases (CSD) in Central and Eastern Europe are limited. This study aimed to assess the relationship between SED and mortality due to CSD at a population level in 66 sub-regions of Poland.

METHODS

The 2010-2014 data regarding mortality and SED components were obtained from the Central Statistical Office. An area-based SED index was calculated based on the higher education rates, employment structure, wages, unemployment, and poverty. The dynamics of changes in mortality due to CSD was expressed by the number of deaths prevented or postponed (DPP) in terciles of the SED index. The associations between the mortality from CSD and SED index were analyzed using multivariate Poisson regression models and generalized estimating equations.

RESULTS

Among men, the percentage of DPP in 2014 was 13.1% for CSD, 23.4% for ischemic heart disease (IHD), and 21.4% for cerebrovascular diseases (CeVD). In the case of women, the proportion of DPP was 12.8, 25.6, and 21.6%, respectively. More deprived sub-regions experienced a greater decrease in CSD-related mortality than less deprived sub-regions. The disparity in mortality reduction between more deprived and less deprived sub-regions was even more pronounced for women. After adjusting for smoking prevalence, average BMI, population density, and changes in mortality over time, it was found that the SED index over the 2010-2014 time period was significantly associated with CSD- and IHD-related mortality for men (respectively 5.3 and 19.5% expected mortality increase per 1-unit increase of SED index), and with IHD- and CeVD-related mortality for women (respectively 30.3 and 23.0% expected mortality increase per 1-unit increase of SED index).

CONCLUSIONS

Significant differences in mortality changes due to CSD in Poland could be observed in relation to socioeconomic deprivation, resulting in reduced health inequalities. To reduce CSD mortality, more comprehensive preventive measures, including approaches addressing the socioeconomic factors, mainly poverty, education and employment, are needed, particularly in less urbanized areas.

The Prevalence of Depression Symptoms and Their Socioeconomic and Health Predictors in a Local Community with a High Deprivation: A Cross-Sectional Studies

Depression is a heterogeneous and etiologically complex psychiatric syndrome thatshows a strong sexual dimorphism and often impacts people with a low socioeconomic status (SES). The aim of the study was to estimate the occurrence of depression symptoms in a local community with a high deprivation rate, the example being the inhabitants of the JanówLubelski County in eastern Poland. A cross-sectional study was carried out on 3752 people aged between 35 and 64. The prevalence of depression symptoms was assessed using the Patient Health Questionnaire-9 (PHQ-9) scale. In the screening for depression symptoms in the entire population we studied, the risk of depression symptoms was 16.1% (n = 605), with women having a significantly higher mean score than men (p < 0.001). Significant predictors associated with the achievement of 10 points and more in the PHQ-9 assessment in the case of women and men were: living alone, education and having comorbidities. Moreover, female participants living in rural areas were significantly more likely to exhibit depression symptoms, whereas smoking was a significant predictor of depressive symptoms in men. It was observed that in the case of obese women, the chance of being in the higher category of the PHQ-9 assessment was 1.41 times higher than in women with normal body weight. However, in the case of men, an increase in age by one year increased the chance of being in a higher category by 1.02 times. Moreover, the odds of falling into a higher category, as assessed by the PHQ-9 questionnaire, among men who drink alcohol more than once a week was 1.7 times higher than in men who do not drink or consume alcohol occasionally. Summarising the results of studies conducted in a local community characterised by a high deprivation rate, socioeconomic and health variables related to SES significantly impacted the incidence of depression, but they differ in terms of gender.

Years of life lost due to alcohol-related mortality: A nationwide population study in Poland, 1999-2017

BACKGROUND

The aim of this study was to assess alcohol-related mortality and years of life lost (YLL) in Poland between 1999 and 2017.

METHODS

A database of 7,168,765 death certificates of Polish residents who died in 1999-2017 was reviewed. This number included 112,512 people who had died due to alcohol consumption. YLL was calculated with the use of the Standard Expected Years of Life Lost (SEYLL) measure; its value was related to the size of the study population and calculated per 100,000 people (SEYLLp). Time trends were determined by joinpoint regression analysis.

RESULTS

In 1999, the SEYLLp value was 653.99 years among males and 71.20 years among females; in 2017, these numbers rose to 1,263.76 and 293.10 years, respectively. Time trend analysis revealed that SEYLLp increased more quickly in females (by 8.69 % per year) than in males (by 3.68 %). The ratio of male to female SEYLLp values decreased from 9.18 to 4.31 over the study period.

CONCLUSIONS

In Poland, both males and females are experiencing adverse changes in the number of alcohol-induced YLLs. However, the disparity in YLLs between males and females is gradually decreasing, primarily due to the value increasing more quickly in females.

Patterns of Alcohol Consumption in the PURE Poland Cohort Study and Their Relationship with Health Problems

(1) Background: Alcohol is a leading risk factor of premature morbidity and mortality. The objective of this study was to investigate the patterns of alcohol consumption in the PURE Poland cohort study baseline. (2) Methods: A Polish cohort was enrolled in the baseline study in 2007–2010. The study group consisted of 2021 adult participants of urban and rural areas from the Lower Silesia voivodeship in Poland (747 men and 1274 women). (3) Results: In the overall study population, 67.3% were current drinkers, 10.3% were former drinkers, and 22.4% were abstainers. Current use of alcohol products was more prevalent in men (77.2%), people living in urban areas (73.0%), and people with a higher level of education (78.0%). The percentage of current drinkers decreased with increasing age (from 73.4% in 30- to 44-year-olds to 48.8% in participants aged 64 and more). The majority of participants (89.2%) declared a low level of alcohol intake. The chance of high level of intake of alcohol was four times higher in men than in women (OR 4.17; CI 1.64–10.6). The majority of participants (54.6%) declared most frequent consumption of low-alcohol drinks (beer, wine) and 21% declared most frequent consumption of spirits. Current drinkers had almost 1.5-fold higher odds of diabetes and cardiovascular diseases (CVD) than never drinkers (OR 1.49, CI 1.03–2.17; OR 1.66, CI 1.27–2.18, respectively). Former drinkers had higher odds for hypertension and CVD than never drinkers (1.73, CI 1.05–2.85; OR 1.76, CI 1.22–2.53, respectively). (4) Conclusions: In our cohort study, we observed several socio-demographic factors differentiating the patterns of alcohol consumption. The preventive programs should focus predominantly on men, people aged <45 years, and those with a higher level of education.

Population-based epidemiological data of follicular lymphoma in Poland: 15 years of observation

Available epidemiological reports on follicular lymphoma (FL) often highlight a significant discrepancy between its high and low incidence rates in Western and Eastern Europe, respectively. The reasons behind that difference are not fully understood, but underreporting is typically presumed as one of the main factors. This study aimed to assess FL epidemiology in Poland based on 2000-2014 data from the Polish National Cancer Registry, which has 100% population coverage and over 90% completeness of the registration. All cases were coded according to ICD-10 and ICD-O-3 recommendations. The total number of registered FL cases was 3,928 with crude (CR) and standardized (SR) incidence rates of 0.72/10⁵ and 0.87/10⁵, respectively. The median age of FL diagnosis was 61 years, with the male to female incidence ratio of 1.06. The distribution of morphological types of FL: not otherwise specified (NOS), grades 1, 2, or 3 were 72.58, 4.81, 12.88, and 9.73%, respectively. Among all reported mature B-cell non-Hodgkin lymphomas, FL was ranked the fourth in incidence, just after chronic lymphocytic leukemia/small lymphocytic lymphoma (CR 3.62/10⁵, SR 4.99/10⁵), plasma cell neoplasms (CR 3.78/10⁵, SR 4.97/10⁵) and diffuse B-cell lymphoma, NOS (CR 2.13/10⁵, SR 2.65/10⁵). The systematic increase in FL incidence among females was observed. Our study confirms a lower FL incidence rate in Poland as compared to other European countries. Moreover, as our analysis was based on a registry with high data completeness, it provides evidence that reasons other than underreporting are responsible for FL incidence discrepancies between Eastern and Western Europe.

Years of life lost due to diseases of the digestive system in Poland according to socioeconomic factors: a cross-sectional study

OBJECTIVES

To analyse years of life lost (YLLs) due to digestive diseases in Poland according to: marital status, education, working status and place of residence.

DESIGN

A cross-sectional study.

SETTING

The study was based on a dataset containing information from death certificates of Poles who died in 2002 and in 2011.

PARTICIPANTS

The analysis covered records with codes K00-K93 according to the International Classification of Diseases and Related Health Problems, 10th Revision.

OUTCOME MEASURES

YLL values were calculated using the Standard Expected Years of Life Lost measure. For each socioeconomic variable, the rate ratio (RR) was calculated as the quotient of YLLs in the less privileged group to the more privileged group.

RESULTS

Among the categories of marital status, the smallest YLL values (per 10 000) were recorded among singles (men: 100.63 years in 2002, 121.10 years in 2011; women: 26.99, 33.33, respectively), and the most among divorced men (657.87, 689.32) and widowed women (173.97, 169.46). YLL analysis according to education level revealed the lowest values in people with higher education (men: 54.20, 57.66; women: 17.31, 18.31) and the highest in people with lower than secondary education (men: 178.85, 198.32; women: 104.95, 125.76). Being economically active was associated with a smaller YLL score (men: 39.93, 59.51; women: 10.31, 14.96) than being inactive (men: 340.54, 219.93; women: 126.86, 96.80). Urban residents had higher YLL score (men: 159.46, 174.18, women: 73.03, 78.12) than rural ones (men: 126.83, 137.11, women: 57.32, 57.56).In both sexes, RR according to education level and place of residence increased, and those according to marital status and working status decreased with time.

CONCLUSIONS

Activities aimed at reducing health inequalities in terms of YLL due to digestive diseases should be primarily addressed to inhabitants with lower than secondary education, divorced and widowed people, urban residents and those who are economically inactive.

Area-Based Socio-Economic Inequalities in Mortality from Lung Cancer and Respiratory Diseases

Background: After political transformation in 1989/1990, Poland experienced a general improvement in living conditions and quality of life, but the benefits did not extend evenly across all segments of the society. We hypothesized that the regional differences in mortality due to diseases of the respiratory system are related to socioeconomic status (SES) and its changes over time. Materials and methods: An ecological study was carried out in 66 sub-regions of Poland using the data from the period of 2010 to 2014. Age-standardized mortality rates (SMRs) were calculated separately for men and women in three age categories: ≥15, 25–64 years, and ≥65 years. An area-based SES index was derived from the characteristics of the sub-regions using the z-score method. Multiple weighted linear regression models were constructed to estimate a real socioeconomic gradient for mortality resulting from lung cancer and respiratory diseases. Results: In the regions studied, the SMRs for respiratory disease varied from 70/100,000 to 215/100,000 in men and from 18/100,000 to 53/100,000 in women. The SMRs for lung cancer varied from 36/100,000 to 110/100,000 among men and from 26/100,000 to 77/100,000 among women. After adjusting for the prevalence of smoking and environmental pollution, the SES index was found to be inversely associated with the SMR for lung cancer in each category of age among men, and in the age group of 25–64 years among women. An increase of the SES index between 2010 and 2014 was associated with a decrease of SMR for respiratory disease both in men and women, but this change was not significantly associated with the SMR for lung cancer. Conclusion: SES appears to be an important correlate of mortality from respiratory diseases and lung cancer at the population level, particularly in men. A lower SES was associated with greater mortality from lung cancer and respiratory diseases. An increase in SES over time was related to a decrease in mortality from respiratory disease, but not from lung cancer.

Educational inequalities in premature mortality in Poland, 2002-2011: a population-based cross-sectional study

BACKGROUND

The aim of the study is to evaluate the differences in premature mortality between educational groups of Polish inhabitants in 2002 and 2011.

METHODS

The analysis included all deaths among inhabitants of Poland, aged 25-64 years, which occurred in 2002 (N=97 004) and 2011 (N=104 598). We calculated age-standardised death rates (SDRs) and summary measures on inequalities. The relative index of inequality (RII) was calculated with Poisson regression.

RESULTS

The SDR for Poland decreased from 285.7 per 100 000 in 2002 to 246.0 in 2011 among males with higher education and increased from 1141.0 in 2002 to 1183.0 in 2011 among males with lower secondary or less education (the rate ratio increased from 4.0 to 4.8). With regard to females with higher education, the SDR decreased from 127.2 per 100 000 in 2002 to 115.6 in 2011. Among females with lower secondary or less education, the SDR increased from 375.8 per 100 000 in 2002 to 423.1 in 2011 (the rate ratio increased from 3.0 to 3.7). The RII increased from 5.8 to 9.7 in the male group and from 4.4 to 8.3 in the female group. The greatest educational inequalities in 2011 were observed in females who died of cardiovascular diseases (RII=14.9) and lung cancer (RII=6.6) and in males who died of suicides (RII=19.3) and lung cancer (RII=11.9).

CONCLUSIONS

Educational inequalities in premature mortality in Poland are growing. There is a need to implement health education programmes targeted at groups of the most poorly educated Polish inhabitants, especially for diseases resulting from smoking and excessive alcohol consumption.

Alcohol and Cigarette Use Among Warsaw Adolescents: Factors Associated With Risk and Resilience

BACKGROUND

Youth in Poland are at notable risk for substance use. Guided by resiliency theory, we examine if developmental risk and promotive factors are associated with substance abuse risk.

OBJECTIVES

We examined the association between adolescent cigarette and alcohol use and related risk and promotive factors including maternal support, neighbors' informal social control, friends' acceptance of substance use, and alcohol and cigarette use by nonparental adults.

METHOD

Data were collected from a random sample of 13- to 14-year-old students attending Warsaw middle schools (N = 3029). We used hierarchical regression models and examined compensatory and protective models of resilience, controlling for sociodemograhic factors.

RESULTS

Our results indicated that friends' acceptance of substance use and perceived drug use among nonparental adults was associated with increased risk cigarette and alcohol use among youth. We found that maternal support moderated the relationship between friends' acceptance of substance use and cigarette use (protective model of resilience). Thus, mother support buffered the negative effects of friends' acceptance of substance use on youths' cigarette use. Neighbor's informal social control and maternal support were associated with reduced risk of alcohol use (compensatory model of resilience).

CONCLUSION

Collectively, results of the study support compensatory and protective models of resilience in a large representative sample of Warsaw adolescents.

Impact of the post-2008 economic crisis on harmful drinking in the Dutch working-age population

BACKGROUND

Studies on the impact of economic crises on alcohol consumption have yielded ambiguous results. Therefore, we studied changes in trends in harmful drinking among Dutch working-age men and women after the post-2008 economic crisis started. We also assessed whether these trend changes differed across age and socioeconomic groups.

METHODS

We used repeated cross-sectional data from the Dutch Health Interview Survey conducted by Statistics Netherlands. Representative samples were independently drawn each month (January, 2004-December, 2013). Our working-age study population consisted of 20,140 men and 22,394 women aged 25-64. For men and women, episodic drinking was defined as drinking ≥6 glasses on one day at least once a week. Chronic drinking was defined as consuming ≥14 glasses/week for women and ≥21 for men. Segmented logistic regression was used to model trend changes separately in men and women.

RESULTS

A downward trend in episodic and chronic drinking before the crisis slowed down after the crisis started. For episodic drinking, we observed a ceasing-of-decline among men aged 35-44/45-54/55-64, compared to a start-of-decline among those aged 25-34 (p-interaction=0.042/0.020/0.047). For chronic drinking, we observed a ceasing-of-decline among women (p=0.023) but not among men in general (p=0.238). Among men, a ceasing-of-decline did occur in those with a high income, but a start-of-decline was found among those with a low income (p-interaction=0.049).

CONCLUSION

In some subgroups of the Dutch working-age population, the downward trend in episodic and chronic drinking ceased after the crisis started. This suggests that the crisis had an upward effect on harmful drinking, but only in specific populations.

Psychiatric Comorbidity in Alcohol Dependence

We review our clinical studies of psychiatric comorbidity in short-term and long-term abstinent and in treatment naïve alcoholics (STAA, LTAA and TNA). TNA ypically have less severe alcoholism than treated abstinent samples and evidence less severe psychiatric disturbance. Lifetime psychiatric diagnoses are the norm for STAA and LTAA but not for TNA. Individuals with alcohol and drug use disorders show greater antisocial personality disturbance, but do not show differences in the mood or anxiety domains or in borderline personality disorder (BPD) symptoms. The studies show that alcoholics can achieve and maintain abstinence in the face of ongoing mood, anxiety, or BPD problems. By contrast, for ASPD, LTAA essentially stop current antisocial behaviors in all seven domains of antisocial behaviors. We believe that ongoing antisocial behavior is not consistent with maintaining abstinence, and that LTAA modify their antisocial behavior despite continued elevated social deviance proneness and antisocial dispositionality. Abstinent individuals without lifetime psychiatric disorders and TNA show more (subdiagnostic threshold) psychiatric symptoms and abnormal psychological measures than non-alcoholic controls in the mood, anxiety, BPD, and antisocial domains. In summary, our studies show that although LTAA have achieved multi-year abstinence, they still report significant psychological distress compared to NAC. We believe this distress may negatively affect their quality of life. This suggests the importance of developing effective care models to address comorbid mental health problems in LTAA. We also show that antisocial personality disorder symptoms decline to the levels seen in normal controls, and that excluding individuals from research with a psychiatric diagnosis does not control for subdiagnostic psychiatric differences between alcoholics and controls.

Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe

Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude of its effect, and whether it is due to regular high intake or episodic binge drinking remain unclear. The aim of this paper was to estimate the contribution of alcohol to mortality in four Central and Eastern European countries. We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe is a prospective multi-centre cohort study in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns. Random population samples of 34,304 men and women aged 45–69 years in 2002–2005 were followed up for a median 7 years. Drinking volume, frequency and pattern were estimated from the graduated frequency questionnaire. Deaths were ascertained using mortality registers. In 230,246 person-years of follow-up, 2895 participants died from all causes, 1222 from cardiovascular diseases (CVD), 672 from coronary heart disease (CHD) and 489 from pre-defined alcohol-related causes (ARD). In fully-adjusted models, abstainers had 30–50 % increased mortality risk compared to light-to-moderate drinkers. Adjusted hazard ratios (HR) in men drinking on average ≥60 g of ethanol/day (3 % of men) were 1.23 (95 % CI 0.95–1.59) for all-cause, 1.38 (0.95–2.02) for CVD, 1.64 (1.02–2.64) for CHD and 2.03 (1.28–3.23) for ARD mortality. Corresponding HRs in women drinking on average ≥20 g/day (2 % of women) were 1.92 (1.25–2.93), 1.74 (0.76–3.99), 1.39 (0.34–5.76) and 3.00 (1.26–7.10). Binge drinking increased ARD mortality in men only. Mortality was associated with high average alcohol intake but not binge drinking, except for ARD in men.

Geographical Inequalities in Alcohol-Related Mortality Rates in Taiwan due to Socio-Demographic Differences

AIMS

To assess the relationships between alcohol-related mortality and socio-demography in Taiwan.

METHODS

Using 2002-2006 data from the national death-diagnosis registration system, we calculated the alcohol-attributed disease mortality of those aged 15 and older in 348 townships in Taiwan. This study provides spatial clustering of alcohol-attributed disease mortality rates and area socio-demographic conditions across townships, examining the relationship between the two using a spatial autoregressive model.

RESULTS

The relative risk of death due to alcohol-attributed diseases was estimated to increase by 2.1 and 0.9% as a result of a 1% increase in the percentage of men and aboriginal residents, respectively. The risk of death was estimated to decrease by 25% for every 1 year increase in education level. Industrialization and labor participation were also found to be predictors of the outcome measure in areas with differing levels of urbanization.

CONCLUSIONS

This study provides significant evidence that township-level relationships between alcohol-related mortality and socioeconomic variables exist in Taiwan. Public health policymakers should better prioritize the specific areas in which comprehensive intervention should be undertaken accordingly.

How economic crises affect alcohol consumption and alcohol-related health problems: a realist systematic review

Economic crises are complex events that affect behavioral patterns (including alcohol consumption) via opposing mechanisms. With this realist systematic review, we aimed to investigate evidence from studies of previous or ongoing crises on which mechanisms (How?) play a role among which individuals (Whom?). Such evidence would help understand and predict the potential impact of economic crises on alcohol consumption. Medical, psychological, social, and economic databases were used to search for peer-reviewed qualitative or quantitative empirical evidence (published January 1, 1990-May 1, 2014) linking economic crises or stressors with alcohol consumption and alcohol-related health problems. We included 35 papers, based on defined selection criteria. From these papers, we extracted evidence on mechanism(s), determinant, outcome, country-level context, and individual context. We found 16 studies that reported evidence completely covering two behavioral mechanisms by which economic crises can influence alcohol consumption and alcohol-related health problems. The first mechanism suggests that psychological distress triggered by unemployment and income reductions can increase drinking problems. The second mechanism suggests that due to tighter budget constraints, less money is spent on alcoholic beverages. Across many countries, the psychological distress mechanism was observed mainly in men. The tighter budget constraints mechanism seems to play a role in all population subgroups across all countries. For the other three mechanisms (i.e., deterioration in the social situation, fear of losing one's job, and increased non-working time), empirical evidence was scarce or absent, or had small to moderate coverage. This was also the case for important influential contextual factors described in our initial theoretical framework. This realist systematic review suggests that among men (but not among women), the net impact of economic crises will be an increase in harmful drinking. Such a different net impact between men and women could potentially contribute to growing gender-related health inequalities during a crisis.

Neighbourhood availability of alcohol outlets and hazardous alcohol consumption in New Zealand

The socio-spatial arrangement of alcohol retailers is potentially important in understanding the relationship between neighbourhood context and 'excessive' alcohol consumption. This New Zealand study examines whether the availability of alcohol products is associated with individual-level alcohol consumption. Measures capturing the availability of alcohol retailers were calculated for neighbourhoods across the country and then appended to a national health survey. At the national level there was no evidence for an association between hazardous consumption and alcohol outlet access. However, there was evidence of associations with neighbourhood retailing for younger Māori and Pacific peoples males; younger European females; middle-aged European men; and older men. The findings provide evidence that 'alcogenic' environments are associated with excessive drinking in New Zealand, albeit that the associations are restricted to particular vulnerable groups.

Spiritual awakening predicts improved drinking outcomes in a Polish treatment sample

PURPOSE

This study examined concurrent and longitudinal associations between two dimensions of affiliation in Alcoholics Anonymous (AA)-attendance and spiritual awakening-and drinking outcomes among adult patients who were in treatment for alcohol dependence in Warsaw, Poland. In a study conducted at four addiction treatment centers, male and female patients (n = 118) with a DSM-IV diagnosis of alcohol dependence were assessed at baseline (Time 1 or T1), 1 month (T2), and 6-12 months postbaseline (T3) for AA meeting attendance, various aspects of AA affiliation, and alcohol use. Alcoholics Anonymous meeting attendance and alcohol consumption were measured using the Timeline Followback interview. Self-report of having had a spiritual awakening was measured using a modified version of the Alcoholics Anonymous Involvement Scale.

RESULTS

There were no cross-sectional or longitudinal associations between AA meeting attendance and improved drinking outcomes. In contrast, self-report of a spiritual awakening between T2 and T3 was significantly associated with abstinence (OR = 2.4, p < .05) and the absence of any heavy drinking (OR = 3.0, p < .05) at T3, even when demographic and clinical characteristics were statistically controlled.

CONCLUSIONS

Self-reports of spiritual awakening predicted improved drinking outcomes in a Polish treatment sample.

Trends in alcohol-related deaths in the EU countries in 1980-2003

AIMS

To explore temporal trends since 1980 in alcohol-related death for people resident in the European Union (EU) and to examine differences between EU members admitted prior to 2004 and new EU members admitted since 2004.

METHODS

The data were extracted from the World Health Organization's European mortality database and the European Health for All database.

RESULTS

New EU members had higher rates of alcohol-related deaths (135.0 ± 18.48 vs 88.9 ± 18.93; t = -8.55 (d.f. = 46), p < .001) and higher death rates from alcohol abuse (whole population: 3.4 ± 1.24 vs 2.6 ± 0.12; t = -2.98 (d.f. = 23.45), p < .01; male population: 6.1 ± 2.17 vs 4.4 ± 0.19; t = -3.87 (d.f. = 23.35), p < .001) than early EU countries. However, a mortality gradient between groups of countries was visible only for female alcohol-related deaths when controlling for mortality rates from all causes. Multivariate regression analyses also indicated that alcohol-related deaths and alcohol consumption were associated negatively with the gross national product (GNP) of EU countries and positively with levels of urbanization.

CONCLUSIONS

Alcohol-related deaths represent more than 10% of all EU mortality and confirm the importance of national prevention strategies for alcohol problems.

The GENACIS project: a review of findings and some implications for global needs in women-focused substance abuse prevention and intervention

Gender, Alcohol, and Culture: An International Study (GENACIS) is a collaborative study of gender-related and cultural influences on alcohol use and alcohol-related problems of women and men. Members conduct comparative analyses of data from comparable general population surveys in 38 countries on five continents. This paper presents GENACIS findings that (1) age-related declines in drinking are uncommon outside North America and Europe; (2) groups of women at increased risk for hazardous drinking include women who cohabit, women with fewer social roles, more highly educated women in lower-income countries, and sexual minority women in North America; (3) heavier alcohol use shows strong and cross-culturally consistent associations with increased likelihood and severity of intimate partner violence; and (4) one effect or accompaniment of rapid social, economic, and gender-role change in traditional societies may be increased drinking among formerly abstinent women. These findings have potentially important implications for women-focused intervention and policy. Substance abuse services should include attention to middle-aged and older women, who may have different risk factors, symptoms, and treatment issues than their younger counterparts. Creative, targeted prevention is needed for high-risk groups of women. Programs to reduce violence between intimate partners must include attention to the pervasive role of alcohol use in intimate partner aggression. Social and economic empowerment of women, together with social marketing of norms of abstention or low-risk drinking, may help prevent increased hazardous alcohol use among women in countries undergoing rapid social change. Greater attention to effects of gender, culture, and their interactions can inform the design of more effective prevention, intervention, and policy to reduce the substantial global costs of alcohol abuse in both women and men.

The incidence of alcohol-associated osteonecrosis of the knee is lower than the incidence of steroid-associated osteonecrosis of the knee: an MRI study

OBJECTIVE

The purpose of the study was to clarify the incidence of alcohol-associated osteonecrosis of the knee using MRI.

METHODS

A total of 131 patients (56 women and 75 men) with osteonecrosis of the femoral head were enrolled; 60 patients had a history of alcohol abuse and 71 had previously received steroids. All patients underwent MRI of the knee. The incidence of alcohol-associated osteonecrosis of the knee was compared with that of steroid-associated osteonecrosis of the knee. Predictive factors of alcohol- and steroid-associated osteonecrosis of the knee were also evaluated.

RESULTS

The incidence of alcohol-associated osteonecrosis of the knee was lower than that of steroid-associated osteonecrosis of the knee (18.3 vs 54.9%; P < 0.001, Fisher's exact probability test). No significant difference in weekly alcohol consumption was observed between patients with osteonecrosis of the knee and those without osteonecrosis of the knee. No significant difference in daily maximum steroid doses was observed between patients with osteonecrosis of the knee and those without osteonecrosis of the knee.

CONCLUSION

The present study revealed that the incidence of alcohol-associated osteonecrosis of the knee is lower than that of steroid-associated osteonecrosis of the knee.

Area of residence and alcohol-related mortality risk: a five-year follow-up study

AIMS

To examine differences in alcohol-related mortality risk between areas, while adjusting for the characteristics of the individuals living within these areas.

DESIGN

A 5-year longitudinal study of individual and area characteristics of those dying and not dying from alcohol-related deaths.

SETTING

The Northern Ireland Mortality study.

PARTICIPANTS

A total of 720,627 people aged 25-74, enumerated in the Northern Ireland 2001 Census, not living in communal establishments.

MEASUREMENTS

Five hundred and seventy-eight alcohol-related deaths.

FINDINGS

There was an increased risk of alcohol-related mortality among disadvantaged individuals, and divorced, widowed and separated males. The risk of an alcohol-related death was significantly higher in deprived areas for both males [hazard ratio (HR) 3.70; 95% confidence interval (CI) 2.65, 5.18] and females (HR 2.67 (95% CI 1.72, 4.15); however, once adjustment was made for the characteristics of the individuals living within areas, the excess risk for more deprived areas disappeared. Both males and females in rural areas had a reduced risk of an alcohol-related death compared to their counterparts in urban areas; these differences remained after adjustment for the composition of the people within these areas.

CONCLUSIONS

Alcohol-related mortality is higher in more deprived, compared to more affluent areas; however, this appears to be due to characteristics of individuals within deprived areas, rather than to some independent effect of area deprivation per se. Risk of alcohol-related mortality is lower in rural than urban areas, but the cause is unknown.

Anti-alcohol posters in Poland, 1945-1989: diverse meanings, uncertain effects

We provide a historical study of the anti-alcohol public health poster in Poland between 1948 and 1990. Our case study illuminates public health policies under communism, with the state as the dominant force in health communication. Poland has a distinctive history of poster art, moving from a Stalinist phase of socialist realism to the diverse styles of the later Polish School. Quantitative and qualitative analysis of 213 posters establishes the major themes and differentiates community approaches, which depict the drinker as a social or political deviant, from those emphasizing individual risk. Medical issues were a minor theme, reflecting public policies geared more toward confinement than treatment. However, Polish School artists used metaphor and ambiguity, and references to the contested cultural symbolism of drink, to complicate and subvert the narrow propaganda intent. Thus, although apparently unsuccessful in restraining overall consumption, these posters offer valuable lessons for policymakers on the use of visual media in health campaigns.

Alcohol and injury in Poland: review and training recommendations

Background

Alcohol plays a significant role in accidents, injuries, and their outcomes. According to the World Health Organization (WHO), there are 76.3 million people with alcohol use disorders worldwide; in 2000, 1.8 million deaths and loss of 58.3 million disability-adjusted life years were attributed to alcohol.

Methods

Although the association between alcohol consumption and trauma-related morbidity and mortality is well-documented, particularly in the US, there is much less information on trauma and alcohol in Poland, a country undergoing unprecedented economic and cultural changes stemming from entry into the European Union (EU) in the midst of a global recession.

Results

Injury is the third leading cause of death in Poland. Rates for all injuries in Poland are higher than in the rest of the EU. Alcohol is one of the greatest risk factors for disease and injury among men and one of the top ten health and injury risk factors for women. In this paper we review the last 10 years of research on injury and alcohol in Poland.

Conclusion

Recommendations are provided for next steps with regard to training health care professionals in emergency medical settings to address this serious and growing problem.

Are there gender differences in the geography of alcohol-related mortality in Scotland? An ecological study

BACKGROUND

There is growing concern about alcohol-related harm, particularly within Scotland which has some of the highest rates of alcohol-related death in western Europe. There are large gender differences in alcohol-related mortality rates in Scotland and in other countries, but the reasons for these differences are not clearly understood. In this paper, we aimed to address calls in the literature for further research on gender differences in the causes, contexts and consequences of alcohol-related harm. Our primary research question was whether the kind of social environment which tends to produce higher or lower rates of alcohol-related mortality is the same for both men and women across Scotland.

METHODS

Cross-sectional, ecological design. A comparison was made between spatial variation in men's and women's age-standardised alcohol-related mortality rates in Scotland using maps, Moran's Index, linear regression and spatial analyses of residuals. Directly standardised mortality rates were derived from individual level records of death registration, 2000-2005 (n = 8685).

RESULTS

As expected, men's alcohol-related mortality rate substantially exceeded women's and there was substantial spatial variation in these rates for both men and women within Scotland. However, there was little spatial variation in the relationship between men's and women's alcohol-mortality rates (r2 = 0.73); areas with relatively high rates of alcohol-related mortality for men tended also to have relatively high rates for women. In a small number of areas (8 out of 144) the relationship between men's and women's alcohol-related mortality rates was significantly different.

CONCLUSION

In as far as geographic location captures exposure to social and economic environment, our results suggest that the relationship between social and economic environment and alcohol-related harm is very similar for men and women. The existence of a small number of areas in which men's and women's alcohol-related mortality had an different relationship suggests that some places may have unusual drinking cultures. These might prove useful for further investigations into the factors which influence drinking behaviour in men and women.

Psychiatric comorbidity in older long-term abstinent alcoholics

BACKGROUND

We compared 89 older abstinent alcoholics (OAA, mean abstinence of 14.8 years), to 53 age and gender-comparable older non-alcoholic controls (ONC) with regard to lifetime and current psychiatric diagnoses, lifetime psychiatric symptom counts, and psychological measures in the mood, anxiety, and externalizing disorder domains. We compared these findings with our previously reported results in analogous middle-aged samples (MAA versus MNC).

METHODS

The methods used were the same as in our previous study of MAA versus MNC.

RESULTS

OAA had more lifetime psychiatric and mood disorder diagnoses than ONC. They also had more lifetime symptoms and psychological test evidence of psychiatric disorder in all domains. However, OAA were less different from ONC than were MAA from MNC on most psychiatric and psychological measures. In both studies, differences between alcoholics and controls were dramatically larger in the externalizing compared with the mood and anxiety domains, and there was little evidence that psychiatric comorbidity measures impacted abstinence duration.

CONCLUSIONS

The finding that OAA had less psychiatric illness than MAA may involve a combination of selective survivorship, selection bias, and cohort differences. Although selection bias may be present in clinical studies of samples of any age, it is a more potent problem in older samples. However, given these potential biases, our results underestimate psychiatric comorbidity in OAA, strengthening our finding of increased psychiatric disorder in OAA versus ONC.

Cognitive performance in long-term abstinent elderly alcoholics

BACKGROUND

To date, there is a wealth of literature describing the deleterious effects of active alcoholism on cognitive function. There is also a growing body of literature on the extent of cognitive recovery that can occur with abstinence. However, there is still a dearth of published findings on cognitive functioning in very long-term abstinence alcoholics, especially in the elderly population.

METHODS

The current study examines 91 elderly abstinent alcoholics (EAA) (49 men and 42 women) with an average age of 67.3 years, abstinent for an average of 14.8 years (range 0.5 to 45 years), and age and gender comparable light/nondrinking controls. The EAA group was divided into 3 subgroups: individuals that attained abstinence before age 50 years, between the ages 50 and 60 years, and after age 60 years. Attention, verbal fluency, abstraction/cognitive flexibility, psychomotor, immediate memory, delayed memory, reaction time, spatial processing, and auditory working memory were assessed. The AMNART and cranium size were used as estimates of brain reserve capacity, and the association of all variables with alcohol use measures was examined.

RESULTS

Overall, the EAA groups performed comparably to controls on the assessments of cognitive function. Only the abstinent in group before 50 years of age performed worse than controls, and this was only in the domain of auditory working memory. EAAs had larger craniums than their controls. This effect was strongest for those who drank the longest and had the shortest abstinence. Such individuals also performed better cognitively.

CONCLUSIONS

Our data showed that elderly alcoholics that drank late into life, but with at least 6 months abstinence can exhibit normal cognitive functioning. Selective survivorship and selection bias probably play a part in these findings. Cognitively healthier alcoholics, with more brain reserve capacity, may be more likely to live into their 60s, 70s, or 80s of age with relatively intact cognition, and to volunteer for studies such as this. Our results do not imply that all elderly alcoholics with long-term abstinence will attain normal cognition.

Alcohol poisoning in Russia and the countries in the European part of the former Soviet Union, 1970 2002

BACKGROUND

To investigate the phenomenon of alcohol poisoning in Russia and the countries in the European part of the former Soviet Union in the period 1970-2002.

METHODS

Four time points were chosen spanning the late Soviet and post-Soviet periods. Data relating to alcohol poisoning deaths were collected at each point for the countries in the region-Belarus, Estonia, Latvia, Lithuania, Russia and Ukraine. Age-standardized death rates from alcohol poisoning were subsequently calculated for the total population and separately for men and women.

RESULTS

In 1970, the alcohol poisoning rates in the countries in this region were exceptionally high in comparative terms. Rates continued to rise in the late Soviet period in all the countries, only falling in the period following Gorbachev's anti-alcohol campaign. Mortality from alcohol poisoning became more common amongst women during the study period. In post-Soviet society alcohol poisoning mortality is occurring on an unprecedented scale although there may be some divergence in trends between the Slavic and Baltic countries which had mirrored each other in the Soviet period. Extremely high poisoning rates are probably explained by a combination of the volume of alcohol being consumed, what exactly is drunk and how it is being drunk. The consumption of illicitly produced alcohol in the post-Soviet period may also be contributing to the high mortality rates.

CONCLUSIONS

Acute alcohol poisoning has now reached unprecedented rates in parts of the ex-USSR with worrying trends among men as well as among women. Effective action by the governments concerned is now essential.