Socio-economic disadvantage is associated with heavier drinking in high but not middle-income countries participating in the International Alcohol Control Study

INTRODUCTION AND AIMS

To investigate if socio-economic disadvantage, at the individual- and country-level, is associated with heavier drinking in some middle- and high-income countries.

DESIGN AND METHODS

Surveys of drinkers were undertaken in some high- and middle-income countries. Participating countries were Australia, England, New Zealand, Scotland (high-income) and Peru, Thailand and Vietnam (middle-income). Disadvantage at the country-level was defined as per World Bank (categorised as middle-or high-income); individual-level measures were (i) years of education and (ii) whether and individual was under or over the poverty line in each country. Measures of heavier drinking were (i) proportion of drinkers that consumed 8+ drinks and (ii) three drinking risk groups (lower, increasing and higher). Multi-level logistic regression models were used.

RESULTS

Individual-level measures of disadvantage, lower education and living in poverty, were associated with heavier drinking, consuming 8+ drinks on a typical occasion or drinking at the higher risk level, when all countries were considered together. Drinkers in the middle-income countries had a higher probability of consuming 8+ drinks on a typical occasion relative to drinkers in the high-income countries. Interactions between country-level income and individual-level disadvantage were undertaken: disadvantaged drinkers in the middle-income countries were less likely to be heavier drinkers relative to those with less disadvantage in the high-income countries.

DISCUSSION AND CONCLUSIONS

Associations between socio-economic disadvantage and heavier drinking vary depending on country-level income. These findings highlight the value of exploring cross-country differences in heavier drinking and disadvantage and the importance of including country-level measurements to better elucidate relationships.

Brief Report: Trends in Social Inequality in Drunkenness Among Danish Adolescents, 1991-2014

OBJECTIVE

This study examined whether social inequality in frequent drunkenness among Danish adolescents changed from 1991 to 2014.

METHOD

We used data from the international Health Behaviour in School-aged Children (HBSC) study, which provided nationally representative samples of 15-year-olds from seven comparable cross-sectional studies in Denmark (N = 8,655). The students provided data about frequency of drunkenness and parents' occupation.

RESULTS

In total, 38.6% reported to have been drunk at least four times, decreasing from 44.2% in 1991 to 21.2% in 2014. Most of the decrease took place in the latter part of the period. This decrease was found in all occupational social classes, but there was no change in absolute social inequality in drunkenness four or more times reported from 1991 to 2014. The sex- and yearadjusted odds ratio for frequent drunkenness was 0.80, 95% CI [0.70, 0.93] in low compared with high occupational social class. The statistical interaction between survey year and occupational social class was insignificant (p = .3601); that is, there was no change in relative social inequality in frequent drunkenness over time.

CONCLUSIONS

Drunkenness was more prevalent among adolescents from the high occupational social class, and this social inequality did not change from 1991 to 2014.

Reinforcer Pathology: The Behavioral Economics of Abuse Liability Testing

Understanding the abuse liability of novel drugs is critical to understanding the risk these new compounds pose to society. Behavioral economics, the integration of psychology and economics, can be used to predict abuse liability of novel substances. Here, we describe the behavioral economic concept of reinforcer pathology and how it may predict the use of novel drugs in existing drug-users and initiation of use in the drug-naive.

The effect of alcohol consumption on household income in Ireland

This paper presents a study of the effects of alcohol consumption on household income in Ireland using the Slán National Health and Lifestyle Survey 2007 dataset, accounting for endogeneity and selection bias. Drinkers are categorised into one of four categories based on the recommended weekly drinking levels by the Irish Health Promotion Unit; those who never drank, non-drinkers, moderate and heavy drinkers. A multinomial logit OLS Two Step Estimate is used to explain individual's choice of drinking status and to correct for selection bias which would result in the selection into a particular category of drinking being endogenous. Endogeneity which may arise through the simultaneity of drinking status and income either due to the reverse causation between the two variables, income affecting alcohol consumption or alcohol consumption affecting income, or due to unobserved heterogeneity, is addressed. This paper finds that the household income of drinkers is higher than that of non-drinkers and of those who never drank. There is very little difference between the household income of moderate and heavy drinkers, with heavy drinkers earning slightly more. Weekly household income for those who never drank is €454.20, non-drinkers is €506.26, compared with €683.36 per week for moderate drinkers and €694.18 for heavy drinkers.

Effects of Economic Disruptions on Alcohol Use and Problems: Why Do African Americans Fare Worse?

OBJECTIVE

This study tested a model of the effects of recession-related job loss on alcohol use disorder (AUD) and examined why African Americans who lost their jobs during the 2008-2009 recession were at increased risk for AUD relative to Whites. We hypothesized that (a) job loss would be positively associated with psychological distress (i.e., higher levels of depressive symptoms) and increased drunkenness, and (b) low levels of family social support and experiences of racial stigma would exacerbate the effects of job loss on distress, especially among African Americans and Hispanics.

METHOD

Data were drawn from the 2010 U.S. National Alcohol Survey (NAS), a cross-sectional survey of the U.S. general population. Using data from the 2010 NAS (telephone survey of 1,111 African American, 964 Hispanic, and 3,133 White adults), we conducted simultaneous path modeling in Mplus to test mediation and moderation hypotheses. Our key outcome was AUD as measured by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

RESULTS

Recession-related job loss was significantly associated with AUD through its effects on increased drunkenness, and the associations were positive for Whites, stronger for African Americans than Whites, and nonexistent for Hispanics. Job loss was associated with distress in the overall sample, and distress was positively associated with drunkenness among African Americans only, suggesting that distress is another pathway by which job loss affects AUD among African Americans. Higher levels of family social support mitigated the effects of job loss on psychological distress, and this relationship did not differ by race/ethnicity.

CONCLUSIONS

During economic downturns, increased stress and heavy drinking are important pathways through which recession-related job loss can lead to greater AUD among African Americans relative to Whites.

The behavioral economics of drunk driving

This study investigates whether drinker-drivers attributes are associated with imperfect rationality or irrationality. Using data from eight U.S. cities, we determine whether drinker-drivers differ from other drinkers in cognitive ability, ignorance of driving while intoxicated (DWI) laws, have higher rates of time preference, are time inconsistent, and lack self-control on other measures. We find that drinker-drivers are relatively knowledgeable about DWI laws and do not differ on two of three study measures of cognitive ability from other drinkers. Drinker-drivers are less prone to plan events involving drinking, e.g., selecting a designated driver in advance of drinking, and are more impulsive. Furthermore, we find evidence in support of hyperbolic discounting. In particular, relative to non-drinker-drivers, the difference between short- and long-term discount rates is much higher for drinker-drivers than for other drinkers. Implications of our findings for public policy, including incapacitation, treatment, and educational interventions, are discussed.

Minimum pricing of alcohol versus volumetric taxation: which policy will reduce heavy consumption without adversely affecting light and moderate consumers?

BACKGROUND

We estimate the effect on light, moderate and heavy consumers of alcohol from implementing a minimum unit price for alcohol (MUP) compared with a uniform volumetric tax.

METHODS

We analyse scanner data from a panel survey of demographically representative households (n = 885) collected over a one-year period (24 Jan 2010-22 Jan 2011) in the state of Victoria, Australia, which includes detailed records of each household's off-trade alcohol purchasing.

FINDINGS

The heaviest consumers (3% of the sample) currently purchase 20% of the total litres of alcohol (LALs), are more likely to purchase cask wine and full strength beer, and pay significantly less on average per standard drink compared to the lightest consumers (A$1.31 [95% CI 1.20-1.41] compared to $2.21 [95% CI 2.10-2.31]). Applying a MUP of A$1 per standard drink has a greater effect on reducing the mean annual volume of alcohol purchased by the heaviest consumers of wine (15.78 LALs [95% CI 14.86-16.69]) and beer (1.85 LALs [95% CI 1.64-2.05]) compared to a uniform volumetric tax (9.56 LALs [95% CI 9.10-10.01] and 0.49 LALs [95% CI 0.46-0.41], respectively). A MUP results in smaller increases in the annual cost for the heaviest consumers of wine ($393.60 [95% CI 374.19-413.00]) and beer ($108.26 [95% CI 94.76-121.75]), compared to a uniform volumetric tax ($552.46 [95% CI 530.55-574.36] and $163.92 [95% CI 152.79-175.03], respectively). Both a MUP and uniform volumetric tax have little effect on changing the annual cost of wine and beer for light and moderate consumers, and likewise little effect upon their purchasing.

CONCLUSIONS

While both a MUP and a uniform volumetric tax have potential to reduce heavy consumption of wine and beer without adversely affecting light and moderate consumers, a MUP offers the potential to achieve greater reductions in heavy consumption at a lower overall annual cost to consumers.

[Evaluation of selected socioeconomic factors in patients with acute ethanol intoxication and alcohol withdrawal syndrome]

INTRODUCTION

Ethanol is commonly overused psychoactive substance in Poland and all around the world. It causes addiction, which occurs as a result of its chronic administration. One of the main symptoms of addiction is hunger due to psychoactive substance that prevents interruption of its adoption and contributes to relapse drinking. Acute poisoning with ethyl alcohol and alcohol withdrawal syndrome are diseases causing a potential danger to life. The prevalence of use and abuse of alcoholic beverages is a potential risk, causing health problems, including permanent damage of the central and peripheral nervous system and socio-economic problems.

OBJECTIVE

The aim of this study is to analyze certain aspects of the socio-economic situation of the patients hospitalized in the Department of Toxicology in Raszeja City Hospital in Poznan due to acute ethanol intoxication or alcohol withdrawal syndrome in 2010.

MATERIAL AND METHODS

299 patients history was evaluated, among which 161 were treated for acute intoxication with ethanol and 138 due to alcohol withdrawal syndrome. Objects of interest were elements of subjective tests including: marital status of patients, their education and professional activity and the problem of homelessness.

RESULTS

The study group consisted of 299 patients in age from 16 to 77 years, hospitalized in the Department of Toxicology in Raszeja City Hospital in Poznan due to acute ethanol intoxication or alcohol withdrawal syndrome. It was found that the largest group consisted of patients remaining married (42.81%) and unmarried (30.43%). Alcohol abuse affects people of all levels of education. In the present study, most patients had a vocational education (37.79%) and medium (23.08%). Patients were analyzed in terms of economic activity, among which about 40% were unemployed. In the whole group more than 10% of those were homeless.

CONCLUSIONS

Ethyl alcohol intoxication and alcohol withdrawal represents a significant hazard. As a result of reliance, patients lose control of alcohol consumption and they cannot reduce the amount and the time of its adoption. Reducing the dose of alcohol can lead to unpleasant withdrawal symptoms that the patient eliminate by adopting another dose. Typical is to continue the alcohol consumption despite knowledge of its harmful health and difficulties such as professional (problems at work or loss), financial (lack of livelihood, poverty) and interpersonal (loss of friends, marriage breakdown, loss of relationships with relatives).

Cost-effectiveness of interventions for reducing road traffic injuries related to driving under the influence of alcohol

OBJECTIVE

To determine the cost-effectiveness of interventions to reduce road traffic injuries caused by driving under the influence of alcohol in Thailand.

METHODS

We used generalized cost-effectiveness analysis and included costs from a health sector perspective. The model considered road traffic crash victims who were injured, disabled, or died. We obtained proportions of alcohol-related crashes from the Thai Injury Surveillance system. Intervention effectiveness was derived from published reviews and a study in one province of Thailand. Random breath testing, selective breath testing, and mass media campaigns, both current and intervention scenarios, were compared with a "do-nothing" scenario. We calculated intervention costs and cost offsets of prevented treatment costs in 2004 Thai baht (US $1 = 41 baht) and measured benefits in terms of disability-adjusted life-years averted. Interventions with incremental cost-effectiveness ratios below 110,000 Thai baht (1×gross domestic product per capita) per disability-adjusted life-year (US $2,680) were considered very cost-effective.

RESULTS

Compared with doing nothing, mass media campaigns, random breath testing, and selective breath testing are all cost saving. When averted treatment costs are ignored and only intervention costs are included, all three interventions are very cost-effective, with incremental cost-effectiveness ratios of 10,300, 14,300 and 13,000 baht/disability-adjusted life-year, respectively. The current mix of mass media campaigns and sobriety checkpoints is therefore also cost-effective, but underinvestment in checkpoints limits its overall effect.

CONCLUSIONS

A greater intensity of conducting sobriety checkpoints in Thailand is recommended to complement the investment in mass media campaigns. Together these interventions have the potential to reduce the burden of alcohol-related road traffic injuries by 24%.

Dutch adolescent private drinking places: prevalence, alcohol consumption, and other risk behaviors

The aim of this research was to explore the increasingly popular Dutch health phenomenon of 'gathering in private peer group settings (barracks)', with a focus on the prevalence and characteristics of barracks, alcohol consumption, and other (risk) behaviors of their visitors. Three studies were conducted. The first consisted of field research in which 51 barracks were visited and group-interviews were held. The second was an Internet study in which 442 barracks' websites were analyzed using content analysis. The third consisted of a questionnaire completed by 1457 adolescents, aged 15-17, in order to explore differences in behavior between barracks visitors and non-visitors. There was wide variation in barracks' characteristics and culture. Barracks' members and visitors also organize diverse activities that are publicly shown on the websites. Barracks are associated with various legal issues, such as alcohol sales to minors, lack of parental supervision, and illicit drug use. Barracks' visitors drink alcohol more frequently, drink more alcohol per occasion (up to fifteen bottles of beer a night), and have been drunk more frequently than non-visitors. Policymakers must be aware of the barracks phenomenon and use their powers in adjacent political and legal areas (such as in binge drinking, illicit drug use, and public safety) to intervene and create solid, responsible, and tailor-made policies.

Economic costs of excessive alcohol consumption in the U.S., 2006

BACKGROUND

Excessive alcohol consumption causes premature death (average of 79,000 deaths annually); increased disease and injury; property damage from fire and motor vehicle crashes; alcohol-related crime; and lost productivity. However, its economic cost has not been assessed for the U.S. since 1998.

PURPOSE

To update prior national estimates of the economic costs of excessive drinking.

METHODS

This study (conducted 2009-2010) followed U.S. Public Health Service Guidelines to assess the economic cost of excessive alcohol consumption in 2006. Costs for health care, productivity losses, and other effects (e.g., property damage) in 2006 were obtained from national databases. Alcohol-attributable fractions were obtained from multiple sources and used to assess the proportion of costs that could be attributed to excessive alcohol consumption.

RESULTS

The estimated economic cost of excessive drinking was $223.5 billion in 2006 (72.2% from lost productivity, 11.0% from healthcare costs, 9.4% from criminal justice costs, and 7.5% from other effects) or approximately $1.90 per alcoholic drink. Binge drinking resulted in costs of $170.7 billion (76.4% of the total); underage drinking $24.6 [corrected] billion; and drinking during pregnancy $5.2 billion. The cost of alcohol-attributable crime was $73.3 billion. The cost to government was $94.2 billion (42.1% of the total cost), which corresponds to about $0.80 per alcoholic drink consumed in 2006 (categories are not mutually exclusive and may overlap).

CONCLUSIONS

On a per capita basis, the economic impact of excessive alcohol consumption in the U.S. is approximately $746 per person, most of which is attributable to binge drinking. Evidence-based strategies for reducing excessive drinking should be widely implemented.

The effect of drink price and next-day responsibilities on college student drinking: a behavioral economic analysis

More than [3/4] of U.S. college students report a heavy drinking episode (HDE; 5 (for men) and 4 (for women) drinks during an occasion) in the previous 90 days. This pattern of drinking is associated with various risks and social problems for both the heavy drinkers and the larger college community. According to behavioral economics, college student drinking is a contextually bound phenomenon that is impacted by contingencies such as price and competing alternative reinforcers, including next-day responsibilities such as college classes. This study systematically examines the role of these variables by using hypothetical alcohol purchase tasks to analyze alcohol consumption and expenditures among college students who reported recent heavy drinking (N = 207, 53.1% women). The impact of gender and the personality risk factor sensation seeking (SS) were also assessed. Students were asked how many drinks they would purchase and consume across 17 drink prices and 3 next-day responsibility scenarios. Mean levels of hypothetical consumption were highly sensitive to both drink price and next-day responsibility, with the lowest drinking levels associated with high drink prices and a next-day test. Men and participants with greater levels of SS reported more demand overall (greater consumption and expenditures) than women and students with low SS personality. Contrary to our hypotheses women appeared to be less sensitive to increases in price than men. The results suggest that increasing drink prices and morning academic requirements may be useful in preventing heavy drinking among college students.

The benefits and harms of alcohol use in New Zealand: what politicians might consider

The New Zealand Government is currently considering ways to reduce alcohol-related harm, following on from a detailed report by the Law Commission. To inform discussions we briefly summarise the benefits and harms of alcohol use in this country. The most substantive benefits to society are probably pleasure to users and economic benefits (largely to industry). The most substantive harms are probably those to mental and physical health, harm to society (e.g. from crime) and adverse net economic impacts. Overall the picture is suggestive that New Zealand society would be likely to achieve a large net benefit from reducing heavy and binge drinking, and shifting alcohol consumption towards a pattern of smaller amounts. The substantial harm to non-users is a key argument for democratic governments to use regulations and taxes to minimise harm from alcohol.

Gasoline prices and their relationship to drunk-driving crashes

This study investigates the relationship between changing gasoline prices and drunk-driving crashes. Specifically, we examine the effects of gasoline prices on drunk-driving crashes in Mississippi by several crash types and demographic groups at the monthly level from 2004 to 2008, a period experiencing great fluctuation in gasoline prices. An exploratory visualization by graphs shows that higher gasoline prices are generally associated with fewer drunk-driving crashes. Higher gasoline prices depress drunk-driving crashes among young and adult drivers, among male and female drivers, and among white and black drivers. Results from negative binomial regression models show that when gas prices are higher, there are fewer drunk-driving crashes, particularly among property-damage-only crashes. When alcohol consumption levels are higher, there are more drunk-driving crashes, particularly fatal and injury crashes. The effects of gasoline prices and alcohol consumption are stronger on drunk-driving crashes than on all crashes. The findings do not vary much across different demographic groups. Overall, gasoline prices have greater effects on less severe crashes and alcohol consumption has greater effects on more severe crashes.

Vehicle occupant injury severity on highways: an empirical investigation

Accident severity analysis is important to both researchers and practitioners because of its implications in accident cost estimation, external cost estimation and road safety. Although much research has been done to explore the factors influencing crash-injury severity, few studies have investigated the association between severity and traffic characteristics collected real-time during the time the accident occurred. We apply a random parameters ordered probit model to explore the influence of speed and traffic volume on the injury level sustained by vehicle occupants involved in accidents on the A4-A86 junction in the Paris region. Results indicate that increased traffic volume has a consistently positive effect on severity, while speed has a differential effect on severity depending on flow conditions.

The role of monthly spending money in college student drinking behaviors and their consequences

OBJECTIVE

Alcohol use among college students is pervasive and affected by economic factors such as personal income and alcohol price. The authors examined the relationship among students' spending money, drinking rate, and alcohol-related consequences.

PARTICIPANTS

In 2005, the authors conducted a Web-based survey among a random sample of 3,634 undergraduate students from 2 large universities.

METHODS

The authors used multiple logistic regression to model drinking behaviors and multiple linear regression to model alcohol-related consequences.

RESULTS

The lowest reported levels of average monthly spending money were associated with reduced levels of drinking and getting drunk. Spending money was independently associated with experiencing alcohol-related consequences caused by a student's own drinking, even after the authors controlled for personal drinking behaviors. The effects for consequences caused by others' drinking were significant for students who had gotten drunk.

CONCLUSIONS

These findings have implications for alcohol price and marketing, particularly around colleges, and suggest actions for parents to consider.

Alert eyes and DWIs: an indirect evaluation of a DWI witness reward program in Stockton, CA

We evaluate a "grassroots" anonymous reward program targeting drunken driving in Stockton, CA. The time-series cross-sectional data covers 19 years for Stockton and six other California cities. Exploiting interrupted time-series regression, Zellner's seemingly unrelated regression (SUR) framework, and bootstrapped standard errors, we test for an impact of this program on alcohol-related injury or fatality accidents, the proportion of all accidents involving alcohol, and the number of DWI arrests. In its first decade, the citizen reward program appears to have averted some 275 alcohol-related accidents for social cost savings of between $21,000 and $5.6 million. Further, possibly 4495 arrests were precluded, saving some $1-3 million in arrest-related costs. Incentivized public monitoring of driving-after-drinking may be an effective drunken driving abatement program though our exploratory findings need further confirmation.

[The interrelationship of alcoholic psychoses and lethal alcohol intoxications with population cash income]

The analysis of dependence of alcoholic psychoses and lethal alcohol intoxications from the portion of poor population all over 87 regions of the Russian Federation revealed the decrease in alcoholism morbidity up to 70.7%. Thereby, the poorer is the territory the higher is the indexes of morbidity and mortality because of alcoholism.

The prevalence of alcohol intoxication in the night-time economy

AIM

To assess the prevalence of alcohol misuse in the night-time economy.

METHOD

A random sample of 893 people were interviewed and breathalysed in 24 repeated, cross-sectional surveys over the course of a year in the city centre streets of a European capital city between 11.00 pm and 3.00 am.

RESULTS

Median blood alcohol concentration (BAC) in men was 0.13% (min = 0%, max = 0.33%) and in women was 0.09% (min = 0%, max = 0.27%)-which were below the threshold used to indicate 'at risk BAC' (0.15%; for men t = 9.32, P < 0.001 and for women t = 17.54, P < 0.001). Men provided higher BACs than women (t = 7.17, P < 0.001). The relationship between age and BAC for men described an inverted 'u', peaking at 29 years, but for women the relationship was positive and linear. BAC was inversely related to the ability to remember and report the evening's consumption (z = 4.76, P < 0.001). Reported consumption predicted only 12% (P < 0.001) of the variance in BAC for men and 10% (P < 0.001) for women.

CONCLUSION

'At risk' intoxication was apparent only in a minority of drinkers, who were mostly employed men in their late twenties, but a third of men and half of women had consumed more than the recommended daily limit. The probability for respondents to recall past consumption diminished as BAC increased suggesting self-report data are not suitable to assess consumption in heavy drinkers. Breath analysis surveys are valuable in understanding alcohol misuse in the night-time economy.

Motives for malt liquor consumption in a sample of community college students

Health and community advocates have raised concerns about consumption of malt liquor, a high alcohol content beverage, among youth. Research on malt liquor use is, however, very limited, leaving unanswered questions about what strategies may effectively prevent this use. This study employed qualitative and quantitative research methods with ethnically diverse college samples to explore and identify motives associated with consumption of malt liquor. Of the motives examined, those representing social facilitation and mood enhancement were the most important predictors of malt liquor use. Anticipation of quick intoxication and economic considerations were also uniquely associated with increased consumption of malt liquor after controlling for other motives and background variables. Coping motives and availability of malt liquor, although being significantly related to malt liquor use in bivariate analyses, were not significantly associated with increased consumption of malt liquor in multivariate analyses. Conformity motives were endorsed by few malt liquor drinkers. Study findings suggest that raising the price and lowering the alcohol content of malt liquor may help reduce consumption of this beverage by young people.

[Marginal case of a practice fee for psychiatric emergency service]

Since 1 January 2004, the German Act for the Modernisation of Health Insurance (GMG) has regulated collection of a so-called practice fee-a charge to patients for their first outpatient health care in any given quarter. We report the case of a slightly inebriated patient who, against his will, was taken to a psychiatric outpatient department by local authorities, where he had to pay the quarterly charge of 10 EUR. Considering that he was forced and therefore had to pay the fee against his will, the present regulation is being discussed with respect to legal and moral implications in psychiatric emergency cases.

Cost-effectiveness of screening and referral to an alcohol health worker in alcohol misusing patients attending an accident and emergency department: a decision-making approach

We present the cost and cost-effectiveness of referral to an alcohol health worker (AHW) and information only control in alcohol misusing patients. The study was a pragmatic randomised controlled trial conducted from April 2001 to March 2003 in an accident and emergency department (AED) in a general hospital in London, England. A total of 599 adults identified as drinking hazardously according to the Paddington Alcohol Test were randomised to referral to an alcohol health worker who delivered a brief intervention (n = 287) or to an information only control (n = 312). Total societal costs, including health and social services costs, criminal justice costs and productivity losses, and clinical measures of alcohol consumption were measured. Levels of drinking were observably lower in those referred to an AHW at 12 months follow-up and statistically significantly lower at 6 months follow-up. Total costs were not significantly different at either follow-up. Referral to AHWs in an AED produces favourable clinical outcomes and does not generate a significant increase in cost. A decision-making approach revealed that there is at least a 65% probability that referral to an AHW is more cost-effective than the information only control in reducing alcohol consumption among AED attendees with a hazardous level of drinking.

Alcohol-related hand injuries

The study was based on 1199 patients consecutively treated for hand injuries in the Second Department of Surgery of the Jagiellonian University in Krakow between the years 1987 and 2000. Three hundred and twenty of these patients (26.6%) had consumed alcohol several hours before an accident. Data collected from an interview with the patient and a doctor on duty were used in the study. Routine tests for blood alcohol concentration were not carried out. Young men (89.3%), mostly manual workers (74.3%) (p<0.001), constituted the majority of patients in the alcohol group. They were younger on average (p<0.001) than sober patients. In most cases, the accident had happened at home (65.9%) (p<0.001) and the main cause of injury was a cut with glass (p<0.001). Despite only minor injuries they were treated in hospital due to their state of intoxication. The degree of hand disability was higher (p<0.05) than with sober patients. The average cost of treatment in a state of intoxication was more than twice as high as the cost of treatment in sober patients. Alcohol-related hand injuries present a major medical and socioeconomic problem.

Effect of the Uniform Accident and Sickness Policy Provision Law on alcohol screening and intervention in trauma centers

BACKGROUND

Alcohol screening and intervention in trauma centers are widely recommended. The Uniform Accident and Sickness Policy Provision Law (UPPL) exists in most states, and allows insurers to refuse payment for treatment of injuries in patients with a positive alcohol or drug test. This article analyzed the UPPL's impact on screening and reimbursement, measured the knowledge of legislators about substance use problems in trauma centers, and determined their opinions about substance use-related exclusions in insurance contracts for trauma care.

METHODS

A nationwide survey of members of the American Association for the Surgery of Trauma was conducted. A separate survey of legislators who are members of the Senate, House, or Assembly and serve in some leadership role on committees responsible for insurance in their state was also performed.

RESULTS

Ninety-eight trauma surgeon and 56 legislator questionnaires were analyzed. Surgeons' familiarity with the UPPL was limited; only 13% believed they practiced in a UPPL state, but 70% actually did. Despite lack of knowledge of the statute, 24% reported an alcohol- or drug-related insurance denial in the past 6 months. This appeared to affect screening practices; the majority of surgeons (51.5%) do not routinely measure blood alcohol concentration, even though over 91% believe blood alcohol concentration testing is important. Most (82%) indicated that if there were no insurance barriers, they would be willing to establish a brief alcohol intervention program in their center. Legislators were aware of the impact of substance use on trauma centers. They overwhelmingly agreed (89%) that alcohol problems are treatable, and 80% believed it is a good idea to offer counseling in trauma centers. As with surgeons, the majority (53%) were not sure whether the UPPL existed in their state, but they favored prohibiting alcohol-related exclusions by a 2:1 ratio, with strong bipartisan support.

CONCLUSIONS

The study documents strong support for screening and intervention programs by both trauma surgeons and legislators. Surgeons experience alcohol-related insurance denials but are not familiar with the state law that sanctions this practice. A majority of legislators are also not familiar with the UPPL but support elimination of insurance statutes that allow exclusion of coverage for trauma care on the basis of intoxication.

The Alcohol Hangover And Its Potential Impact On The UK Armed Forces: A review Of The Literature On Post-alcohol Impairment

OBJECTIVE

To raise awareness within the Defence Medical Services regarding the potential effect of post-alcohol impairment / alcohol hangover.

METHOD

Literature relating to post-alcohol impairment / alcohol hangover, and the evidence for impairment is reviewed, with discussion relating to UK Armed Forces.

CONCLUSION

The evidence for performance impairment during alcohol hangover is not conclusive. Until further evidence is available policy should acknowledge the potential for impaired functioning, particularly the morning after a heavy drinking session, and even when blood alcohol has returned to zero. Recommendations for clinical practice and areas for further research are presented.

[A study of factors effecting on an observation time needed for outpatient treatment of acute alcohol intoxication in Japan]

The purpose of this study was to investigate the factors effecting on an observation time needed for outpatient treatment of acute alcohol intoxication. Subjects were 181 patients with acute alcohol intoxication who visited at the Center of Critical Care Medicine of St. Luke's International Hospital from June 1999 to May 2000. One of 181 patients was admitted as an inpatient. The mean observation time of 180 outpatients was about 3 hours. Ninety-nine outpatients (55%) needed observation time less than 3 hours. High level of Blood Alcohol Concentration (BAC), moderate consciousness disorder (Japan Coma Scale; JCS 10-30), and severe consciousness disorder (JCS 100-300) were significant factors to increase observation time more than 3 hours. Gender and age were not significant factors associated with more-than-3-hour observation time. Observation time of mild consciousness disorder (JCS 1-3) was significantly decreased against that of clear consciousness (JCS 0). Effects of acetaldehyde might be related to elongation of the observation time among clear consciousness patients. Medical resources of emergency medicine in Japan are not enough in some cases (such as few beds and small numbers of staffs), and it is occasionally difficult for patients to stay at a emergency unit for a long time. And the number of hospitalization for acute alcohol intoxication is likely to increase in Japan. Consideration on the attributes, such as BAC or patient's consciousness, associated with observation time of outpatient treatment might be useful to reduce the number of hospitalization and the cost of medical care for acute alcohol intoxication in emergency medicine.

Outlets, drinking and driving: a multilevel analysis of availability

OBJECTIVE

This study examines the degree to which the physical availability of alcohol as measured by outlet densities is related to self-reported individual drinking patterns, preferred drinking location, as well as both driving after drinking (DAD) and driving while intoxicated (DWI).

METHOD

Data from 7,826 drinkers were obtained from a general-population telephone survey of 1,353 zip code areas in California. Measures of individual alcohol consumption included drinking frequency, drinks per occasion and variance in quantities consumed per occasion. Preferred drinking locations included bars, restaurants and the homes of drinkers and of their friends. DAD was defined as driving a motor vehicle within 4 hours of having one or more alcoholic drinks, and DWI was defined as driving after having too much to drink and drive safely. Geographic measures of outlet densities were obtained for bars, restaurants and off-premises establishments, using zip codes as geographic units of analysis. Hierarchical linear modeling was used to relate outlet densities within and surrounding respondents' area of residence to respondents' drinking and to respondents' drinking and driving.

RESULTS

Whereas restaurant densities were directly related to greater drinking frequencies and DAD, bar densities were inversely related to DAD. There were no direct effects of drinking patterns on drinking and driving. Drinking and driving was strongly related to drinking location preference (e.g., bars and restaurants) only when considered simultaneously with individual drinking patterns, particularly drinking frequency.

CONCLUSIONS

Increased restaurant density is strongly related to higher rates of both self-reported driving after drinking and drinking frequency. The strongest influence on both driving after drinking and driving while intoxicated is preferred drinking location considered together with individual drinking patterns. Outlet density and preferred drinking location when considered together with individual drinking patterns support driving after drinking and thereby increase the potential for alcohol-related accidents.

Can alcohol price policies be used to reduce drunk driving? Evidence from Canada

Drunk driving is one of the more serious negative consequences of alcohol consumption. Since consumption of alcohol is sensitive to the price of alcohol, and the occurrence of drunk driving is sensitive to the level of alcohol consumption, the possibility exists for alcohol pricing policies to be used to reduce drunk driving in the population. This paper reviews the evidence on this possibility in the literature and adds results based on data from the Canadian province of Ontario. Multiple regression analysis of time series data for Ontario from 1972 to 1990 indicate that, controlling for income, the proportion of young males in the population, changes in the minimum drinking age, and other confounding variables, increasing the price of alcohol has a significant effect in reducing alcohol-related motor vehicle accidents (elasticity = - 1.2, p < .05) and alcohol-related traffic offenses (elasticity = -0.50, p < .05). Overall, the evidence strongly supports the view that alcohol tax and pricing policies can be used to reduce the extent of drunk driving.

Costs of alcohol-related crashes: New Zealand estimates and suggested measures for use internationally

This paper presents policy-oriented measures of alcohol-related crash incidence and costs in New Zealand (N.Z.). Costs of crashes, where alcohol probably was a contributing factor were computed from official crash costs and police-reported crash/injury counts adjusted for under-reporting of crashes and of alcohol involvement. Alcohol-related crashes cost an estimated $1.2 billion in N.Z. in 1996. They equate to an estimated $0.75 per drink consumed, $17.80 per km driven above the legal limit of 0.08. and $1,100 per heavy drinker. People other than the drinkers, who caused the crashes, paid half the costs. An estimated one in 90 drunk-driving trips resulted in a crash (and often a drunk driving conviction) while one in 375 crash-free drunk driving trips also resulted in a drunk-driving conviction. Ten measures of alcohol-related crash incidence and costs are recommended for international use. They include number of alcohol-related deaths and injuries; innocent victims and children harmed in crashes caused by drinkers; annual costs and costs paid by people other than the drinker who caused the crash; crash costs per drink consumed, per heavy drinker, per kilometer driven drunk versus sober; probabilities of crash and of drunk-driving conviction.

The gin epidemic: much ado about what?

While there is no doubt that the era of the 'gin epidemic' was associated with poverty and social unrest, the surge in gin drinking was localized to London and was a concomitant, not the cause, of these problems. The two main underlying social problems were widespread overcrowding and poverty. The former was related to an unprecedented migration of people from the country to London. The latter stemmed from an economic ideology called 'poverty theory', whose basic premise was that, by keeping the 'inferior order' in poverty, English goods would be competitive and would remain that way since workers would be completely dependent on their employers. Widespread overcrowding and poverty led to societal unrest which manifested itself in increased drunkenness when cheap gin became available after Parliament did away with former distilling monopolies that had kept prices high. Reformers ignored the social causes of this unrest and, instead, focused on gin drinking by the poor which they feared was endangering England's wealth and security by enfeebling its labour force, and reducing its manpower by decreasing its population. Part of this hostility was also related to gin itself. While drunkenness was often spoken of affectionately when it was induced by beer, England's national drink, gin was considered a foreign drink, and therefore less acceptable. These concerns were voiced less often after the passage of the Tippling Act of 1751, which resulted in an increase in gin prices and decreased consumption. However, the second half of the century was also a period in which England's military victory over the French gave it new wealth and power, which dispelled upper-class fears about an enfeebled and dissolute working class. It was also an era when new public health measures, such as mass inoculation against smallpox, and a decrease in the marrying age, led to a population increase that dispelled reformist fears about manpower shortages. The conclusion is that, while the lower cost of gin sparked the 'gin epidemic', the social unrest associated with this unprecedented surge in gin consumption was exacerbated, rather than caused, by the increase in drinking.

Youth cultures and consumption in contemporary Europe

Angelo Varni, ed., Il mondo giovanile in Italia tra Ottocento e Novecento (Bologna: Il Mulino, 1998), 252 pp., £38.00, ISBN 8-815-06779-5. Frank Mort, Cultures of Consumption: Masculinities and Social Space in Late Twentieth-century Britain (London: Routledge, 1996), 280 pp., ISBN 0-415-03052-8. Andrew Blake, The land without music: music, culture and society in twentieth-century Britain (Manchester: Manchester University Press, 1997), 256 pp., ISBN 0-719-04299-2. Bill Osgerby, Youth in Britain since 1945 (Oxford: Blackwell, 1998), 256 pp., ISBN 0-631-19477-0. Christoph Bernhardt and Gerd Kuhn, Keiner darf zurückgelassen werden! Aspekte der Jugendhilfepraxis in der DDR 1959–1989 (Münster: Votum, 1998), 176 pp., ISBN 3-930-40595-4. David Fowler, The first Teenagers: The Lifestyle of Young Wage-earners in Interwar Britain (London: The Woburn Press, 1995), 212 pp., ISBN 0-713-04018-1. Alfons Klenkmann, Wilde Jugend. Lebenswelt grossstaedtischer Jugendllcher zwischen Weltwirtschaftkrise, Nationalsozialismus und Waehningsreform (Essen: Klartext, 1996), 480 pp., ISBN 3-884-74283-3. Paola Ghione and Marco Grispigni, eds. Giovani prima della rivolta (Roma: Manifestolibri, 1998), 252 pp., £28.00, ISBN 8-872-85172-6.

The operation failed, but the patient survived: varying assessments of the Soviet Union's last anti-alcohol campaign

From the mid 1980s mortality levels have fluctuated greatly in the former Soviet Union. After dropping substantially during the late 1980s, mortality rose to unprecedented levels during the early 1990s. The sharp fluctuations in mortality are commonly linked to variations in alcohol consumption in connection with the anti-alcohol campaign launched in 1985. This large-scale natural alcohol policy experiment has produced very mixed appraisal and this article provides a systematic review of the wide variety of judgments, focusing on goals, implementation, and effects on life expectancy, alcohol consumption, mortality, crime, etc. Deviant evaluations are in part ascribable to a general schism between narrowly focused epidemiological perspectives on public health interventions and broader social science approaches to political reform.

The alcohol hangover

PURPOSE

To review the cause, pathophysiologic characteristics, cost, and treatment of alcohol-induced hangover.

DATA SOURCES

A MEDLINE search of English-language reports (1966 to 1999) and a manual search of bibliographies of relevant papers.

STUDY SELECTION

Related experimental, clinical, and basic research studies.

DATA EXTRACTION

Data in relevant articles were reviewed, and relevant clinical information was extracted.

DATA SYNTHESIS

The alcohol hangover is characterized by headache, tremulousness, nausea, diarrhea, and fatigue combined with decreased occupational, cognitive, or visual-spatial skill performance. In the United States, related absenteeism and poor job performance cost $148 billion annually (average annual cost per working adult, $2000). Although hangover is associated with alcoholism, most of its cost is incurred by the light-to-moderate drinker. Patients with hangover may pose substantial risk to themselves and others despite having a normal blood alcohol level. Hangover may also be an independent risk factor for cardiac death. Symptoms of hangover seem to be caused by dehydration, hormonal alterations, dysregulated cytokine pathways, and toxic effects of alcohol. Physiologic characteristics include increased cardiac work with normal peripheral resistance, diffuse slowing on electroencephalography, and increased levels of antidiuretic hormone. Effective interventions include rehydration, prostaglandin inhibitors, and vitamin B6. Screening for hangover severity and frequency may help early detection of alcohol dependency and substantially improve quality of life. Recommended interventions include discussion of potential therapies and reminders of the possibility for cognitive and visual-spatial impairment. No evidence suggests that alleviation of hangover symptoms leads to further alcohol consumption, and the discomfort caused by such symptoms may do so. Therefore, treatment seems warranted.

CONCLUSIONS

Hangover, a common disorder, has substantial morbidity and societal cost. Appropriate management may relieve symptoms in many patients.

How intoxicated are drivers in the United States? Estimating the extent, risks and costs per kilometer of driving by blood alcohol level

This study develops and applies an algorithm with international applicability for estimating vehicle kilometers (kms) driven by blood alcohol level (BAL) from police crash report data. In the United States, an estimated one in 120 kms was driven with BAL > or = 0.10% in 1992-1993. The ratio increased to 1 in 7 kms driven on weekend evenings. The estimated cost per vehicle km driven with BAL > or = 0.08% was $3.40 compared to $0.07 per sober km. Males, those age 21-29 and those driving between 22:00 and 04:00 had the greatest percentage of driving with BAL > or = 0.08%. These estimates are computed, in part, from early 1960s data on crash odds by driver BAL and assume crash odds by BAL relative to sober do not vary with driver age and sex. Preliminary investigation indicates that the method provides reliable estimates of alcohol-positive kms from roadside surveys at night, but seems to over-estimate high-BAL kms. Direct field validation is highly desirable.

The effects of price on the consequences of alcohol use and abuse

Economists have examined the impact of alcohol prices on various outcomes related to alcohol consumption, including nonfatal and fatal motor vehicle accidents, other accidents, liver cirrhosis, and other alcohol-related mortality, crime, and education attainment. Price, in the context of this research, includes not only the monetary price of alcoholic beverages, but also a wide variety of other "costs" of drinking and heavy drinking, including the time spent obtaining alcoholic beverages and the legal costs associated with drinking and related behavior. This research clearly demonstrates that increases in the monetary prices of alcoholic beverages, which could be achieved by increasing taxes on alcohol, can significantly reduce many of the problems associated with alcohol use and abuse. In addition, control policies that raise other "costs" of drinking, including reduced availability of alcoholic beverages, higher legal drinking ages, and others, are also effective in reducing the consequences of alcohol use and abuse.

Hospital charges to injured drinking drivers in Washington State: 1989-1993

The Washington State Patrol Crash Database and computerized hospitalization records for 1989-1993 were used to determine total hospital charges billed for motor vehicle collision injuries to drivers whose crash reports contained any indication of alcohol use. In this population-based study, total hospital charges were summed, and mean charges and lengths of stay were computed within alcohol use and insurance coverage status categories in an attempt to evaluate the hospital charges billed to public funding and private insurance. Of the total hospital charges for drivers with injuries from motor vehicle collisions for which a police-reported indicator of alcohol use status was available, 43% (U.S.$64.8 million) were for drivers who reportedly had been drinking. At the time of discharge, Medicaid was identified as the payor for 47% of these hospitalizations. The mean hospital charge billed per collision was greater for drinking (U.S.$18,258) than nondrinking drivers (U.S.$14,181). Drinking drivers also had longer hospital stays, even after adjustment for patient age, gender and injury severity. During this time in Washington state, the average annual amount billed at discharge for initial inpatient care of injuries to drivers who reportedly had been drinking at the time of the motor vehicle collision was U.S.$13 million. This includes only the amount assessed by the hospital at the time of discharge for treatment of the initial injury and does not include other related medical charges for rehabilitation or outpatient care, or for doctors' or laboratory fees. As increasing pressures of managed and capitated care lead to a shift of financial risk from the federal government and insurers to states and providers, the financial burden of specific, potentially preventable conditions such as this will receive greater attention.

Costs and benefits of a community sobriety checkpoint program

OBJECTIVE

Alcohol-involved crashes cost society more than $100 billion a year. Sobriety checkpoints are effective in apprehending drunk drivers. This article compares the costs and the estimated monetary benefits from a hypothetical community sobriety checkpoint program.

METHOD

The analysis is constructed around a hypothetical community with 100,000 licensed drivers. A literature review suggests that a generously funded intensive checkpoint program (156 checkpoints per year) can be expected to reduce alcohol-attributable crashes by about 15%. The benefits (cost savings) of the checkpoint program are calculated using 1993 alcohol-involved crash incidence from the National Highway Traffic Safety Administration. Costs per alcohol-involved crash and the percentage of alcohol-involved crashes attributable to alcohol are updated from published studies.

RESULTS

Estimated annual savings to the hypothetical community total $7.9 million. This includes $3.1 million for averted fatalities, $4.5 million for averted non-fatal injuries, and $0.3 million for averted property damage. Every $1 spent on a sobriety checkpoint program can be expected to save the community more than $6, including $1.30 of insurer costs.

CONCLUSIONS

An intensive sobriety checkpoint program can save a community more in automobile crash costs than the program costs.

The financial impact of alcohol-related emergencies on a rural EMS system

HYPOTHESIS

Alcohol is a major factor in ambulance responses in rural Alaska; alcohol-related emergencies significantly increase the expense of operating an advanced life support ambulance service.

METHODS

A prospective analysis was performed on emergency medical responses one year, ending September 30, 1997. Data were collected from medical records, police documents, and court records.

ANALYSIS

Each ambulance response was analyzed for the presence of alcohol. The departmental budget was reviewed to separate out fixed and variable costs. Between these analyses, a determination was made regarding the actual cost of all alcohol-related ambulance responses.

RESULTS

Six hundred eighty-one patients were included for study. Alcohol was a factor in one hundred ninety-one (28.0%) of these patients. The cost to the community for alcohol-related responses amounted to $81,503, representing 19.2% of the budget.

CONCLUSION

The cost to respond to alcohol-related emergencies represents a significant fraction of Ketchikan's total emergency medical budget.

Economic costs of alcohol abuse and alcoholism

The economic cost to society from alcohol abuse and alcoholism in the United States was an estimated $148 billion in 1992. When adjusted for inflation and population, the estimates are generally comparable with cost estimates produced over the past 20 years. The current estimates are significantly greater than the most recent detailed estimates developed for 1985--about 42% above increases due to population growth and inflation. Between 1985 and 1992, inflation accounted for about 37.5% and population growth for 7.1% increases. Changes in prevalence have been associated with a modest reduction in alcohol costs. Though crime rates did not materially change over this period, criminal justice expenditures more than doubled overall, even after adjustment for price increases. The balance of changes are due to new findings and/or methodology indicating larger impacts than previously estimated. It is estimated that 45.1% of costs are borne by alcohol abusers and/or members of their households, 38.6% are borne by government, 10.2% by private insurance, and 6.0% by victims of alcohol-related trauma (motor vehicle crashes plus crime). The costs staying in the household of the abusers may be materially incident on persons other than the abuser, e.g., spouses, children.

Shifting categories of the social harms associated with alcohol: examples from late medieval and early modern England

This paper offers a historical perspective on our own attempts to define the social harms associated with the abuse of alcohol. Challenging the notion that categories are necessarily objective and constant, it instead emphasizes the extent to which even harms that are visible and thus susceptible to measurement are in fact socially constructed. English sources from the preindustrial era revealed six broad categories of social harms associated with the abuse of alcohol. Four of the categories consisted of visible harms in the form of income lost, domestic violence, brawling, and accidents, all of which are still recognized as social harms associated with the abuse of alcohol. The other two categories, reversal of the established moral order and susceptibility to trickery, were of an essentially intrinsic or subjective nature and have since dropped from the lexicon of social harms.