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Alcohol Use: Global Public Health Impact. Camila M. Silveira, MD, PhD University of São Paulo. Global Alcohol Use. 2 billion worldwide drink ~1.4 billion moderate → health benefits ~600 million harmful use → global public health problem 76 million → alcohol use disorders (AUD)

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alcohol use global public health impact

Alcohol Use: Global Public Health Impact

Camila M. Silveira, MD, PhD

University of São Paulo

global alcohol use
Global Alcohol Use
  • 2 billion worldwide drink
  • ~1.4 billion moderate → health benefits
  • ~600 million harmful use → global public health problem
  • 76 million → alcohol use disorders (AUD)
  • 60+ diseases and injuries
  • Relationship alcohol ↔ health is complex
dimensions of alcohol use
Dimensions of Alcohol Use

The Society

Demography

Acceptable

Patterns

Availability

Age

Gender

Income

How

Much

The

Pattern

The

Beverage

Problems

The Person

this lecture will cover
This Lecture Will Cover
  • Measures and health impact
  • Geographical and cultural differences
  • Gender and demographic differences
  • Health care implications
  • Prevention of harmful use
different measures
Different Measures
  • Per capita consumption (PCC)
    • Drinking patterns
  • Comparative risk assessment (CRA)
    • Alcohol use disorders
  • Global burden
per capita consumption
Per Capita Consumption
  • (production + imports) – exports population
  • Useful:
    • Monitor consumption
  • Limitations:
    • Unrecorded consumption
    • Abstainers
    • Drinking patterns
different measures1
Different Measures
  • Per capita consumption
    • Drinking patterns
  • Comparative risk assessment (CRA)
    • Alcohol use disorders
  • Global burden
standard drink
Standard Drink
  • ~10 gm pure alcohol
    • 12 oz. beer
    • 5 oz. wine
    • 1 oz. spirits
drinking patterns
DrinkingPatterns
  • ModerateDrinking:
    • up to 2 drinks/day ♂
    • up to 1 drink/day ♀
moderate drinking
ModerateDrinking
  • Benefits
    • Heart attacks
    • Stroke
    • Cognitive impairment
    • Gall stones
    • Diabetes mellitus
  • Problems ~7%
    • Sleep disruption
    • Liver diseases
people who should not drink
People Who Should Not Drink
  • Children and adolescents
  • Pregnant
  • Drivers
  • Medications
  • Certain medical conditions
drinking patterns1
DrinkingPatterns
  • HighRiskDrinking:
  • Men:

> 14 drinks/weekOR

> 4 drinks/day

    • Women:

> 7 drinks/week OR

> 3 drinks/day

high risk drinking cont d
HighRiskDrinking (cont’d)
  • Danger ↑ as intake ↑:
    • 3x laryngeal cancer
    • 3x blood pressure
    • 4x fatty liver
    • Infections
drinking patterns2
Drinking Patterns
  • Heavy Episodic Drinking (HED):
      • 5+ drinks/occasion ♂
      • 4+ drinks/occasion ♀
  • BAC > 0.08 gm%
risks of hed
Risks of HED
  • Vehicle crashes
  • Violence
  • Unsafe sex
  • Unintended pregnancy
  • Heart diseases
  • Psychosocial problems
  • Psychiatric symptoms
different measures2
Different Measures
  • Per capita consumption
    • Drinking patterns
  • Comparative risk assessment (CRA)
    • Alcohol use disorders
  • Global burden
comparative risk assessment cra
Comparative Risk Assessment (CRA)
  • Heavy drinking occasions
    • High usual quantity/occasion
    • Frequency festive drinking
    • Proportion drinking occasions/getting drunk
    • Drinking daily or nearly daily
  • Drinking in public places
  • Drinking with meals
different measures3
Different Measures
  • Per capita consumption
    • Drinking patterns
  • Comparative risk assessment (CRA)
    • Alcohol use disorders
  • Global burden
alcohol use disorders
Alcohol Use Disorders

Dependence

3+ in same 12 mos:

  • Tolerance
  • Withdrawal
  • ↑ amts. or more time
  • Desire/inability to ↓
  • ↓ other activities
  • ↑ obtain, use, recover
  • ↑ consequences

Abuse

1+ in same 12 mos:

  • ↓ role obligations
  • Hazardous use
  • Legal problems
  • Interpersonal problems
  •  dependence
different measures4
Different Measures
  • Per capita consumption
    • Drinking patterns
  • Comparative risk assessment (CRA)
    • Alcohol use disorders
  • Global burden
global burden of disease
Global Burden of Disease
  • Deaths
  • DALY: Disability-Adjusted Life Years:
      • Life yrs lost from early death
      • Healthy years lost from:
          • Poor health
          • Disability
deaths worldwide
DeathsWorldwide

2.5 million deaths/yr (4% of total)

burden of disease worldwide
Burden of Disease Worldwide

3rdleading cause of DALYs

this lecture will cover1
This Lecture Will Cover
  • Measures and health impact✔
  • Geographical/cultural differences
  • Gender and demographic differences
  • Health care implications
  • Prevention of harmful use
per capita consumption pcc
Per Capita Consumption (PCC)

PCC in litres pure alcohol

0 – 6 L

6 – 12 L

12 – 25 L

prevalence of abstention
Prevalence of Abstention

% Abstention

0% - 40%

40%-60%

60%-100%

drinking patterns cra
DrinkingPatterns (CRA)

Drinking Patterns

1 - 2

2 – 2.5

2.5 – 3.5

3.5 - 4

summary
Summary

E Europe worst all measures

Developing countries near top on CRA (middle PCC, abstinence)

E Med and Africa near top on CRA (↓PCC↑ abst)

W Europe lowest CRA (↑ PCC ↓ abst)

this lecture will cover2
This Lecture Will Cover
  • Measures and health impact✔
  • Geographical/cultural differences✔
  • Gender and demographic differences
  • Health care implications
  • Prevention of harmful use
women have
Women Have:
  • ↑BAC/drink

▪↓ muscle → ↓ body water ▪↓ first pass metabolism

  • ↑ hormone/reproduction problems

▪ ↓ progesterone ▪ ↑ estradiol

▪ ↓ luteinizing hormone

  • ↑ some health risks

▪ Breast cancer ▪ Harm to fetus

  • Remember women also:

▪ ↑ abstain ▪Genders are converging

▪ ↓ HED

hed demography
HED Demography
  • Age
    • 18–24 most common HED
    • Earlier onset HED ↑risk of AUD
  • Ethnicity (USA)
    • White non Hispanics: ↓ drinks per HED episode
    • Other than white: ↑ drinks per HED episode
  • Marital status
    • single > married
hed beverage type
HED Beverage Type
  • USA adolescents and young adults
    • Beer>spirits>wine
    • Alcohol-pops ↑ concern (adolescents)
  • European adults
    • ↑ HED beer/spirits (E Europe)
    • ↓ HED if wine with meals (W Europe)
hed college
HED College
  • College 12 mo prevalence
    • USA/ Brazil: ~40% (Male/Female ratio~ 1:1)
  • Alc problems USA
    • 100,000 victims of sexual assault
    • 600,000 injuries
    • 700,000 assaults
    • 3.4 million drove under influence
    • 25% negative academic consequences
this lecture will cover3
This lecture will cover
  • Measures and health impact✔
  • Geographical/cultural differences✔
  • Gender and demographic differences✔
  • Health care implications
  • Prevention of harmful use
health care implications
Health Care Implications
  • ~ 45% with HED see MD
  • MD needs to ask:
    • Quantity/frequency/pattern use
    • Alcohol problems
    • Consider gender and cultural differences
    • Consider use of CAGE
slide38
CAGE

C: Felt you should cut down your drinking

A:Annoyed you by criticizing your drinking

G: Felt guilty about your drinking

E: Drink in AM to ↓ symptoms (eye-opener)

health care implications1
Health Care Implications

Abstinent: don’t encourage to start

Moderate drinkers: explain risks

Hazardous drinkers: brief intervention

Abuse/dependence: refer to specialist

brief intervention
Brief Intervention
  • Target: primary care physicians
  • Effective: non alcohol dependent subjects
  • Goal: moderate drinking not abstinence
  • 4 sessions or fewer (just a few minutes).
  • Elements of Brief Intervention- FACT
    • Feedback
    • Advice
    • Commitment
    • Tracking
this lecture will cover4
This Lecture Will Cover
  • How to measure use and problems✔
  • Geographical/cultural differences✔
  • Gender and demographic differences✔
  • Health care implications ✔
  • Prevention of harmful use
targets to hed
Targets To ↓ HED
  • Leadership, awareness and commitment
  • Health services
        • Community action
  • Drink–driving policies
  • Availability of alcohol
        • Marketing of alcoholic beverages
        • Pricing policies
        • ↓ negative alcohol consequences
        • ↓ public health impact of illicit alcohol
special steps for colleges
Special Steps for Colleges

Campus-based

Education efforts

Treat students who have HED

Parent-based intervention

this lecture covered
This Lecture Covered
  • How to measure use and problems✔
  • Geographical/cultural differences✔
  • Gender and demographic differences✔
  • Health care implications ✔
  • Prevention of harmful use ✔
key messages
KeyMessages
  • Different measures of alc use/problems
  • Countries differ on problem rates
  • Global problems need global interventions
    • Act globally
    • Interventions: effective but underused
    • Health systems: transform to meet new challenges
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