Alcohol use global public health impact
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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

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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)

  • 60+ diseases and injuries

  • Relationship alcohol ↔ health is complex


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

  • Measures and health impact

  • Geographical and cultural differences

  • Gender and demographic differences

  • Health care implications

  • Prevention of harmful use


Different Measures

  • Per capita consumption (PCC)

    • Drinking patterns

  • Comparative risk assessment (CRA)

    • Alcohol use disorders

  • Global burden


Per Capita Consumption

  • (production + imports) – exports population

  • Useful:

    • Monitor consumption

  • Limitations:

    • Unrecorded consumption

    • Abstainers

    • Drinking patterns


Different Measures

  • Per capita consumption

    • Drinking patterns

  • Comparative risk assessment (CRA)

    • Alcohol use disorders

  • Global burden


Standard Drink

  • ~10 gm pure alcohol

    • 12 oz. beer

    • 5 oz. wine

    • 1 oz. spirits


DrinkingPatterns

  • ModerateDrinking:

    • up to 2 drinks/day ♂

    • up to 1 drink/day ♀


ModerateDrinking

  • Benefits

    • Heart attacks

    • Stroke

    • Cognitive impairment

    • Gall stones

    • Diabetes mellitus

  • Problems ~7%

    • Sleep disruption

    • Liver diseases


People Who Should Not Drink

  • Children and adolescents

  • Pregnant

  • Drivers

  • Medications

  • Certain medical conditions


DrinkingPatterns

  • HighRiskDrinking:

  • Men:

    > 14 drinks/weekOR

    > 4 drinks/day

    • Women:

      > 7 drinks/week OR

      > 3 drinks/day


HighRiskDrinking (cont’d)

  • Danger ↑ as intake ↑:

    • 3x laryngeal cancer

    • 3x blood pressure

    • 4x fatty liver

    • Infections


Drinking Patterns

  • Heavy Episodic Drinking (HED):

    • 5+ drinks/occasion ♂

    • 4+ drinks/occasion ♀

  • BAC > 0.08 gm%


  • Risks of HED

    • Vehicle crashes

    • Violence

    • Unsafe sex

    • Unintended pregnancy

    • Heart diseases

    • Psychosocial problems

    • Psychiatric symptoms


    Different Measures

    • Per capita consumption

      • Drinking patterns

    • Comparative risk assessment (CRA)

      • Alcohol use disorders

    • Global burden


    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 Measures

    • Per capita consumption

      • Drinking patterns

    • Comparative risk assessment (CRA)

      • Alcohol use disorders

    • Global burden


    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 Measures

    • Per capita consumption

      • Drinking patterns

    • Comparative risk assessment (CRA)

      • Alcohol use disorders

    • Global burden


    Global Burden of Disease

    • Deaths

    • DALY: Disability-Adjusted Life Years:

      • Life yrs lost from early death

      • Healthy years lost from:

        • Poor health

        • Disability


    DeathsWorldwide

    2.5 million deaths/yr (4% of total)


    Burden of Disease Worldwide

    3rdleading cause of DALYs


    This Lecture Will Cover

    • Measures and health impact✔

    • Geographical/cultural differences

    • Gender and demographic differences

    • Health care implications

    • Prevention of harmful use


    Geographical Regions


    Per Capita Consumption (PCC)

    PCC in litres pure alcohol

    0 – 6 L

    6 – 12 L

    12 – 25 L


    Prevalence of Abstention

    % Abstention

    0% - 40%

    40%-60%

    60%-100%


    DrinkingPatterns (CRA)

    Drinking Patterns

    1 - 2

    2 – 2.5

    2.5 – 3.5

    3.5 - 4


    Rankings by Geographic Regions

    +

    -


    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 Cover

    • Measures and health impact✔

    • Geographical/cultural differences✔

    • Gender and demographic differences

    • Health care implications

    • Prevention of harmful use


    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

    • 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

    • 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

    • 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 cover

    • Measures and health impact✔

    • Geographical/cultural differences✔

    • Gender and demographic differences✔

    • Health care implications

    • Prevention of harmful use


    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


    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 Implications

    Abstinent: don’t encourage to start

    Moderate drinkers: explain risks

    Hazardous drinkers: brief intervention

    Abuse/dependence: refer to specialist


    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 Cover

    • How to measure use and problems✔

    • Geographical/cultural differences✔

    • Gender and demographic differences✔

    • Health care implications ✔

    • Prevention of harmful use


    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

    Campus-based

    Education efforts

    Treat students who have HED

    Parent-based intervention


    This Lecture Covered

    • How to measure use and problems✔

    • Geographical/cultural differences✔

    • Gender and demographic differences✔

    • Health care implications ✔

    • Prevention of harmful use ✔


    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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