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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


    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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