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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. 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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  1. Alcohol Use: Global Public Health Impact Camila M. Silveira, MD, PhD University of São Paulo

  2. 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

  3. Dimensions of Alcohol Use The Society Demography Acceptable Patterns Availability Age Gender Income How Much The Pattern The Beverage Problems The Person

  4. This Lecture Will Cover • Measures and health impact • Geographical and cultural differences • Gender and demographic differences • Health care implications • Prevention of harmful use

  5. Different Measures • Per capita consumption (PCC) • Drinking patterns • Comparative risk assessment (CRA) • Alcohol use disorders • Global burden

  6. Per Capita Consumption • (production + imports) – exports population • Useful: • Monitor consumption • Limitations: • Unrecorded consumption • Abstainers • Drinking patterns

  7. Different Measures • Per capita consumption • Drinking patterns • Comparative risk assessment (CRA) • Alcohol use disorders • Global burden

  8. Standard Drink • ~10 gm pure alcohol • 12 oz. beer • 5 oz. wine • 1 oz. spirits

  9. DrinkingPatterns • ModerateDrinking: • up to 2 drinks/day ♂ • up to 1 drink/day ♀

  10. ModerateDrinking • Benefits • Heart attacks • Stroke • Cognitive impairment • Gall stones • Diabetes mellitus • Problems ~7% • Sleep disruption • Liver diseases

  11. People Who Should Not Drink • Children and adolescents • Pregnant • Drivers • Medications • Certain medical conditions

  12. DrinkingPatterns • HighRiskDrinking: • Men: > 14 drinks/weekOR > 4 drinks/day • Women: > 7 drinks/week OR > 3 drinks/day

  13. HighRiskDrinking (cont’d) • Danger ↑ as intake ↑: • 3x laryngeal cancer • 3x blood pressure • 4x fatty liver • Infections

  14. Drinking Patterns • Heavy Episodic Drinking (HED): • 5+ drinks/occasion ♂ • 4+ drinks/occasion ♀ • BAC > 0.08 gm%

  15. Risks of HED • Vehicle crashes • Violence • Unsafe sex • Unintended pregnancy • Heart diseases • Psychosocial problems • Psychiatric symptoms

  16. Different Measures • Per capita consumption • Drinking patterns • Comparative risk assessment (CRA) • Alcohol use disorders • Global burden

  17. 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

  18. Different Measures • Per capita consumption • Drinking patterns • Comparative risk assessment (CRA) • Alcohol use disorders • Global burden

  19. 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

  20. Different Measures • Per capita consumption • Drinking patterns • Comparative risk assessment (CRA) • Alcohol use disorders • Global burden

  21. Global Burden of Disease • Deaths • DALY: Disability-Adjusted Life Years: • Life yrs lost from early death • Healthy years lost from: • Poor health • Disability

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

  23. Burden of Disease Worldwide 3rdleading cause of DALYs

  24. This Lecture Will Cover • Measures and health impact✔ • Geographical/cultural differences • Gender and demographic differences • Health care implications • Prevention of harmful use

  25. Geographical Regions

  26. Per Capita Consumption (PCC) PCC in litres pure alcohol 0 – 6 L 6 – 12 L 12 – 25 L

  27. Prevalence of Abstention % Abstention 0% - 40% 40%-60% 60%-100%

  28. DrinkingPatterns (CRA) Drinking Patterns 1 - 2 2 – 2.5 2.5 – 3.5 3.5 - 4

  29. Rankings by Geographic Regions + -

  30. 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)

  31. This Lecture Will Cover • Measures and health impact✔ • Geographical/cultural differences✔ • Gender and demographic differences • Health care implications • Prevention of harmful use

  32. 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

  33. 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

  34. 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)

  35. 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

  36. This lecture will cover • Measures and health impact✔ • Geographical/cultural differences✔ • Gender and demographic differences✔ • Health care implications • Prevention of harmful use

  37. 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

  38. 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)

  39. Health Care Implications Abstinent: don’t encourage to start Moderate drinkers: explain risks Hazardous drinkers: brief intervention Abuse/dependence: refer to specialist

  40. 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

  41. This Lecture Will Cover • How to measure use and problems✔ • Geographical/cultural differences✔ • Gender and demographic differences✔ • Health care implications ✔ • Prevention of harmful use

  42. 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

  43. Special Steps for Colleges Campus-based Education efforts Treat students who have HED Parent-based intervention

  44. This Lecture Covered • How to measure use and problems✔ • Geographical/cultural differences✔ • Gender and demographic differences✔ • Health care implications ✔ • Prevention of harmful use ✔

  45. 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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