Hervé Kuendig

Alcohol outlet density, perceived availability and adolescent alcohol use: a multilevel structural equation model

Objectives: Perceived availability is commonly associated with adolescent alcohol use. Little is known about the factors which shape this perceived availability. The present study investigates (1) whether perceived alcohol availability is related to the characteristics of the adolescents’ social environment and the per capita outlet density in the community and (2) whether adolescent alcohol use is related to perceived availability, social environment characteristics and outlet density. Methods: Multilevel structural equation models were estimated based on data from a national representative sample of 6183 adolescents in the 8th and 9th grades of school (mean age 14.8 years) in 254 communities in Switzerland. Findings: Social environment characteristics, that is, having peers and siblings who drink, going out without parental knowledge of the adolescents’ whereabouts, drinking in public settings and the density of on-premises but not off-premises alcohol outlets, were related to perceived availability. Adolescent alcohol use increased with the permissiveness of social environment characteristics and with increasing perceived availability. Community-level perceived availability and the density of on-premises but not off-premises outlets were related to volume drinking but not to the frequency of risky drinking occasions. Conclusions: Perceived availability and drinking volume appear to be shaped by the adolescents’ social and physical environments. Adolescents who have a variety of opportunities to obtain alcohol might develop the impression that underage drinking is common and socially endorsed. Consequently, preventive actions to curb adolescent alcohol consumption should take into account the social acceptance of drinking and the physical availability of alcohol in the community.

Alcohol and cannabis use as risk factors for injury – a case-crossover analysis in a Swiss hospital emergency department

BackgroundThere is sufficient and consistent evidence that alcohol use is a causal risk factor for injury. For cannabis use, however, there is conflicting evidence; a detrimental dose-response effect of cannabis use on psychomotor and other relevant skills has been found in experimental laboratory studies, while a protective effect of cannabis use has also been found in epidemiological studies.MethodsImplementation of a case-crossover design study, with a representative sample of injured patients (N = 486; 332 men; 154 women) from the Emergency Department (ED) of the Lausanne University Hospital, which received treatment for different categories of injuries of varying aetiology.ResultsAlcohol use in the six hours prior to injury was associated with a relative risk of 3.00 (C.I.: 1.78, 5.04) compared with no alcohol use, a dose-response relationship also was found. Cannabis use was inversely related to risk of injury (RR: 0.33; C.I.: 0.12, 0.92), also in a dose-response like manner. However, the sample size for people who had used cannabis was small. Simultaneous use of alcohol and cannabis did not show significantly elevated risk.ConclusionThe most surprising result of our study was the inverse relationship between cannabis use and injury. Possible explanations and underlying mechanisms, such as use in safer environments or more compensatory behavior among cannabis users, were discussed.

Detrimental drinking patterns: Empirical validation of the pattern values score of the Global Burden of Disease 2000 study in 13 countries

In addition to volume, patterns of drinking have an effect on disease and injury. Depending on the prevailing way alcohol is coghnsumed (i.e. on drinking patterns), mortality and morbidity should vary across cultures even if per capita consumption is about the same. In a Comparative Risk Analysis (CRA), the WHO estimated for the year 2000 the Global Burden of Disease stemming from alcohol consumption by including both dimensions of intake (volume and patterns). For this purpose, a detrimental drinking pattern scale was developed. This scale used expert ratings of six dimensions of the prevailing drinking patterns in each country. The present study attempts first to replicate the expert ratings based on survey data from 13 countries. Secondly, it compares the scaling of individual level data with the scaling of aggregate level data. For the latter, such survey measures as percentage usually drinking with meals and percentage usually getting drunk when drinking to approximate the pattern scoring system used in CRA were constructed. Aggregate and individual level analyses resulted in similar orderings of countries on a one‐dimensional scale. There was a good correspondence between the orderings and countrys values on the CRA detrimental drinking pattern scale. The ordering of countries varied if men and women were scaled separately. The results indicated a bias of expert ratings towards focusing on male drinking patterns. From analysis of the survey data, the patterns in Nigeria appeared relatively more detrimental than the CRA score based on expert ratings, while the patterns in Finland appeared less detrimental. Future attempts to include drinking patterns in addition to volume should take gender differences into account.

Beyond drinking: Differential effects of demographic and socioeconomic factors on alcohol-related adverse consequences across European countries

Background/Aims: Evidence underlines the importance of drinking patterns and individual characteristics in experiencing adverse alcohol-related consequences; however, little research has been conducted to explore who does and who does not experience consequences with similar drinking patterns. Using data from seven European countries, this study assesses the association between demographic and socioeconomic characteristics and six adverse consequences. Methods: Conditional logistic regression models were estimated, cases (experiencing a consequence) being matched to controls (not experiencing the consequence) by drinking patterns. Results: In general, protective effects with increasing age and being in a partnership were consistent. Gender effects were mixed, but mainly protective for women. Educational achievement and economic status showed consistent effects across countries, but different directions of effect across consequences. Consequences mostly associated with individual drinking pattern (injury, blackout, and loss of control over drinking) exhibited similar patterns of associations, but varying ones arose for consequences additionally influenced by societal reaction to drinking (guilt, role failure, and pressure to cut down drinking). Conclusion: Differences in strengths and directions of effects across consequences pointed to the possibility that the reporting of adverse consequences is not only influenced by alcohol consumption, but also by attributional processes related to demographic and socioeconomic statuses.

Alcohol and nonlethal injuries: a Swiss emergency department study on the risk relationship between acute alcohol consumption and type of injury.

BACKGROUND Acute alcohol consumption has been reported to be an important risk factor for injury, but clear scientific evidence on issues such as injury type is not available. The present study aims to improve the knowledge of the importance of alcohol consumption as an injury determinant with regards to two dimensions of the type of injury, namely the nature and the body region involved. METHODS Risk relationships between two injury type components and acute alcohol use were estimated through multinomial and logistic regression models based on data from 7,529 patients-among whom 3,682 had injury diagnoses-gathered in a Swiss emergency department. RESULTS Depending on the type of injury, between 31.1% and 48.7% of casualties report alcohol use before emergency department attendance. The multinomial regression models show that even low alcohol levels are consistently associated with nearly all natures of injury and body regions. A persistent dose-response effect between alcohol levels and risk associations was observed for almost all injury types. CONCLUSIONS The results highlight the importance and consistency of the risk association between low and moderate levels of acute alcohol consumption and all types of injury. None of the body regions and natures of injury could pride on absence of association between alcohol and injury. Public health, prevention, and care implications are considered.

Sport and alcohol: An emergency department study in Switzerland

Abstract The aim of the present study was to empirically determine whether: (a) sport injuries were associated with alcohol consumption before the injury (acute intake) and with usual consumption patterns (chronic high intake and heavy intake on single occasions); (b) the risk of sport injuries related to alcohol consumption differs from that of other injuries; and (c) there are differences between the sexes and between types of sport. Data from 8694 patients attending the emergency department of Lausanne University Hospital between 1 January 2003 and 30 June 2004 were analysed. Of those patients, 4861 came to the hospital because of an injury and 885 patients were identified as having a sport injury (18.2%). Logistic regression was used to estimate the odds ratios of injury relating to alcohol consumption. With increasingly acute intake, the risk of sport and other injuries increased (sports injury and alcohol use in the 6 h before injury compared with no use: odds ratio=4.29, 7.46, and 14.75 for low, medium, and high alcohol use among women, and 2.81, 3.39, and 1.64 for low, medium, and high alcohol use among men). Alcohol consumption was associated with an increasingly higher risk of sport injuries compared with other injuries among women (consumption 6 h before injury: odds ratio=1.12, 1.23, and 1.56 for low, medium, and high alcohol use), but not men (odds ratio=1.17, 0.83, and 0.23 for low, medium, and high alcohol use). Regarding usual consumption patterns, those men and women injured while exercising were more often at-risk drinkers (men: 44%; women: 25%) compared with those injured during other activities (men: 37%; women: 13%). The results indicate that both men and women, but particularly women, should not practise sports after alcohol ingestion. The study raises questions as to whether sport should be generally promoted as an alternative to alcohol consumption in prevention programmes. Whereas some sports seem to be protective (e.g. endurance and fitness sport) for risky alcohol use, the majority are not. It is important to note, however, that we do not dismiss the beneficial effects of practising for an individuals health. The other positive aspect of practising, namely interacting socially with others, may come at the price of an increased alcohol use, particularly in a “wet” culture like Switzerland where any social contact is often accompanied by alcohol consumption.

Acute and usual drinking among emergency trauma patients: a study on alcohol consumption and injury patterns

Objective: To investigate the relationship between usual and acute alcohol consumption among injured patients and, when combined, how they covary with other injury attributes. Methods: Data from a randomised sample of 486 injured patients interviewed in an emergency department (Lausanne University Hospital, Switzerland) were analysed using the χ2 test for independence and cluster analysis. Results: Acute alcohol consumption (24.7%) was associated with usual drinking and particularly with high volumes of consumption. Six injury clusters were identified. Over-representations of acute consumption were found in a cluster typical of injuries sustained through interpersonal violence and in another formed by miscellaneous circumstances. A third cluster, typical of sports injuries, was linked to a group of frequent heavy episodic drinkers (without acute consumption). Conclusions: Among injured patients, acute alcohol consumption is common and associated with usual drinking. Acute and/or usual consumption form part of some, but not all, injury clusters.

Alcohol Dependence Figures in the Swiss General Population: A Sisyphean Challenge for Epidemiologists

Background: Research in Switzerland and elsewhere calls for valid estimations of alcohol dependence figures at the population level. As none of the methodologies developed for this purpose has proven to possess higher validity over others, this study follows the idea of methodological triangulation and compares estimates to assess their convergence. Methods: This study considers 6 standard methodological approaches to derive 17 estimates for alcohol dependence in the Swiss general population. Results: Estimates from statistics on cirrhosis mortality and from the application of external pool estimates agree with the central tendency of adjusted estimates derived using standard alcohol-related screening tools in population surveys. The number of alcohol-dependent individuals living in Switzerland is expected to be close to 250,000 (i.e. approximately 3.9% of the population aged 15 or older). Conclusion: Due to variations in estimates, it is difficult to report consistent figures for alcohol dependence at the general population level in Switzerland. Nonetheless, observation of an unambiguous central tendency and the convergence of estimates support their validity.

Do Objective Measures of Blood Alcohol Concentrations Make More Sense than Self-reports in Emergency Department Studies?

Purpose:Concerns about self-reports have led to calls for objective measures of blood alcohol concentration (BAC). The present study compared objective measures with self-reports. Methods:BAC from breath or blood samples were obtained from 272 randomly sampled injured patients who were admitted to a Swiss emergency department (ED). Self-reports were compared a) between those providing and refusing a BAC test, and b) to estimated peak BAC (EPBAC) values based on BACs using the Widmark formula. Results:Those providing BACs were significantly (P < 0.05) younger, more often male, and less often reported alcohol consumption before injury, but consumed higher quantities when drinking. Eighty-eight percent of those with BAC measures gave consistent reports (positive or negative). Significantly more patients reported consumption with negative BAC measures (N = 29) than vice versa (N = 3). Duration of consumption and times between injury and BAC measurement predicted EPBAC better than did the objective BAC measure. Conclusions:There is little evidence that patients who provide objective BAC measures deliberately conceal consumption. ED studies must rely on self-reports, eg, take the time period between injury and ED admission into account. Clearly, objective measures are of clinical relevance, eg, to provide optimal treatment in the ED. However, they may be less relevant to establishing effects in an epidemiologic sense, such as estimating risk relationships. In this respect, efforts to increase the validity and reliability of self-reports should be preferred over the collection of additional objective measures.

Beyond personality: Experimental investigations of the effects of personality traits on in situ alcohol consumption in social and solitary drinking contexts

Numerous studies have highlighted that personality traits are associated with alcohol problems and disorders; however, little is known on the link between personality and the quantities of alcohol actually ingested during given drinking episodes (i.e. in situ alcohol consumption, in grams of pure alcohol). Based on data of 123 young adults who participated in two wine-tasting assignments (one performed in group, the other individually; sequence of participation assigned at random), the results from regression models suggest that individual characteristics and personality traits are, to some extent, associated with in situ alcohol consumption, but contextual factors (e.g., in line with behavioral exposition and perceptions of norms) might overwhelm such associations in a social context, or later on in similar drinking contexts. These findings argue for the development of early preventive initiatives focusing on social influences and on specific drinking context.