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Recent research has suggested a decline in alcohol use among students, however, only a few papers offer to explain why adolescents are drinking less. According to ESPAD, adolescents' alcohol use is decreasing in Europe, but only Hungary shows an increasing trend. The paper aims to give explanation for the opposite trends. The analysis is based on a cross-national dataset, ESPAD in 2003 and 2019, involving 25 countries (N = 157,790). The background variables cover family, school, leisure time, risk behaviors. Chi-square tests, logit explanatory model, KHB method were applied. In Hungary and in countries with decline the strongest relation with current alcohol use was found for internet use, going out, parental control, daily smoking, and alcohol intake. In countries with decline and in Hungary, stronger parental control, going out less often, smoking less may contribute to a declining trend while a more widespread internet use may contribute to an increasing trend. Hungary shows the same pattern as the countries with decline, so other factors such as a lack of alcohol policy, permissive attitudes, media representation, health awareness may be behind the different trends. Future research should be directed toward providing further explanations for the opposite trends. [ABSTRACT FROM AUTHOR]

Background: Youth mortality from drugs is worryingly increasing in Europe. Little is so far known about what substance use services are available to young people. An out-of-home care placement is often used but does not suffice alone as an intervention in problematic substance use among youth. Additional interventions are needed. Objective: This narrative review investigated what has been done, what works, and what is needed in treating youth substance use in the Nordic countries from the viewpoint of social services. This study brought together previous Nordic studies on this topic and presented responses to youth substance use in Nordic social welfare system to the wider international audience. Methods: A search of the ProQuest and EBSCOhost databases revealed seven interventions reported in 17 papers. Narrative synthesis was used. Results: Interventions included the Cannabis Cessation Program (CCP), the Icelandic version of the Motivation to Change Inventory for Adolescents, the Norwegian multisystemic therapy program (MST), the Structured Interview Manual UngDOK implemented in the Swedish Maria clinics, the Finnish ADSUME-based intervention in school health care, and the Swedish Comet 12–18 and ParentStep 13–17 programs. Many interventions had originated in the US rather than in the Nordic countries and most of them were adapted from adult interventions when youth specificity was lacking. Parental involvement was deemed important, but ineffective without involving the adolescent themself. Interventions and ways for dealing with young offenders required reconsideration from the perspective of the best interests of the child. The current research focuses on universal prevention while more knowledge about selective and indicative prevention was called for. Conclusions: Not enough is known about the cessation of problematic youth substance use and subsequent rehabilitation in social services. We would encourage further research on the multi-producer system, subscriber-provider-cooperation in youth substance use services, non-medical youth-specific substance use interventions in social services, and rehabilitative juvenile drug offense practices. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present development in the alcohol policy area in Europe in the last 30 years. Design/methodology/approach: Description of policy instruments and analysis of legal basis are used in this study. Findings: Progress has been achieved in some areas; however, as complicated policy areas, it requires constant effort and engagement of all public health actors. Research limitations/implications: Continuous advocacy effort leads to increased policy actions, interest and research in the area. Lack of policy instruments jeopardises the future of the field. Practical implications: This study provides a brief overview of policy landscape and aims to spark readers interest in the alcohol policy. Originality/value: This study provides an overview of a policy field, not only looking at the legal basis but also meshing with the experience of working in an alliance of civil society organisations. [ABSTRACT FROM AUTHOR]

Alcohol use is one of the top five causes of disease and disability in almost all countries in Europe, and in the eastern part of Europe it is the number one cause. In the UK, alcohol is now the leading cause of death in men between the ages of 16–54 years, accounting for over 20% of the total. Europeans above 15 years of age in the EU on average consume alcohol at a level which is twice as high as the world average. Alcohol should therefore be a public health priority, but it is not. This paper puts forward a new approach to reduce alcohol use and harms that would have major public health and social impacts. Our approach comprises individual behaviour and policy elements. It is based on the assumption that heavy drinking is key. It is simple, so it would be easy to introduce, and because it lacks stigmatising issues such as the diagnosis of addiction and dependence, it should not be contentious. [ABSTRACT FROM PUBLISHER]

Introduction and Aims To develop a measure of alcohol affordability ( AA) and compare the AA of 65 cities worldwide. Design and Methods In this paper, AA is defined as the proportion of median daily income needed to buy a certain quantity of certain alcoholic beverages. The income data and the price of alcoholic beverages were drawn from the Union Bank of Switzerland survey and the Economist Intelligence Unit respectively. Results A large majority of cities (87.7%, n = 57) had a high level of AA. The top 20 ranking was occupied by European and American cities with Tokyo in the Western Pacific region being the exception. All cities belonging to high-income countries had high levels of AA. However, two cities with low-level AA came from low-middle-income countries instead of low-income countries. Discussion and Conclusions The findings have shown that alcohol consumption is highly affordable in many cities. If price policy is being considered as policy instrument of alcohol control, it is in urgent need of price adjustments. More specifically, the new emerging economies play a significant role in the world alcohol control movement because of their bright economic performance with huge population size. Further studies on AA, especially periodical monitoring and its impacts on alcohol consumption and alcohol related health problems, should be conducted so as to facilitate the formulation and evaluation price measure of alcohol control. [ABSTRACT FROM AUTHOR]

Alcohol is a major risk factor for burden of disease and injury in Europe, and contributes markedly to between region differences in life expectancy. Monitoring and surveillance systems have shown to be a key factor in implementing effective policies. The aim of this paper is to propose a system of indicators for alcohol consumption and attributable harm which can be used as an over-time monitoring tool at the country level as well as for comparisons between countries. A systematic research in electronic data bases was conducted but most of the information was derived from ongoing international efforts to establish alcohol monitoring and surveillance systems. European Union. Countries. Exposure to alcohol, mortality, burden of disease. Adult per capita alcohol consumption, prevalence of abstention, and frequency of drinking more than 60g pure alcohol in one occasion are proposed as a minimal set of alcohol exposure indicators, which can quickly be implemented in all EU countries. With respect to health harm indicators, the best minimal choice which can be implemented quickly in all countries of the EU would be alcohol-attributable years of life lost due to premature death. In addition, country specific indicators could be added, when alcohol places specific burden on specific diseases. National and European Union-wide monitoring systems for alcohol exposure and attributable harm to inform public health-related policy decisions could be implemented easily. The establishement of such monitoring systems would follow the recent World Assembly resolution for a global strategy to reduce alcohol-related harm. [ABSTRACT FROM AUTHOR]

Reducing alcohol-related harm in young people is a major priority across Europe. Much alcohol use and associated harm in young people occurs in public drinking environments. This review aims to identity environmental factors in drinking establishements that are associated with increased alcohol consumption and associated harm and to understand the extent of study in this area across Europe. A systematic literature search identified studies that had explored associations between physical, staffing and social factors in drinking environments and increased alcohol use or alcohol-related harm. Fifty-three papers were identified, covering 34 studies implemented in nine countries. Most studies had been implemented in non-European countries and many had collected data more than a decade prior to the review. The majority had used observational research techniques. Throughout the studies, a wide range of physical, staffing and social factors had been associated with higher levels of alcohol use and related harm in drinking environments. Factors that appeared particularly important in contributing to alcohol-related problems included a permissive environment, cheap alcohol availability, poor cleanliness, crowding, loud music, a focus on dancing and poor staff practice. However, findings were not always consistent across studies. Drinking establishments, their management and the behaviours of the young people who use them vary widely across Europe. While international research shows that environmental factors in drinking settings can have an important influence on alcohol-related harm, there is currently a scarcity of knowledge on the relevance and impacts of such factors in modern European settings. Developing this knowledge will support the implementation of strategies to create drinking environments in Europe that are less conducive to risky drinking and alcohol-related harm. [ABSTRACT FROM AUTHOR]

This paper examines the drinking behaviour of young adults aged 24-32 who were married or were cohabiting. Data on this subject were available from surveys in 10 European countries. These were carried out under the auspices of the major investigation entitled 'Gender, Alcohol and Culture: An International Study (GENACIS)'. In general married people were similar to those cohabiting on annual frequencies of alcohol consumption, but lower on amounts consumed on each occasion and, therefore, on annual volumes. However, the extent of these differences varied in different countries. On the usual consumption per occasion measure, there were larger differences between married and cohabiting in Sweden, Spain, the United Kingdom, the Czech Republic and Norway than in Germany, Finland, Denmark, Iceland and Hungary. The differences between married and cohabiting people were, however, not associated with gender or with the presence of children. At the aggregate country level no associations could be shown with women's empowerment, age of first marriage or per capita alcohol consumption. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) is a significant health concern among European women, with the highest prevalence rates among all cancers. Existing BC prediction models account for major risks such as hereditary, hormonal and reproductive factors, but research suggests that adherence to a healthy lifestyle can reduce the risk of developing BC to some extent. Understanding the influence and predictive role of lifestyle variables in current risk prediction models could help identify actionable, modifiable, targets among high-risk population groups. Purpose: To systematically review population-based BC risk prediction models applicable to European populations and identify lifestyle predictors and their corresponding parameter values for a better understanding of their relative contribution to the prediction of incident BC. Methods: A systematic review was conducted in PubMed, Embase and Web of Science from January 2000 to August 2021. Risk prediction models were included if (i) developed and/or validated in adult cancer-free women in Europe, (ii) based on easily ascertained information, and (iii) reported models' final predictors. To investigate further the comparability of lifestyle predictors across models, estimates were standardised into risk ratios and visualised using forest plots. Results: From a total of 49 studies, 33 models were developed and 22 different existing models, mostly from Gail (22 studies) and Tyrer-Cuzick and co-workers (12 studies) were validated or modified for European populations. Family history of BC was the most frequently included predictor (31 models), while body mass index (BMI) and alcohol consumption (26 and 21 models, respectively) were the lifestyle predictors most often included, followed by smoking and physical activity (7 and 6 models respectively). Overall, for lifestyle predictors, their modest predictive contribution was greater for riskier lifestyle levels, though highly variable model estimates across different models. Conclusions: Given the increasing BC incidence rates in Europe, risk models utilising readily available risk factors could greatly aid in widening the population coverage of screening efforts, while the addition of lifestyle factors could help improving model performance and serve as intervention targets of prevention programmes. [ABSTRACT FROM AUTHOR]

Objectives: Even low to moderate levels of alcohol consumption can have detrimental health consequences, especially in older adults (OA). Although many studies report an increase in the proportion of drinkers among OA, there are regional variations. Therefore, we examined alcohol consumption and the prevalence of hazardous alcohol use (HAU) among men and women aged 50+ years in four European regions and investigated predictors of HAU. Methods: We analyzed data of N = 35,042 participants of the European SHARE study. We investigated differences in alcohol consumption (units last week) according to gender, age and EU-region using ANOVAs. Furthermore, logistic regression models were used to examine the effect of income, education, marital status, history of a low-quality parent–child relationship and smoking on HAU, also stratified for gender and EU-region. HAU was operationalized as binge drinking or risky drinking (<12.5 units of 10 ml alcohol/week). Results: Overall, past week alcohol consumption was 5.0 units (±7.8), prevalence of HAU was 25.4% within our sample of European adults aged 50+ years. Male gender, younger age and living in Western Europe were linked to both higher alcohol consumption and higher risks of HAU. Income, education, smoking, a low-quality parent–child relationship, living in Northern and especially Eastern Europe were positively associated with HAU. Stratified analyses revealed differences by region and gender. Conclusions: HAU was highly prevalent within this European sample of OA. Alcohol consumption and determinants of HAU differed between EU-regions, hinting to a necessity of risk-stratified population-level strategies to prevent HAU and subsequent alcohol use disorders. [ABSTRACT FROM AUTHOR]

Issues Numerous studies have examined the impact of the COVID‐19 pandemic on alcohol use changes in Europe, with concerns raised regarding increased use and related harms. Approach: We synthesised observational studies published between 1 January 2020 and 31 September 2021 on self‐reported changes in alcohol use associated with COVID‐19. Electronic databases were searched for studies evaluating individual data from European general and clinical populations. We identified 646 reports, of which 56 general population studies were suitable for random‐effects meta‐analyses of proportional differences in alcohol use changes. Variations by time, sub‐region and study quality were assessed in subsequent meta‐regressions. Additional 16 reports identified were summarised narratively. Key Findings: Compiling reports measuring changes in overall alcohol use, slightly more individuals indicated a decrease than an increase in their alcohol use during the pandemic [3.8%, 95% confidence interval (CI) 0.00–7.6%]. Decreases were also reported more often than increases in drinking frequency (8.0%, 95% CI 2.7–13.2%), quantity consumed (12.2%, 95% CI 8.3–16.2%) and heavy episodic drinking (17.7%, 95% CI 13.6–21.8%). Among people with pre‐existing high drinking levels/alcohol use disorder, high‐level drinking patterns appear to have solidified or intensified. Implications: Pandemic‐related changes in alcohol use may be associated with pre‐pandemic drinking levels. Increases among high‐risk alcohol users are concerning, suggesting a need for ongoing monitoring and support from relevant health‐care services. Conclusion: Our findings suggest that more people reduced their alcohol use in Europe than increased it since the onset of the pandemic. However high‐quality studies examining specific change mechanisms at the population level are lacking. [ABSTRACT FROM AUTHOR]

Background and aims: Graph theoretic analysis of structural covariance networks (SCN) provides an assessment of brain organization that has not yet been applied to alcohol dependence (AD). We estimated whether SCN differences are present in adults with AD and heavy‐drinking adolescents at age 19 and age 14, prior to substantial exposure to alcohol. Design Cross‐sectional sample of adults and a cohort of adolescents. Correlation matrices for cortical thicknesses across 68 regions were summarized with graph theoretic metrics. Setting and participants: A total of 745 adults with AD and 979 non‐dependent controls from 24 sites curated by the Enhancing NeuroImaging Genetics through Meta Analysis (ENIGMA)–Addiction consortium, and 297 hazardous drinking adolescents and 594 controls at ages 19 and 14 from the IMAGEN study, all from Europe. Measurements Metrics of network segregation (modularity, clustering coefficient and local efficiency) and integration (average shortest path length and global efficiency). Findings The younger AD adults had lower network segregation and higher integration relative to non‐dependent controls. Compared with controls, the hazardous drinkers at age 19 showed lower modularity [area‐under‐the‐curve (AUC) difference = −0.0142, 95% confidence interval (CI) = −0.1333, 0.0092; P‐value = 0.017], clustering coefficient (AUC difference = −0.0164, 95% CI = −0.1456, 0.0043; P‐value = 0.008) and local efficiency (AUC difference = −0.0141, 95% CI = −0.0097, 0.0034; P‐value = 0.010), as well as lower average shortest path length (AUC difference = −0.0405, 95% CI = −0.0392, 0.0096; P‐value = 0.021) and higher global efficiency (AUC difference = 0.0044, 95% CI = −0.0011, 0.0043; P‐value = 0.023). The same pattern was present at age 14 with lower clustering coefficient (AUC difference = −0.0131, 95% CI = −0.1304, 0.0033; P‐value = 0.024), lower average shortest path length (AUC difference = −0.0362, 95% CI = −0.0334, 0.0118; P‐value = 0.019) and higher global efficiency (AUC difference = 0.0035, 95% CI = −0.0011, 0.0038; P‐value = 0.048). Conclusions: Cross‐sectional analyses indicate that a specific structural covariance network profile is an early marker of alcohol dependence in adults. Similar effects in a cohort of heavy‐drinking adolescents, observed at age 19 and prior to substantial alcohol exposure at age 14, suggest that this pattern may be a pre‐existing risk factor for problematic drinking. [ABSTRACT FROM AUTHOR]

We provide new cross‐country evidence on alcohol price and income elasticities based on microdata on individual behaviour. Our approach is original as previous research mainly estimates determinants of consumption with macroeconomic data. We use the latest available wave of the European Social Survey, 2014, merged with the Annual Database of National Beverage Consumption. We estimate a generalised Heckman model on the individual and national determinants of alcohol consumption with standard errors bootstrapped at the country level. We were able to identify direct and indirect effects of price and income, including their specific impacts on drinkers and abstainers. [ABSTRACT FROM AUTHOR]

Over the past 10 years, there has been a rise in the number of reports of drugs being used covertly to incapacitate potential victims for the purpose of sexual assault. However, recent evidence from forensic studies indicates that alcohol is much more commonly implicated in cases of drug facilitated sexual assault (DFSA) when victims are too intoxicated to give consent. Campaigns that warn about the risk of becoming a victim, or even a perpetrator, of sexual assault by excessive use of alcohol are being increasingly promoted as a necessary step in addressing the problem. New recommendations from the UK Advisory Council on the Misuse of Drugs (ACMD) and from the Council of Europe call for better monitoring of drug- and alcohol-facilitated sexual assault. However, public attitudes to sexual assault in the form of stereotyping and victim blaming are prevalent and entrenched and are widely recognized as barriers to reporting this type of crime. Population surveys suggest that up to 20% of women experience some form of sexual assault in their adult lifetime but reporting and conviction rates remain low. Monitoring DFSA will require a raft of changes, including improved methods of forensic analysis and training for police and hospital emergency staff. [ABSTRACT FROM AUTHOR]

Background, Aims and Scope. To all Member States, the European Union has imposed a minimum percentage of 2% of biofuels in the fuels consumed for road transport since 2005. This percentage is expected to reach 5.75% in 2010, and probably 10% in 2020. In this context, investments are made everywhere in Europe in local productions of biofuels. In Belgium, ethanol from sugar beet and rapeseed methyl ester (RME) are generally supposed to be two of the more valuable possibilities. As these industries are growing, it is important to evaluate the environmental impacts of these productions and to highlight the main sources of these impacts using Life Cycle Assessment methodology. This evaluation will also lead to propositions of improvements of the environmental performances. A comparison with the impacts of the related fossil fuels (petrol and diesel) should also be conducted. Even if these fuels are different and used in different types of engines, it is important to determine which one offers the best environmental performances, as both require arable land, which is the limiting parameter in biofuel production. Methods. The system boundaries include cultivation, extraction, processing and final use of the biofuels. The system has been expanded to take into account valorization of by-products in substitution of animal feed (rapeseed meal or pulps from sugar beet) or chemicals (glycerin). No economical, mass or energetic allocation was made. The yields and fertilizer consumptions of the crops are those of the Belgian conditions. Simapro 7.1 databases and the Eco-Indicator 99 method have been used for the Life Cycle Impact Assessment. The functional unit was road transport over 100 km. Results. The results show that, without valorization of the by-products, the impacts of the two biofuels over their whole life cycle are not significantly lower than those of the related fossil fuels. However, the credits accorded thanks to the valorization of by-products lead to improvements of the environmental performances in comparison to fossil fuels, especially for RME. Discussion. The impacts of agriculture and production of the fertilizers are more important in the case of RME, because the yield per hectare is lower than in the production of ethanol from sugar beet. However, the extraction of the sugar from the beet, fermentation, purification of the ethanol and drying of the pulps and slops consume much more energy than extraction and esterification of rapeseed oil. Moreover, the by-products of RME (rapeseed meal and glycerin) are more valuable than those of ethanol from sugar beet (pulps). This induces a more important environmental benefit in the production of RME. These parameters lead to a global environmental impact that is higher for the production of ethanol than for RME. Conclusions. Life Cycle Assessment methodology has been successfully applied to two of the major ways of production of biofuels in Belgium using specific local data. The assessment of the environmental impacts reveals that rapeseed methyl ester allows a considerable improvement of the environmental performances compared to fossil diesel, while ethanol from sugar beet offers a more limited benefit compared to petrol. Recommendations. Arable land is a limited resource, especially in West-European countries like Belgium. Therefore, choices must be made to have the most valuable environmental benefit. Soil quality and crop rotations should also be taken into account before making a decision. [ABSTRACT FROM AUTHOR]

Issues: Drug use accounts for one of the main disease groups in Europe, with relevant consequences to society. There is an increasing need to evaluate the economic consequences of drug use in order to develop appropriate policies. Here, we review the social costs of illegal drugs, alcohol and tobacco in the European Union.Approach: A systematic search of relevant databases was conducted. Grey literature and previous systematic reviews were also searched. Studies reporting on social costs of illegal drugs, alcohol and tobacco were included. Methodology, cost components as well as costs were assessed from individual studies. To compare across studies, final costs were transformed to 2014 Euros.Key Findings: Forty-five studies reported in 43 papers met the inclusion criteria (11 for illegal drugs, 26 for alcohol and 8 for tobacco). While there was a constant inclusion of direct costs related to treatment of substance use and comorbidities, there was a high variability for the rest of cost components. Total costs showed also a great variability. Price per capita for the year 2014 ranged from €0.38 to €78 for illegal drugs, from €26 to €1500 for alcohol and from €10.55 to €391 for tobacco.Implications and Conclusions: Drug use imposes a heavy economic burden to Europe. However, given the high existing heterogeneity in methodologies, and in order to better assess the burden and thus to develop adequate policies, standardised methodological guidance is needed. [Barrio P, Reynolds J, García-Altés A, Gual A, Anderson P. Social costs of illegal drugs, alcohol and tobacco in the European Union: A systematic review. Drug Alcohol Rev 2017;00:000-000]. [ABSTRACT FROM AUTHOR]

Background: Alcohol consumption is one of the main risk factors for death by road injuries, but little is known about the global distribution of the population‐attributable risk (PAR) of alcohol use for death by road injuries. Methods: We used publicly available data from the 2019 Global Burden of Disease Study (GBD) to estimate the PAR of alcohol use for 5 types of road injury, globally and individually for available countries, by socio‐demographic index (SDI), and by age, sex, and year from 1990 to 2019. Results: 6.6% of all road injuries in 2019 were attributable to alcohol consumption, with large variations worldwide; the highest burden was in Europe and among countries classified in the high–middle SDI. PAR was higher in men than in women, and among younger individuals. Important variations in PAR of alcohol were also observed by road injury type, with motorcyclist road injuries having the highest PAR. Overall, PAR showed a small increase during 1990–2019; younger (<39 years old) men showed an increasing trend during this period, while older women had a decreasing trend in PAR. Conclusions: PAR for alcohol and road injuries is not homogenous. Large PAR for alcohol and road deaths was found in Europe, among men, young adults, and motorcyclists. These results could help public health agencies, law enforcement, and the public guide efforts to reduce these deaths. [ABSTRACT FROM AUTHOR]

Driving under the influence of alcohol, drugs and fatigue are all important factors of crash causation. Exploring the link between driver attitudes and crash involvement provides understanding on these important issues. To that end, questionnaire answers of car drivers disclosing their attitudes on the impacts of driving under the influence of alcohol, drugs and fatigue, and their relationship with past crash involvement as car drivers were analysed. A two-step approach is adopted: Principal Component Analysis (PCA) was employed to consolidate relative questions in numeric factor quantities. Afterwards, binary logistic regression was implemented on the calculated component scores to determine the impact of perspectives of road users for each factor on past crash involvement of car drivers. Data from the international ESRA2015 survey were utilized. PCA indicated that it is possible to meaningfully merge 29 ESRA2015 questions relevant to driving under the influence of alcohol, drugs and fatigue into 8 informative components accounting for an adequate percentage of variance. Binary logistic analysis indicated that components involving overall personal and communal acceptance of impaired driving, overall and past year personal behaviour towards impaired driving and frequency of typical journey checks by traffic police were all quantities positively correlated with past crash involvement. [ABSTRACT FROM AUTHOR]

Background: Smoking, obesity and alcohol abuse greatly affect mortality and exhibit a distinct time dynamic, with their prevalence and associated mortality rates increasing and (eventually) declining over time. Their combined impact on secular trends in life expectancy is unknown but is relevant for understanding these trends. We therefore estimate the combined impact of smoking, obesity and alcohol on life-expectancy trends in Europe.Methods: We used estimated national age-specific smoking-, obesity- and alcohol-attributable mortality fractions for 30 European countries by sex, 1990-2014, which we aggregated multiplicatively to obtain lifestyle-attributable mortality. We estimated potential gains in life expectancy by eliminating lifestyle-attributable mortality and compared past trends in life expectancy at birth (e0) with and without lifestyle-attributable mortality. We examined all countries combined, by region and individually.Results: Among men, the combined impact of smoking, obesity and alcohol on e0 declined from 6.6 years in 1990 to 5.8 years in 2014, mainly due to declining smoking-attributable mortality. Among women, the combined impact increased from 1.9 to 2.3 years due to mortality increases in all three lifestyle-related factors. The observed increase in e0 over the 1990-2014 period was 5.0 years for men and 4.0 years for women. After excluding lifestyle-attributable mortality, this increase would have been 4.2-4.3 years for both men and women.Conclusion: Without the combined impact of smoking, obesity and alcohol, the increase over time in life expectancy at birth would have been smaller among men but larger among women, resulting in a stable increase in e0, parallel for men and women. [ABSTRACT FROM AUTHOR]

The article focuses on the development of a comprehensive alcohol policy in Europe. It mentions the Alcohol Measures for Public Health Research Alliance (AMPHORA) project, a plan that aims to push through with researches pertinent to alcohol policy in the European Union (EU). According to the author, a previous research indicates how unevenly research about the effects of alcohol taxes and prices is spread within the EU. He adds that AMPHORA proposes diverse projects including technical work for checking contamination on unrecorded alcohols and an analysis of alcohol's role in the Global Burden of Diseases and alcohol consumption. Another project mentioned is one that evaluates the need of alcohol treatment services and intervention in EU countries including Austria, Germany and Italy.

Besides the consumption of salt, sugar and fats, which has been shown to directly contribute to increased blood pressure, tobacco, alcohol consumption and the lack of exercise are also considered risk factors for the occurrence of cardiovascular diseases. The impact these risk factors have on the health of people, as well as the costs of treating the diseases caused by them can be reversed by developing and implementing interventions to reduce tobacco and alcohol consumption among populations and to promote the active mobility. This paper presents the interventions made by some Member States, interventions that resulted in decreased consumption of the above-mentioned risk factors, improving thus, the public health. [ABSTRACT FROM AUTHOR]

Today, alcohol addiction has the largest expansion in all population groups, as recognized by the experts in various fields as a true "pandemic toxic". Alcohol and drugs are the main causes for the increase of the crime rate. Statistics show that alcohol consumption is correlated with 50% of suicide cases, 80% of crimes, 30% of serious traffic accidents and 15% of drowning cases. The paper aims at providing an insight into the level and trend of alcohol consumption in Europe and Romania based on the statistics of the last decade. [ABSTRACT FROM AUTHOR]

Today, alcohol addiction has the largest expansion in all population groups, as recognized by the experts in various fields as a true "pandemic toxic". Alcohol and drugs are the main causes for the increase of the crime rate. Statistics show that alcohol consumption is correlated with 50% of suicide cases, 80% of crimes, 30% of serious traffic accidents and 15% of drowning cases. The paper aims at providing an insight into the level and trend of alcohol consumption in Europe and Romania based on the statistics of the last decade. [ABSTRACT FROM AUTHOR]

Background: Travelling away from home can be associated with fewer limits on behavior, particularly for students who participate in exchange programs. Aims: To examine the effects of eight moderators on change in alcohol use and related negative outcomes, drug use and unprotected sexual behavior in European study abroad students before, during, and after their time abroad. Methods: A three wave (before departure, while abroad, and after their return) longitudinal design collecting data on the frequency and volume of alcohol consumed, heavy episodic drinking, alcohol-related outcomes, drug use, and unprotected casual sex. Results: The baseline survey was completed by 1145 students participating in one or two semester exchange programs (67.5% spent up to a semester abroad), of which 906 participated in two or more waves, representing 42 and 33 countries of origin and destination, respectively. Mean age was 22.2 years (SD = 2.28) and 72.7% were female. Students increased the amount of alcohol consumed by 35% (B = 0.32; 95% CI 0.287–0.349) and experienced more alcohol-related consequences (B = 0.15; 95% CI 0.089–0.219) during the study abroad experience, though levels fell below pre-departure levels when they returned home. Factors related to greater alcohol use while abroad include pre-departure expectations about alcohol use during the study abroad experience, psychological adjustment to the host country, academic involvement, and host country living costs. No statistically meaningful change in drug use and unprotected sexual behavior was observed. Conclusions: Studying abroad exposes European students to additional time-limited alcohol-related health risks. [ABSTRACT FROM AUTHOR]

Objective: Normalization thesis assumes that high prevalence rates of substance use are associated with a shift in the recruitment of substance users from risky to a more well-adjusted population. This study tests the application of normalisation thesis by examining levels of substance use (smoking, alcohol and cannabis) and its relation to reported suicide ideation and attempt in 13 European countries. The hypothesis of the study is that in countries with low prevalence of substance use the correlation and predicting odds ratios between substance use and suicide ideation and suicide attempt will be higher than in high prevalence countries. Method: Data from the ESPAD (European School Survey Project on Alcohol and Other Drugs) study from 13 countries was used for the analysis. The data were collected from a sample of 15-year-old adolescents using ESPAD standardised sampling strategy and data collection methodology across countries. Results: Evidence is provided for normalisation thesis, specifically, in countries with low prevalence of substance use reported higher association between substance use and suicidal behaviour compared to countries with higher prevalence of substance use. Conclusion: The normalisation thesis is a useful scheme to understand the relation of adolescent alcohol, tobacco and cannabis use in relation to suicide ideation and attempt in different cultural circumstances. Implications: study findings highlight the importance of selective and universal drug prevention programmes in different cultural contexts. [ABSTRACT FROM AUTHOR]

Abstract: Aims: This review provides an up‐to‐date curated source of information on alcohol, tobacco and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future. Methods: Online data sources were identified through expert review. Data were obtained mainly from the World Health Organization, United Nations Office on Drugs and Crime and Institute for Health Metrics and Evaluation. Results: In 2015, the estimated prevalence among the adult population was 18.4% for heavy episodic alcohol use (in the past 30 days); 15.2% for daily tobacco smoking; and 3.8, 0.77, 0.37 and 0.35% for past‐year cannabis, amphetamine, opioid and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age‐standardized prevalence of alcohol dependence was 843.2 per 100 000 people; for cannabis, opioids, amphetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100 000 people, respectively. High‐income North America region had among the highest rates of cannabis, opioid and cocaine dependence. Attributable disability‐adjusted life‐years (DALYs) were highest for tobacco smoking (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance‐attributable mortality rates were highest for tobacco smoking (110.7 deaths per 100 000 people), followed by alcohol and illicit drugs (33.0 and 6.9 deaths per 100 000 people, respectively). Attributable age‐standardized mortality rates and DALYs for alcohol and illicit drugs were highest in eastern Europe; attributable age‐standardized tobacco mortality rates and DALYs were highest in Oceania. Conclusions: In 2015 alcohol use and tobacco smoking use between them cost the human population more than a quarter of a billion disability‐adjusted life years, with illicit drugs costing further tens of millions. Europeans suffered proportionately more, but in absolute terms the mortality rate was greatest in low‐ and middle‐income countries with large populations and where the quality of data was more limited. Better standardized and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden. [ABSTRACT FROM AUTHOR]

Aims: To estimate temporal trends in adolescents’ current cigarette, alcohol and cannabis use in Europe by gender and region, test for regional differences and evaluate regional convergence. Design and Setting: Five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 28 countries between 1999 and 2015. Countries were grouped into five regions [northern (NE), southern (SE), western (WE), eastern Europe (EE) and the Balkans (BK)]. Participants: A total of 223 814 male and 211 712 female 15–16‐year‐old students. Measurements: Daily cigarette use, weekly alcohol use, monthly heavy episodic drinking (HED) and monthly cannabis use. Linear and quadratic trends were tested using multi‐level mixed‐effects logistic regression; regional differences were tested using pairwise Wald tests; mean absolute differences (MD) of predicted prevalence were used for evaluating conversion. Findings: Daily cigarette use among boys in EE showed a declining curvilinear trend, whereas in all other regions a declining linear trend was found. With the exception of BK, trends of weekly drinking decreased curvilinear in both genders in all regions. Among girls, trends in WE, EE and BK differed from trends in NE and SE. Monthly HED showed increasing curvilinear trends in all regions except in NE (both genders), WE and EE (boys each). In both genders, the trend in EE differed from the trend in SE. Trends of cannabis use increased in both genders in SE and BK; differences were found between the curvilinear trends in EE and BK. MD by substance and gender were generally somewhat stable over time. Conclusions: Despite regional differences in prevalence of substance use among European adolescents from 1999 to 2015, trends showed remarkable similarities, with strong decreasing trends in cigarette use and moderate decreasing trends in alcohol use. Trends of cannabis use only increased in southern Europe and the Balkans. Trends across all substance use indicators suggest no regional convergence. [ABSTRACT FROM AUTHOR]

Background: Other-sex friendship (girls with boy friends, boys with girl friends) has been associated with substance use, but how the gender composition of schools influences substance use has not been known. Objectives: We analyzed the influence of other-sex friendship on substance use and took into account the proportion of each gender group at the schools, and hypothesized that other-sex friendship is associated with higher levels of substance use and that schools with a majority of males have higher levels of use than female-majority schools. Methods: In 2013, a social network survey was carried out in six European cities. In each city, schools were selected and 11,015 adolescents (aged 14-16) were recruited (participation rate = 79.4%). We collected data on smoking, binge drinking, cannabis use, and peer group composition. Results: Other-sex friendship was associated with smoking, binge drinking, and cannabis use for girls and with smoking for boys. Substance use was more frequent in schools with a majority of males. Conclusions/Importance: Adolescent girls are best protected from substance use if they are in gender-balanced schools, but in same-sex friendship. This offers new perspectives on gender mixing at school. In schools with a majority of boys, more attention should be paid to girls, and gender-specific health promotion programs should be implemented. This European study is the first to take into account both individual (other-sex friendship) and contextual (gender composition of schools) gender interactions. It confirms previous studies on other-sex friendship, while shedding light on the influence of gender-normative contexts on substance use. [ABSTRACT FROM AUTHOR]

Background: It is estimated that up to a third of injuries requiring emergency department (ED) admission are alcohol-related. While injuries that are alcohol-related are unsurprising to ED staff, less is understood about the precursors to the injury event. Methods: Using data from representative ED injury patients in 22 countries, we examined associations between context of injury (private or public), cause of injury (fall or trip, being stuck/cut/or burned and violence) and alcohol use. Alcohol-related policy data were also obtained from each study locale. Results: Injuries were similarly reported in private (54%) and public settings (46%), while cause of injury was most often due to falls (39%) or being struck/cut or burned (38%). Violence-related injuries were reported by approximately 1 in 5 patients (23%). Increased odds of drinking prior to the injury event was associated with injury due to violence in private settings but not public venues. Similarly, patients from regions with fewer restrictive alcohol policies were more likely to report drinking prior to an injury event and have elevated violence-related injuries in private settings. Conclusion: Understanding the cause and context of injury and alcohol use are important components to evaluation and development of alcohol policies. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Several European countries have observed an increase in the proportion of adolescents that abstain from drinking alcohol in the last decade. The reasons for this trend remain underexplored. We hypothesised that more generous government expenditures on health services and benefits to families with children relate to a positive trend in abstainers.Design and Methods: We used data on 15-year-olds in four successive cycles of the World Health Organization Health Behaviour in School-aged Children study (2002 to 2014) in 24 North American and European countries (pooled n = 175 331). Generalised linear mixed-effects models were tested to analyse trends in alcohol abstinence and to investigate whether cross-country differences in these trends relate to public expenditures on health and families with children (in proportion to gross domestic product).Results: Overall, we observed an increase in the proportion of abstainers from 21% in 2002 to 35% in 2014. An exception was Greece where abstaining had decreased from 20% to 15%. Similar results were found in boys and girls. The upward trend in abstinence related to larger government expenditures on health and families.Discussions and Conclusions: More generous expenditures on health services and family benefits relate to more adolescents abstaining from alcohol. [ABSTRACT FROM AUTHOR]

Background and Aims Low-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Life-time mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts. Methods The maximum acceptable voluntary premature mortality risk was determined to be one in 1000, with sensitivity analyses of one in 100. Life-time mortality risks for different alcohol consumption levels were estimated by combining disease-specific relative risk and mortality data for seven European countries with different drinking patterns (Estonia, Finland, Germany, Hungary, Ireland, Italy and Poland). Alcohol consumption data were obtained from the Global Information System on Alcohol and Health, relative risk data from meta-analyses and mortality information from the World Health Organization. Results The variation in the life-time mortality risk at drinking levels relevant for setting guidelines was less than that observed at high drinking levels. In Europe, the percentage of adults consuming above a risk threshold of one in 1000 ranged from 20.6 to 32.9% for women and from 35.4 to 54.0% for men. Life-time risk of premature mortality under current guideline maximums ranged from 2.5 to 44.8 deaths per 1000 women in Finland and Estonia, respectively, and from 2.9 to 35.8 deaths per 1000 men in Finland and Estonia, respectively. If based upon an acceptable risk of one in 1000, guideline maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men. Conclusions If low-risk alcohol guidelines were based on an acceptable risk of one in 1000 premature deaths, then maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men, and some of the current European guidelines would require downward revision. [ABSTRACT FROM AUTHOR]

Background: Influencing the life-style risk-factors alcohol, body mass index (BMI), and smoking is an European Union (EU) wide objective of public health policy. The population-level health effects of these risk-factors depend on population specific characteristics and are difficult to quantify without dynamic population health models.Methods: For eleven countries-approx. 80 % of the EU-27 population-we used evidence from the publicly available DYNAMO-HIA data-set. For each country the age- and sex-specific risk-factor prevalence and the incidence, prevalence, and excess mortality of nine chronic diseases are utilized; including the corresponding relative risks linking risk-factor exposure causally to disease incidence and all-cause mortality. Applying the DYNAMO-HIA tool, we dynamically project the country-wise potential health gains and losses using feasible, i.e. observed elsewhere, risk-factor prevalence rates as benchmarks. The effects of the "worst practice", "best practice", and the currently observed risk-factor prevalence on population health are quantified and expected changes in life expectancy, morbidity-free life years, disease cases, and cumulative mortality are reported.Results: Applying the best practice smoking prevalence yields the largest gains in life expectancy with 0.4 years for males and 0.3 year for females (approx. 332,950 and 274,200 deaths postponed, respectively) while the worst practice smoking prevalence also leads to the largest losses with 0.7 years for males and 0.9 year for females (approx. 609,400 and 710,550 lives lost, respectively). Comparing morbidity-free life years, the best practice smoking prevalence shows the highest gains for males with 0.4 years (342,800 less disease cases), whereas for females the best practice BMI prevalence yields the largest gains with 0.7 years (1,075,200 less disease cases).Conclusion: Smoking is still the risk-factor with the largest potential health gains. BMI, however, has comparatively large effects on morbidity. Future research should aim to improve knowledge of how policies can influence and shape individual and aggregated life-style-related risk-factor behavior. [ABSTRACT FROM AUTHOR]

This article argues that we need to reverse our complacency in dealing with alcohol, a drug that kills at least 2.7 million people worldwide annually. Ecological studies suggest that humans have evolved to be active and functional in relation to alcohol use; the present problem is that alcohol is too easily available in too potent a form. Toxicological analyses indicate that European adults consume, on average, 1,000 times the dose of alcohol that would normally be set for voluntary exposure to a consumed carcinogen. Political analyses find that a predominant driver of alcohol-related harm is the potency of business influence on policy making. Complacency would be reversed by compulsory warning labels that alcohol causes cancer; by holding producers accountable for the harm that their products cause; and, by governments moving toward a global legally binding agreement for alcohol. [ABSTRACT FROM PUBLISHER]

The article reviews portrayals of 'the addict' in press items from Italy, Finland, Poland, and The Netherlands. The dataset consists of 1,327 items from four national newspapers published in 1991, 1998, 2011. The portrayals varied according to country, period, and type of addiction problem. Results can be read as four cases where different conceptualizations ('the sinner,' 'the sick,' 'the social problem,' 'the criminal,' and 'the famous') assume diverse importance. These conceptual frames-of-reference are clearly neither unambiguous nor fixed. They are constantly modified and part of different trends. [ABSTRACT FROM AUTHOR]

Aims To investigate the association between having a favourite alcohol advertisement and binge drinking among European adolescents. Design Data were obtained from a longitudinal observational study on relationships between smoking and drinking and film tobacco and alcohol exposures. Setting State-funded schools. Participants Baseline survey of 12 464 German, Italian, Polish and Scottish adolescents (mean age 13.5 years), of whom 10 259 (82%) were followed-up 12 months later. Measurements Pupils were asked the brand of their favourite alcohol advertisement at baseline. Multi-level mixed-effects logistic regressions assessed relationships between having a favourite alcohol advertisement ('alcohol marketing receptivity') and (i) binge drinking at baseline; and (ii) initiating binge drinking during follow-up among a subsample of 7438 baseline never binge drinkers. Findings Life-time binge drinking prevalence at baseline was 29.9% and 25.9% initiated binge drinking during follow-up. Almost one-third of the baseline sample (32.1%) and 22.6% of the follow-up sample of never-bingers named a branded favourite alcohol advertisement, with high between-country variation in brand named. After controlling for age, gender, family affluence, school performance, TV screen time, personality characteristics and drinking behaviour of peers, parents and siblings, alcohol marketing receptivity was related significantly to both binge drinking at baseline [adjusted odds ratio ( AOR) = 2.13, 95% confidence interval ( CI) = 1.92, 2.36] and binge drinking initiation in longitudinal analysis ( AOR = 1.45, 95% CI = 1.26, 1.66). There was no evidence for effect heterogeneity across countries. Conclusions Among European adolescents naming a favourite alcohol advertisement was associated with increased likelihood of initiating binge drinking during 1-year follow-up, suggesting a relationship between alcohol marketing receptivity and adolescent binge drinking. [ABSTRACT FROM AUTHOR]

The Artificial Adaptive Systems (AAS) are theories with which generative algebras are able to create artificial models simulating natural phenomenon. Artificial Neural Networks (ANNs) are the more diffused and best-known learning system models in the AAS. This article describes an overview of ANNs, noting its advantages and limitations for analyzing dynamic, complex, non-linear, multidimensional processes. An example of a specific ANN application to alcohol consumption in Spain, as part of the EU AMPHORA-3 project, during 1961-2006 is presented. Study's limitations are noted and future needed research using ANN methodologies are suggested. [ABSTRACT FROM AUTHOR]

Having qualitatively investigated, both the temporal curves of alcoholic beverage consumption trends and the introduction of preventive alcohol policy measures in six European countries during the 1960s-2000s, drinking control policy measures often appeared to operate as co-factors of change, while during some periods of time they were not even present even if effective consumption changes were occurring. Study limitations are noted. [ABSTRACT FROM AUTHOR]

Aims To analyse the association between alcohol advertising restrictions and the prevalence of hazardous drinking among people aged 50-64 years in 16 European countries, taking into account both individual and contextual-level factors (alcohol taxation, availability, etc.). Design Cross-sectional study based on SHARE project surveys. Setting and Participants A total of 27 773 subjects, aged 50-64 years, from 16 European countries who participated in wave 4 of the SHARE ( Survey of Health, Ageing and Retirement in Europe) project. Measurements We estimated the prevalence of hazardous drinking (through adaptation of the SHARE questions to the scheme used by the Alcohol Use Disorders Identification Test Consumption ( AUDIT- C) for each country. To determine whether the degree of advertising restrictions was associated with prevalence of hazardous drinking, we fitted robust variance multi-level Poisson models, adjusting for various individual and contextual variables. Prevalence ratios ( PR) and their 95% confidence intervals (95% CI) were obtained. Findings The observed prevalence of hazardous drinking was 24.1%, varying by sex and country. Countries with greater advertising restrictions had lower prevalence of hazardous drinking: 30.6% (95% CI = 29.3-31.8) in countries with no restrictions, 20.3% (95% CI = 19.3-21.2) in countries with some restrictions and 14.4% (95% CI = 11.9-16.8) in those with greatest restrictions. The PR found (with respect to countries with greatest restrictions) were 1.36 (95% CI = 0.90-2.06) for countries with some restrictions and 1.95 (95% CI = 1.31-2.91) for those with no advertising restrictions. Conclusions The extent of advertising restrictions in European countries is associated inversely with prevalence of hazardous drinking in people aged 50-64 years. [ABSTRACT FROM AUTHOR]

The study examines groups of 15-16-year-old students whose attitudes toward drug use are out of line with the prevailing norms. It analyzes data from eight countries from the 2003 European School Survey on Alcohol and Other Drugs (ESPAD): Bulgaria, the Czech Republic, Hungary, France, Malta, Slovenia, Sweden, and the United Kingdom. In those countries, 22,900 15-16-year-old pupils answered the ESPAD questionnaire. Groups of subjects whose responses are far removed from the modal value are sought and studied. The aim is to explore 'rare answers' compared to what is perceived by the majority of students. In order to explore what can lead a pupil to an atypical perception of risk, a cluster analysis, based on the risk perceptions of alcohol, tobacco, and cannabis use, was run to isolate the groups in which pupils tend to answer differently. Six clusters were established classifying students into those who failed to respond, deny the risks, do not know about the risks, see any drug use as great risk, see regular use as great risk, and who see a moderate risk for most frequencies of use. The nonresponders, risk deniers, and those ignorant of the risks are infrequent making up, in all, only 16.9% of the total sample. Gender, country, alcohol use, cannabis use, tobacco use, and friends' consumption were used to describe both the individual risk perceptions and the clusters based on them. Both global context (country) and 'micro' context (frequencies of drug use, peers lifestyle, and parental permissiveness) appear to play a major role in the risk perception of drug use. [ABSTRACT FROM AUTHOR]

The article studies self-reported alcohol consumption of European juveniles and examines its link to the level of their self-control, making use of data from International Self-Report Delinquency Study 2 (ISRD-2). The proportion of problematic drinkers and the mean level of self-control as well as the strength of the association differs among European countries. Following Gottfredson and Hirschi’s general theory of crime, two hypotheses are tested, focusing on different degrees of social tolerance of juvenile drinking and alcohol availability (i.e., opportunity). Findings based on logistic multilevel models for several indicators of problematic alcohol use suggest that social tolerance (reflected in the level of cultural acceptance of juvenile drinking and in the level of policy strictness) can indeed explain the cross-national differences in the strength of self-control–problematic drinking relationship, while the contribution of opportunity is questionable in this respect. Opportunity, however, is highly relevant when explaining cross-cultural differences in the extent of problematic drinking. [ABSTRACT FROM PUBLISHER]

Violence is one of the leading social problems in both Europe and the United States. The development of appropriate public policies to curtail violence is confounded by the relationship between alcohol and violence. In this article, we estimate the propensity of alcohol control policies to reduce the perpetration and victimization of criminal violence. We measure violence with data on individual-level victimizations from the U.S. National Crime Victimization Survey. We examine the effects of a number of different alcohol control policies in reducing violent crime. These policies include the retail price of beer, drunk driving laws and penalties, keg laws and serving and selling laws. We find some evidence of a negative relationship between alcohol prices and the probability of alcohol- or drug-related assault victimizations. However, we find no strong evidence that other alcohol policies are effective in reducing violent crimes. [ABSTRACT FROM AUTHOR]

Aims: The study explores the existence and types of law on compulsory commitment to care (CCC) of adult substance misusers in Europe and how such laws are related to variations in demographics, alcohol consumption and epidemiology in misuse of opiates, cocaine, amphetamines, temperance culture heritage, health and welfare expenditure, and involvement and role of the state in welfare distribution. Material and Methods: Legal information on laws on CCC of misusers was obtained primarily through a survey of 38 European countries. Predictors of laws on CCC, and types of such, were analyzed from country descriptors in multivariate models. Results: A majority (74%) of the explored countries have a law concerning CCC. The most common type of CCC law is within criminal justice legislation (45%), but civil CCC is almost as frequent (37%). These two models of CCC legislation are related to differences in cultural heritage and welfare distribution models. Conclusions: Temperance cultures, i.e. countries with a history of a strong temperance movement, and countries with a Beveridgean distribution of welfare, i.e. through the state, tend to favor civil CCC, while countries with a Bismarckian distribution of welfare, i.e. through insurance with less state interference, tend to favor CCC within criminal justice legislation. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

To describe three aspects of the epidemiology of alcohol-attributable deaths in Europe, dose, demography and place, and to illustrate how such knowledge can better be used to inform alcohol policy formulation and implementation. epidemiological and population health modeling. Europe. Based on country-specific aggregate statistics. Exposure: country-specific adult per capita consumption triangulated with survey data; outcomes: mortality statistics. The absolute risk of dying from an alcohol-attributable disease and injury (accounting for a protective effect for ischaemic diseases) increases with increasing daily alcohol consumption beyond 10g alcohol per day, the first data point. Over 2/3 of all alcohol-attributable deaths occurring amongst the 20-64 year old population of the European Union (minus Cyprus and Malta) occur in the 45-64 year olds. About 25% of the difference in life expectancy between western and eastern Europe for men aged 20-64 years in 2002 can be attributed to alcohol, largely, but not exclusively, as a result of differences in heavy episodic drinking patterns. Any reduction in the dose of alcohol consumed, at least down to 10g/day, will reduce the annual and lifetime risk of an alcohol-related death. There is a need for alcohol policy to focus on measures in reducing alcohol consumption, throughout middle age, with immediacy of impact. Policy should strive to reduce alcohol-related health inequalities, with the specific recommendations for policy depending on the cost-effectiveness of interventions related to the epidemiological profile of the country or region under consideration. Fortunately, there are evidence-based policy options that reduce the amount of alcohol consumed and many alcohol-related harms with immediate effect, that reduce the risk of an alcohol-related death in middle age, and that would help to close the health gap between eastern and western Europe. [ABSTRACT FROM AUTHOR]

The importance of building and strengthening effective infrastructures within the field of public health has increasingly been recognized. A wide variety of actors and structures can be identified for alcohol policy, including systems for policy development, monitoring, research and work-force development, but too little is known about the complex systems of infrastructure available across European countries and their impact on alcohol policy. This study is part of the Alcohol Measures for Public Health Research Alliance (AMPHORA) project, and aims to map existing infrastructures, but also to examine the relationship between infrastructures and alcohol policy change. A survey of alcohol policy infrastructure and infrastructure needs at the national level will be conducted using an updated and adapted questionnaire based on the Health Promotion (HP) Source Project tool. Case studies involving in-depth interviews will be conducted for a selection of countries. Data will be analysed descriptively, mapping alcohol policy infrastructure and identifying needs to reveal any relationship between infrastructure and alcohol policy. This study can contribute to building the scientific knowledge base on this topic as well to policy development. First, the Alcohol Measures for Public Health Research Alliance will produce an extended map of alcohol policy infrastructures in a wide range of European countries. Secondly, the Alcohol Measures for Public Health Research Alliance will foster a better understanding and expand the knowledge base on the role and influence of infrastructure on alcohol policy and practice. Recommendations deriving from this study will identify the need for better utilization of existing infrastructures and for the development of new infrastructures, necessary to develop and implement effective alcohol policy from a public health perspective. [ABSTRACT FROM AUTHOR]

To describe the extent to which the content of the European Commission's Communication on alcohol reflects public health-based scientific evidence. Document retrieval and content analysis. European Union. Background documents leading up to the European Commission's Communication on alcohol, the Communication itself and implementation actions following the Communication. Documents were read and analyzed for evidence-based alcohol policy content. Although the Communication acknowledges and supports existing interventions which have high evidence for effectiveness, such as enforcing blood alcohol concentration (BAC) limits for drivers, it extensively promotes other interventions which have been shown to be ineffective; for example, recommending education and persuasion strategies as a measure across all its five priority areas. Measures to influence price are mentioned only once in relation to sales in drinking venues limiting two-for-one drinks offers. Measures to control physical availability are mentioned infrequently. The Communication reflects the science, in that it acknowledges the significance of alcohol as a social and health determinant in Europe. However, it places more emphasis on policy actions with less evidence for effectiveness than on those with strong evidence. It also focuses its efforts more on mapping member state actions and coordinating knowledge exchange than on providing concrete recommendations for action or developing Europe-wide policy measures. This may be a compromise between the rights of Member States to develop national policy and legislation and the obligation of the European Union as a collaborative body to protect health. Furthermore, it has been suggested that the European Union's roots as a trading block emphasizes collaboration with industry stakeholders and this influences the ability to prioritize health over trade considerations. [ABSTRACT FROM AUTHOR]

Background: Although social environments may influence alcohol-related behaviours in youth, the relationship between neighbourhood socioeconomic context and effectiveness of school-based prevention against underage drinking has been insufficiently investigated. We study whether the social environment affects the impact of a new school-based prevention programme on alcohol use among European students. Methods: During the school year 2004-2005, 7079 students 12-14 years of age from 143 schools in nine European centres participated in this cluster randomised controlled trial. Schools were randomly assigned to either control or a 12-session standardised curriculum based on the comprehensive social influence model. Randomisation was blocked within socioeconomic levels of the school environment. Alcohol use and alcohol-related problem behaviours were investigated through a self-completed anonymous questionnaire at baseline and 18 months thereafter. Data were analysed using multilevel models, separately by socioeconomic level. Results: At baseline, adolescents in schools of low socioeconomic level were more likely to report problem drinking than other students. Participation in the programme was associated in this group with a decreased odds of reporting episodes of drunkenness (OR = 0.60, 95% CI = 0.44-0.83), intention to get drunk (OR = 0.60, 95% CI = 0.45-0.79), and marginally alcohol-related problem behaviours (OR = 0.70, 95% CI = 0.46-1.06). No significant programme's effects emerged for students in schools of medium or high socioeconomic level. Effects on frequency of alcohol consumption were also stronger among students in disadvantaged schools, although the estimates did not attain statistical significance in any subgroup. Conclusions: It is plausible that comprehensive social influence programmes have a more favourable effect on problematic drinking among students in underprivileged social environments. [ABSTRACT FROM AUTHOR]

Background: Despite high mortality from injuries and accidents, data on rates and distribution of non-fatal injuries in Central and Eastern European populations are scarce. Methods: Cross-sectional study of random population samples of 45–69-year-old men and women (n = 28 600) from Novosibirsk (Russia), Krakow (Poland) and six Czech towns, participating in the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study. Participants provided information on non-fatal injuries in the past 12 months, socio-economic characteristics, alcohol consumption and other covariates. Results: The period prevalence of non-fatal injuries in the last year among Czech, Russian and Polish men was 12.5, 9.4 and 5.3%, respectively; among women, the respective proportions were 9.9, 9.8 and 6.4%. Injury prevalence declined with age in men and increased with age in women. Higher injury prevalence was associated with being unmarried, material deprivation, higher drinking frequency and problem drinking. In the pooled data, the adjusted odds ratio (OR) for the highest versus lowest material deprivation category was 1.57 [95% confidence interval (CI) 1.38–1.79]; for problem drinking, the OR was 1.44 (95% CI 1.23–1.69). Alcohol did not mediate the link between socio-economic status and injury. Conclusion: Non-fatal injuries were associated with material deprivation, other socio-economic characteristics and with alcohol. These results not only underscore the universality of the inequality phenomenon, but also suggest that the mediating role of alcohol in social differentials in non-fatal injury remains an unresolved issue. [ABSTRACT FROM AUTHOR]

Issue. Scotland has experienced a substantial rise in alcohol-related harm, which is now one of the biggest public health challenges it faces. Approach. Alcohol problems in Scotland are described along with national alcohol policy response in addressing them. The role of a program of Alcohol Brief Interventions is discussed therein. Key Findings. In Scotland, considerable proportions of the population are drinking hazardously or harmfully, common across different age and socioeconomic groups. Rising consumption has been set in wider environmental changes with alcohol becoming more available and affordable. Scotland has had one of the fastest growing chronic liver disease mortality rates in the world at a time when rates in most of Western Europe are falling. Scotland's alcohol policy has an explicit aim to reduce population consumption and includes legislative measures to tackle price and availability. A national program to deliver Alcohol Brief Interventions for hazardous drinkers is a key plank of this wider strategy. A portfolio of studies will monitor and evaluate national policy and, through contribution analysis, describe the role Alcohol Brief Interventions play in reducing alcohol misuse. Implications. Effective alcohol policy recognises that determinants of health not only lie at individual level, but include wider social, environmental and economic factors. Scotland's policy is addressing these determinants with both population-based and population-targeted interventions. Conclusion. Scotland has a serious problem with alcohol. A comprehensive, evidence-based, resourced alcohol policy is being implemented, which will need continual review to ensure it remains anchored in evidence while maintaining its ambition.[Graham LJC, MacKinnon D. Grasping the thistle: The role of alcohol brief interventions in Scottish alcohol policy. Drug Alcohol Rev 2010;29;603-607] [ABSTRACT FROM AUTHOR]

Data are from the European School Survey Project on Alcohol and other Drugs (ESPAD) in eight countries (Sweden, United Kingdom, France, Malta, Slovenia, Hungary, Bulgaria, and the Czech Republic) in spring 2003. Two scales were constructed, measuring beliefs that alcohol and cannabis harm people. Relationships of these scales with measures of parental control, parental attitudes, respondent's own drug use, friend's drug use, and gender were assessed within each country. Both at the country and the individual level, subject's own drug use showed strong inverse relationships with risk perceptions. Parental control and parental attitudes also showed associations with risk perception but these seemed largely mediated by the parental influence on subject's own use and by choice of friends. In countries with low prevalence of drug use the extent to which the predictor variables accounted for risk perceptions was lowest. Also the predictor variables showed greater associations with cannabis risk perception than with alcohol risk perception. For cannabis the explained variance in risk of harm varied from 8.1% in Sweden to 30.4% in the Czech Republic. For alcohol harm this range was from 3.1% in Bulgaria to 15.1% in Malta. [ABSTRACT FROM AUTHOR]