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Background: Alcohol consumption has many different dimensions. For each potential medical or social outcome, different dimensions of consumption may have different relationships. However, these relationships are not independent of each other and this multidimensionality is often mishandled or not taken into consideration at all in current alcohol epidemiology., Objective: To give recommendations on how to aggregate dimensions of alcohol consumption to predict social and medical consequences., Methods: Based on a review of relevant papers, different statistical methods to deal with aggregating dimensions of alcohol consumption in predicting outcomes are compared and discussed., Results: Regression approaches may be used to aggregate different dimensions of alcohol consumption to predict medical and social outcomes. However, the substantive interpretation of regression in general has to be taken into consideration., Conclusions: Future research in alcohol epidemiology should incorporate different dimensions of consumption and should analyze them by regression approaches either using the dummy variable approach or using suitable interaction terms.

Aims: To examine (a) effects of different modes of data collection on the reporting of alcohol consumption and non-response rate, and (b) differences in reported consumption between respondents and non-respondents., Design: Two versions of a health questionnaire survey were assigned to two random samples, one version to each sample. Version 1 consisted of a telephone interview without alcohol questions, followed by a mailed questionnaire with alcohol questions. Version 2 consisted of a telephone interview with alcohol questions, followed by a mailed questionnaire without alcohol questions., Setting: Participants were recruited randomly in eight Swiss cantons., Participants: Five hundred and thirty-seven (404) respondents to the telephone interview (and subsequent mailed questionnaire) with version 1, and 451 (360) with version 2., Measurements: Alcohol-use variables derived from a quantity-frequency measure., Results: Respondents to the mailed questionnaire (version 2) did not differ significantly in alcohol consumption from non-respondents. Response rate was not affected by inclusion of alcohol questions, but respondents asked by telephone about their alcohol use were more often abstainers and less often hazardous drinkers than respondents to the mailed question., Conclusion: The study gives no indication that interviews are refused because alcohol consumption is a questionnaire topic, but suggests that postal questionnaires give slightly greater disclosure of alcohol consumption.

Dimensions of alcohol-related social and health consequences are approached from two different perspectives. First, classical approaches with factor analytic techniques are used to empirically determine the dimensionality of item batteries intended to measure harm. Second, a closer look is taken at theoretically underlying dimensions of social and health consequences and their association with alcohol consumption. Using as empirical material data from the US national survey of males aged 21-59 (N3) conducted in 1969, the following specific questions are discussed: (1) What are the underlying dimensions of alcohol-related social and health consequences? (2) How should the relation between alcohol consumption and consequences best be assessed (in terms of epidemiological traditions or social constructivist traditions)? (3) How can we best incorporate the time perspective into modeling the relationship between alcohol consumption and consequences? A first attempt is made to develop practical guidelines for future research on handling these problems.

The study examined sex-specific changes in beverage preference by age group in three Swiss linguistic regions, the relationship between preference and self-reporting of alcohol-related problems, and sociocultural and linguistic influences. A sample of 953, interviewed in 1987, was reinterviewed in 1995. Preference differed by region and remained relatively stable. Only young adults changed, adopting typical regional patterns. Self-reporting, and remission and incidence of problem-reporting, were related to total intake and to changes in total intake, but only at younger ages to changes in preference. Beverage preference has little value as a predictor of self-reporting of problems.

Aims: (1) To estimate the impact of drinking patterns on negative social (behaviour) consequences. (2) To test for the additional impact of overall volume of alcohol consumed on these social consequences. (3) To explore whether the impact on social consequences of drinking patterns is comparable for measures that do and do not explicitly mention alcohol consumption., Design and Setting: An 8-year follow-up to a 1987 study of the Swiss general population carried out through face-to-face interviews; the follow-up data presented in this article was collected in 1995 through a mailed questionnaire., Participants: Nine hundred and fifty-three respondents from the 1987 survey who also completed the mailed questionnaire in 1995., Measurements: Variables used were as follows: volume of drinking, eight drinking patterns differentiated by volume and frequency, four social consequences without mention of alcohol and six with mention of alcohol. All multivariate analyses control for sex, age and linguistic region., Findings: High volumes of drinking per occasion predicted negative social consequences independently of overall drinking volume. This finding was independent of explicit mention of alcohol in item formulation. For unemployment and accidents, if assessed independently of alcohol consumption, no significant relationship with either overall volume of drinking or drinking pattern was observed., Conclusions: Patterns of alcohol consumption are an important determinant of social problems. Future research with better design is necessary to establish their exact risk relations with different social consequences.

Given the changes of gender roles in this century it is hardly justified to assume constant proportions of alcohol consumption for males and females. The purpose of the study was to reconstruct the consumption trends of males and females in Switzerland since the beginning of the 20th century. Cirrhosis mortality and survey data were used to disaggregate by sex the per capita alcohol consumption derived from sales data. The disaggregation of the per capita alcohol consumption based on liver cirrhosis mortality suggests that the evolution of alcohol consumption in Switzerland followed a parallel course for both sexes only until the 1930s. The low consumption during World War II and the evident increase until the beginning of the '60s seem to have resulted above all from the variations in consumption of beer by men. The decrease in total alcohol consumption observed since the '70s is also most probably due only to men; there is no indication of a decreasing consumption by women. The tendency of male and female consumption patterns to become more similar should be taken into account in the prevention of alcohol misuse.

A split-sample study investigated whether changes in the order of questions about the use of several medicines and remedies affected the estimation of prevalence of their use. In October 1996 the two versions of the questionnaires used for the First and Second Swiss Health Surveys were assigned respectively to two random samples (N1 = 537; N2 = 457). The general aim of the study was to investigate the comparability of the two questionnaire versions with regard to future analyses of trends. As assumed by the inclusion/exclusion model it was postulated that questionnaire changes in the order in which items on medicines and remedies were placed produced a contrast effect. A contrast effect would be a reduction in the estimation of the prevalence of use of those groups of medicines that followed remedies. The study found that question order produced no, or only small, effects on estimation of prevalence of use for purposes of future trend analysis. For eight groups of medicines the different questionnaire versions resulted in no significant differences (p > 0.05) in the prevalence of use. Effects on estimation of prevalence, however, must be expected according to whether a skip question about the use of medicines in general precedes the questions on specific medicines. As a tendency, the version without a skip question yielded a higher prevalence of daily use of tonics and fortifiers (4.8% versus 7.4%; p < 0.10). The difference (9.9% with a skip question versus 15.1% without) was significant (p < 0.05) for daily use of vitamins.

Objective: To assess public awareness of performance-enhancing drug use, that is, doping in sport in Switzerland., Design: Representative telephone survey in September 1995., Setting: Two of the three Swiss linguistic areas (French and German), representing 96% of the entire Swiss population., Subjects: A total of 1201 respondents between 18 to 74 years old, selected by stratified random sampling., Main Outcome Measures: Perception of the doping problem in elite versus recreational sport, estimated prevalence of doping in different sports, parents' decisions to keep children out of sport because of doping., Results: The use of doping in sport was perceived as a "somewhat serious problem" or "very serious problem" by 84% of the respondents for elite sport and by 44% for recreational sport (p < 0.01 for difference). Doping was mostly perceived to represent a physical health problem or an ethical problem. Track and field (79%) and cycling (27%) were most often cited as sports having doping problems, and 35% of the respondents believed that > 60% of bodybuilders use doping. The black market (91%), athletes and trainers (80%), and fitness centers (74%) were the most frequently mentioned sources of doping substances. Thirteen of 14 parents would not dissuade their children from participating in sport because of a concern about the problems of doping., Conclusions: The Swiss population perceives a high prevalence of doping in sports. There is a clear distinction, however, made by the respondents between the estimated prevalence of doping in elite sport, seen overwhelmingly as a "very serious problem" or "somewhat serious problem," and recreational sport, in which doping is less often seen as a problem. Doping is considered a serious threat to health and ethics in sport, but despite this judgment, only a few parents would hold back their children from sport because of the risks of doping.

At the aggregate-data level, time-series analysis of annual data for the period 1950-90 gives little support for a relation between alcohol consumption and suicide in Switzerland. Input series in the analysis were per capita consumption and rates of unemployment and divorce. Output series were gender-specific and age-adjusted suicide rates. Different time-series techniques were used to assure stationarity and to avoid spurious correlation because of common trends. The Box-Jenkins approach on differenced data was compared with simultaneous equation modelling, where time trends were modeled by means of dummy variables. The effects were weak and unstable for different methods. The advantage of simultaneous equation models is discussed. Furthermore, a single "harmonic" long-term wave explained more of the variance in the suicide rates than any input variable examined. Its implication for a "natural suicide rate" is considered.

In 1987, the Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA) developed a set of questions on alcohol-related problems in the general population. The aim of this article is to study the results of the questionnaire used as a screening instrument to detect problem drinking in the Swiss population, and to compare it with the CAGE test. The sample consisted of 953 people aged 20 or over. Among the drinkers (89% of the sample), 91 males (21.7%) and 34 females (8.7%) had a positive SIPA test and 53 males (12.7%) and 17 females (4.3%) a positive CAGE test. The SIPA test was more sensitive than the CAGE in detecting persons who drink regularly and quite heavily but without binge drinking. The item "Eye-opener" of the CAGE is too blunt for application to the Swiss general population and could with advantage be removed from the questionnaire. Females tend to deny alcohol problems much more than males. Binge drinking increases the risk of a positive test (SIPA: OR: 1.9; i.c. 95%: 1.2-3.0; CAGE: OR: 3.3; i.c. 95%: 1.8-6.0). In short, the SIPA test is more suitable in estimating the number of problem drinkers in the Swiss population than the CAGE, which was initially developed for the American medical population. Furthermore, the results suggest the necessity of using a different cut-off for each gender.

In 1987, a national survey on psychotropic substances and life styles was carried out by the Swiss Institute for Alcohol and Drug Problems (SIPAD). Out of 1910 participants, 1568 did agree to take part in a further study. In 1995, in order to execute a cohort type survey with minimal cost, the co-ordinates of 1472 of them were retrieved and a new questionnaire was sent to them. After 2 written reminders and another one by phone, the response rate reached 72.6%. It is therefore possible, at least in Switzerland, to lead a cohort type survey using a cross-sectional study as the starting point. Significant differences arise between the respondents and non-respondents at the level of linguistic region, age, income, civil status, educational level and alcohol or drugs consumption. On the other hand, neither sex, nor tobacco or cannabis consumption had an influence on the response rate.

Based on four representative surveys independently conducted at 6-year intervals, the study presented here delineates the development of alcohol consumption in the general population of Switzerland between 1975 and 1992. A description of changes in the frequency and quantity of alcohol consumption by sex is presented, as well as specific changes by beverage type. Even though Switzerland remains one of the high consumption countries, a marked decline can be observed. Compared to 1975 when 28% of respondents reported daily alcohol consumption, this figure dropped to 20% in 1992. Although 10% consumed more than 60 grams of pure alcohol in the 1975 sample, this proportion fell to only 3% in 1992. This downward trend, which is also reflected in secondary statistics such as sales and mortality figures, can be mainly attributed to male consumers. In contrast to international trends, which in general demonstrate converging drinking patterns, reduced consumption in Switzerland, a wine-producing country, is mainly due to a decline in beer consumption and not in wine consumption.

This paper is based on data from the first Swiss Health Survey, but deals with a more general problem; the estimation of age of onset in illegal substance consumption. First, it is shown that taking the arithmetic mean for different age-groups as estimator leads to an underestimation of age of onset in the younger groups. Consequently, an alternative method is proposed based on survival models with right censoring. The prediction of age of onset is modeled with nonlinear functions. Results show for cannabis consumption in Switzerland that age of onset did not decrease notably during the past decade.