Regional abundance of on-premise outlets and drinking patterns among Swiss young men: district level analyses and geographic adjustments.

INTRODUCTION AND AIMS: This study investigated the associations of alcohol outlet density with specific alcohol outcomes (consumption and consequences) among young men in Switzerland and assessed the possible geographically related variations. DESIGN AND METHODS: Alcohol consumption and drinking consequences were measured in a 2010-2011 study assessing substance use risk factors (Cohort Study on Substance Use Risk Factors) among 5519 young Swiss men. Outlet density was based on the number of on- and off-premise outlets in the district of residence. Linear regression models were run separately for drinking level, heavy episodic drinking (HED) and drinking consequences. Geographically weighted regression models were estimated when variations were recorded at the district level. RESULTS: No consistent association was found between outlet density and drinking consequences. A positive association between drinking level and HED with on-premise outlet density was found. Geographically weighted regressions were run for drinking level and HED. The predicted values for HED were higher in the southwest part of Switzerland (French-speaking part). DISCUSSION AND CONCLUSIONS: Among Swiss young men, the density of outlets and, in particular, the abundance of bars, clubs and other on-premise outlets was associated with drinking level and HED, even when drinking consequences were not significantly affected. These findings support the idea that outlet density needs to be considered when developing and implementing regional-based prevention initiatives.

Adolescents smoking in the crosslight of other substance use and parental and peers' smoking behaviors.

This study investigates the connectedness of adolescents' smoking status, history of alcohol and cannabis use, and parental and peers' smoking, dimensions only rarely explored concurrently. Multinomial regression models that compared the smoking status of adolescents were estimated based on a representative sample of 3,560 adolescents aged 14-15 from Switzerland. While 49.0% of respondents had never smoked, 9.0% smoked on a daily basis and 12.0% occasionally; 32.6% had never drank alcohol and 74.7% had never used cannabis. Overall, parental and peers' smoking and other substance use factors are significantly associated with smoking status. Yet, history of substance use revealed less consistent associations with smoking status among current smokers (daily versus occasional smoking). The findings highlight the connectedness of adolescents' and other substance use behaviors and support the relevance of concurrent prevention initiatives targeting adolescents with specific substance use profiles and/or growing up in prosmoking social milieus.

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.

Beyond self-reports: drinking motives predict grams of consumed alcohol in wine-tasting sessions.

The link between drinking motives and alcohol-related outcomes has been investigated extensively, yet almost exclusively using retrospective self-reports that are subject to recall bias. This study overcomes this limitation using an experimental design to test whether the 4 drinking-motive dimensions (social, enhancement, coping and conformity, as measured in the baseline questionnaire) predict the quantity of alcohol actually ingested during 2 wine-tasting sessions conducted approximately 3 and 7 weeks after the baseline motive assessment. Regression modeling was based on an analog measurement of grams of pure alcohol among 123 young adults. Self-reported data at baseline concurred with the data collected during the experimental sessions, that is, alcohol consumption was high for males and enhancement drinkers and low for conformity drinkers. Coping drinkers significantly increased their consumption between the first and second sessions, while social drinkers tended to decrease theirs. Yet when separately considering data recorded during the first session, none of the drinking motives predicted the amounts of alcohol actually consumed. To conclude, this study demonstrates that motives predict actual alcohol consumption, which is consistent with evidence-based self-reports. Particularly, enhancement and coping drinkers seem to take advantage of the drinking situation probably because they usually appreciate the psychoactive properties of alcohol, either to maximize pleasurable sensations or to alleviate negative ones. However, if the setting is unusual (first tasting session), situational characteristics may "overrule" the effect of personal motives.

Solitary versus social drinking: an experimental study on effects of social exposures on in situ alcohol consumption.

BACKGROUND: Whereas the effects of modeling and of drinking contexts on alcohol use are documented, studies are lacking regarding the effect of given social exposures on actual alcohol consumption during drinking episodes (i.e., in situ alcohol consumption, the quantity of alcohol actually ingested in given occasion, e.g., in grams). METHODS: Applying the experimental paradigms, our study investigates the impact of social condition (alone vs. with others) on in situ alcohol consumption (analog measurements) of 123 young adults who participated in 2 wine-tasting sessions (one together with others, i.e., group condition; 1 solitary, i.e., individual condition: the sequence of participation was assigned at random). Bivariate and multivariate analyses, that is, paired- and independent-samples t-tests and repeated measure analysis of variance, were applied to investigate the effects through both transversal and longitudinal perspectives. RESULTS: In the first session, higher average amounts of alcohol were consumed in the group condition compared with the individual one. Conversely, higher average consumption was recorded in the individual compared with the group condition in the second session. Considering simultaneously data from the 2 experimental sessions demonstrated that subjects consumed higher amounts of alcohol in individual condition when this condition was organized subsequent and not prior to the group condition. Yet, alcohol consumption in group condition appeared to not vary between the 2 sessions. CONCLUSIONS: Results first highlight the effects of social condition on in situ alcohol consumption. However, they also suggest that in situ exposition to others drinking is possibly involved in shaping the perception of context-related drinking norms, which might further influence subsequent drinking behaviors in an analogous context. Beyond the issues of imitation effects, these findings raise the issues of the development of preventive initiatives aiming to induce changes in individuals' perception of context-specific drinking norms.

Enforcement of regional bans on tobacco sales to minors in Switzerland--example of missed opportunity?

Tobacco control policies, aiming at reducing youth's access to tobacco, revealed positive outcomes and were implemented in most of the European countries. A naturalistic field study was conducted to assess retailer compliance with a regional ban forbidding selling tobacco products to youths under the age of 18 in a Swiss canton. Results revealed that, 20 months after implementation, the ban was respected by about one out of seven retailers and compliance did not improve significantly over the following 24-month period. Potentials for concrete improvements were observed and a call for stronger implementation at the regional and local levels was made.

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.

Time of injury in light of prior-to-injury and usual alcohol consumption: an emergency department study.

PURPOSE: To investigate how prior-to-injury and usual alcohol consumption relate to time of injury. PATIENTS AND METHODS: The associations between injury time of day and day of week and prior-to-injury (labeled as "acute") alcohol intake and hazardous usual alcohol consumption (considered from the point of view of both heavy episodic drinking [HED] and risky volumes of consumption) are assessed using interview data from a randomized sample of 486 injured patients treated in a Swiss emergency department (ED; Lausanne University Hospital). RESULTS: Acute consumption was associated with both injury time of day and day of week, HED with day of week only, and risky volume with none. CONCLUSIONS: Acute consumption and HED, but not risky volume of consumption, show specific time distributions for injuries. These findings highlight the potential importance of considering the time dimension of an injury when providing emergency care and have additional implications for interventions aimed at influencing the alcohol consumption of injured patients presenting to the ED.

'I have no interest in drinking': a cross-national comparison of reasons why men and women abstain from alcohol use.

AIMS: To examine country differences in reasons for abstaining including the association of reasons with country abstaining rate and drinking pattern. PARTICIPANTS: Samples of men and women from eight countries participating in the GENACIS (Gender Alcohol and Culture: an International Study) project. METHODS: Surveys were conducted with 3338 life-time abstainers and 3105 former drinkers. Respondents selected all applicable reasons for not drinking from a provided list. Analyses included two-level hierarchical linear modelling (HLM) regression. FINDINGS: Reasons for abstaining differed significantly for life-time abstainers compared to former drinkers, by gender and age, and by country-level abstaining rate and frequency of drinking. Life-time abstainers were more likely than former drinkers to endorse 'no interest', 'religion' and 'upbringing' and more reasons overall. Gender differences, especially among former drinkers, suggested that norms restricting drinking may influence reasons that women abstain ('no interest', 'not liking taste') while drinking experiences may be more important considerations for men ('afraid of alcohol problems', 'bad effect on activities'). Younger age was associated with normative reasons ('no interest', 'taste', 'waste of money') and possibly bad experiences ('afraid of problems'). Reasons such as 'religion', 'waste of money' and 'afraid of alcohol problems' were associated with higher country-level rates of abstaining. Higher endorsement of 'drinking is bad for health' and 'taste' were associated with a country pattern of less frequent drinking while 'not liking effects' was associated with higher drinking frequency. CONCLUSIONS: Reasons for abstaining depend on type of abstainer, gender, age and country drinking norms and patterns.

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

BACKGROUND: There 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. METHODS: Implementation 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. RESULTS: Alcohol 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. CONCLUSION: The 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.

Pleasures of drinking: a cross-cultural perspective.

The purpose of this study was to evaluate how drinking is related to positive expectations of the effects of drinking. Data emanates from Gender, Alcohol and Culture - An International Study (GENACIS), a collaborative project in which surveys from all included countries utilized the same core questionnaire. Three indicators for positive expectations were used, representing a social, relational, and intimate dimension. Cross-country comparisons of positive expectancy reports were conducted, as well as exploratory multiple regression analyses of the relationships between expectations and drinking. Volume and binge drinking were used as two indicators for drinking pattern. The share of current drinkers varied between countries and genders. In all countries, men reported on expectancies more often than women. Regression model results are variable and not directly interpretable into cultural patterns, across countries and continents.

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.

Acute alcohol consumption and injury: risk associations and attributable fractions for different injury mechanisms.

OBJECTIVE: Most studies on alcohol as a risk factor for injuries have been mechanism specific, and few have considered several mechanisms simultaneously or reported alcohol-attributable fractions (AAFs)-which was the aim of the current study. METHOD: Data from 3,592 injured and 3,489 noninjured patients collected between January 2003 and June 2004 in the surgical ward of the emergency department of the Lausanne University Hospital (Switzerland) were analyzed. Four injury mechanisms derived from the International Classification of Diseases, 10th Revision, were considered: transportation-related injuries, falls, exposure to forces and other events, and interpersonal violence. Multinomial logistic regression models were calculated to estimate the risk relationships of different levels of alcohol consumption, using noninjured patients as quasi-controls. The AAFs were then calculated. RESULTS: Risk relationships between injury and acute consumption were found across all mechanisms, commonly resulting in dose-response relationships. Marked differences between mechanisms were observed for relative risks and AAFs, which varied between 15.2% and 33.1% and between 10.1% and 35.9%, depending on the time window of consumption (either 6 hours or 24 hours before injury, respectively). Low and medium levels of alcohol consumption generally were associated with the most AAFs. CONCLUSIONS: This study underscores the implications of even low levels of alcohol consumption on the risk of sustaining injuries through any of the mechanisms considered. Substantial AAFs are reported for each mechanism, particularly for injuries resulting from interpersonal violence. Observation of a so-called preventive paradox phenomenon is discussed, and prevention or intervention measures are described.

Alcohol-related adverse consequences: cross-cultural variations in attribution process among young adults.

BACKGROUND: Social norms around what is culturally accepted in terms of alcohol consumption and drunken comportment appear important regarding the acceptance of alcohol-related adverse consequences; however, investigations often neglect to consider differences in terms of attribution. This study aims at assessing cross-cultural differences in the reporting of alcohol-related adverse consequences. It also considers differences across consequences that might explain which type of consequences (mainly acute or mainly chronic) are most affected by an attribution process. METHODS: Conditional regression models were estimated based on data from eight European countries participating in the Gender, Alcohol and Culture--An International Study (GENACIS) project. Cases were matched to controls based on usual drinking patterns in order to control for average volume of alcohol and frequency of 'risky single occasion drinking' (RSOD). RESULTS: Differences among the patterns of associations between countries and consequences were evident. The distinction between Nordic and other European countries was persistent. A higher variability of associations was observed for some consequences, namely the mainly acute instances. Finally, the Isle of Man and Switzerland showed specific trends with associations across consequences. CONCLUSION: Reporting of alcohol-related adverse consequences seemed strongly affected by cultural norms. The latter may be exemplified by viewing drinking as 'time-out' behaviour. Respondents in countries with a stereotypical history of being 'dry' or with a stereotyped 'binge' drinking culture were more likely to attribute consequences to their alcohol consumption than people in 'wet' countries. This was particularly true for consequences that related to episodic 'time-out' heavy drinking.

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.

[Alcohol-related injuries--an emergency department study in the Lausanne University Hospital]. / Traumatismes dus a l'alcool--une etude aux départements des urgences du Centre hospitalier universitaire vaudois (CHUV).

Alcohol-related injuries are responsible for a large share of the global mortality and morbidity burden. Scant information existed, however, for Switzerland. Based on 3653 injured patients and 3519 patients attending the emergency department of the Lausanne University Hospital for other reasons, alcohol attributable fractions with regard to the alcohol consumption in the 6 hours before the injury were estimated. Among men 17% of all injures were alcohol attributable, and 12% among women. Relative risks increased in dose-response relationship with alcohol intake. Leisure time related injuries were most likely to be alcohol attributable. Most of the alcohol-related injuries occurred at already small ethanol quantities ingested.

Gender and cultural differences in the association between family roles, social stratification, and alcohol use: a European cross-cultural analysis.

AIMS: First, this paper investigates (i) gender differences in associations of social stratification, family roles, and heavy drinking, and (ii) country differences in these associations. Second, it seeks to explain country differences in the associations of social stratification and family roles with alcohol consumption by societal level variables. METHODS: Survey data of 25 to 49-years-old from eight European countries were used. Logistic regressions were used to analyse gender differences in the association between family roles (marriage, having children), social stratification (education, employment), and heavy drinking (>20 g/day for women; 30 g/day for men). Gender differences were tested by means of interactions between gender and social stratification/family roles. Structural measures of work desirability, social welfare, and gender equity were used to explain differences in associations across countries. RESULTS: The associations between social stratification, family roles, and heavy drinking varied across gender and countries. A country's social welfare system was associated with heavy drinking only among women. Women in countries with a strong social welfare system, such as Nordic countries, tended to drink more heavily if employed, having lower formal education, and a non-traditional family role. In countries with weak social welfare systems or work desirability, heavy drinking was associated with high education, while effects of family roles and employment were small. CONCLUSIONS: It appeared that the social welfare system and gender equity of a country determines to a large extent how education, employment, and family roles are associated with heavy drinking.

Drinking patterns and their gender differences in Europe.

AIMS: To compare drinking habits and to examine differences between drinking cultures in different regions and countries in Europe; to examine gender differences in drinking habits and to compare them over countries. METHODS: Data consisted of independently conducted, centrally analysed surveys in the general population aged 20-64 years in 14 European countries. Central measures were abstention, frequency and volume of drinking overall and by beverage type, amounts drunk per drinking day, and heavy episodic drinking. RESULTS: There were clear gender differences in all drinking measures, except for wine drinking. Differences between genders were often smaller than average in northern Europe. Gender ratios did not show systematic changes by age, with the exception that young men and women differed less than older men and women in the frequency of heavy episodic drinking. The results on beverage preferences indicate that the distinction among wine/beer/spirits cultures have implicitly been based on male drinking. Our expectation was for more daily light drinking integrated in everyday life in the Mediterranean countries, more heavy episodic drinking associated with weekends and celebrations in the North, with the traditional beer countries somewhere in between. The differences observed were usually in the direction expected. However, no country represented an ideal type of drinking culture, i.e. drinking for 'mood-changing effects' only or for 'nutritional purposes' only; all countries were mixtures of these two extremes. CONCLUSIONS: There were clear and consistent gender differences in all countries, while the differences in drinking between countries and regions were not as obvious.

Family bonding and adolescent alcohol use: moderating effect of living with excessive drinking parents.

AIMS: Excessive parental drinking has been shown to be positively related to adolescent alcohol use and family bonding negatively related. The aim of the present study was to determine if the perception of parental drinking moderates the relationship between family bonding and adolescent alcohol use. METHODS: Linear structural equation models for multiple group comparisons were estimated based on a national representative sample of 3,448 eight and ninth graders in Switzerland (mean age 14.77; SD 0.89). RESULTS: Adjusted for gender and age, the results confirm that strong family bonds were negatively related to both frequency of alcohol intake and lifetime frequency of drunkenness. Furthermore, a positive link was found with regard to the perception of parental drinking. However, the multiple group comparison revealed that the negative relationship between bonding and adolescent alcohol use was even stronger among adolescents whose parents drink excessively than among those whose parents did not. CONCLUSIONS: These results indicate that it may be particularly important for parents in the former category to establish strong family bonds (e.g. by spending free time with their children, listening to their worries) so as to limit adolescent excessive drinking.