Relations among alcohol consumption measures derived from the Cognitive Lifetime Drinking History.

Few studies have been conducted of chronic alcohol effects on health and social outcomes. To evaluate the utility and feasibility of such studies, correlations between lifetime and current measures of total alcohol consumption (ounces) and times intoxicated were examined to determine whether these dimensions of drinking are distinct. Studies were conducted in 2142 respondents ages 35 to 70 selected from lists of licensed drivers and individuals eligible for Medicare. Lifetime measures of alcohol consumption and times intoxicated were derived from the Cognitive Lifetime Drinking History (CLDH). Depending on age and sex of the subgroups examined, current consumption accounted for only about 10-25% of the variability in lifetime alcohol consumption; current and lifetime times intoxicated were even less highly correlated. Lifetime and current measures of alcohol consumption accounted for approximately 40-50% of the variability in corresponding lifetime and current measures of times intoxicated in younger cohorts, but this fell to 25% and less in older cohorts. These findings support the use of lifetime measures of alcohol consumption and times intoxicated based on the CLDH together with current measures to investigate chronic and acute alcohol effects on health and social outcomes.

Test-retest reliability of the cognitive lifetime drinking history.

A new measure of lifetime alcohol consumption, the Cognitive Lifetime Drinking History (CLDH) uses beverage-specific questions on drink sizes and assesses drinking patterns to enhance recall. Two methods of establishing drinking intervals were examined: 1) floating--the respondent's report of when drinking changed, and 2) fixed--defined in terms of decades. Test-retest reliability for lifetime ounces of alcohol consumed and times intoxicated in lifetime estimated at visits 1 week or more apart was assessed in postmyocardial infarction patients (n = 81) and controls (n = 138) who had had at least 12 drinks in a year during their lifetimes. No significant differences in estimates of lifetime ounces of alcohol or times intoxicated were observed. Spearman's r ranged between 0.85 and 0.92 for the floating and fixed versions of the CLDH administered at a single visit and between 0.74 and 0.85 for the floating or fixed administered at both visits. Time between visits did not influence correlations. Intervals reported on the floating CLDH were comparable for postmyocardial infarction patients and controls. It took approximately 5 minutes longer to administer the floating CLDH than the fixed CLDH. Findings support use of the CLDH for case-control studies and suggest that the floating and fixed versions would yield comparable results.

The academic health center and the healthy community.

US medical care reflects the priorities and influence of academic health centers. This paper describes the leadership role assumed by one academic health center, the State University at Buffalo's School of Medicine and Biomedical Sciences and its eight affiliated hospitals, to serve its region by promoting shared governance in educating graduate physicians and in influencing the cost and quality of patient care. Cooperation among hospitals, health insurance payers, the business community, state government, and physicians helped establish priorities to meet community needs and reduce duplication of resources and services; to train more primary care physicians; to introduce shared governance into rural health care delivery; to develop a regional management information system; and to implement health policy. This approach, spearheaded by an academic health center without walls, may serve as a model for other academic health centers as they adapt to health care reform.