ContextModifiable behavioral risk factors are leading causes of mortality in
the United States. Quantifying these will provide insight into the effects
of recent trends and the implications of missed prevention opportunities.ObjectivesTo identify and quantify the leading causes of mortality in the United
States.DesignComprehensive MEDLINE search of English-language articles that identified
epidemiological, clinical, and laboratory studies linking risk behaviors and
mortality. The search was initially restricted to articles published during
or after 1990, but we later included relevant articles published in 1980 to
December 31, 2002. Prevalence and relative risk were identified during the
literature search. We used 2000 mortality data reported to the Centers for
Disease Control and Prevention to identify the causes and number of deaths.
The estimates of cause of death were computed by multiplying estimates of
the cause-attributable fraction of preventable deaths with the total mortality
data.Main Outcome MeasuresActual causes of death.ResultsThe leading causes of death in 2000 were tobacco (435 000 deaths;
18.1% of total US deaths), poor diet and physical inactivity (400 000
deaths; 16.6%), and alcohol consumption (85 000 deaths; 3.5%). Other
actual causes of death were microbial agents (75 000), toxic agents (55 000),
motor vehicle crashes (43 000), incidents involving firearms (29 000),
sexual behaviors (20 000), and illicit use of drugs (17 000).ConclusionsThese analyses show that smoking remains the leading cause of mortality.
However, poor diet and physical inactivity may soon overtake tobacco as the
leading cause of death. These findings, along with escalating health care
costs and aging population, argue persuasively that the need to establish
a more preventive orientation in the US health care and public health systems
has become more urgent.

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Actual causes of death in the United States, 2000.

International guide for monitoring alcohol consumption and related harm

Programs targeted at high-risk youth are designed to prevent high-school dropout, crime, drug abuse, and other forms of delinquency. Even if shown to be successful in reducing one or more social ill, a key policy question is whether the cost to society from that intervention program exceeds its benefits. Although the costs of intervention programs are often available, the benefits are more illusive. This paper provides estimates of the potential benefits from "saving" a high-risk youth, by estimating the lifetime costs associated with the typical career criminal, drug abuser, and high-school dropout. In the absence of controlled experimental data on the number of career criminals averted, one can ask the reverse question—How many career criminals must be prevented before the program "pays for itself?" Based on a 2% discount rate, the typical career criminal causes $1.3$1.5 million in external costs; a heavy drug user, $370,000 to $970,000; and a high-school dropout, $243,000 to $388,000. Eliminating duplication between crimes committed by individuals who are both heavy drug users and career criminals results in an overall estimate of the "monetary value of saving a high-risk youth" of $1.7 to $2.3 million.

https://www.epi.msu.edu/janthony/requests/articles/Cohen_Monetary%20High-Risk%20Youth.pdf

The Monetary Value of Saving a High-Risk Youth

Alcohol use is related to a wide variety of negative health outcomes including morbidity, mortality, and disability. Research on alcohol-related morbidity and mortality takes into account the varying effects of overall alcohol consumption and drinking patterns. The results from this epidemiological research indicate that alcohol use increases the risk for many chronic health consequences (e.g., diseases) and acute consequences (e.g., traffic crashes), but a certain pattern of regular light-to-moderate drinking may have beneficial effects on coronary heart disease. Several issues are relevant to the methodology of studies of alcohol-related morbidity and mortality, including the measurement of both alcohol consumption and the outcomes studied as well as study design. Broad summary measures that reflect alcohol's possible effects on morbidity, mortality, and disability may be more useful than measures of any one outcome alone.

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Alcohol-related morbidity and mortality.

Aim To compare alternative survey methods for estimating (a) levels of at risk alcohol consumption and (b) total volume of alcohol consumed per capita in comparison with estimates from sales data and to investigate reasons for under-reporting.

Setting  The homes of respondents who were eligible and willing to participate.

Participants  A total of 21 674 Australians aged 14 years and older.

Design  A 2001 national household survey of drug use, experiences and attitudes with weights applied for age, sex, geographic location and day of week of interview.

Measures  Self-completion questionnaire using quantity–frequency (QF) and graduated–frequency (GF) methods plus two questions about consumption ‘yesterday’: one in standard drinks, another with empirically based estimates of drink size and strength.

Results  The highest estimate of age 14 + per capita consumption of 7.00 l of alcohol derived from recall of consumption ‘yesterday’ or 76.8% of the official estimate. The lowest was QF with 49.8%. When amount consumed ‘yesterday’ was recalled in standard drinks this estimate was 5.27 l. GF questions yielded higher estimates than did QF questions both for total volume (5.25 versus 4.54 l) and also for the proportion of the population at risk of long-term alcohol-related harm (10.6%versus 8.1%). With the detailed ‘yesterday’ method 61% of all consumption was on high risk drinking days.

Conclusions  Questions about typical quantities of alcohol consumed can lead to underestimates, as do questions about drinking ‘standard drinks’ of alcohol. Recent recall methods encourage fuller reporting of volumes plus more accurate estimates of unrecorded consumption and the proportion of total alcohol consumption that places drinkers at risk of harm. However, they do not capture longer-term drinking patterns. It is recommended that both recent recall and measures of longer-term drinking patterns are included in national surveys.

Under-reporting of alcohol consumption in household surveys: a comparison of quantity-frequency, graduated-frequency and recent recall.

Aims, design and setting. The economic costs of alcohol, tobacco and illicit drugs to Canadian society in 1992 are estimated utilizing a cost-of-illness framework and recently developed international guidelines. Measurements. For causes of disease or death (using ICD-9 categories), pooled relative risk estimates from meta-analyses are combined with prevalence data by age, gender and province to derive the proportion attributable to alcohol, tobacco and/or illicit drugs. The resulting estimates of attributable deaths and hospitalizations are used to calculate associated health care, law enforcement, productivity and other costs. The results are compared with other studies, and sensitivity analyses are conducted on alternative measures of alcohol consumption, alternative discount rates for productivity costs and the use of diagnostic-specific hospitalization costs. Findings. The misuse of alcohol, tobacco and illicit drugs cost more than $18.4 billion in Canada in 1992, representing $649 per capita or 2.7% of GDP. Alcohol accounts for approximately $7.52 billion in costs, including $4.14 billion for lost productivity, $1.36 billion for law enforcement and $1.30 billion in direct health care costs. Tobacco accounts for approximately $9.56 billion in costs, including $6.82 billion for lost productivity and $2.68 billion for direct health care costs. The economic costs of illicit drugs are estimated at $1.4 billion. Conclusions. Substance abuse exacts a considerable toll to Canadian society in terms of illness, injury, death and economic costs.

The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992

Background There are no standardized ways to assess alcohol consumption in epidemiological studies. The main objective of the present study was to compare three widely used methods for assessing alcohol consumption with respect to resulting prevalence estimates for high risk drinking and harm as defined by morbidity and mortality indicators. Methods A within-subjects design was used to compare a quantity frequency, a graduated frequency, and a weekly drinking recall measure. Data consisted of a representative sample of 3961 adult residents of the province of Ontario, Canada, who participated in a multi-wave cross-sectional survey between 1990‐1994. Crosstabulation, Spearman correlation, and standard methodologies for prevalencebased cost-of-illness studies were used. Results The graduated frequency measure consistently yielded higher estimates of the prevalences of high risk drinking and harm. Differences were marked on all indicators, but were most pronounced for harmful drinking as defined by consuming an average of .60 g pure alcohol per day for males, and .40 g per day for females. Prevalence estimates of harmful drinking were almost five times higher for graduated frequency versus weekly drinking measures, and almost three times higher for graduated frequency versus quantity frequency measures. Conclusions The characteristics of different measures of alcohol consumption should be considered in future research in epidemiology.

Assessment methods for alcohol consumption, prevalence of high risk drinking and harm: a sensitivity analysis.

BACKGROUND: In 1996 the number of deaths and admissions to hospital in Canada that could be attributed to the use of alcohol, tobacco and illicit drugs were estimated from 1992 data. In this paper we update these estimates to the year 1995. METHODS: On the basis of pooled estimates of relative risk, etiologic fractions were calculated by age, sex and province for 90 causes of disease or death attributable to alcohol, tobacco or illicit drugs; the etiologic fractions were then applied to national mortality and morbidity data for 1995 to estimate the number of deaths and admissions to hospital attributable to substance abuse. RESULTS: In 1995, 6507 deaths and 82,014 admissions to hospital were attributed to alcohol, 34,728 deaths and 194,072 admissions to hospital were attributed to tobacco, and 805 deaths and 6940 admissions to hospital were due to illicit drugs. INTERPRETATION: The use and misuse of alcohol, tobacco and illicit drugs accounted for 20.0% of deaths, 22.2% of years of potential life lost and 9.4% of admissions to hospital in Canada in 1995.

/pdf/the-relative-risks-and-etiologic-fractions-of-different-fpes7bw8w9.pdf

The relative risks and etiologic fractions of different causes of death and disease attributable to alcohol, tobacco and illicit drug use in Canada

Compositional analysis of plasma membranes from rats fed nutritionally adequate diets different in fatty acid composition establishes that fundamentally different dietary fat intake results in alteration in structural lipid composition of plasma membranes in brain, liver and the intestinal mucosa Dietary differences in fatty acid intake altered the fatty acyl tail composition of plasma membrane phospholipids in brain, liver and intestinal mucosa Diet altered the phospholipid profile observed in brain synaptosomal and liver plasma membrane Feeding high vs low polyunsaturated to saturated fat diets for 7 days altered the fatty acid composition of phosphatidylcholine, phosphatidylethanolamine, sphingomyelin and monoglucosylceramide isolated from plasma membrane of the intestinal mucosa

Lynda Robson

Papers

The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992

Assessment methods for alcohol consumption, prevalence of high risk drinking and harm: a sensitivity analysis.

The relative risks and etiologic fractions of different causes of death and disease attributable to alcohol, tobacco and illicit drug use in Canada

Plasma membrane: can its structure and function be modulated by dietary fat?

The economic costs of alcohol abuse in ontario