Paul A. Shuper

Bio: Paul A. Shuper is an academic researcher from Centre for Addiction and Mental Health. The author has contributed to research in topics: Acquired immunodeficiency syndrome (AIDS) & Psychological intervention. The author has an hindex of 22, co-authored 48 publications receiving 2142 citations. Previous affiliations of Paul A. Shuper include University of Toronto & South African Medical Research Council.

Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies

Abstract: Aims To review and analyse in experimentally controlled studies the impact of alcohol consumption on intentions to engage in unprotected sex. To draw conclusions with respect to the question of whether alcohol has an independent effect on the incidence of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Methods A systematic review and meta-analysis of randomized controlled studies examined the association between blood alcohol content (BAC) and self-perceived likelihood of using a condom during intercourse. The systematic review and meta-analysis were conducted according to internationally standardized protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses: PRISMA). The meta-analysis included an estimate of the dose–response effect, tests for publication bias and sensitivity analyses. Results Of the 12 studies included in the quantitative synthesis, our pooled analysis indicated that an increase in BAC of 0.1 mg/ml resulted in an increase of 5.0% (95% CI: 2.8–7.1%) in the indicated likelihood (indicated by a Likert scale) of engaging in unprotected sex. After adjusting for potential publication bias, this estimate dropped to 2.9% (95% CI: 2.0–3.9%). Thus, the larger the alcohol intake and the subsequent level of BAC, the higher the intentions to engage in unsafe sex. The main results were homogeneous, persisted in sensitivity analyses and after correction for publication bias. Conclusions Alcohol use is an independent risk factor for intentions to engage in unprotected sex, and as risky sex intentions have been shown to be linked to actual risk behavior, the role of alcohol consumption in the transmission of HIV and other STIs may be of public health importance.

Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis.

Abstract: To analyze the relationship between alcohol consumption and incident HIV infection. Articles were identified via electronic and hand searches. Inclusion criteria were: incident HIV infection, preceding alcohol consumption, and association relating the two. The DerSimonian and Laird random effects model was used. For studies with more than one estimate of a given type, estimates were combined using the inverse variance weighted method. Publication bias was assessed using Begg’s and Egger’s tests. Heterogeneity was assessed using Q and I 2 statistics. Ten studies were included. Overall alcohol consumption (any of the three types identified) increased the risk of HIV (RR 1.98, 95% CI 1.59–2.47). Alcohol consumers were at 77% higher risk (RR 1.77, 95% CI 1.43–2.19). Those consuming alcohol prior to, or at the time of, sexual relations were at an 87% increased risk (RR 1.87, 95% CI 1.39–2.50). For binge drinkers, the risk was double that of non-binge drinkers (RR 2.20, 95% CI 1.29–3.74). Alcohol consumption is associated with an increased risk of incident HIV infection. Additional research is required to further investigate a possible causal role.

Causal considerations on alcohol and HIV/AIDS--a systematic review.

Abstract: Aim: The study aimed to explore the possible causal nature of the association between alcohol consumption and HIV/AIDS. Methods: A review based on meta-analyses and reviews was conducted according to standard epidemiological criteria to distinguish causality from association, examining (i) the potential impact of alcohol on the incidence of HIV and (ii) alcohol's impact on worsening the disease course. Results: In terms of incidence of HIV, although we found a consistent and strong association with consumption, there was not enough evidence for a causal connection. In particular, it is not clear whether personality traits such as sensation seeking or sexual compulsivity and psychiatric disorders such as antisocial personality disorder impact both alcohol consumption and risky sex, subsequently creating an association between both behaviors. In terms of worsening the disease course of HIV/AIDS, we found enough evidence for a causal impact of alcohol. Alcohol affects the immune system, thus contributing to a worsened course of HIV/AIDS. In addition, alcohol negatively impacts on behaviors that include support seeking and medication adherence. Conclusions: A randomized controlled clinical trial targeted toward at-risk HIV-negative individuals who live in areas with high HIV prevalence is suggested to test the effects of proven effective alcohol interventions on HIV incidence.

CLINICAL ASPECTS Causal Considerations on Alcohol and HIV/AIDS — A Systematic Review

Abstract: Aim:Thestudyaimedto explorethepossiblecausalnatureoftheassociationbetweenalcoholconsumptionandHIV/AIDS. Methods: A review based on meta-analyses and reviews was conducted according to standard epidemiological criteria to distin- guish causality from association, examining (i) the potential impact of alcohol on the incidence of HIV and (ii) alcohol's impact on worsening the disease course. Results: In terms of incidence of HIV, although we found a consistent and strong association with consumption, there was not enough evidence for a causal connection. In particular, it is not clear whether personality traits such as sensation seeking or sexual compulsivity and psychiatric disorders such as antisocial personality disorder impact both alcohol consumption and risky sex, subsequently creating an association between both behaviors. In terms of worsening the dis- ease course of HIV/AIDS, we found enough evidence for a causal impact of alcohol. Alcohol affects the immune system, thus contributing to a worsened course of HIV/AIDS. In addition, alcohol negatively impacts on behaviors that include support seeking and medication adherence. Conclusions: A randomized controlled clinical trial targeted toward at-risk HIV-negative individuals who live in areas with high HIV prevalence is suggested to test the effects of proven effective alcohol interventions on HIV incidence.

Characteristics of women undergoing repeat induced abortion

Abstract: Background: Although repeat induced abortion is common, data concerning characteristics of women undergoing this procedure are lacking. We conducted this study to identify the characteristics, including history of physical abuse by a male partner and history of sexual abuse, of women who present for repeat induced abortion. Methods: We surveyed a consecutive series of women presenting for initial or repeat pregnancy termination to a regional provider of abortion services for a wide geographic area in southwestern Ontario between August 1998 and May 1999. Self-reported demographic characteristics, attitudes and practices regarding contraception, history of relationship violence, history of sexual abuse or coercion, and related variables were assessed as potential correlates of repeat induced abortion. We used χ2 tests for linear trend to examine characteristics of women undergoing a first, second, or third or subsequent abortion. We analyzed significant correlates of repeat abortion using stepwise multivariate multinomial logistic regression to identify factors uniquely associated with repeat abortion. Results: Of the 1221 women approached, 1145 (93.8%) consented to participate. Data regarding first versus repeat abortion were available for 1127 women. A total of 68.2%, 23.1% and 8.7% of the women were seeking a first, second, or third or subsequent abortion respectively. Adjusted odds ratios for undergoing repeat versus a first abortion increased significantly with increased age (second abortion: 1.08, 95% confidence interval [CI] 1.04–1.09; third or subsequent abortion: 1.11, 95% CI 1.07–1.15), oral contraceptive use at the time of conception (second abortion: 2.17, 95% CI 1.52–3.09; third or subsequent abortion: 2.60, 95% CI 1.51–4.46), history of physical abuse by a male partner (second abortion: 2.04, 95% CI 1.39–3.01; third or subsequent abortion: 2.78, 95% CI 1.62–4.79), history of sexual abuse or violence (second abortion: 1.58, 95% CI 1.11–2.25; third or subsequent abortion: 2.53, 95% CI 1.50–4.28), history of sexually transmitted disease (second abortion: 1.50, 95% CI 0.98–2.29; third or subsequent abortion: 2.26, 95% CI 1.28–4.02) and being born outside Canada (second abortion: 1.83, 95% CI 1.19–2.79; third or subsequent abortion: 1.75, 95% CI 0.90–3.41). Interpretation: Among other factors, a history of physical or sexual abuse was associated with repeat induced abortion. Presentation for repeat abortion may be an important indication to screen for a current or past history of relationship violence and sexual abuse.

Food, Nutrition, Physical Activity, and the Prevention of Cancer : a Global Perspective : 食物、栄養、身体活動とがんの予防 : 世界的展望(後篇)

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The relation between different dimensions of alcohol consumption and burden of disease - an overview

Abstract: Aims As part of a larger study to estimate the global burden of disease and injury attributable to alcohol: to evaluate the evidence for a causal impact of average volume of alcohol consumption and pattern of drinking on diseases and injuries; to quantify relationships identified as causal based on published meta-analyses; to separate the impact on mortality versus morbidity where possible; and to assess the impact of the quality of alcohol on burden of disease. Methods Systematic literature reviews were used to identify alcohol-related diseases, birth complications and injuries using standard epidemiological criteria to determine causality. The extent of the risk relations was taken from meta-analyses. Results Evidence of a causal impact of average volume of alcohol consumption was found for the following major diseases: tuberculosis, mouth, nasopharynx, other pharynx and oropharynx cancer, oesophageal cancer, colon and rectum cancer, liver cancer, female breast cancer, diabetes mellitus, alcohol use disorders, unipolar depressive disorders, epilepsy, hypertensive heart disease, ischaemic heart disease (IHD), ischaemic and haemorrhagic stroke, conduction disorders and other dysrhythmias, lower respiratory infections (pneumonia), cirrhosis of the liver, preterm birth complications and fetal alcohol syndrome. Dose-response relationships could be quantified for all disease categories except for depressive disorders, with the relative risk increasing with increased level of alcohol consumption for most diseases. Both average volume and drinking pattern were linked causally to IHD, fetal alcohol syndrome and unintentional and intentional injuries. For IHD, ischaemic stroke and diabetes mellitus beneficial effects were observed for patterns of light to moderate drinking without heavy drinking occasions (as defined by 60+ g pure alcohol per day). For several disease and injury categories, the effects were stronger on mortality compared to morbidity. There was insufficient evidence to establish whether quality of alcohol had a major impact on disease burden. Conclusions Overall, these findings indicate that alcohol impacts many disease outcomes causally, both chronic and acute, and injuries. In addition, a pattern of heavy episodic drinking increases risk for some disease and all injury outcomes. Future studies need to address a number of methodological issues, especially the differential role of average volume versus drinking pattern, in order to obtain more accurate risk estimates and to understand more clearly the nature of alcohol-disease relationships.

Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Abstract: Importance Lack of current and comprehensive trend data derived from a uniform, reliable, and valid source on alcohol use, high-risk drinking, andDSM-IValcohol use disorder (AUD) represents a major gap in public health information. Objective To present nationally representative data on changes in the prevalences of 12-month alcohol use, 12-month high-risk drinking, 12-monthDSM-IVAUD, 12-monthDSM-IVAUD among 12-month alcohol users, and 12-monthDSM-IVAUD among 12-month high-risk drinkers between 2001-2002 and 2012-2013. Design, Setting, and Participants The study data were derived from face-to-face interviews conducted in 2 nationally representative surveys of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions, with data collected from April 2001 to June 2002, and the National Epidemiologic Survey on Alcohol and Related Conditions III, with data collected from April 2012 to June 2013. Data were analyzed in November and December 2016. Main Outcomes and Measures Twelve-month alcohol use, high-risk drinking, andDSM-IVAUD. Results The study sample included 43 093 participants in the National Epidemiologic Survey on Alcohol and Related Conditions and 36 309 participants in the National Epidemiologic Survey on Alcohol and Related Conditions III. Between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, andDSM-IVAUD increased by 11.2%, 29.9%, and 49.4%, respectively, with alcohol use increasing from 65.4% (95% CI, 64.3%-66.6%) to 72.7% (95% CI, 71.4%-73.9%), high-risk drinking increasing from 9.7% (95% CI, 9.3%-10.2%) to 12.6% (95% CI, 12.0%-13.2%), andDSM-IVAUD increasing from 8.5% (95% CI, 8.0%-8.9%) to 12.7% (95% CI, 12.1%-13.3%). With few exceptions, increases in alcohol use, high-risk drinking, andDSM-IVAUD between 2001-2002 and 2012-2013 were also statistically significant across sociodemographic subgroups. Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income. Increases were also seen for the total sample and most sociodemographic subgroups for the prevalences of 12-monthDSM-IVAUD among 12-month alcohol users from 12.9% (95% CI, 12.3%-17.5%) to 17.5% (95% CI, 16.7%-18.3%) and 12-monthDSM-IVAUD among 12-month high-risk drinkers from 46.5% (95% CI, 44.3%-48.7%) to 54.5% (95% CI, 52.7%-56.4%). Conclusions and Relevance Increases in alcohol use, high-risk drinking, andDSM-IVAUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis. Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role.

Explaining Society, Critical Realism in the Social Sciences:

Abstract: he revised English edition of this book tlie T original Swcdisli cdition. without tlie subtitle. is froni 1997 should be considered :is i111 important contribution to sociology and social science in general to tlie extent tliat it is a clear and wcll-structured introduction to critical i-disrri, one of the most rccent and vigorous theoretical streams in the field of thc social scicnces. if we take into coiisidcration tlic influential work of hlargaret t\\rclier (1995: Realist Socinl Tlicory: Tlic I\\loriJlio!gciicti(’

Examining the impact of Culture's consequences: a three-decade, multilevel, meta-analytic review of Hofstede's cultural value dimensions.

Abstract: Using data from 598 studies representing over 200,000 individuals, we meta-analyzed the relationship between G. Hofstede's (1980a) original 4 cultural value dimensions and a variety of organizationally relevant outcomes. First, values predict outcomes with similar strength (with an overall absolute weighted effect size of rho = 0.18) at the individual level of analysis. Second, the predictive power of the cultural values was significantly lower than that of personality traits and demographics for certain outcomes (e.g., job performance, absenteeism, turnover) but was significantly higher for others (e.g., organizational commitment, identification, citizenship behavior, team-related attitudes, feedback seeking). Third, cultural values were most strongly related to emotions, followed by attitudes, then behaviors, and finally job performance. Fourth, cultural values were more strongly related to outcomes for managers (rather than students) and for older, male, and more educated respondents. Fifth, findings were stronger for primary, rather than secondary, data. Finally, we provide support for M. Gelfand, L. H. Nishii, and J. L. Raver's (2006) conceptualization of societal tightness-looseness, finding significantly stronger effects in culturally tighter, rather than looser, countries.