Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations.

This book was commissioned by the Department of Ethics, Equity, Trade and Human Rights as part of the work undertaken by the Priority Public Health Conditions Knowledge Network of the Commission on Social Determinants of Health, in collaboration with 16 of the major public health programmes of WHO: alcohol-related disorders, cardiovascular diseases, child health, diabetes, food safety, HIV/AIDS, maternal health, malaria, mental health, neglected tropical diseases, nutrition, oral health, sexual and reproductive health, tobacco and health, tuberculosis, and violence and injuries. In addition to this, through collaboration with the Special Programme of Research, Development and Research Training in Human Reproduction, the Special Programme for Research and Training in Tropical Diseases, and the Alliance for Health Policy and Systems Research, 13 case studies were commissioned to examine the implementation challenges in addressing social determinants of health in low-and middle-income settings. The Priority Public Health Conditions Knowledge Network has analysed the impact of social determinants on specific health conditions, identified possible entry-points, and explored possible interventions to improve health equity by addressing social determinants of health.

Equity, social determinants and public health programmes.

https://link.springer.com/content/pdf/10.2307%2F3342422.pdf

Inequalities in Health: The Black Report

Alcohol in Europe: a public health perspective

This is excellent background reading in medical microbiology. The book is in nine parts and covers bacteria, viruses, fungi and parasites and their infections. Medically important micro-organisms are discussed in terms of their classification, morphology, and pathogenesis. In addition, for each micro-organism the diagnosis, treatment, epidemiology and control are briefly discussed. The authors also discuss common infections of the cardiovascular system, urinary tract, and central nervous system and food poisoning. The last two parts of this book concentrate on the control of infections, clinical and laboratory diagnosis, treatment, and finally the prevention of infections. This is a simple and easy to follow book on infection and its control, I recommend it for undergraduate students in medicine, nursing and science.

https://jech.bmj.com/content/jech/50/1/111.4.full.pdf

Alcohol policy and the public good

AIMS: We investigated the presence of social inequalities of alcohol use and misuse using educational attainment as an indicator of socio-economic status in 15 countries: Sweden, Norway, Finland, Germany, The Netherlands, Switzerland, Hungary, the Czech Republic, Israel, Brazil, and Mexico. METHODS: Study surveys were independently conducted and the data centrally analysed. Most samples were national. Survey modes and sample sizes varied. The age range was restricted to between 25 and 59 years of age. Socio-economic status was measured by educational level. Multiple logistic regressions were employed to calculate age-adjusted odds ratios for men and women in each country by educational level for current drinking status, heavy drinking (>/=20 g ethanol per day for women, >/=30 g a day for men), heavy episodic (binge) drinking, and alcohol-related problems (using AUDIT). RESULTS: Men and women demonstrated similar patterns in inequalities with regard to current drinking status within a country. In Germany, The Netherlands, France, Switzerland, and Austria higher educated women were most likely to drink heavily, while among men the lower educated were more at risk in most countries. For heavy episodic drinking, almost no significant differences were evident among women, but for men a social gradient was observable with lower educated being more at risk in several countries. Among five countries with data from the AUDIT, men of lower education in Finland, Czech Republic, and Hungary had higher risks to report problems. Nordic countries shared a common pattern in social inequalities as did two Latin American countries, while a mixed picture was observed for middle European countries. Social inequalities in the two Latin American countries display a pattern emerging in other research on developing countries: namely that those in the higher educated groups are more likely to consume alcohol in a risky manner. CONCLUSIONS: Patterns in the distribution of social inequalities are not universal. Social inequalities in alcohol use differ by gender according to alcohol measure used and differ also across groups of countries. These variations should be taken into account when formulating international and cross-cultural alcohol policies. Language: en

/pdf/social-inequalities-in-alcohol-consumption-and-alcohol-2wkaudxack.pdf

Social inequalities in alcohol consumption and alcohol-related problems in the study countries of the EU concerted action 'gender, culture and alcohol problems: a multi-national study'

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.

/pdf/gender-and-cultural-differences-in-the-association-between-42infm85p6.pdf

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

Screening for alcohol-related problems in the general population using CAGE and DSM-IV: Characteristics of congruently and incongruently identified participants

Aims To investigate changes in measures of frequency of general alcohol and beverage-specific alcohol drinking in eastern and western Germany between 1991 and 1998.

Design, setting and participants  Data come from two nationally representative health surveys, one conducted in 1991/1992 and the other in 1998. The earlier sample comprises two separate surveys, a 1991 western German survey (n = 5255) and a 1992 eastern German survey (n = 2211); the sample from 1998 contains information from 5463 people. The two 1991/1992 samples were merged to produce a single data set, comprising 7466 cases. The 1998 sample was limited to people aged 25–69 years, the age range of the 1991/1992 surveys.

Measurements  The surveys included measures of current drinking, current beverage-specific drinking, weekly drinking, daily drinking, heavy drinking and mean amount consumed per day.

Findings  The prevalence of almost all measures of drinking frequency declined in both regions of Germany and for both genders. Decreases were larger in the East and especially for frequency of current spirits drinking and daily drinking. Despite the decreases, western women consistently consumed at higher levels than eastern women, as did eastern men in relation to western men. Moreover, gender and regional differences within the country decreased.

Conclusions  Overall frequency of consumption has declined in Germany in the 1990s and drinking behaviour in the two regions has become more similar.

Developments in alcohol consumption in reunited Germany

Numerous epidemiological studies have shown an association between social status and disease. In alcohol research, socio-economic status (SES) has been associated with drinking patterns, misuse and alcohol problems. SES is a construct which is usually built by using the indicators education, occupation or income separately or combined as a summary score. However, either approach involves theoretical assumptions about the explanatory value of a chosen indicator before the data have been analysed. In this study we have created a gender-specific metric social status indicator for Germany by using all three single SES-indicators (education, occupation, income). We used national representative data from a postal survey from 2000. The age range was restricted to 25 - 59 years. To construct the indicator we used optimal scaling (categorical principal components analysis). Therefore no theoretical assumptions were necessary about the hierarchical order of educational or occupational categories. The optimal-scaling approach allows variables to be scaled on different levels. We used education and occupation as the original categorical data and income (equivalent income) as continuous data. The result of the scaling is a two-dimensional solution. The first dimension explains that variance which could be described by status consistencies (corresponding levels for education, occupation and income). The second dimension of the indicator results from the low correlation between education and income for some individuals (status inconsistencies). The two-dimensional indicator yields differentiated results which would not be visible using a one-dimensional SES-indicator such as education or a summary score. With regard to drinking patterns there are clear differences between middle or low-educated women or men with higher incomes and other social groups. Middle or low-educated men or women with a high income are more likely to be heavy episodic drinkers than people in other social status groups.

Stephanie Kramer

Papers

Social inequalities in alcohol consumption and alcohol-related problems in the study countries of the EU concerted action 'gender, culture and alcohol problems: a multi-national study'

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

Screening for alcohol-related problems in the general population using CAGE and DSM-IV: Characteristics of congruently and incongruently identified participants

Developments in alcohol consumption in reunited Germany

Die Konstruktion eines empirisch bestimmten Sozialschichtindexes mittels optimaler Skalierung am Beispiel von Deutschland