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Biomedical subjects

G Gmel

Publications and source records attributed to G Gmel.

At least 19 recordsLinked to original sources
PubMed2006

[The construction of an empirically based social status index through optimal scaling as illustrated by 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.

Adult↗
PubMed2005

Drinking patterns and traffic casualties in Switzerland: matching survey data and police records to design preventive action.

OBJECTIVE: To examine the association between drinking patterns and alcohol-related traffic casualties. STUDY DESIGN: Data linkage of cross-sectional survey data on alcohol consumption with official traffic casualty records. METHODS: Alcohol consumption measures for usual heavy drinking and risky single occasion drinking were derived for different time segments of the day from a 7-day drinking diary study of 747 current drinkers. Measures were correlated with official records of alcohol-related traffic casualties. RESULTS: There was a high correlation between alcohol-related traffic casualties and the number of risky single occasion drinkers that consumed alcohol outside their homes (r=0.92). On average, about 50% of these drinking occasions were attributed to usual moderate drinkers. The proportion of usual heavy drinkers was lowest in the time segments with the most alcohol-related casualties. CONCLUSION: Preventive countermeasures should be targeted at the general population, enforced particularly during specific periods of the week.

Accidents, Traffic↗
PubMed2004

Characteristics of binge drinkers in Europe.

Binge drinking has been shown to be associated with considerable social harm and disease burden. This review aims to give an overview from a European perspective of the socio-demographical, individual, and social factors that affect binge drinking and to identify effective interventions to reduce binge drinking. To this end, a computer-assisted search of relevant articles was conducted. Results showed that males tended to binge drinking more frequently than females. Binge drinking was most prevalent among adolescents and young adults, and prevalence levelled off later in life. Socio-economic conditions seemed to have an effect on binge drinking, independent of their effects on the volume of alcohol consumed. The early onset of binge drinking was associated with a history of drinking in the family, but pathways into adulthood are less clear. Binge drinking often co-occurred with other substance use. Motives for binge drinking included both social camaraderie and tension reduction. Which aspect prevails may vary according to the type of binge drinker, but to date has not been satisfactorily explained. Binge drinkers were not likely to know enough about or be aware of the potential risks of bingeing. Pressure from peers was one of the strongest influencing factors for binge drinking and seemed to outweigh parental influences, especially from late adolescence onwards. Binge drinking also varied according to both the predominant adult and adolescent drinking culture with more binge drinking in the northern and middle parts of Europe compared to the southern parts. Thus, a variety of socio-demographical, individual, and social characteristics associated with binge drinking have been identified. However, knowledge in this area is limited, as most research has been conducted among particular groups in specific situations, in particular North American college students. More research in Europe is urgently needed, as results from other cultural backgrounds are difficult to generalize.

Adolescent↗
PubMed2001

Is frequency of drinking an indicator of problem drinking? A psychometric analysis of a modified version of the alcohol use disorders identification test in Switzerland.

BACKGROUND: To study the psychometric properties of a modified Alcohol Use Disorders Identification Test in the multilingual context of Switzerland. METHODS: Data were obtained from the most extensive health survey to date in Switzerland, with a response rate of 69%. Seven core items of AUDIT were used. The first two items of AUDIT (frequency of drinking, quantity of drinking) were not used in their original form, but reconstructed from a quantity-frequency instrument (QF) measuring alcohol consumption, and categorized according to the AUDIT. The third AUDIT item (frequency of binge drinking) was similarly not used in its original form, but 8+ drinks instead of 6+ drinks was used. All 10 items of the modified AUDIT were completed by 10321 subjects - 6677 in the German-speaking region and 3644 in the Latin-language (French, Italian) regions. The dimensionality of the modified AUDIT was modelled by confirmatory factor analysis. The contribution of each item to the total modified AUDIT score was investigated by the prevalence of positively screened subjects when items were deleted, and factor loadings of the unidimensional model. RESULTS: In Switzerland the modified AUDIT fitted neither a unidimensional nor the hypothesized tri-dimensional model. Consumption items, especially frequency of drinking, showed almost no correlation with items measuring alcohol-related problems, but the latent constructs 'harmful drinking' and 'alcohol dependence' were highly correlated, indicating a shared underlying factor. Frequency of drinking was the item that most influenced whether an individual screened positively or not. Except for the correlation of frequency and binge drinking, results were almost identical for both linguistic regions. CONCLUSIONS: The current form of the modified AUDIT may have to be changed for screening in Switzerland, as the study raised questions about the suitability of the frequency-of-drinking item as an indicator of a screening device for alcohol-related problems in this country.

Adult↗
PubMed2001

Imputation of missing values in the case of a multiple item instrument measuring alcohol consumption.

Missing values in survey instruments are a common problem for survey researchers. It is aggravated in the case of instruments used to measure alcohol consumption: they usually consist of item batteries from which summary measures, such as grams of pure alcohol per day, are constructed, and a missing value (for example, quantity or frequency) in regard to a single item for only one of several beverages results in a missing summary measure across all of the beverages, though the values for the remaining items are known. The present paper examines different approaches to imputation of missing values, feasible with standard statistical software packages. Hot-deck imputation is shown to have certain advantages, but even single-value imputation (for example, median imputation) results in values that are comparable to those of the other three imputation methods.

Adult↗
PubMed2001

Defining alcohol-related fatal medical conditions for social-cost studies in western societies: an update of the epidemiological evidence.

OBJECTIVES: To elaborate a state-of-the-art list of alcohol-related fatal medical conditions for future social-cost studies in Western societies. METHODS: Three major social-cost studies were compared with regard to their respective section on fatal health effects attributable to long-term as well as short-term use of alcohol. On discordant conditions, a systematic literature search was conducted in the Medline and ETOH databases. RESULTS: There is no consensus between social-cost studies with respect to alcohol-related causes of mortality. Based on the recent epidemiological evidence on alcohol and health, this paper suggests an up-to-date list of fatal medical conditions for which the causal relationship has been established with sufficient scientific evidence. A further investigation is needed, however, to reestimate relative risks by meta-analysis. CONCLUSIONS: Evaluating new epidemiological evidence regularly is necessary for the purpose of up-to-date social-cost studies.

Alcohol-Related Disorders↗
PubMed2001

Revising the preventive paradox: the Swiss case.

AIMS: To examine Kreitman's preventive paradox of alcohol consumption and its revisions by Stockwell and colleagues and by Skog, with regard to alcohol-related social harm in Switzerland, and to shed light on the reporting of alcohol-related social harm in the low-volume drinking, non-binging subpopulation. The paper compares occurrence and severity of social harm in four subgroups defined by average consumption (volume) and binge drinking. Stage-of-change membership was used to further distinguish low-risk drinkers who might have changed their drinking patterns from those who had not. DESIGN, SETTING, AND PARTICIPANTS: Telephone interviews were conducted with 1256 current drinkers of a probabilistic two-stage sample of the general population of Switzerland. Moderate and hazardous mean consumption (volume) was defined by means of a quantity-frequency instrument. Daily average consumption of 20 g was set as the cut-off point for women, and 30 g for men. Binge drinking was defined as taking four or more drinks on an occasion for women, and five or more for men. Structural equation modelling was used to construct a severity scale of six alcohol-related consequences: work problems, accidents and problems with the police, with friends, with a partner or with the family. Explanatory factor analysis was used to assign drinkers to motivational stages of change. FINDINGS: Moderate drinkers in terms of volume reported more problems than hazardous drinkers, which confirms Kreitman's view. Binge drinkers reported more problems than non-binge drinkers, confirming the view of Stockwell and colleagues. Binge drinkers were more numerous in the moderate drinking group, which constituted the majority of drinkers, in accordance with Skog's view. Binge drinkers in the moderate-volume and hazardous-volume drinking groups did not differ significantly as to either severity or number of problems. Approximately 40% of moderate-volume, non-binge drinkers who reported alcohol-related social harm had already changed their consumption pattern, which indicated that reported harm was related to an earlier drinking pattern. CONCLUSIONS: As Skog has pointed out, the second-order preventive paradox of binge drinking reappeared, in that most binge drinkers were found to occur in the drinker group with low average consumption. Findings also indicate that, with respect to social harm, a preventive strategy aimed at the majority of the population, but on heavy-drinking occasions rather than on mean consumption, may be valuable.

Adolescent↗
PubMed2001

Aggregate time-series regression in the field of alcohol.

Time-series regression of successive aggregate data has been used widely to explore relationships between substance use and harm, or to measure effects of policy interventions. This paper suggests minimal standards to conduct such analyses with respect to validity and reliability of underlying data, statistical techniques and requirements and interpretation of results.

Alcohol Drinking↗
PubMed2001

[Method determines results: indirect economic costs of alcohol abuse and alcoholism in Switzerland].

OBJECTIVE: The present contribution aims at illustrating the methodological problems that may arise from investigating the indirect social costs of alcohol consumption. METHODS: In order to estimate the alcohol-related productivity losses through excessive morbidity, regression analysis was performed, using data from the 2(nd) Swiss Health Survey (1997). For the purpose of sensitivity analysis two approaches were used (a) Rice and b) Harwood), and all models were calculated with and without smearing-adjustment as well as with and without adjustment for confounding variables. RESULTS: The present study shows that small changes in method may result in major variations in the estimated total costs. In monetary terms, the indirect costs for alcohol consumption in Switzerland through excess-morbidity were estimated at between 0.119 billion Francs (model Harwood, smearing-adjusted) and 2.175 billions Francs (model Rice, adjusted for confounding variables). CONCLUSION: Since many methodological problems in estimating the indirect costs of alcohol consumption have not been adequately resolved yet, results of those studies have to be interpreted with caution.

Alcohol-Related Disorders↗
PubMed2001

Relation between average alcohol consumption and disease: an overview.

OBJECTIVE: To conduct an overview of alcohol-related health consequences and to estimate relative risk for chronic consequences and attributable fractions for acute consequences. METHODS: Identification of alcohol-related consequences was performed by means of reviewing and evaluating large-scale epidemiological studies and reviews on alcohol and health, including epidemiological contributions to major social cost studies. Relative risks and alcohol-attributable fractions were drawn from the international literature and risk estimates were updated, whenever possible, by means of meta-analytical techniques. RESULTS: More than 60 health consequences were identified for which a causal link between alcohol consumption and outcome can be assumed. CONCLUSIONS: Future research on alcohol-related health consequences should focus on standardization of exposure measures and take into consideration both average volume of consumption and patterns of drinking.

Alcohol Drinking↗
PubMed2001

Methodological approaches to conducting pooled cross-sectional time series analysis: the example of the association between all-cause mortality and per capita alcohol consumption for men in 15 European states.

AIM: To compare different statistical models in order to estimate the association of alcohol consumption and total mortality when time series data stem from different regions. DATA AND METHODS: Data on per capita consumption in 15 European countries were combined with standardized mortality rates covering different periods between 1950 and 1995. An indicator of region-specific drinking patterns was measured without reference to a concrete time point, thus generating a hierarchical data structure. Two groups of models were compared: pooled cross-sectional time series models with different error structures and hierarchical linear models (random coefficient models). RESULTS: If historical time is not controlled for in cross-sectional models, this might result in estimating a negative association between alcohol consumption and total mortality. Hierarchical linear models or cross-sectional models controlling for historical time, however, resulted in the expected positive association. Only hierarchical linear models were able to adequately estimate the moderating effect of drinking patterns on the association between alcohol consumption and total mortality. CONCLUSION: For pooled cross-sectional time series data, control for the potential impact of historical time is of utmost importance. Hierarchical linear models constitute a superior alternative to analyze such complex data sets, especially as time-independent characteristics of regions can be implemented in the model.

Alcohol Drinking↗
PubMed2001

Steps towards constructing a global comparative risk analysis for alcohol consumption: determining indicators and empirical weights for patterns of drinking, deciding about theoretical minimum, and dealing with different consequences.

In order to conduct a comparative risk analysis for alcohol within the Global Burden of Disease Study (GBD 2000), several questions had to be answered. (1) What are the appropriate dimensions for alcohol consumption and how can they be categorized? The average volume of alcohol and patterns of drinking were selected as dimensions. Both dimensions could be looked upon as continuous but were categorized for practical purposes. The average volume of drinking was categorized into the following categories: abstention; drinking 1 (> 0-19.99 g pure alcohol daily for females, > 0-39.99 g for males); drinking 2 (20-39.99 g for females, 40-59.99 g for males), and drinking 3 (> or =40 g for females, > or =60 g for males). Patterns of drinking were categorized into four levels of detrimental impact based on an optimal scaling analysis of key informant ratings. (2) What is the theoretical minimum for both dimensions? A pattern of regular light drinking (at most 1 drink every day) was selected as theoretical minimum for established market economies for all people above age 45. For all other regions and age groups, the theoretical minimum was set to zero. Potential problems and uncertainties with this selection are discussed. (3) What are the health outcomes for alcohol and how do they relate to the dimensions? Overall, more than 60 disease conditions were identified as being related to alcohol consumption. Most chronic conditions seem to be related to volume only (exceptions are coronary heart disease and ischemic stroke), and most acute conditions seem to be related to volume and patterns. In addition, using methodology based on aggregate data, patterns were relevant for attributing harms for men but not women.

Adolescent↗
PubMed2001

Average volume of alcohol consumption, drinking patterns and related burden of mortality in young people in established market economies of Europe.

OBJECTIVE: To determine the burden of mortality in young people (age 15-29) in established market economies in Europe in 1999, which is attributable to alcohol consumption. Two dimensions of alcohol consumption were considered: average volume of consumption, and patterns of drinking. METHODS: Mortality data were obtained from the WHO EIP data bank, average volume data from the WHO global databank on alcohol, pattern of drinking data from a questionnaire sent out to experts, from the published literature and from the WHO global databank. Methods are explained and discussed in detail in two other contributions to this volume. RESULTS: More than 8,000 deaths of people aged 15-29 in Europe in 1999 were attributable to alcohol. Young males show a higher proportion of alcohol-attributable deaths (12.8%) than females (8.3%). Both average volume and patterns of drinking contribute to alcohol-related death. CONCLUSIONS: Alcohol-related deaths constitute a considerable burden in young people in Europe.

Adolescent↗
PubMed2001

Interviewers' and respondents' effects on self-reported alcohol consumption in a Swiss health survey.

OBJECTIVE: Characteristics of interviewers and respondents have been shown to influence the quality of data from survey research in various domains. There is little evidence for such effects in alcohol research, however. The purpose of the study reported here was to examine effects of gender and age of interviewers and respondents simultaneously This was done using hierarchical linear modeling, the advantage of which is that it can account for the clustering effects of respondents being nested within interviewers. METHOD: Data were obtained from the first wave of an ongoing randomized longitudinal study on changes in alcohol consumption in Switzerland. The response rate was 77.9%. Analyses were based on 2,746 (1,749 male) subjects with an average of at least monthly consumption in the 6 months before the telephone interview. Consumption was assessed by means of a graduated frequency measure. Five different hierarchical linear models of increasing complexity were used to test several hypotheses of interviewer and respondent effects. Findings from hierarchical linear modeling were compared with those from "classical" analysis of variance. RESULTS: A theoretical design effect of 1.89 attributable to interviewers was found. Both analyses of variance and hierarchical linear modeling provide support for a structure with a main effect for gender of respondents, as well as a main effect for age of respondents and an interaction effect between interviewers' and respondents' ages. CONCLUSIONS: Interviewer effects affect the estimation of statistics in survey research and must be adjusted for either by means of multilevel analysis or by the use of specialized sample survey software.

Adolescent↗
PubMed2001

Can legislation prevent debauchery? Mother gin and public health in 18th-century England.

The "gin epidemic" of 1720 to 1751 in England was the first time that government intervened in a systematic fashion to regulate and control sales of alcohol. The epidemic therefore provides an opportunity to gauge the effects of multiple legislative interventions over time. Toward that end, we employed time series analysis in conjunction with qualitative methodologies to test the interplay of multiple independent variables, including real wages and taxes, on the consumption of distilled spirits from 1700 through 1771. The results showed that each of the 3 major gin acts was successful in the short term only, consistent with the state's limited resources for enforcement at the local level, and that in each instance consumption actually increased shortly thereafter. This was true even of the Gin Act of 1751, which, contrary to the assumptions of contemporaries and many historians, succeeded by accident rather than by design. The results also suggest that the epidemic followed the inverse U-shaped trajectory of more recent drug scares and that consumption declined only after the more deleterious effects of distilled spirits had been experienced by large numbers of people.

Alcohol Drinking↗
PubMed2000

[Prevalence of tobacco use in Switzerland in the 1990's--estimation of consumption trends based on 2 methods].

Smoking prevalence rates in Switzerland in the 1990s++ have been estimated from Perma data, which have been available quarterly since 1991, as well as from the data of the first and second Swiss Health Surveys, conducted in 1992/93 and 1997. Both sources--each providing data on more than 10,000 respondents--have been large-scale surveys that have used different but complementary survey designs. The probabilistic sampling design of the Health Surveys assures representative findings; the Perma data, although obtained through a non-probabilistic sampling design, permits trend analysis as Perma uses multiple measurement points and therefore time-series methodology can be applied. Both Perma and the Health Surveys yielded approximately the same prevalence of 37% male smokers in 1992/93 and 39% in 1997. For females Perma gave 4% higher prevalence rates than the Health Surveys (Surveys 1992/93: 24%; 1997: 31%). For both sexes the increase in total smoking prevalence was accounted for mainly by adolescents and young adults. Whereas the Surveys showed an increase from 29% to 41% (18% to 39%) in males (females) aged 15 to 19 years, the corresponding increase derived from Perma was 50% less. Except for this youngest age-group, differences between the methods remained within standard statistical norms. There is no doubt, however, that smoking in adolescents increased between 1992/93 and 1997.

Adolescent↗