Antigua and Barbuda

COUNTRY PROFILES REGION OF THE AMERICAS

ANTIGUA AND BARBUDA

Recorded adult per capita consumption (age 15+)

Total 4 Beer Spirits 3 Wine

Litres of pure alcohol pure of Litres 2

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Morbidity, health and social problems from alcohol use In a 1995/1996 study looking at 138 cases of congestive heart failure admitted to Holberton Hospital in Antigua, the aetiology of congestive heart failure was found to be alcohol-related in 2% of the cases reviewed.1

Country background information

Total population 2003 67 897 Life expectancy at birth (2002) Male 69.0 Adult (15+) 48 885 Female 73.9 % under 15 28 Probability of dying under age 5 per 1000 (2002) Male 22 Population distribution 2001 (%) Female 18 Urban 37 Gross National Income per capita 2002 US$ 9390 Rural 63

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 2003, The World Health Report 2004

References 1. McSwain M, Martin TC, Amaraswamy R. The prevalence, aetiology and treatment of congestive heart failure in Antigua and Barbuda. West Indian Medical Journal, 1999, 48(3):137–140.

WHO Global Status Report on Alcohol 2004 1 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

ARGENTINA

Recorded adult per capita consumption (age 15+)

12 Total Beer 10 Spirits 8 Wine Litres of pure alcohol 6

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers in Buenos Aires

Data from the WHO GENACIS Total study. Regional survey conducted 16.2% in 2003 (age group 20 to 64 years) in Buenos Aires and Capital Federal. Total sample size n = 928; males n = 367 and females n 1 = 561.

Male 7.5% Male 23.2% Female

A national survey conducted in 1999 (total sample size n = 2699; age group 16–64 years) found the rate of lifetime prevalence of alcohol consumption to be 91.4% (total), 96.4% (males) and 86.6% (females). The prevalence rate of alcohol use in the last 30 days was 66.2% (total), 78.8% (males) and 54.4% (females).2 Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 7% (males) and 21% (females). Data is for after year 1995.3 In a 2001 study of 31 male sex workers in Córdoba, Argentina, it was found that about half of the sample (53.3%) reported drinking alcohol at least once a week.4

2 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Heavy drinkers

National survey conducted in 1999 (total sample size n = 2699; age group 16–64 years). Heavy Total drinking was defined as average 6.6% consumption of 70 g of absolute alcohol daily (including during 2 the month before the survey).

Heavy and hazardous drinkers (among drinkers) in Buenos Aires

Data from the WHO GENACIS study. Regional survey conducted in 2003 (age group 20 to 64 years) in Buenos Aires and Capital Federal. Total sample size n = 928; males n = 367 and females n = 561. Definition used: average consumption of 40 g or more of pure alcohol a day for males and 20 g or more of pure alcohol a day for females (among drinkers Male 11.5% Male 2.0% Female only).1

Data from the WHO GENACIS study (total sample size n = 1000) conducted in Buenos Aires and the province of Buenos Aires (urban population aged 18 to 65 years) show that the rates of infrequent heavy drinkers and frequent heavy drinkers were 31.3% and 2.4% respectively. Infrequent heavy drinking was defined as drinking less than weekly five or more drinks a day and frequent heavy drinking was defined as drinking weekly or more five or more drinks a day.5

Heavy episodic drinkers (among drinkers) in Buenos Aires

Data from the WHO GENACIS study. Regional survey conducted in 2003 (age group 20 to 64 years) in Buenos Aires and Capital Federal. Total sample size n = 928; males n = 367 and females n = 561. Definition used: consumption of five or more drinks in one sitting at least once a month in the last year (among drinkers only).1 Male 26.5% Male Female 1.0% Female

Youth drinking in Buenos Aires (last year alcohol use)

A survey of adolescent school children (956 boys and 303 girls) in Buenos Aires province.6

Male 25.8% Male 25.7% Female

WHO Global Status Report on Alcohol 2004 3 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Recently, there has been a trend toward alcohol use at younger ages; in the metropolitan Buenos Aires area, for instance, 70% of adolescents drank beer on a daily basis.7

Alcohol dependence (last year)

National survey conducted in 1999 (total sample size n = 2699; Total age group 16–64 years) using ICD 4.31% (The International Statistical Classification of Diseases and Related Health Problems) 2 methodology. Male 6.67% Male Female 1.74% Female

Studies on the prevalence of alcoholism do not provide full data, but they do indicate a high percentage of alcoholics among economically active males (between 30% and 50%).7 A national survey conducted in 1999 (total sample size n = 2699; age group 16–64 years) also found the rate of alcohol abuse within the past 30 days to be 6.6% (total), 11.9% (males) and 1.6% (females).2

Unrecorded alcohol consumption The unrecorded alcohol consumption in Argentina is estimated to be 1.0 litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).3

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.25 2

1.8

0.2 1.6

1.4 Alcohol use disorders

0.15 1.2 Cirrhosis of the liver

1 Mouth and oropharynx cancers

SDR per 1000 per SDR 0.1 0.8 Ischaemic heart disease

0.6

0.05 0.4

0.2

0 0 1966 1970 1980 1984 1988 1992 1996 2000 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

4 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Acute mortality

0.25

0.2

0.15 Falls Intentional injuries Accidental poisonings

SDR per 1000 per SDR 0.1 Road traffic accidents

0.05

0 1966 1970 1980 1984 1988 1992 1996 2000 Year

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use A study carried out in October 1993 in four hospitals in the province of Buenos Aires found that 7% of all the consultations in the Hospital Emergency Facility were associated with alcohol or drugs. Of these, 70.4% were associated with alcoholic beverages. The prevalence of those having taken absolute alcohol in excess of 40 cc (defined as risky intake) in the previous six hours before attendance at the emergency facility was 5.4%.8 A study carried out in 1994 in hospitals nationwide of both in-patients and patients who had been released within 30 days prior to the study found that the main cause of internment in the sample (n = 260) was associated with the consumption of alcohol and other drugs (42.3%), the main cause being directly or indirectly related to alcohol consumption.9 A study conducted in the Federal Capital in 1978 by the Institute of Biology and Experimental Medicine found that blood alcohol levels of drivers of between 0.03% and 0.07% represented 14.2% of the sample tested, and levels higher than 0.07% correspond to 9.1% of the sample.10 In a case-control study conducted in the city of Mar del Plata, Argentina in 1992–1993 with the purpose of investigating the incidence of and the risk factors associated with proximal femur fractures due to osteoporosis, alcohol consumption was one of the factors found associated with a statistically significant increased risk of fracture of the proximal femur.11

Country background information

Total population 2003 38 428 000 Life expectancy at birth (2002) Male 70.8 Adult (15+) 28 052 440 Female 78.1 % under 15 27 Probability of dying under age 5 per 1000 (2002) Male 20 Population distribution 2001 (%) Female 16 Urban 88 Gross National Income per capita 2002 US$ 4060 Rural 12

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

WHO Global Status Report on Alcohol 2004 5 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

References 1. Preliminary results from the Gender, Alcohol and Culture: An International Study (GENACIS Project). International Research Group on Gender and Alcohol (for more information please see http://www.med.und.nodak.edu/depts/irgga/GENACISProject.html). 2. Miguez H. Consumo de sustancias psicoactivas en Argentina [Consumption of psychoactive substances in Argentina]. Psicoactiva, 2000, 18:1–17. 3. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 4. Mariño R, Minichiello V, Disogra C. Male sex workers in Córdoba, Argentina: sociodemographic characteristics and sex work experiences. Revista Panamericana de Salud Pública [Pan American Journal of Public Health], 2003, 13(5):311–319. 5. Munné M. Gender, alcohol and culture: an international study. Final report presented at the World Health Organization, Geneva, March 2003. 6. Moss HB et al. Substance use and associated psychosocial problems among Argentina adolescents: sex heterogeneity and familial transmission. Drug and Alcohol Dependence, 1998, 52(3):221–230. 7. Health in the Americas. Pan American Health Organization, 1998 Edition. 8. Miguez H. El abuso del alcohol y las drogas en la consulta hospitalaria de la provincia de Buenos Aires [Abuse of alcohol and drugs in hospital consultations in the province of Buenos Aires]. Revista de Prevención, Salud y Sociedad, 1994, Volume 6. In: Munné MI. Alcohol-related problems in Argentina. Preliminary draft of a paper to be presented at the 26th Annual Epidemiology Symposium of the Kettil Brunn Society for Social and Epidemiological Research on Alcohol. Oslo, 5–9 June 2000. 9. Investigaciõn intrahospitalaria sobre consumo de drogas [Intrahospital investigation into the consumption of drugs]. SEDRONAR, Secretaria de Programación para la Prevención de la Drogadiccion y Lucha contra el Narcotráfico [National Secretary for the Prevention of Drug Addiction and Fight Against Drug Trafficking], Buenos Aires, 1999. In: Munné MI. Alcohol-related problems in Argentina. Preliminary draft of a paper to be presented at the 26th Annual Epidemiology Symposium of the Kettil Brunn Society for Social and Epidemiological Research on Alcohol. Oslo, 5–9 June 2000. 10. Pan American Health Organization. Epidemiologic report on the use and abuse of psychoactive substances in 16 countries of Latin America and the Caribbean. Bulletin of the Pan American Health Organization, 1990, 24(1):97–139. 11. Mosquera MT et al. Incidencia y factores de riesgo de la fractura de fémur proximal por osteoporosis [Incidence and risk factors associated with fractures of the proximal femur due to osteoporosis]. Revista Panamericana de Salud Pública [Pan American Journal of Public Health], 1998, 3(4):211–219.

6 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

BAHAMAS (THE)

Recorded adult per capita consumption (age 15+)

12 Total Beer 10 Spirits 8 Wine

6 Litres of pure alcohol

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Youth drinking (last year alcohol use)

Data from the Bahamas Youth Health Survey 1997 showing past year alcohol use among Total adolescents aged between 10 and 32.2% 19 years old.1

Youth drinking (lifetime prevalence of use)

Survey conducted in 1987 among 4767 junior and senior high school students aged 11 years or over.2 Total 66%

The Boys and Girls Industrial School Study was conducted among 74 incarcerated delinquents in 1988 and found that 74% of the total sample reported ever having used alcohol.2

WHO Global Status Report on Alcohol 2004 7 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Youth drinking (daily drinkers)

Survey conducted in 1987 among 4767 junior and senior high school students aged 11 years or 2 Total over. 11.5%

The Boys and Girls Industrial School Study was conducted among 74 incarcerated delinquents in 1988 and found that 50% of the total sample reported drinking alcohol daily.2

Mortality rates from selected death causes where alcohol is one of the underlying risk factors The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.5 1.2

0.45 1 0.4

0.35 0.8 Alcohol use disorders

0.3 Cirrhosis of the liver 0.25 0.6 Mouth and oropharynx cancers

SDR per 1000 per SDR 0.2 Ischaemic heart disease 0.4 0.15

0.1 0.2 0.05

0 0 1969 1979 1984 1994 1998 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

8 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Acute mortality

0.3

0.25

0.2

1000 per SDR Falls Intentional injuries 0.15 Accidental poisonings Road traffic accidents 0.1

0.05

0 1969 1979 1984 1994 1998 Year

Source: WHO Mortality Database Note: Caution should be exercised when interpreting the results as death registration level is incomplete.

Morbidity, health and social problems from alcohol use Drinking, drug use and unruly behaviour have been known to lead to serious problems in the Bahamas. Alcohol is involved in the vast majority of arrests, accidents, violent crimes and deaths suffered by students on holiday in the Bahamas. Violent crimes such as rape often happen at night or in the early morning hours, and frequently involve alcohol and the club environment.3 The number of new clients treated at the Community Counselling and Assessment Centre in 2003 for alcohol abuse was 114 (86 males and 28 females). Out of this 114, 24 patients were aged between 21 and 35 years and 88 patients were aged 35 years and older.4 The number of persons presenting with alcohol abuse for treatment at the Community Mental Health Clinic (the principal outpatient treatment facility in the country) declined from 134 in 1990 to 68 in 1996. However, alcoholism is still a major health problem that remain at unacceptably high levels. Between 1988 and 1994, alcohol abuse was one of the three most common disorders presented at the clinic (the other two being drug abuse and depression).5 In 2000, 81.8% of all deaths due to mental conditions was attributed to alcohol-related mental disorders. In 1998, 25% of all deaths due to mental disorders was attributed to alcohol dependence.4 A study of the coroner’s records in the Bahamas between 1959 and 1969 revealed 61 deaths by suicide. 37% of all suicide victims were said to have had an alcohol-related problem.6

Country background information

Total population 2003 314 000 Life expectancy at birth (2002) Male 69.4 Adult (15+) 222 940 Female 75.7 % under 15 29 Probability of dying under age 5 per 1000 (2002) Male 18 Population distribution 2001 (%) Female 14 Urban 89 Gross National Income per capita 2002 US$ 14 860 Rural 11

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Bahamas Youth Health Survey, Ministry of Health Bahamas,1997. 2. Smart RG, Patterson SD. Comparison of alcohol, tobacco, and illicit drug use among students and delinquents in the Bahamas. Bulletin of the Pan American Health Organization, 1990, 24(1):39–45.

WHO Global Status Report on Alcohol 2004 9 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

3. U.S. Department of State. Fact Sheet: Spring break in the Bahamas. February 2003 (http://www.travel.state.gov/springbreak_bahamas.html, accessed 10 February 2004). 4. Health Information and Research Unit, Ministry of Health Bahamas. 5. Health in the Americas. Pan American Health Organization, 1998 Edition. 6. Spencer DJ. Suicide in the Bahamas. West Indian Medical Journal, 1973, 22(4):192.

10 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

BARBADOS

Recorded adult per capita consumption (age 15+)

10 l 8 Total Beer 6 Spirits Wine 4 Litres of purealcoho

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol experts showing proportion of adult males and females who had Total been abstaining (last year before 49.7% the survey). Data is for after year 1 1995. Male 29% Male Female 70.4% Female

A 1991–1994 urban survey conducted in Bridgetown, Barbados (males n = 329 and females n = 482; aged 25 years and above) found that 37.1% of males and 4.4% of females surveyed had consumed at least 12 drinks of any kind of alcoholic beverage in the past 12 months.2

Problem drinkers among acute medical admissions

A study of 203 emergency Total admissions to two medical wards. 18% Problem drinking was assessed using the brief Michigan Alcoholic Screening Test 3 (MAST) questionnaire. Male 31.0% Male Female 5.0% Female

WHO Global Status Report on Alcohol 2004 11 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

The study also found that 51% of problem drinkers started drinking between the ages of 16 and 20 years. Seventy per cent of all problem drinkers had a first degree family relative who drank compared to 28% of nondrinkers.3

Youth drinking (last year prevalence)

Rapid Assessment Survey conducted between October 1999 Total and July 2000 in 12 different 51% communities in Barbados among secondary school students.4

The study also found that an estimated 89% of students had experimented with alcohol and one half of the students below the legal drinking age of 16 had drunk alcohol in the past year.4

Unrecorded alcohol consumption The unrecorded alcohol consumption in Barbados is estimated to be -0.5 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.16 1.4

0.14 1.2

0.12 1 Alcohol use disorders 0.1

0.8 Cirrhosis of the liver 0.08 Mouth and oropharynx 0.6 cancers SDR per 1000 0.06 Ischaemic heart disease

0.4 0.04

0.2 0.02

0 0 1961 1966 1970 1974 1978 1982 1986 1990 1994 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

12 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Acute mortality

0.25

0.2

0.15 Falls Intentional injuries SDR per 1000 per SDR Accidental poisonings Road traffic accidents 0.1

0.05

0 1960 1964 1969 1973 1977 1981 1985 1989 1993

Year

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use A Rapid Situational Assessment conducted in Barbados in 1999–2000 found that social consequences of substance abuse in Barbados include petty crimes committed against person and property, increases in school dropout rates and increased promiscuity and sexually transmitted diseases.5 A study looking at a subset of the Barbados Eye Study of 3752 participants without glaucoma (aged 40 to 84 years) found that current alcohol use was a positively related factor associated with intraocular pressure.6

Country background information

Total population 2003 270 000 Life expectancy at birth (2002) Male 70.5 Adult (15+) 218 700 Female 77.9 % under 15 19 Probability of dying under age 5 per 1000 (2002) Male 17 Population distribution 2001 (%) Female 15 Urban 51 Gross National Income per capita 2002 US$ 9750 Rural 49

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 2. Cooper R et al. The prevalence of hypertension in seven populations of West African origin. American Journal of Public Health, 1997, 87(2):160–168. In: WHO Global NCD InfoBase. Geneva, World Health Organization. 3. Mansoor GA, Edwards CN. Questionnaire detection of problem drinkers among acute medical admissions. West Indian Medical Journal, 1991, 40(2):65–68. 4. Community Asset Development Consultants. The Barbados National Anti-Drug Plan 2003–2008. National Council on Substance Abuse, 2003. 5. Drug and alcohol use in Barbados: Its impact, factors related to use, available resources and current interventions. A rapid situational assessment. Bridgetown, National Council on Substance Abuse, 2000.

WHO Global Status Report on Alcohol 2004 13 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

6. Wu SY, Leske MC. Associations with intraocular pressure in the Barbados Eye Study. Archives of Ophthalmology, 1997, 115(12):1572–1576.

14 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

BELIZE

Recorded adult per capita consumption (age 15+)

7 l 6 Total 5 Beer

4 Spirits Wine 3 Litres of pure alcoho

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol experts showing proportion of Total adult males and females who had been abstaining (last year before 34% the survey). Data is for after year 1995.1

Male 24%Male Female 44% Female

Unrecorded alcohol consumption The unrecorded alcohol consumption in Belize is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

WHO Global Status Report on Alcohol 2004 15 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Chronic mortality

0.35 0.9

0.8 0.3

0.7 0.25 0.6 Alcohol use disorders

0.2 0.5 Cirrhosis of the liver

Mouth and oropharynx 0.4 0.15 cancers SDR per 1000 per SDR Ischaem ic heart disease 0.3 0.1 0.2

0.05 0.1

0 0 1964 1968 1972 1976 1980 1986 1991 1996 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.6

0.5

0.4

Falls Intentional injuries

SDR per 1000 per SDR 0.3 Accidental poisonings Road traffic accidents

0.2

0.1

0 1964 1968 1972 1976 1980 1986 1991 1996 Year

Source: WHO Mortality Database

Country background information

Total population 2003 256 000 Life expectancy at birth (2002) Male 67.4 Adult (15+) 158 720 Female 72.4 % under 15 38 Probability of dying under age 5 per 1000 (2002) Male 44 Population distribution 2001 (%) Female 34 Urban 48 Gross National Income per capita 2002 US$ 2960 Rural 52

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

16 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157.

WHO Global Status Report on Alcohol 2004 17 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

BERMUDA

Recorded adult per capita consumption (age 15+)

10 Total Beer 8 Spirits 6 Wine Litres of pure alcohol 4

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Note: Bermuda is not a WHO Member State.

18 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

BOLIVIA

Recorded adult per capita consumption (age 15+)

5 l 4 Total Beer 3 Spirits Wine 2 Litres of pure alcoho

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol experts showing proportion of adult males and females who had Total been abstaining (last year before 34.2% the survey). Data is for after year 1995.1

Female 44.6% Female Male 23.8% Male

It is estimated that in 1998, 10.01% (approximately 800 785 persons) and 7.8% (approximately 626 247 persons) of the Bolivian population are heavy drinkers and alcohol dependents respectively.2

Youth drinking (last year prevalence)

1999 survey of students aged between 12 and 21 years of age.3

Total 54.5%

WHO Global Status Report on Alcohol 2004 19 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

The same survey also found the rate of lifetime prevalence of alcohol use to be 60.8% and the rate of last month alcohol use to be 31.5%.3

Traditional alcoholic beverages Chicha is a clear, yellowish, effervescent, alcoholic beverage prepared from maize. It has a flavour similar to that of cider. Chicha has been consumed by the Andean Indians for centuries. When prepared from pigmented maize varieties, its colour varies from red to purple. The alcoholic content of chicha varies between 2 and 12% (v/v). The traditional production of chicha is a somewhat unique fermentation process in which saliva serves as the source of amylase for converting starch to fermentable sugars. Malting (germination) of maize kernels to produce the amylase required for starch conversion is an alternative procedure which is widely used in modern day processing. Frequently, salivation is combined with malting to yield chichi.4

Unrecorded alcohol consumption The unrecorded alcohol consumption in Bolivia is estimated to be 3.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Morbidity, health and social problems from alcohol use A study by the Department of Hygiene and Industrial Safety in three factories in La Paz found that 7.3% of absenteeism in the first two days of the work week and 1.2% of work-related accidents were directly related to the consumption of alcohol.5 According to statistics collected by the La Paz Traffic Department, in 1980, intoxication was the second most common cause of traffic accidents, being involved in 12.7% of the total number of traffic accidents. This figure increased to 18.6% in 1986.5 A study conducted in El Alto found that approximately one third of the women surveyed had been forced by their partner to have sexual intercourse, usually after the man had been drinking. The women claimed that one of the biggest problems at home is that the men drink too much. Alcohol abuse was identified by the women surveyed as being a major problem at home, linked to incidences of domestic violence and coercive sex.6

Country background information

Total population 2003 8 808 000 Life expectancy at birth (2002) Male 61.8 Adult (15+) 5 372 880 Female 64.7 % under 15 39 Probability of dying under age 5 per 1000 (2002) Male 78 Population distribution 2001 (%) Female 73 Urban 63 Gross National Income per capita 2002 US$ 900 Rural 37

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 2. Pages JA. WHO Representative in Bolivia. Personal communication. 29 March 2004. 3. Del Castillo FA. El uso indebido de drogas en estudiantes de Bolivia 1993–1996–1999. Psicoactiva, 2000, 18:53–70. 4. Haard NF et al. Fermented cereals: a global perspective. Rome, Food and Agriculture Organization of the United Nations, 1999 (http://www.fao.org/docrep/x2184e/x2184e07.htm, accessed 25 September 2004). 5. Pan American Health Organization. Epidemiologic report on the use and abuse of psychoactive substances in 16 countries of Latin America and the Caribbean. Bulletin of the Pan American Health Organization, 1990, 24(1):97–139. 6. Camacho A. Bolivia: Fertility regulation and its relationship to stability of the couple, sexuality and quality of life. Proyecto Integral de Salud (www.fhi.org/en/RH/Pubs/wsp/fctshts/Bolivia3.htm, accessed 24 February 2004).

20 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

BRAZIL

Recorded adult per capita consumption (age 15+)

5 l 4 Total Beer 3 Spirits Wine 2 Litres of pure alcoho pure of Litres

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Lifetime abstainers

Data from the 2003 World Health Survey. Total sample size n = Total 4803; males n = 2115 and females 22.8% n = 2688. Population aged 18 years and above.1

Male 13.2% Male Female 30.5% Female

According to the WHO GENACIS Study (2001/2002 regional survey of all urban residents in Botucatu; total sample size n = 857, males n = 377 and females n = 480; age range 20 to 64 years), the rate of last year abstainers was 51.5% (total), 40% (males) and 60.5% (females).2 Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 36% (males) and 57% (females). Data is for after year 1995.3

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Heavy and hazardous drinkers (among drinkers)

Data from the 2003 World Health Survey. Total sample size n = 4803; males n = 2115 and females Total n = 2688. Population aged 18 2.2% years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women.1 Male 3.3% Male 1.3% Female

According to the 2003 World Health Survey (total sample size n = 3719; males n = 1841 and females n = 1878), the mean value (in grams) of pure alcohol consumed per day among drinkers was 4.3 (total), 6.8 (males) and 1.9 (females).1 According to the WHO GENACIS Study (2001/2002 regional survey of all urban residents in Botucatu; total sample size n = 857, males n = 377 and females n = 480; age range 20 to 64 years), the rate of last year heavy and hazardous drinking among drinkers was 17.8% for men and 18.2% for women. Heavy and hazardous drinking was defined as consumption of 40 g or more of pure alcohol a day for males and 20 g or more of pure alcohol a day for females.2 An urban survey conducted in the city of Pelotas, southern Brazil among 1277 subjects aged 15 years and over found that the rate of prevalence of alcohol consumption was 54.2%; 11.9% (21.7% of men and 4.1% of women) reported potentially harmful levels of alcohol use and 4.2% were classified as manifesting alcohol dependence by the CAGE questionnaire.4

Heavy episodic drinkers

Data from the 2003 World Health Survey. Total sample size n = 4803; males n = 2115 and females n = 2688. Population aged 18 Total years and above. Definition used: 9.9% at least once a week consumption of five or more standard drinks in one sitting.1

Male 17.2% Male 4.1% Female

According to the WHO GENACIS Study (2001/2002 regional survey of all urban residents in Botucatu; total sample size n = 857, males n = 377 and females n = 480; age range 20 to 64 years), the rate of heavy episodic drinking among drinkers was 29.3% for men and 22.5% for women. Heavy episodic drinking was defined as consumption of five or more drinks in one sitting at least once a month in the last year.2 In a recent household survey carried out in a sample of 2302 adults in Salvador, Brazil (1052 males and 1250 females), 56% of the sample acknowledged drinking alcoholic beverages. Overall 12-month prevalence of high- risk drinking was 7%, six times more prevalent among males than females (almost 13% compared to 2.4%). Cases of high-risk drinking were defined as those subjects who referred weekly binge drinking (eight or more drinks in one sitting) plus episodes of drunkenness and those who reported any use of alcoholic beverages but with frequent drunkenness (at least once a week).5

22 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Youth drinking (lifetime abstainers)

Data from the 2003 World Health Survey. Total sample size n = Total 762; males n = 361 and females n 19.8% = 401. Population aged 18 to 24 years old.1

Male 11.4% Male 27.3% Female

A 1999 survey of 1500 university students (aged between 18 and 25 years) in the state of Minas Gerais found that the rate of lifetime prevalence of alcohol use was 83% and that 48% of students currently use alcohol.6 Street children of Brazil’s urban centres also seem to use alcohol regularly. A 1993 survey conducted in five Brazilian cities and using a convenience sample of children aged 6 to 18 years old showed that the prevalence rate of last month alcohol use ranged from 24.5% in Fortaleza to 81.5% in Recife.7

Youth drinking in large cities (lifetime prevalence)

National household survey conducted in 2001 covering the 107 largest cities in Brazil. Data Total shows lifetime consumption rate 48.3% for 12–17-year-olds (total sample size n = 1000; males n = 511 and 8 females n = 489). Male 52.2% Female 44.7% Female

A 1997 survey of 15 501 students (aged 10 to 18 years old) in Brazil’s ten largest state capitals found that 15% of the students were frequent users of alcoholic drinks (frequent use was defined as consumption of alcohol six or more times in the 30 days preceding the survey).9

Youth drinking (heavy episodic drinkers)

Data from the 2003 World Health Survey. Total sample size n = Total 762; males n = 361 and females n 15.3% = 401. Population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting.1 Male 26.3% Male Female 5.2% Female

Note: These are preliminary, early-release, unpublished data from WHO's World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of these data.

WHO Global Status Report on Alcohol 2004 23 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Alcohol dependence in large cities

National household survey conducted in 2001 covering the 107 largest cities in Brazil. Total sample size n = 8589 (age group Total 8 11.2% 12 to 65 years old).

Male 17.1% 5.7% Female

An urban survey of a representative sample of 1260 people aged 15 and over in a town in southern Brazil found that the prevalence rate of alcohol use disorder (using AUDIT) was 7.9% (total), 14.5% (males) and 2.4% (females).10 A cross-sectional study carried out in a random representative sample (n = 330; 243 men and 76 women) out of 1977 homeless people lodged in five public hostels of the Rio de Janeiro metropolitan area found the overall lifetime prevalence of alcohol abuse or dependence using the Composite International Diagnostic Interview (CIDI) and the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) to be 44.2% (53.1% in men and 15.8% in women).11 An urban survey conducted in 1995 of 275 inpatients in a general hospital found that 12.4% were diagnosed as having an alcohol use disorder by the AUDIT questionnaire. Among men the prevalence was 22% and for women it was 3%.12 A survey of 1459 people aged over 13 years living in a district of Rio de Janeiro found that 51% of the total sample used alcohol and that 3% (4.9% of males and 1.7% of females) were suspected of alcoholism, based on the CAGE test. The greatest prevalence of the use of alcohol and alcoholism was found among men between 30 and 49 years of age. Abstinence from alcohol was more frequent among low-income groups.13

Traditional alcoholic beverages Cachaça, aguardente de cana, pinga or caninha are the beverages obtained with an alcohol content of 38–54% v/v, from the distillation of fermented sugar-cane juice.14 Pinga is a highly popular spirit distilled from sugar-cane and is cheaply available. According to one study, it sells at an average price of just US$ 0.25 per 50 ml dose. The average cost of a 750 ml bottle of lager is US$ 0.82.15

Unrecorded alcohol consumption The unrecorded alcohol consumption in Brazil is estimated to be 3.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).3 Ministry of Agriculture figures suggest that illegal production of pinga is estimated to be one billion litres per year. This is in addition to the approximately one billion litres produced annually through legal means. This massive production is partly a by-product of the huge sugar-cane plantation programme, which was instigated as a means of producing alcohol as a petrol substitute to drive cars. Side-effects of this over production of sugar- cane are that alcohol in all forms is extremely cheap. For example, 1 litre of domestic alcohol, used for household cleaning, costs less than US$ 0.50, whilst a litre of pinga costs US$ 2.00. At one quarter the price, and despite its unsavoury and dangerous additives (which include sulfuric acid), some alcohol-dependents intermittently resort to drinking domestic alcohol instead of pinga.16

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

24 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Chronic mortality

0.16 1

0.9 0.14

0.8 0.12 0.7 Alcohol use disorders 0.1 0.6 Cirrhosis of the liver

0.08 0.5 Mouth and oropharynx cancers

SDR per 1000 per SDR 0.4 0.06 Ischaemic heart disease

0.3 0.04 0.2

0.02 0.1

0 0 1979 1983 1987 1991 1995 1999

Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.35

0.3

0.25

0.2 Falls Intentional injuries Accidental poisonings 0.15 Road traffic accidents SDR per 1000 per SDR

0.1

0.05

0 1979 1983 1987 1991 1995 1999 Year

Source: WHO Mortality Database Note: Caution should be exercised when interpreting the results as death registration level is incomplete.

WHO Global Status Report on Alcohol 2004 25 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Morbidity, health and social problems from alcohol use A cross-sectional study carried out in the emergency room of a level 1 trauma centre in the city of São Paulo between August 1998 and August 1999 analysed 464 patients. Positive blood alcohol concentrations (BAC) were found in 28.9% of the cases and in 83.4% BAC was equal to 0.10%.17 A study in the Metropolitan area of São Paulo during 1994 showed that a high blood alcohol concentration was found in 50.6% of motor vehicle accident victims.18 A youth survey of 7th to 11th grade students in public and private schools in São Paulo city found that Episodic Heavy Drinkers (EHDs) reported higher percentage of adverse consequences, such as physical fights, accidents and school absenteeism after drinking. EHDs are more likely to engage in other high-risk behaviours. In the public schools, they were more likely to carry guns, get involved in physical fights, attempt suicide, and use inhalants than abstainers. They are also more likely to use marijuana and smoke cigarettes than moderate drinkers.19 In a survey of adolescents in Porto Alegre, it was found that 30.5% of the subjects who had ever drunk alcohol admitted having experienced some kind of problem related to its use. In 70% of these cases the problem was a physical one such as headaches, dizziness and vomiting. However, 16.5% woke up late and 4.1% missed classes due to alcohol consumption.20 Data from a study conducted in 1990–1991 in three metropolitan regions looking at the distribution of mental disorders in the Brazilian population found that the prevalence of various forms of alcoholism point to a significant potential demand for psychiatric care in the population over the age of 15, with rates ranging from 4.5% to 8.7% and up to 15% among males in some cities.21 Alcoholism and drug use together account for close to 20% of all hospitalizations for mental disorders in Brazil. The proportion is as high as 28% in the South, according to data for 1995. Alcoholism was the underlying cause of 3621 deaths (only 10.8% of those were women), 35.5% of which were of persons under the age of 40.21 In a study looking at 616 children and youth patients hospitalized for alcoholic intoxication in São Paulo between 1993 and 1997, it was found that 35.2% of cases were due to reasons of abuse, 26.3% of cases were accidental and 18.8% were for suicidal reasons. The most frequently involved toxic agents were aguardiente (pinga), accounting for 12.2% of cases, beer (5.2%), wine (4.4%) cleaning alcohol (15.6%), cosmetic alcohol (5.8%) and combustive fuel (3.9%).22 A study of 2000 cases of mild head trauma in Curitiba, southern Brazil found that alcohol intoxication played a major role as an associated factor related to head trauma and was involved in 17.6% of the cases studied.23

Country background information

Total population 2003 178 470 000 Life expectancy at birth (2002) Male 65.7 Adult (15+) 128 498 400 Female 72.3 % under 15 28 Probability of dying under age 5 per 1000 (2002) Male 42 Population distribution 2001 (%) Female 34 Urban 82 Gross National Income per capita 2002 US$ 2850 Rural 18

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003. 2. Preliminary results from the Gender, Alcohol and Culture: An International Study (GENACIS Project). International Research Group on Gender and Alcohol (for more information please see http://www.med.und.nodak.edu/depts/irgga/GENACISProject.html). 3. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157.

26 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

4. de Lima MS et al. Gender differences in the use of alcohol and psychotropics in a Brazilian population. Substance Use and Misuse, 2003, 38(1):51–65. 5. Almeida-Filho N et al. Alcohol drinking patterns by gender, ethnicity, and social class in Bahia, Brazil. Revista de Saúde Pública, 2004, 38(1):45–54. 6. Fiorini JE et al. Use of licit and illicit drugs at the University of Alfenas. Revista do Hospital das Clínicas da Faculdade de Medicina de São Paulo, 2003, 58(4):199–206. 7. Noto AR et al. III Levantamento sobre o uso de drogas entre meninos e meninas em situação derua de cinco capitais brasileiras – 1993. São Paulo, CEBRID/Escola Paulista de Medicina, 1994. In: Riley L, Marshall M, eds. Alcohol and public health in 8 developing countries. Geneva, World Health Organization, 1999. 8. Carlini EA et al. I levantamento domiciliar sobre o uso de drogas psicotrópicas no Brasil – 2001. São Paulo, CEBRID, 2002. 9. Galduróz JCF et al. Trends in drug use among students in Brazil: analysis of four surveys in 1987, 1989, 1993 and 1997. Brazilian Journal of Medical and Biological Research, 2004, 37(4):523–531. 10. Mendoza-Sassi RA, Béria JU. Prevalence of alcohol use disorders and associated factors: a population- based study using AUDIT in southern Brazil. Addiction, 2003, 98(6):799–804. 11. Lovisi GM et al. Mental illness in an adult sample admitted to public hostels in the Rio de Janeiro metropolitan area, Brazil. Social Psychiatry and Psychiatric Epidemiology, 2003, 38(9):493–498. 12. Figlie NB et al. The frequency of smoking and problem drinking among general hospital inpatients in Brazil – using the AUDIT and Fagerström questionnaires. São Paulo Medical Journal, 2000, 118(5):139–143. 13. de Almeida LM, Coutinho ESF. Prevalencia de consumo de bebidas alcoólicas e de alcoolismo em uma região metropolitana do Brasil [Prevalence of the consumption of alcoholic beverages and of alcoholism in an urban region of Brazil]. Revista de Saúde Pública, 1993, 27(1):23–29. 14. Info on cachaca. eGullet Forums, 2003 (http://forums.egullet.com/index.php?showtopic=30121, accessed 13 April 2004). 15. Laranjeira R, Hinkly D. Avaliação da densidade de pontos de vendas de álcool e sua relação com a violência [Evaluation of alcohol outlet density and its relation with violence]. Revista de Saúde Pública, 2002, 36(4):455–461. 16. Dunn J, Laranjeira RR. News from Latin America – alcohol prices and consumption in Brazil. Addiction, 1995, 90(2):298. 17. Gazal-Carvalho C et al. Prevalência de alcoolemia em vítimas de causas externas admitidas em centro urbano de atenção ao trauma [Blood alcohol content prevalence among trauma patients seen at a level 1 trauma center]. Revista de Saúde Pública, 2002, 36(1):47–54. 18. Carlini-Cotrim B, da Matta Chasin AA. Blood alcohol content and death from fatal injury: A study in the Metropolitan area of Sao Paulo. Journal of Psychoactive Drugs, 2000, 32(3):269–275. 19. Carlini-Marlatt B et al. Drinking practices and other health-related behaviors among adolescents of São Paulo City, Brazil. Substance Use and Misuse, 2003, 38(7):905–932. 20. Pechansky F, Barros FC. Problems related to alcohol consumption by adolescents living in the city of Porto Alegre, Brazil. Journal of Drug Issues, 1995, 25(4):735–750. In: Riley L, Marshall M, eds. Alcohol and public health in 8 developing countries. Geneva, World Health Organization, 1999. 21. Health in the Americas. Pan American Health Organization, 1998 Edition. 22. Ferreira MG et al. Abordagem epidemiológica das intoxicações alcoólicas em crianças e jovens em diversas circunstâncias, notificadas ao Centro de Controle de Intoxicações de São Paulo, no período de janeiro de 1993 a dezembro de 1997 [Epidemiological approach of alcohol intoxication in children and youth, at the São Paulo Intoxication Centre, in the period from January 1993 through December 1997]. Revista de Psiquiatria Clínica, 2000, 27(2):71–75. 23. Bordignon KC, Arruda WO. CT scan findings in mild head trauma. A series of 2000 patients. Arquivos de Neuro-Psiquiatria, 2002, 60(2-A):204–210.

WHO Global Status Report on Alcohol 2004 27 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

CANADA

Recorded adult per capita consumption (age 15+)

10 l 8 Total Beer 6 Spirits Wine 4 Litres of pure alcoho pure of Litres

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Abstainers

Data from the National Population Health Survey 1998–1999. The Total original sample size of adults 15 22.1% years of age and older was 14 682. The data shown here has been weighted. ‘Abstainers’ here include abstainers and former drinkers.1

Male 17.8% Male 26.1% Female

Daily drinkers

Data from the National Population Health Survey 1998–1999. The original sample size of adults 15 Total years of age and older was 14 6.9% 682. The data shown here has been weighted.1

Male 9.7% Male 4.0% Female

28 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Heavy episodic drinking (last year among drinkers)

Data from the 2000/2001 Canadian Community Health Total Survey. Heavy episodic drinking 20.1% was defined as consuming five or more drinks on one occasion, twelve or more times in the last year. Data is for current drinkers only.2

Male 28.3% Male Female 11.2% Female

Data from the National Population Health Survey 1998–1999 (original sample size of adults 15 years of age and older was 14 682) shows that the rate of heavy episodic drinking was 4.5% (total), 7.3% (males) and 1.5% (females). Heavy episodic drinking was defined as having five or more drinks once a week. The data shown here has been weighted.1 In a 1989 national survey of 5689 men and 5945 women aged 15 years and above, the rate of last year binge drinking among drinkers was 62.1% (males) and 35.4% (females). Binge drinking was defined as having five or more drinks per drinking occasion.3 In a 1993 regional survey of Ontario residents (553 men and 481 women aged 18 years and over), the rate of past year binge drinking among current drinkers was found to be 55% among men and 22% among women. Binge drinking was defined as having five or more drinks per drinking occasion. In a 1990 regional survey of Ontario residents (22 967 men and 24 028 women aged 12 years and above), the rate of past year binge drinking among current drinkers was found to be 34.8% among men and 14.1% among women. Binge drinking was defined as having 10 or more drinks per drinking occasion.3

Youth drinking (drink at least weekly)

Data from the Health Behaviour in School-aged Children (HBSC) Total survey 2001/2002. Data shows 27.5% proportion of 15-year-olds who report drinking beer, wine or spirits at least weekly. Total 4 sample size n = 1207. Male 33.6% Male Female 22.7% Female

According to the 1997/1998 HBSC survey (total sample size n = 2403), 22% of 15-year-old boys and 17% of 15- year-old girls reported drinking beer, wine or spirits at least weekly.5

Youth drinking (heavy episodic drinkers among drinkers)

Data from the 2000/2001 Canadian Community Health Total Survey. Data shown is for 28.8% subsample age group 15–19 years old. Heavy episodic drinking was defined as consuming five or more drinks on one occasion, twelve or more times in the last year. Data is for current drinkers only.2 Male 35.2% Male 22.1% Female

WHO Global Status Report on Alcohol 2004 29 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Youth drinking (drunkenness) According to the 2001/2002 HBSC survey (total sample size n = 1625), the proportion of 15-year-olds who reported having been drunk at least two or more times was 30.4% for boys and 22.7% for girls.4

Alcohol dependence (last year)

Data from the 2002 Canadian Community Health Survey, Mental Health and Well-being (total sample size n = 36 984; Total subjects aged 15 years and over). 9.9% Alcohol dependence classification was based on a set of questions which examined aspects of alcohol tolerance, (for example, needing more to have an effect), Male 14.0%Male 4.5% Female withdrawal, loss of control, and social or physical problems related to alcohol use in daily life.6

A survey of a representative household sample using the University of Michigan version of the CIDI of the Ontario population aged 15–64 years found the rate of lifetime prevalence of alcohol dependence to be 12% (total), 19.2% (males) and 4.8% (females).7

Unrecorded alcohol consumption The unrecorded alcohol consumption in Canada is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).8

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.14 3

0.12 2.5

0.1 2 Alcohol use disorders

0.08 Cirrhosis of the liver

1.5 Mouth and oropharynx 0.06 cancers SDR per 1000 Ischaemic heart disease 1 0.04

0.5 0.02

0 0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

30 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Acute mortality

0.3

0.25

0.2

Falls Intentional injuries 0.15 Accidental poisonings SDR per 1000 per SDR Road traffic accidents

0.1

0.05

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997

Year

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use Recent research have shown statistically significant associations between alcohol consumption and overall fatal accident rates in all Canadian provinces for males, and in all provinces except Ontario for females. For Canada at large, an increase in per capita alcohol consumption of 1 litre was accompanied by an increase in accident mortality of 5.9 among males and 1.9 among females per 100 000 inhabitants. Among males there was a significant association with alcohol for both falling accidents, motor vehicle accidents and other accidents. Among females, the association with falling accidents and other accidents was significant.9 In a study to determine the prevalence and context of alcohol use in the deaths of children and youth in the British Colombia province, it was found that alcohol was present at the time of death in two fifths of motor vehicle accidents and one third of suicides and drownings.10 According to the official statistics of 1997, alcohol was involved in 38.6% of fatal motor vehicle crashes.11 A study that compared traumatic deaths occurring while driving a snowmobile and a control group of fatal motor vehicle driver and motorcycle driver accidents found that blood alcohol concentrations in snowmobile fatalities exceeded provincial limits in 64% of the cases. When snowmobile fatalities were adjusted for occurrence during suboptimal lighting conditions, only alcohol use was associated independently with fatal outcome. Drivers in snowmobile fatalities are associated with an approximately fourfold greater use of alcohol than are age- and sex- matched drivers in automobile and motorcycle fatalities.12 An analysis of 29 air rage cases reported in the Canadian Press for the time period 1998 to 2000 found that excessive alcohol use was an important precipitating factor.13 A study conducted in 1999 of 1001 adults (542 women) aged 18 and over found that the proportion of respondents who reported that at least one person had been drinking in the most recent incident of aggression was 38.1% for arguments, 56.5% for threats and 67.9% for physical aggression. Bivariate analysis suggested that drinkers were significantly more likely than nondrinkers to report aggression, with 11.4% of drinkers reporting verbal aggression only and 13.8% reporting physical aggression, compared to 6.9% and 7.4% of abstainers.14 A national Canadian survey on violence against women revealed that women with drunkard partners are six times more at risk of violence since alcohol is considered as one of the major factors of wife assault.15 Groups considered to be at particular risk from harm associated with alcohol and other drugs include women, youth, seniors, First Nations and Inuit peoples, and driving-while-impaired offenders. First Nations youths are at two to six times greater risk for alcohol-related problems than their counterparts in other segments of the

WHO Global Status Report on Alcohol 2004 31 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Canadian population.16 In Canada at large, a 1-litre increase in per capita consumption of alcohol was associated with a 17% increase in male total cirrhosis rates and a 13% increase in female total cirrhosis rates. Alcohol consumption had a stronger impact on alcoholic cirrhosis, which increased by fully 30% per litre in alcohol per capita for men and women.17

Economic and social costs The abuse of alcohol in 1992 cost Canada approximately $7.52 billion, including $4.14 billion for lost productivity due to illness and premature death, $1.36 billion for law enforcement and $1.3 billion in direct health care costs.18

Country background information

Total population 2003 31 510 000 Life expectancy at birth (2002) Male 77.2 Adult (15+) 25 838 200 Female 82.3 % under 15 18 Probability of dying under age 5 per 1000 (2002) Male 6 Population distribution 2001 (%) Female 5 Urban 79 Gross National Income per capita 2002 US$ 22 300 Rural 21

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Statistics Canada. Canadian National Population Health Survey, 1998–1999. In: Dell CA, Garabedian K. 2002 CCENDU National Report: Drug Trends and the CCENDU Network. Ottawa, Canadian Centre on Substance Abuse. 2. Statistics Canada. Canadian Community Health Survey 2000/01. Ministry of Industry, 2002. 3. Wilsnack RW et al. Gender differences in alcohol consumption and adverse drinking consequences: cross-cultural patterns. Addiction, 2000, 95(2):251–265. 4. Currie C et al., eds. Young people's health in context. Health Behaviour in School-aged Children (HBSC) study: international report from the 2001/2002 survey. Copenhagen, WHO Health Policy for Children and Adolescents (HEPCA), 2004. 5. Health Behaviour in School-aged Children: a WHO Cross-National Study (HBSC) International Report. Copenhagen, World Health Organization, 2000. 6. Statistics Canada. Canadian Community Health Survey, Mental Health and Well-being, 2002. Ministry of Industry, 2003. 7. Ross HE. DSM-III-R alcohol abuse and dependence and psychiatric comorbidity in Ontario: results from the Mental Health Supplement to the Ontario Health Survey. Drug and Alcohol Dependence, 1995, 39(2):111–128. 8. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 9. Skog O. Alcohol consumption and fatal accidents in Canada, 1950–98. Addiction, 2003, 98(7):883–893. 10. Mitic W, Greschner J. Alcohol’s role in the deaths of BC children and youth. Canadian Journal of Public Health, 2002, 93(3):173–175. 11. National Highway Traffic Safety Administration. Alcohol involvement in fatal crashes: comparisons among countries (http://www.nhtsa.dot.gov/people/injury/research/AlcoholCountries/references.htm, accessed 19 March 2004). 12. Rowe B et al. The association of alcohol and night driving with fatal snowmobile trauma: a case-control study. Annals of Emergency Medicine, 1994, 24(5):842–848. 13. Smart RG, Mann RE. Causes and consequences of air rage in Canada: cases in newspapers. Canadian Journal of Public Health, 2003, 94(4):251–253. 14. Wells S, Graham K, West P. Alcohol-related aggression in the general population. Journal of Studies on Alcohol, 2000, 61(4):626–632. 15. Rodgers K. Wife assault: the findings of a national survey. Juristat, 1994, 14(9):1–21. 16. Health in the Americas. Pan American Health Organization, 1998 Edition. 17. Ramstedt M. Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol: the case of Canada. Addiction, 2003, 98(9):1267–1276.

32 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

18. Single E et al. The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992. Society for the Study of Addiction to Alcohol and other Drugs (http://www.madd.ca/library/abstra02.htm, accessed 8 December 2003).

WHO Global Status Report on Alcohol 2004 33 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

CHILE

Recorded adult per capita consumption (age 15+)

14 l 12 Total 10 Beer

8 Spirits Wine 6 Litres of pure alcoho pure of Litres

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

2002 Fifth National Household Total Study. Total sample size n = 16 1 25.3% 476.

Male 22.0% 28.6% Female

Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 31% (males) and 47% (females). Data is for after year 1995.2 The 1998 Third National Household Survey of Drug Abuse with a sample size of 31 665 people aged between 12 to 64 years old who were representative of the national population found the rate of lifetime abstainers to be 15.6% of the total sample population.3

34 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Problem drinkers (prevalence)

Quality of Life Survey 2000. Definition used: two or more Total positive answers in a validated 16% questionnaire (derived from the Michigan Alcohol Screening Test (MAST) and CAGE).4

Female 5.5% Female Male 29.9% Male

A 1996 survey found that 24% of persons who said they had consumed alcohol in the past year fall into the category of problem drinkers (35.6% of the males and 11.1% of the females surveyed), with higher percentages in the lower socioeconomic groups.5

Youth drinking (last month prevalence)

2002 Fifth National Household Study (age group 12–18 years old).1 Total

35.4%

Male 35.8% Male 34.5% Female

The corresponding survey in 2000 showed that last month prevalence of alcohol use among those 12–18 years old was 32.8% (males) and 28.4% (females).6

Alcohol dependence (lifetime diagnosis)

The Composite International Diagnostic Interview (CIDI) was Total administered to a representative 6.4% sample of Chilean individuals (n = 2978) and prevalences were calculated based on DSM-III-R.7

Male 11% Male 2.1% Female

In a study of 406 patients hospitalized in the internal medicine service of a public hospital in Santiago (203 males and 203 females), it was found that 38% of males and 6% of females qualified for alcohol dependence or alcohol abuse at some point in their lives. DSM-III-R criteria was used to assess alcohol dependence and alcohol abuse.8 In a study of 406 patients (203 men and 203 women aged 11 to 90 years) hospitalized in an internal medicine service of a public hospital, the rate of current prevalence of alcohol dependence was found to be 6.6% (total), 12.3% (males) and 1% (females). The rate of lifetime prevalence of alcohol dependence was found to be 7.6% (total), 13.8% (males) and 1.5% (females).9

WHO Global Status Report on Alcohol 2004 35 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

With regard to alcoholism, it is estimated that at present 20% of persons can be classified as problem drinkers; 15% of them are not dependent on alcohol, and 5% are dependent on alcohol. Alcoholism is more frequent among males and among persons who are unemployed or irregularly employed.5

Unrecorded alcohol consumption The unrecorded alcohol consumption in Chile is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.8 1.4

0.7 1.2

0.6 1 Alcohol use disorders 0.5

0.8 Cirrhosis of the liver

SDR per 1000 per SDR 0.4 Mouth and oropharynx cancers 0.6 0.3 Ischaemic heart disease

0.4 0.2

0.2 0.1

0 0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997

Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

36 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Acute mortality

0.3

0.25

0.2

Falls Intentional injuries 0.15 Accidental poisonings

SDR per 1000 per SDR Road traffic accidents

0.1

0.05

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 Year

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use It is estimated that 20–22% of work-related accidents have a direct or indirect relationship with recent alcohol use. In a study of patients who required hospitalization for severe work-related accidents, it was found that 15% reported recent use of alcohol.10 In a study to determine the prevalence of family violence against women in a population sample in Temuco, Chile, it was found that alcohol abuse was a risk factor for violence against women. Among men, alcohol abuse was also identified as a risk factor for violent behaviours.11 In a survey in Temuco, Chile, it was found that parental alcohol abuse was an associated factor of child abuse.12 Alcoholism is associated with 38% of hospital discharges. It is the primary cause reported in 4.5% of hospital discharges and in 7% of deaths, and it is an associated cause in 25% of deaths. Alcohol use is a factor in 48.6% of homicides, 38.6% of suicides, and 50% of traffic accidents.5 Cirrhosis of the liver is the fifth cause of mortality in Chile in spite of the fact that the disease has shown a downward trend during the last decade. A significant increase in the median age of hospital discharges and deaths in men and women is noticed. The age-adjusted death rate per 100 000 people was 17.8 in 1999 (26.4 for men and 9.2 for women). In 1999, there were 2671 deaths caused by cirrhosis of the liver, representing 3.3% of total deaths recorded. The lifetime probability of hospital admission caused by cirrhosis of the liver in 1996 was 5.9% (total), 8.1% (men) and 4.4% (women). The lifetime probability of death caused by cirrhosis of the liver in 1999 was 3.6% (total), 5.7% (men) and 1% (women).13 In a case-control study of 170 breast cancer cases and 340 controls (all females) in Santiago, the odds ratio for breast cancer associated with alcohol consumption was found to be 1.61.14

Economic and social costs The total cost of excessive alcohol consumption (including indirect and direct costs) to Chile is estimated to be US$ 2.969 billion. The cost per capita is estimated to be US$ 209.15

WHO Global Status Report on Alcohol 2004 37 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Country background information

Total population 2003 15 805 000 Life expectancy at birth (2002) Male 73.4 Adult (15+) 11 537 650 Female 80.0 % under 15 27 Probability of dying under age 5 per 1000 (2002) Male 16 Population distribution 2001 (%) Female 13 Urban 86 Gross National Income per capita 2002 US$ 4260 Rural 14

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Fifth National Household Survey. Consejo Nacional para el Control de Estupefacientes (CONACE), 2002. 2. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 3. Fuentealba R et al. Consumo de drogas lícitas e ilícitas en Chile: resultados del estudio de 1998 y comparacíon con los estudios de 1994 y 1996 [Consumption of licit and illicit drugs in Chile: results of the 1998 study and comparison with the 1994 and 1996 studies]. Pan American Journal of Public Health, 2000, 7(2):79–87. 4. Encuesta de calidad de vida y salud Chile 2000 [Quality of Life and Health Survey Chile 2000]. Chilean Ministry of Health, 2000. 5. Health in the Americas. Pan American Health Organization, 1998 Edition. 6. Fourth National Household Survey. Consejo Nacional para el Control de Estupefacientes (CONACE), 2000. 7. Vicente B et al. Estudio chileno de prevalencia de patología psiquiátrica (DSM-III-R/CIDI) (ECPP) [Chilean study on the prevalence of psychiatric disorders (DSM-III-R/CIDI) (ECPP)]. Revista Médica de Chile, 2002, 130(5):527–536. 8. Hernández GG et al. Prevalencia de trastornos psiquiátricos por uso de alcohol y otras sustancias en hombres y mujeres hospitalizados en medicina interna de un hospital de Santiago de Chile [Prevalence of substance abuse among patients hospitalized in an internal medicine service]. Revista Médica de Chile, 2002, 130(6):651–660. 9. Hernández GG et al. Prevalencia de trastornos psiquiátricos en hombres y mujeres hospitalizados en un Servicio de Medicina Interna de un hospital de Santiago de Chile [Prevalence of psychiatric disorders among subjects hospitalized in a medicine ward of a general hospital]. Revista Médica de Chile, 2001, 129(11):1279–1288. 10. Trucco M et al. Recent alcohol and drug consumption in victims of work-related accidents. Revista Médica de Chile, 1998, 126(10):1262–1267. 11. Vizcarra MB et al. Violencia conyugal en la ciudad de Temuco. Un estudio de prevalencia y factores asociados [Conjugal violence in Temuco. Prevalence and predictive factors]. Revista Médica de Chile, 2001, 129(12):1405–1412. 12. Vizcarra MB et al. Child abuse in the city Temuco. Prevalence study and associated factors. Revista Médica de Chile, 2001, 129(12):1425–1432. 13. Medina E, Kaempffer AM. Cirrosis hepátiva en Chile [Cirrhosis of the liver in Chile]. Revista Médica de Chile, 2002, 6(1):7–14. 14. Atalah ES et al. Factores de riesgo del cáncer de mama en mujeres de Santiago [Breast cancer risk factors in women from Santiago, Chile]. Revista Médica de Chile, 2000, 128(2):137–143. 15. Economic impact of alcohol use in Chile. Unpublished paper. Faculty of Economical Sciences, University of Chile. Ministry of Health, 1998.

38 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

COLOMBIA

Recorded adult per capita consumption (age 15+)

6 l

5 Total Beer 4 Spirits

3 Wine Litres of pure alcoho pure of Litres 2

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Data from the 2000–2001 Multi- Total Country Survey Study. Total 15.1% sample size n = 6000; males n = 2071 and females n = 3929. Population aged 18 years and above.1

Male 4.9% Male 20.7% Female

High risk drinkers

Data from the 2000–2001 Multi- Country Survey Study. Total sample size n = 6000; males n = Total 2071 and females n = 3929. 31.8% Population aged 18 years and above. Definition used: consumption of five or more standard drinks for males and three or more standard drinks for females on a typical drinking day.1 Male 52.4% Male Female 21.0% Female

WHO Global Status Report on Alcohol 2004 39 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Heavy episodic drinkers

Data from the 2000–2001 Multi- Country Survey Study. Total Total sample size n = 6000; males n = 5.2% 2071 and females n = 3929. Population aged 18 years and above. Definition used: at least once a week consumption of six or more standard drinks in one sitting.1

Male 11.6% Male Female 1.9% Female

Youth drinking (last year abstainers)

Data from the 2000–2001 Multi- Country Survey Study. Total sample size n = 1080; males n = Total 384 and females n = 696. 9.6% Population aged 18 to 24 years. For the age group 15 to 19 years (subsample n = 357), the rate of last year abstainers was 11.5% (total), 3.4% (males) and 15.5% (females).1 Male 4.2% Male 12.6% Female

A 1997 survey of 1730 students in grade 10 from 32 randomly selected public high schools in Bogotá shows that the percentage of study participants who reported having had at least one drink during their lifetime was 86.6%.3 In a study of 2611 children (1253 boys and 1358 girls) aged 6–18 years old from the city of Medellín in Colombia, it was found that 46% of the children drank alcohol (52.5% of boys and 40.5% of girls). The study also found that 25.7% of those aged between 10 and 14 years drank alcohol, whilst 63.5% of children aged between 15 and 18 years old drank alcohol.4

Youth drinking (heavy episodic drinkers)

Data from the 2000–2001 Multi- Country Survey Study. Total sample size n = 1080; males n = 384 and females n = 696. Population aged 18 to 24 years old. For the age group 15 to 19 Total years (subsample n = 357), the 7.5% rate of heavy episodic drinkers was 10.1% (total), 16.1% (males) and 7.1% (females). Definition used: at least once a week

Male 14.5% 4.1% Female consumption of six or more standard drinks in one sitting.1

40 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Alcohol dependence

2003 national survey of mental health (total sample size n = 4544; aged 18 to 65 years). DSM-IV definition of alcohol dependence was used.5

Male 4.7% Male 0.3% Female

According to the 2000–2001 Multi-Country Survey Study (total sample size n = 6019; sample population aged 15 years and above), the rate of last year alcohol dependence was 4.8% (total), 9.8% (males) and 2.2% (females). Alcohol dependence was measured using criteria from the International Statistical Classification of Diseases and Related Health Problems (10th Revision).1 Note: These are preliminary, early-release, unpublished data from WHO's Multi-Country Survey Study made available exclusively for this report. Some estimates may change in the final analyses of these data. A 1987 urban survey of 2800 residents between the ages of 12 and 64 in four cities showed that 8.1% of subjects were considered to be alcoholics.6

Traditional alcoholic beverages Aguardiente (anise-based liquor), guarapo (from sugar-cane) and chicha (alcoholic beverage fermented from maize) and chirrinche (similar to aguardiente but made with herbs) are drunk mainly in the rural areas (home- brewed).

Unrecorded alcohol consumption The unrecorded alcohol consumption in Colombia is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

WHO Global Status Report on Alcohol 2004 41 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Chronic mortality

0.1 1.2

0.09

1 0.08

0.07 0.8 Alcohol use disorders

0.06 Cirrhosis of the liver

0.05 0.6 Mouth and oropharynx cancers 0.04 SDR per 1000 Ischaem ic heart disease 0.4 0.03

0.02 0.2

0.01

0 0 1961 1965 1969 1976 1986 1990 1994 1998

Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.9

0.8

0.7

0.6 F a lls Intentional injuries 0.5 Poisonings Road traffic accidents

SDR per 1000 SDR 0.4

0.3

0.2

0.1

0 1961 1965 1969 1976 1986 1990 1994 1998

Year

Source: WHO Mortality Database Note: Caution should be exercised when interpreting the results as death registration level is incomplete.

Morbidity, health and social problems from alcohol use A study of data on road deaths and injuries from 1991 to 1995 in Colombia found that 15% of deaths are attributable to driving whilst under the influence of alcohol.7 In a study looking at homicides that were registered in Cali, Colombia from 1993 to 1998, the bivariate analysis conducted revealed a positive association with alcohol consumption by the victim. Cases that occurred during a fight between individuals or during group fighting also showed an association with alcohol consumption by the victim.8 A cross-sectional study of a random sample of 275 women in Barranquilla, Colombia found that habitual alcohol consumption in the women and in the spouses were factors associated with marital violence.9

42 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

The use of drugs and alcohol is a key factor in 80% of child abuse cases in Colombia, reports a recent study conducted by World Vision in Colombia.10 A 1997 study showed that alcohol consumption is associated with self-perceived academic ability. Students who reported consumption of alcohol during the 30 days prior to the study showed significantly lower self-perceived academic ability than those who did not report alcohol use during the 30 days preceding the survey.3 In a study comparing 85 patients with gastric cancer and 170 controls, alcohol consumption was found to be more common among patients with gastric cancer.11

Country background information

Total population 2003 44 222 000 Life expectancy at birth (2002) Male 67.5 Adult (15+) 30 070 960 Female 76.3 % under 15 32 Probability of dying under age 5 per 1000 (2002) Male 27 Population distribution 2001 (%) Female 19 Urban 75 Gross National Income per capita 2002 US$ 1830 Rural 25

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Ustun TB et al. WHO Multi-Country Survey Study on Health and Health System Responsiveness 2000– 2001. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003. 2. Rehm J et al. Alcohol. In: Ezzati M et al., eds. Comparative quantification of health risks: Global and regional burden of disease due to selected major risk factors. Geneva, World Health Organization, in press. 3. Pérez MA, Pinzon-Pérez H. Alcohol, tobacco and other psychoactive drug use among high school students in Bogota, Colombia. Journal of School Health, 2000, 70(9):377–380. 4. Uscátegui Peñuela RMU et al. Factores de riesgo cardiovascular en niños de 6 a 18 años de Medellín (Colombia) [Cardiovascular risk factors in children and teenagers aged 16–18 years old from Medellín (Colombia)]. Anales de Pediatria, 2003, 58(5):411–417. 5. Encuesta Nacional de Salud Mental 2003 [National Survey of Mental Health, 2003]. Ministry of Health. 6. Torres de Galvis Y, Murrelle L. Consumption of dependence-producing substances in Colombia. Bulletin of the Pan American Health Organization, 1990, 24(1):12–21. 7. Posada J. Death and injury from motor vehicle crashes in Colombia. Revista Panamericana de Salud Pública [Pan American Journal of Public Health], 2000, 7(2):88–91. 8. Concha-Eastman A et al. La epidemiología de los homicidios en Cali, 1993–1998: seis años de un modelo poblacional [Epidemiology of homicides in Cali, Colombia, 1993–1998: six years of a population-based model]. Revista Panamericana de Salud Pública [Pan American Journal of Public Health], 2002, 12(4):230–239. 9. Tuesca R, Borda M. Violencia física marital en Barranquilla (Colombia): prevalencia y factores de riesgo [Marital violence in Barranquilla (Colombia): prevalence and risk factors]. Gaceta Sanitaria, 2003, 17(4):302–308. 10. Drugs, alcohol key factors in child abuse, says study. World Vision Worldview Update (http://www.worldvision.org/worldvision/pr.nsf/stable/update_colombia_120803, accessed 24 February 2004). 11. Rodríguez A et al. Asociación entre Infección por Helicobacter Pylori y Cáncer Gástrico en Colombia. Tomado De Acta Médica Colombiana, 2000, 25:112–116.

WHO Global Status Report on Alcohol 2004 43 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

COSTA RICA

Recorded adult per capita consumption (age 15+)

5 l 4 Total Beer 3 Spirits Wine 2 Litres of pure alcoho pure of Litres

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol experts showing proportion of adult males and females who had been abstaining (last year before the survey). Data is for after year Total 1995.1

60% Male 45% Male Female 75% Female

A national survey conducted in 2000–2001 (total sample size n = 4588, males n = 2298 and females n = 2287; aged 12–70 years old) found that 26.6% of the total subjects, 36.8% of males and 16.4% of females had consumed alcohol in the month prior to the survey.2 A 1995 national survey of Costa Rican inhabitants aged between 12 and 70 years old (total sample size n = 2731; males n = 1360 and females n = 1371) found that 44.8% of males and 70.4% of females were current abstainers.3 According to the WHO GENACIS Study (2003 survey; total sample size n = 1067, males n = 354 and females n = 713; age range 20 to 64 years), the rate of last year abstainers was 44.7% (total), 32.6% (males) and 56.7% (females).4

44 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Heavy and hazardous drinkers (among drinkers)

Data from the WHO GENACIS study. National survey conducted in 2003 (age group 20 to 64 years). Total sample size n = 1067; males n = 354 and females n = 713. Definition used: average consumption of 40 g or more of pure alcohol a day for males and 20 g or more of pure alcohol a day for females (data is for among drinkers only).4 Male 5.0% Male 3.0% Female

A 1995 national survey of Costa Rican inhabitants aged between 12 and 70 years old (total sample size n = 2731; males n = 1360 and females n = 1371) found that of 1154 current drinkers, 23% reported heavy drinking behaviours. This prevalence was higher in men (33.7%) than among women (5.9%). Heavy drinking was defined as having had five or more drinks at least once in the last month.3

Heavy episodic drinkers (among drinkers)

Data from the WHO GENACIS study. National survey conducted in 2003 (age group 20 to 64 years). Total sample size n = 1067; males n = 354 and females n = 713. Definition used: consumption of five or more drinks in one sitting at least once a month in the last year (among drinkers only).4 Male 22.1% 8.2% Female

Youth drinking (past year alcohol use)

1995 study of 304 randomly selected students from rural schools (mean age for females 14.7 years and for males 14.4 years).5

Male 56.6% Male Female 47.4% Female

WHO Global Status Report on Alcohol 2004 45 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Alcohol dependence

A national survey conducted in 2000–2001 (total sample size n = 4588; males n = 2298 and females Total n = 2287; aged 12–70 years old). 7% Alcohol dependency/alcoholic was defined as an individual that presents/displays the inability to abstain from the consumption of spirits or is unable to stop when consuming spirits as well as symptoms of greater deprivation Male 10.8%Male Female 2.4% Female (e.g. tremors).2

Traditional alcoholic beverages Guaro is a local cane spirit.3

Unrecorded alcohol consumption The unrecorded alcohol consumption in Costa Rica is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.2 1.4

0.18 1.2 0.16

0.14 1 Alcohol use disorders

0.12 0.8 Cirrhosis of the liver 0.1 Mouth and oropharynx 0.6 cancers

SDR per 1000 SDR per 0.08 Ischaem ic heart disease

0.06 0.4

0.04 0.2 0.02

0 0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

46 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Acute mortality

0.35

0.3

0.25

0.2 Falls Intentional injuries Accidental poisonings

SDR per 1000 per SDR 0.15 Road traffic accidents

0.1

0.05

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001 Year

Source: WHO Mortality Database Note: Caution should be exercised when interpreting the results as death registration level is incomplete.

Morbidity, health and social problems from alcohol use It is estimated that 30% of absenteeism and workplace accidents are caused by alcoholism.6 Of a total of 927 644 emergency consultations in 1987, 120 594 (13%) were related to problems secondary to the consumption of alcoholic beverages. In the period 1981–1987, 119 435 traffic accidents were recorded, of which 6003 (5%) were associated with drunken driving.6 In a 1995 study of rural male and female Costa Rican adolescents using the Drug Use Screening Inventory (DUSI), it was found that for males especially, those who reported use of alcohol in the past year manifested more problems. For example, there were significant differences between male alcohol users and nonusers on the severity indices for both behavioural patterns and peer relationships.5

Country background information

Total population 2003 4 173 000 Life expectancy at birth (2002) Male 74.8 Adult (15+) 2 921 100 Female 79.5 % under 15 30 Probability of dying under age 5 per 1000 (2002) Male 12 Population distribution 2001 (%) Female 10 Urban 60 Gross National Income per capita 2002 US$ 4100 Rural 40

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 2. Bejarano J, Ugalde F. Consumo de drogas en Costa Rica: resultados de la Encuesta Nacional del 2000– 2001 [Drug consumption in Costa Rica: results from the 2000–2001 National Survey]. In: WHO Global NCD InfoBase. Geneva, World Health Organization. 3. Bejarano J. Alcohol epidemiology in Costa Rica. In: Demers A, Room R, Bourgault C. Surveys of drinking patterns and problems in seven developing countries. Geneva, World Health Organization, 2001.

WHO Global Status Report on Alcohol 2004 47 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

4. Preliminary results from the Gender, Alcohol and Culture: An International Study (GENACIS Project). International Research Group on Gender and Alcohol (for more information please see http://www.med.und.nodak.edu/depts/irgga/GENACISProject.html). 5. Sandi L, Diaz A, Uglade F. Drug use and associated factors among rural adolescents in Costa Rica. Substance Use and Misuse, 2002, 37(5–7):599–611. 6. Pan American Health Organization. Epidemiologic report on the use and abuse of psychoactive substances in 16 countries of Latin America and the Caribbean. Bulletin of the Pan America Health Organization, 1990, 24(1):97–139.

48 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

CUBA

Recorded adult per capita consumption (age 15+)

4.5

3.5

3 Total Beer 2.5 Spirits

Litres of pure alcohol 2 Wine

1.5

0.5

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol experts showing proportion of adult males and females who had been abstaining (last year before Total the survey). Data is for after year 1995.1 49.7%

Male 29% Male 70.4% Female

A national survey conducted in 1995 (subjects 15 years old or above) found the rate of abstainers (according to the CAGE index) to be 54.8% (total), 32.8% (males) and 75.5% (females).2 In a study of 267 individuals aged between 18 and 70 years old in the Municipality of Rodas, Cienfuegos, Cuba, it was found that 52.4% of the sample did not drink or drank only occasionally (1 to 6 times a year), and 32.6% drank moderately (1 to 3 times a week not exceeding 100 ml). For the purposes of this study, 100 ml of alcohol was equivalent to 0.5 litres of spirits or 1 litre of wine or 7 bottles of beer.3

WHO Global Status Report on Alcohol 2004 49 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Excessive drinkers in Cienfuegos

A study of 267 individuals (aged Total between 18 and 70 years old) in 15% the Municipality of Rodas, Cienfuegos, Cuba. Excessive drinking was defined as consuming alcohol 1 to 3 times a week (amounts of 100 ml and above). For the purposes of this study, 100 ml of alcohol was equivalent to 0.5 litres of spirits or 1 litre of wine or 7 bottles of beer.3

Alcohol dependence

National survey conducted in 1995 of subjects 15 years old or Total above. Subjects were reported to 1.2% be alcohol dependent or alcoholic according to the CAGE index.2

Male 2% 0.4% Female

Unrecorded alcohol consumption The unrecorded alcohol consumption in Cuba is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.16 2

1.8 0.14

1.6 0.12 1.4 Alcohol use disorders 0.1

1.2 Cirrhosis of the liver 0.08 1 Mouth and oropharynx cancers

SDR per 1000 SDR per 0.8 0.06 Ischaem ic heart disease

0.6 0.04 0.4

0.02 0.2

0 0 1964 1971 1975 1979 1983 1987 1991 1995 1999

Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

50 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Acute mortality

0.3

0.25

0.2

Falls Intentional injuries 0.15

SDR per 1000 per SDR Accidental poisonings Road traffic accidents 0.1

0.05

0 1964 1971 1975 1979 1983 1987 1991 1995 1999 Y ear

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use A study found that 7% of oral cancer cases in Cuba were attributable to alcohol drinking.4 A study conducted in the Isle of Youth in 1993 found an association between occurrence of neuropathy and alcohol consumption (over 10 grams per day).5

Country background information

Total population 2003 11 300 000 Life expectancy at birth (2002) Male 75.0 Adult (15+) 9 040 000 Female 79.3 % under 15 20 Probability of dying under age 5 per 1000 (2002) Male 8 Population distribution 2001 (%) Female 7 Urban 76 Gross National Income per capita 2002 US$ *

Rural 24 *Estimated to be in the lower middle income range ($736 to $2935)

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 2. National Institute of Hygiene, Epidemiology and Microbiology. National survey of risk factors. Cuban Ministry of Health, National Statistics Office, 1995. In: WHO Global NCD InfoBase. Geneva, World Health Organization. 3. Rodríguez MB et al. Reactividad cardiovascular y factores de riesgo cardiovascular en individuos normotensos del Municipio de Rodas, Cienfuegos [Cardiovascular reactivity and cardiovascular risk factors in normotense individuals in the Municipality of Rodas, Cienfuegos, Cuba]. Revista Española de Salud Pública, 1999, 73(5):577–584. 4. Garrote LF et al. Risk factors for cancer of the oral cavity and oro-pharynx in Cuba. British Journal of Cancer, 2001, 85(1):46–54. 5. Gay J et al. Dietary factors in epidemic neuropathy on the Isle of Youth, Cuba. Bulletin of the Pan American Health Organization, 1995, 29(1):25–36.

WHO Global Status Report on Alcohol 2004 51 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

DOMINICA

Recorded adult per capita consumption (age 15+)

10 l 8 Total Beer 6 Spirits Wine 4 Litres of pure alcoho of pure Litres

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Alcoholism in Marigot district

Prevalence rate of alcoholism detected after screening 201 out- Total patients in the Marigot District 28% (rural community) using the CAGE questionnaire.1

Male 33.6% Male Female 22.7% Female

The study also found that among CAGE-positive patients, there were more males (75%), over age 65 (25%), used alcohol more than 20 years (62%) with rum being the drink of preference (used by 72%). A significantly greater percentage of CAGE-positive patients (65%) were admitted in the preceding year and presented more often with trauma (29%).1

Morbidity, health and social problems from alcohol use According to the 1995 Mental Health Report, 8.7% of the total 652 admissions to Princess Margaret Hospital Psychiatric Unit in 1995 presented with a diagnosis of alcoholism.2

52 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Country background information

Total population 2003 69 655 Life expectancy at birth (2002) Male 71.0 Adult (15+) 50 291 Female 75.8 % under 15 27.8 Probability of dying under age 5 per 1000 (2002) Male 13 Population distribution 2001 (%) Female 14 Urban 71 Gross National Income per capita 2002 US$ 3180 Rural 29

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 2003, The World Health Report 2004

References 1. Sharma D, Nasiro RS, Foster R. Prevalence of alcoholism among medical out-patients in a rural community of Dominica. West Indian Medical Journal, 1996, 45(Supplement 2):32. 2. Health in the Americas. Pan American Health Organization, 1998 Edition.

WHO Global Status Report on Alcohol 2004 53 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

DOMINICAN REPUBLIC (THE)

Recorded adult per capita consumption (age 15+)

7 l 6 Total 5 Beer

4 Spirits Wine 3 Litres ofpure alcoho

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Lifetime abstainers

Data from the 2003 World Health Survey. Total sample size n = Total 4496; males n = 2079 and females 24.5% n = 2417. Population aged 18 years and above.1

Male 12.1% Male Female 35.4% Female

Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 29% (males) and 70% (females). Data is for after year 1995.2

Heavy and hazardous drinkers

Data from the 2003 World Health Survey. Total sample size n = 4496; males n = 2079 and females Total n = 2417. Population aged 18 2.1% years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women.1

Male 3.1% Male 1.1% Female

54 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

According to the 2003 World Health Survey (total sample size n = 3401; males n = 1822 and females n = 1579), the mean value (in grams) of pure alcohol consumed per day among drinkers was 4.1 (total), 6.1 (males) and 1.7 (females).1

Heavy episodic drinkers

Data from the 2003 World Health Survey. Total sample size n = 4496; males n = 2079 and females Total n = 2417. Population aged 18 9.1% years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting.1

Male 15.7% 3.5% Female

Youth drinking (lifetime abstainers)

Data from the 2003 World Health Total Survey. Total sample size n = 20.2% 770; males n = 341 and females n = 429. Population aged 18 to 24 years old.1

Male 13.8% Male Female 25.4% Female

A 1994 survey among 101 students (aged from 12 to 19 years old) in Santa Domingo found the rate of lifetime prevalence of alcohol use to be 71.5%.3

Youth drinking (heavy episodic drinkers)

Data from the 2003 World Health Total Survey. Total sample size n = 12% 770; males n = 341 and females n = 429. Population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting.1

Male 17.9% 7.4% Female

Note: These are preliminary, early-release, unpublished data from WHO's World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of these data.

Unrecorded alcohol consumption The unrecorded alcohol consumption in the Dominican Republic is estimated to be 1.0 litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2

WHO Global Status Report on Alcohol 2004 55 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Country background information

Total population 2003 8 745 000 Life expectancy at birth (2002) Male 64.9 Adult (15+) 5 946 600 Female 71.5 % under 15 32 Probability of dying under age 5 per 1000 (2002) Male 37 Population distribution 2001 (%) Female 30 Urban 66 Gross National Income per capita 2002 US$ 2320 Rural 34

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003. 2. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 3. Drug use in the capital cities of the Dominican Republic, Panama and the countries of Central America 1992–1994: findings of the CIDAD/PAHO epidemiological surveillance project. Panama City, Inter- American Drug Abuse Control Commission (CIDAD), 1995.

56 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

ECUADOR

Recorded adult per capita consumption (age 15+)

3.5

3 l

2.5 Total Beer 2 Spirits 1.5 Wine Litres ofpure alcoho 1

0.5

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Lifetime abstainers

Data from the 2003 World Health Survey. Total sample size n = 4164; males n = 1829 and females n = 2335. Population aged 18 Total 1 55.2% years and above.

Male 40.5% Male Female 66.7% Female

A 1995 survey showed that in the population aged 12 to 49 years, the lifetime prevalence of alcohol consumption was 76.4%. With respect to the preceding month, the prevalence of alcohol consumption was 51.2%.2 Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 20% (males) and 40% (females). Data is for after year 1995.3

WHO Global Status Report on Alcohol 2004 57 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Heavy and hazardous drinkers

Data from the 2003 World Health Survey. Total sample size n = 4164; males n = 1829 and females Total n = 2335. Population aged 18 4.1% years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women.1 Male 7.3% Male 1.7% Female

According to the 2003 World Health Survey (total sample size n = 679; males n = 438 and females n = 241), the mean value (in grams) of pure alcohol consumed per day among drinkers was 29.7 (total), 38.8 (males) and 11.8 (females).1

Heavy episodic drinkers

Data from the 2003 World Health Survey. Total sample size n = 4164; males n = 1829 and females Total n = 2335. Population aged 18 4.7% years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting.1

Male 9.3% Male Female 1.2% Female

A 1995 survey showed that in the population aged 12 to 49 years, in the month preceding the survey, 19.7% of the persons interviewed had consumed alcohol to excess – i.e. they had gotten drunk on more than one occasion.2

Youth drinking (lifetime abstainers)

Data from the 2003 World Health Survey. Total sample size n = 714; males n = 309 and females n = 405. Population aged 18 to 24 Total years old.1 55.4%

Male 42.2% Male Female 65.1% Female

58 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Youth drinking (heavy episodic drinkers)

Data from the 2003 World Health Survey. Total sample size n = 714; males n = 309 and females n Total = 405. Population aged 18 to 24 5.1% years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting.1

Male 11.2% Male 0.5% Female

Note: These are preliminary, early-release, unpublished data from WHO's World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of these data.

Alcohol dependence Alcoholism has a prevalence of 7.7% in the population over 15 years of age.2

Traditional alcoholic beverages Aguardiente (Fire-water), also known as Puro (Pure) or Caña (Cane) is the traditional Ecuadorian liquor. It is basically sugar-cane juice fermented and distilled. It has a very high alcoholic content (approximately 40% to 50% if factory-made and 50% to 70% if not made in a factory).4 Anisados (anisette) are alcoholic drinks with aniseed flavours. They usually have an alcoholic content of approximately 30–35%.4

Unrecorded alcohol consumption The unrecorded alcohol consumption in Ecuador is estimated to be 1.0 litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).3

Morbidity, health and social problems from alcohol use Up to 30% of all traffic accidents are alcohol- or drug-related. In the first three months of 1981 there were 158 accidents caused by persons driving under the influence of alcohol or drugs in the province of Pichincha; deaths occurred in 58% of these accidents.5 Alcoholism has been cited as one of the growing reasons for medical consultations, after depression and epilepsy.2 In May 2000, the Alcoholic Rehabilitation Centre of Cuenca launched a mental health programme in four rural areas, covering a total population of approximately 40 000 inhabitants. At the start of the programme, the main problems of the rural communities were identified. Alcohol abuse was one of the main problems highlighted. Children and women complained that fathers and husbands presented alcohol abuse, wasted money, beat them and were frequently absent from their jobs. It was generally agreed that most problems were closely related to alcohol consumption.6

Country background information

Total population 2003 13 003 000 Life expectancy at birth (2002) Male 67.9 Adult (15+) 8 712 010 Female 73.5 % under 15 33 Probability of dying under age 5 per 1000 (2002) Male 34 Population distribution 2001 (%) Female 30 Urban 63 Gross National Income per capita 2002 US$ 1450 Rural 37

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

WHO Global Status Report on Alcohol 2004 59 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

60 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

EL SALVADOR

Recorded adult per capita consumption (age 15+)

3.5

3 l

2.5 Total Beer 2 Spirits

1.5 Wine Litres of pure alcoho 1

0.5

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol Total experts showing proportion of 23.2% adult males and females who had been abstaining (last year before the survey). Data is for after year 1995.1

Female 37.7% Female Male 8.7% Male

Youth drinking in San Salvador (lifetime prevalence )

A 1994 survey of lifetime prevalence of alcohol use among Total students in San Salvador (total 41.6% sample size n = 1200; aged 12 to 19 years old).2

WHO Global Status Report on Alcohol 2004 61 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Unrecorded alcohol consumption The unrecorded alcohol consumption in El Salvador is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.3 0.9

0.8 0.25 0.7

0.2 0.6 Alcohol use disorders

0 0.5 Cirrhosis of the liver 0.15 Mouth and oropharynx 0.4 cancers SDR per 100 SDR per Ischaem ic heart disease 0.1 0.3

0.2 0.05 0.1

0 0 1961 1965 1969 1973 1983 1992 1997 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.9

0.8

0.7

0.6

Falls 0.5 Intentional injuries SDR per 1000 per SDR Accidental poisonings 0.4 Road traffic accidents

0.3

0.2

0.1

0 1961 1965 1969 1973 1983 1992 1997 Year

Source: WHO Mortality Database Note: Caution should be exercised when interpreting the results as death registration level is incomplete.

62 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Country background information

Total population 2003 6 515 000 Life expectancy at birth (2002) Male 66.5 Adult (15+) 4 234 750 Female 72.8 % under 15 35 Probability of dying under age 5 per 1000 (2002) Male 36 Population distribution 2001 (%) Female 34 Urban 62 Gross National Income per capita 2002 US$ 2080 Rural 38

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 2. Drug use in the capital cities of the Dominican Republic, Panama and the countries of Central America 1992–1994: findings of the CIDAD/PAHO epidemiological surveillance project. Panama City, Inter- American Drug Abuse Control Commission (CIDAD), 1995.

WHO Global Status Report on Alcohol 2004 63 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

GRENADA

Recorded adult per capita consumption (age 15+)

Total 8 Beer Spirits 6 Wine

Litres of pure alcohol 4

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Abstainers among working adults (do not drink)

A 1998 survey based on the WHO Total Alcohol Use Disorders 22% Identification Test (AUDIT) of 824 working adults in Grenada (aged 17 years and over).1

Heavy episodic drinkers among working adults

A 1998 survey based on the WHO AUDIT of 824 working adults in Grenada (aged 17 years and over). Figure shows percentage of adults Total who had six or more drinks on at least one occasion.1 55%

Among drinkers, 18% stated that they drink five or more drinks on a typical day.1

64 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Youth drinking (current drinkers)

A 1998 survey based on the WHO AUDIT of 3579 students (aged 11 to 20 years).1

Total 81% Female 75% Female Male 89% Male

The same survey found that 3% of male and 1% of female students drink four or more times per week. 0.8% of all students have six or more drinks daily or almost daily, 3% of students have seven or more drinks on any one day when drinking, and 2.1% drink four or more times a week.1 A study conducted in 1995–1996 of 409 subjects aged 15 to 24 years old found that 70.7% of the respondents had consumed alcohol, while 27.6% did not.2 A 2000–2001 study among 14–20-year-old adolescents in secondary schools in Grenada found that alcohol proved to be the drug of first choice for young people. The lifetime prevalence of alcohol use was found to be 87.7% of male and 70% of female students.3

Morbidity, health and social problems from alcohol use Out of the 45 persons admitted over a six-month period beginning February 1987 at the Carlton House Alcoholism Treatment Centre, it was found that 25 of the 45 patients had first degree relatives who were alcoholic. One third of the patients had lost employment as a result of drinking.4

Country background information

Total population 2003 89 258 Life expectancy at birth (2002) Male 65.9 Adult (15+) 57 928 Female 68.8 % under 15 35.1 Probability of dying under age 5 per 1000 (2002) Male 25 Population distribution 2001 (%) Female 21 Urban 38 Gross National Income per capita 2002 US$ 3500 Rural 62

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Lehman RE. Alcohol consumption in Grenada [Dissertation]. Grenada, St George’s University, 1998. In: Alexander D. Grenada Drug Information Network (GRENDIN) Annual Report, January 2003. 2. Carter R. Youth in the organization of Eastern Caribbean states: The Grenada Study. In: Alexander D. Grenada Drug Information Network (GRENDIN) Annual Report, January 2003. 3. Cramer H. Evaluation of psychoactive substance use among 14–20 year old adolescents in secondary schools in Grenada and analysis of selected influencing factors in urban-rural comparison 2000–2001. In: Alexander D. Grenada Drug Information Network (GRENDIN) Annual Report, January 2003. 4. Puranik A. A survey of patients with alcohol-related problems in Carlton House, St. George’s Grenada [thesis]. Kingston, University of the West Indies, 1988.

WHO Global Status Report on Alcohol 2004 65 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

GUATEMALA

Recorded adult per capita consumption (age 15+)

3.5

l 2.5

Total 2 Beer Spirits 1.5 Wine

Litres ofpure alcoho 1

0.5

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Lifetime abstainers

Data from the 2003 World Health Survey. Total sample size n = 4755; males n = 1824 and females n = 2931. Population aged 18 years and above.1 Total

70.7% Male 49.1% Male 84.2% Female

Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 45% (males) and 62% (females). Data is for after year 1995.2

Heavy and hazardous drinkers

Data from the 2003 World Health Survey. Total sample size n = 4755; males n = 1824 and females Total n = 2931. Population aged 18 0.7% years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women.1

Male 1.7% Male Female 0.2% Female

66 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

According to the 2003 World Health Survey (total sample size n = 1136; males n = 776 and females n = 360), the mean value (in grams) of pure alcohol consumed per day among drinkers was 3.9 (total), 5.2 (males) and 1.0 (females).1

Heavy episodic drinkers

Data from the 2003 World Health Survey. Total sample size n = Total 4755; males n = 1824 and females 1.3% n = 2931. Population aged 18 years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting.1

Female 0.2% Female Male 3.4% Male

Youth drinking (lifetime abstainers)

Data from the 2003 World Health Survey. Total sample size n = 933; males n = 342 and females n = 591. Population aged 18 to 24 years old.1 Total 77.9% Male 57.7% Male 89.5% Female

A 1994 survey among 688 students (aged 12 to 19 years old) in Guatemala City found the rate of lifetime prevalence of alcohol use to be 26.5%.3

Youth drinking (heavy episodic drinkers)

Data from the 2003 World Health Survey. Total sample size n = 933; males n = 342 and females n Total = 591. Population aged 18 to 24 1.7% years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting.1

Male 4.8% Male Female 0.0% Female

Note: These are preliminary, early-release, unpublished data from WHO's World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of these data.

Traditional alcoholic beverages Chicha is an indigenous fermented beverage made from sugar-cane. This beverage is used in traditional Indian rituals and is called boj by the inhabitants of Alta Verapaz in the northern part of the country. The Pokomam, who live in the central highlands, and the Ixil, who live in the south-western highlands, have a lightly distilled beverage called guaro and kuxa, respectively.4 Aguardiente is a strong, distilled beverage made from sugar-cane and frequently used in public ceremonies.4

WHO Global Status Report on Alcohol 2004 67 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Cuxa is the clandestine counterpart of aguardiente and is produced and consumed in Nahuala, a highland Guatemalan Maya community. The primary ingredients for the traditional concoction are raw brown sugar, wheat chaff or other plant material, yeast and saltpetre.5

Unrecorded alcohol consumption The unrecorded alcohol consumption in Guatemala is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2

Chronic mortality

0.2 0.45

0.18 0.4

0.16 0.35

0.14 0.3 Alcohol use disorders

0.12 0.25 Cirrhosis of the liver 0.1 Mouth and oropharynx 0.2 cancers

SDR per 1000 per SDR 0.08 Ischaem ic heart disease 0.15 0.06

0.1 0.04

0.02 0.05

0 0 1963 1967 1971 1977 1981 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

1.8

1.6

1.4

1.2

Falls 1 Intentional injuries

SDR per 1000 per SDR Accidental poisonings 0.8 Road traffic accidents

0.6

0.4

0.2

0 1963 1967 1971 1977 1981 Year

Source: WHO Mortality Database Note: Caution should be exercised when interpreting the results as death registration level is incomplete.

68 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Morbidity, health and social problems from alcohol use Alcohol was involved in approximately 50% of the 430 traffic accidents in 1986.6 In Guatemala, it is believed that the main reason for social violence in the country was men’s consumption of alcohol, caused by intra-family conflict, family disintegration, parental example, poverty and lack of employment.7 Observers cite the negative effects of alcohol – economic expense, sexual transgressions, and quarrels – as largely attributable to the consumption of aguardiente, not boj. There are at least three reasons for this. Firstly, aguardiente is much more potent than boj. Secondly, aguardiente is more expensive, causing greater economic hardships for poor families. Thirdly, the money from the sale of boj remains in the community, whereas the money from the sale of aguardiente leaves the community. Alcohol consumption to the point of intoxication can result in spousal abuse, especially among Indians and poor ladinos.4

Country background information

Total population 2003 12 347 000 Life expectancy at birth (2002) Male 63.1 Adult (15+) 7 037 790 Female 69.0 % under 15 43 Probability of dying under age 5 per 1000 (2002) Male 57 Population distribution 2001 (%) Female 50 Urban 40 Gross National Income per capita 2002 US$ 1750 Rural 60

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003. 2. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 3. Drug use in the capital cities of the Dominican Republic, Panama and the countries of Central America 1992–1994: findings of the CIDAD/PAHO epidemiological surveillance project. Panama City, Inter- American Drug Abuse Control Commission (CIDAD), 1995. 4. Adams WR. Guatemala. In: Heath DB, ed. International Handbook on Alcohol and Culture. Westport, Greenwood, 1995. 5. Adams WR. Alcohol production and consumption in a highland Guatemalan Maya community. Alcohol and Drug Study Group Bulletin, 1999, 34(2):1–9. 6. Pan American Health Organization. Epidemiologic report on the use and abuse of psychoactive substances in 16 countries of Latin America and the Caribbean. Bulletin of the Pan American Health Organization, 1990, 24(1):97–139. 7. Moser C, McIlwaine C, Solimano A. Violence in Colombia and Guatemala: the voices of the urban poor. id21 society & economy: communicating development research (http://www.id21.org/society/s10bcm1g2.html, accessed 25 February 2004).

WHO Global Status Report on Alcohol 2004 69 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

GUYANA

Recorded adult per capita consumption (age 15+)

14 l 12 Total 10 Beer

8 Spirits Wine 6 Litres ofpure alcoho

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol experts showing proportion of Total adult males and females who had 30% been abstaining (last year before the survey). Data is for after year 1995.1

Male 20% Male 40% Female

Youth drinking A study conducted in 1997 found that 54% of youths aged between 12 and 25 years old were occasional drinkers and 7.5% were regular drinkers. The breakdown by age groups was as follows: 4.3% of 14–15-year-olds were regular drinkers, 5.4% of 16–17-year-olds were regular drinkers and 8.1% of 18–25-year-olds were regular drinkers. The study also found that 49.8% of young people aged between 14 and 17 years reported having been drunk at least once in their life.2

Traditional alcoholic beverages Ti’Punch is the traditional drink made from green lemon, cane syrup with sugar and rum.2

Unrecorded alcohol consumption The unrecorded alcohol consumption in Guyana is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

70 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.35 1.6

1.4 0.3

1.2 0.25 Alcohol use disorders 1

0.2 Cirrhosis of the liver

0.8 Mouth and oropharynx 0.15 cancers SDR per 1000 per SDR 0.6 Ischaem ic heart disease

0.1 0.4

0.05 0.2

0 0 1977 1989 1995

Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.25

0.2

0.15 Falls

SDR per 1000 per SDR Intentional injuries Accidental poisonings 0.1 Road traffic accidents

0.05

0 1977 1989 1995 Year

Source: WHO Mortality Database Note: Caution should be exercised when interpreting the results as death registration level is incomplete.

Morbidity, health and social problems from alcohol use In 2000, there were 140 patients treated for alcoholism.2

WHO Global Status Report on Alcohol 2004 71 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Country background information

Total population 2003 765 000 Life expectancy at birth (2002) Male 61.5 Adult (15+) 535 500 Female 66.9 % under 15 30 Probability of dying under age 5 per 1000 (2002) Male 61 Population distribution 2001 (%) Female 50 Urban 36 Gross National Income per capita 2002 US$ 840 Rural 64

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References

1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 2. Phénomènes émergente liés aux drogues en 2001: rappot locaux des sites TREND. Observatoire Français des Drogues et des Toxicomanies, 2002.

72 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

HAITI

Recorded adult per capita consumption (age 15+)

6 l

5 Total Beer 4 Spirits 3 Wine Litres ofpure alcoho 2

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol experts showing proportion of adult males and females who had Total been abstaining (last year before 60% the survey). Data is for after year 1995.1

Male 58% Male Female 62% Female

Unrecorded alcohol consumption The unrecorded alcohol consumption in Haiti is estimated to be 0.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Country background information

Total population 2003 8 326 000 Life expectancy at birth (2002) Male 49.1 Adult (15+) 5 162 120 Female 51.1 % under 15 38 Probabilty of dying under age 5 per 1000 (2002) Male 138 Population distribution 2001 (%) Female 128 Urban 37 Gross National Income per capita 2002 US$ 440 Rural 63

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

WHO Global Status Report on Alcohol 2004 73 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157.

74 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

HONDURAS

Recorded adult per capita consumption (age 15+)

3.5

l 2.5

Total 2 Beer Spirits 1.5 Wine

Litres ofpure alcoho 1

0.5

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol experts showing proportion of Total adult males and females who had 23.2% been abstaining (last year before the survey). Data is for after year 1995.1

Male 8.7% Male 37.7% Female

The 2001 National Survey of Men’s Health (subjects aged from 15 to 59 years old) found that 28% are current alcohol drinkers.2 In a study consisting of males and females older than 15 years of age residing in a semi-rural area, it was found that male alcohol consumption usually started before the age of 18 years, as compared to 22 years for females. In most cases, peer pressure was usually responsible for taking the first drink.3

WHO Global Status Report on Alcohol 2004 75 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Youth drinking (lifetime prevalence)

2002 survey of secondary school students aged 15 to 20 years old.4

Total 44.3%

Male 53.0% Male Female 38.0% Female

A 1994 survey among 401 students (aged 12 to 19 years) in Tegucigalpa found the lifetime prevalence of alcohol use to be 51.8%.5

Traditional alcoholic beverages In rural areas, aguardiente, which is a traditional spirit and rum, is consumed.

Unrecorded alcohol consumption The unrecorded alcohol consumption in Honduras is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.16 0.45

0.14 0.4

0.35 0.12

0.3 Alcohol use disorders 0.1

0.25 Cirrhosis of the liver 0.08 Mouth and oropharynx 0.2 cancers SDR per 1000 0.06 Ischaem ic heart disease 0.15

0.04 0.1

0.02 0.05

0 0 1966 1971 1975 1979 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left. Source: WHO Mortality Database

76 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Morbidity, health and social problems from alcohol use According to the Department of Forensic Medicine, in the year 2002, 33.7% of all violent death victims had a positive blood alcohol concentration. In addition, 23% of all homicides, 8.6% of accidental deaths and 4.4% of suicides were related to alcohol. The data also showed that 6% of road traffic accidents were alcohol-related.6 42% of traffic accidents are associated with alcohol consumption by the driver, and 61% of occupational accidents (injuries and mutilations) occur among workers who consumed excess alcohol the previous day. 51% of divorces occur in marriages in which one of the spouses, usually the man, is an alcoholic.7 There were 175 alcohol-related traffic accidents (out of 1530 in total) reported in the Central District in 1987.8 In a study conducted by the Honduran Institute for the Prevention of Alcoholism, Drug Addiction, and Drug Dependency on the use of alcohol and drugs among students in teachers’ schools in Honduras in 1996, four of every five students reported that children and adolescents could easily obtain alcohol in their neighbourhoods or communities.7 In 2001 alcohol dependence syndrome ranked first among the discharge diagnoses at the National Psychiatric Hospital of Santa Rosita (58.5%).9

Country background information

Total population 2003 6 941 000 Life expectancy at birth (2002) Male 64.2 Adult (15+) 4 164 600 Female 70.4 % under 15 40 Probability of dying under age 5 per 1000 (2002) Male 44 Population distribution 2001 (%) Female 42 Urban 54 Gross National Income per capita 2002 US$ 920 Rural 46

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 2. La Encuesta Nacional de Salud Masculina 2001 [2001 National Survey of Men’s Health]. 3. Natera G et al. Comparacion transcutoral de las costobres y actitudes asociadas al uso de alcohol en dos zonas rurales de Honduras y Mexcio [Cultural comparison of habits and attitudes associated with the use of alcohol in two rural zones of Honduras and Mexico]. Acta Psiquiatrica y Psicologica de America Latina, 1983, 29(2):116–127. In: National Institute on Alcohol Abuse and Alcohol Problems Science Database [online database]. Bethesda, National Institute on Alcohol Abuse and Alcoholism. 4. La Encuesta Nacional sobre Prevalencia del Consumo de Drogas en Estudiantes de Secundaria 2002 [2002 National Survey on Prevalence and Consumption of Drugs among Secondary School Students]. Ministry of Health. 5. Drug use in the capital cities of the Dominican Republic, Panama and the countries of Central America 1992–1994: findings of the CIDAD/PAHO epidemiological surveillance project. Panama City, Inter- American Drug Abuse Control Commission (CIDAD), 1995. 6. Department of Forensic Medicine, Ministry of Public Affairs, 2002. 7. Health in the Americas. Pan American Health Organization, 1998 Edition. 8. Pan American Health Organization. Epidemiologic report on the use and abuse of psychoactive substances in 16 countries of Latin America and the Caribbean. Bulletin of the Pan American Health Organization, 1990, 24(1):97–139. 9. Boletin de información estadistica de atención hospitalaria, año 2001 [Bulletin of statistical information on hospitalizations in 2001]. Department of Statistics, Ministry of Health.

WHO Global Status Report on Alcohol 2004 77 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

JAMAICA

Recorded adult per capita consumption (age 15+)

5 l 4 Total Beer 3 Spirits Wine 2 Litres ofpure alcoho

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

National survey conducted in 2001 (total sample size n = 2380; aged 12 years and above).1

Total 57.6% Female 69.4% Female Male 43.8% Male

Heavy drinkers (last month)

National survey conducted in 2001 (total sample size n = 2380; aged 12 years and above). Heavy Total drinking was defined as 5.2% consuming five or more drinks on five or more occasions during the 1 past month.

Male 8.8% Male Female 2.2% Female

78 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Heavy episodic drinkers (last month)

A population-based probability sample of 958 (454 males and 504 females) persons aged 15 to 49 years surveyed in 1993 for lifestyle and behaviour risk factors. Heavy episodic drinking was defined as consuming five or more drinks on at least one occasion during the previous month.3 Female 9% Female Male 30% Male

Youth drinking (last year prevalence of alcohol use)

National survey conducted in Total 2001 (original sample size n = 26% 2380). Results shown for the age group 12 to 17 years old.1

According to the 1997 National Adolescent Students’ Drug Survey, 70.9% of students reported having ever had a drink. A little more than one in four students (28.8%) had used alcohol in the month preceding the survey.4 In a study of 2417 Jamaican urban and rural high school students (1063 boys and 1354 girls, aged 16–17 years old), the rate of prevalence of alcohol use was found to be 50.2%.5 In a study of 28 female adolescents (aged 16 to 19.9 years) diagnosed with more than one sexually transmitted disease in Kingston, Jamaica, it was found that 62% of the sample consumed alcoholic drinks.6

Youth drinking (last month heavy drinkers)

National survey conducted in 2001 (original sample size n = 2380). Results shown for the age Total group 12 to 17 years old.1 2.1%

The same survey also found that last year prevalence rates of alcohol dependence or abuse among 12- to 17- year-olds were 1.3% for abuse and 0.9% for dependence.1

WHO Global Status Report on Alcohol 2004 79 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Alcohol dependence (last year)

National survey conducted in 2001 (total n = 2380) using DSM- Total IV criteria (three or more of the 1.6% seven symptoms constituted dependence).1

Male 3% Male Female 0.4% Female

The same survey also found that 5.8% of respondents had a problem of alcohol abuse or dependence and of which 4.3% were diagnosed with abuse without dependence (for abuse only, the male prevalence was 7.2% and female 1.9%). DSM-IV criteria was used to assess alcohol abuse and dependence.1

Unrecorded alcohol consumption According to the WHO Global Burden of Disease Study (2000) the unrecorded alcohol consumption in Jamaica is estimated to be 1.00 litre pure alcohol per adult capita.2

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.12 0.9

0.8 0.1 0.7

0.08 0.6 Alcohol use disorders

0.5 Cirrhosis of the liver 0.06 Mouth and oropharynx 0.4 cancers SDR per 1000 per SDR Ischaem ic heart disease 0.04 0.3

0.2 0.02 0.1

0 0 1960 1967 1982 1986 1990

Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

80 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Acute mortality

0.12

0.1

0.08

Falls Intentional injuries SDR per 1000 per SDR 0.06 Accidental poisonings Road traffic accidents

0.04

0.02

0 1965 1981 1985 1989 Year

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use A study identified that in blood samples of 31 motor vehicle fatalities, evidence of alcohol intake was found in 77.5% of the fatalities and 35.5% had alcohol levels above the legal acceptable limits.7 A recent study done by three doctors revealed that alcohol was found in the bodies of 43% of drivers involved in traffic accidents.8

Country background information

Total population 2003 2 651 000 Life expectancy at birth (2002) Male 71.1 Adult (15+) 1 855 700 Female 74.6 % under 15 30 Probability of dying under age 5 per 1000 (2002) Male 16 Population distribution 2001 (%) Female 14 Urban 57 Gross National Income per capita 2002 US$ 2820 Rural 43

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. National household survey of drug use and abuse in Jamaica 2001. The National Council on Drug Abuse, 2002. 2. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 3. Figueroa JP, Fox K, Minor K. A behaviour risk factor survey in Jamaica. West Indian Medical Journal, 1999, 48(1):9–15. 4. Douglas K. Patterns of substance use and abuse among post primary students in Jamaica: National Adolescent Students’ Drug Survey 1997/1998. Planning Institute of Jamaica, 2000. 5. Soyibo K, Lee MG. Use of alcohol, tobacco and non-prescription drugs among Jamaican high school students. West Indian Medical Journal, 1997, 46(4):111–114. 6. Graham M et al. Risk factors for sexually transmitted diseases among female adolescents. West Indian Medical Journal, 2000, 49(Supplement 4):23–24. 7. Francis M, Eldemire D, Clifford R. A pilot study of alcohol and drug-related traffic accidents and death in two Jamaican parishes, 1991. West Indian Medical Journal, 1995, 44(3):99–101.

WHO Global Status Report on Alcohol 2004 81 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

8. Medical experts should check drivers involved in accidents. Jamaica Gleaner. March 31 2000 (http://www.rism.org/isg/dlp/ganja/news/gj_jg_20000331_1.html, accessed 5 May 2004).

82 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

MEXICO

Recorded adult per capita consumption (age 15+)

5 l 4 Total Beer 3 Spirits Wine 2 Litres ofpure alcoho

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Data from the WHO GENACIS study. National survey conducted Total in 1998 (age group 20 to 64 41.6% years). Total sample size n = 5266; males n = 2174 and females n = 3092.1

Male 22.4% Male Female 55.0% Female

According to a 2000 national survey of both rural and urban populations (males n = 11 952 and females n = 12 147; age group 20 years and above), the rate of current drinkers was 69.4% (males) and 59.5% (females).2 According to the 2003 World Health Survey (total sample size n = 38 745, males n = 16 377 and females n = 22 368; sample population aged 18 years and over), the rate of lifetime abstainers was 52.7% (total), 35.6% (males) and 65.2% (females).3 According to the 2000–2001 Multi-Country Survey Study (total sample size n = 4686, males n = 1888 and females n = 2798; sample population aged 18 years and over), the rate of last year abstainers was 53.5% (total), 35% (males) and 65.9% (females).4 In a study of 2523 emergency room patients in eight hospitals in Mexico City, it was found that 63% had ingested alcoholic beverages, in particular spirits and beer; 58% admitted to having been drunk at least once in the past year.5

WHO Global Status Report on Alcohol 2004 83 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Heavy and hazardous drinkers (among drinkers)

Data from the WHO GENACIS study. National survey conducted in 1998 (age group 20 to 64 years). Total sample size n = 5266; males n = 2174 and females n = 3092. Definition used: average consumption of 40 g or more of pure alcohol a day for males and 20 g or more of pure alcohol a day for females.1 Male 9.2% 1.6% Female

According to the 2000–2001 Multi-Country Survey Study (total sample size n = 4686, males n = 1888 and females n = 2798; sample population aged 18 years and over), the rate of high risk drinking was 14.2% (total), 18.1% (males) and 11.6% (females). High risk drinking was defined as average consumption of five or more standard drinks for males and three or more standard drinks for females on a typical drinking day.4 According to the 2003 World Health Survey (total sample size n = 18 364; males n = 10 541 and females n = 7 823), the mean value (in grams) of pure alcohol consumed per day among drinkers was 2.0 (total), 3.0 (males) and 0.6 (females).3

Heavy episodic drinkers

Data from the 2000–2001 Multi- Country Survey Study. Total sample size n = 4686; males n = Total 1888 and females n = 2798. 2.9% Population aged 18 years and above. Definition used: at least once a week consumption of six or more standard drinks in one sitting.4

Male 6.9% Female 0.3% Female

According to the 2003 World Health Survey (total sample size n = 38 745, males n = 16 377 and females n = 22 368; sample population aged 18 years and over), the rate of heavy episodic drinking among the total population was 3% (total), 6.3% (males) and 0.7% (females). Heavy episodic drinking was defined as at least once a week consumption of five or more standard drinks in one sitting.3 According to the WHO GENACIS Study (1998 survey; total sample size n = 5266, males n = 2174 and females n = 3092; age range 20 to 64 years), the rate of heavy episodic drinking among drinkers was 46.9% for men and 5.8% for women. Heavy episodic drinking was defined as consumption of five or more drinks in one sitting at least once a month in the last year.1

Problem drinkers among an insured population

To estimate the prevalence of hazardous and harmful alcohol consumption (AUDIT definition) among the insured population of Total the Mexican Social Security 12.8% Institute, 45 117 insured subjects from Mexico’s 36 political districts were interviewed.6

Male 22.2% Male 3.4% Female

84 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

The 1993 National Survey of Addictions (ENA) revealed that 66% of the urban population between 12 and 65 years old consumed alcohol (77.2% of men and 57.5% of women), and among them, 41.6% drank occasionally but in large quantities (five or more glasses per time).7

Youth drinking (last year abstainers)

Data from the 2000–2001 Multi- Country Survey Study. Total Total sample size n = 720; males n = 53.2% 306 and females n = 414. Population aged 18 to 24 years. For the age group 15 to 19 years (subsample n = 208), the rate of last year abstainers was 60.1% (total), 43.5% (males) and 71.5% (females).4 Female 63.9% Female Male 38.7%

According to the 2003 World Health Survey (total sample size n = 6616, males n = 2712 and females n = 3904; sample population aged 18 to 24 years), the rate of lifetime abstainers was 56.2% (total), 42.9% (males) and 65.4% (females).3 A 2000 survey of 10 578 students from the Federal District of Mexico City found that the lifetime prevalence of alcohol consumption was 61.4% (total), 62.6% (males) and 60.2% (females).8 Data derived from a 1996 representative survey of 1929 students in junior high and high schools in the city of Pachuca, Hidalgo, Mexico found that 47.9% of the sample have tried alcohol and 12.6% had drunk large quantities – five drinks or more per sitting – during the month prior to the survey.9

Youth drinking (heavy episodic drinkers)

Data from the 2000–2001 Multi- Country Survey Study. Total sample size n = 720; males n = Total 306 and females n = 414. 2.9% Population aged 18 to 24 years old. For the age group 15 to 19 years (subsample n = 208), the rate of heavy episodic drinkers was 1.5% (total), 2.5% (males) and 0.8% (females). Definition used: at least once a week Male 5.9% Female 0.7% Female consumption of six or more standard drinks in one sitting.4

According to the 2003 World Health Survey (total sample size n = 6616, males n = 2712 and females n = 3904; sample population aged 18 to 24 years), the rate of heavy episodic drinking among the total population was 3.1% (total), 6.3% (males) and 0.8% (females). Heavy episodic drinking was defined as at least once a week consumption of five or more standard drinks in one sitting.3

WHO Global Status Report on Alcohol 2004 85 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Alcohol dependence (last year)

Data from the 2000–2001 Multi- Country Survey Study. Total Total sample size n = 4811. Population 1.8% aged 15 years and above. Alcohol dependence was measured using ICD-10 criteria.4

Male 4.2% Male Female 0.2%

Note: These are preliminary, early-release, unpublished data from WHO's Multi-Country Survey Study and World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of these data. In a sample (n = 8890) drawn from a 1988 national survey on addictions in Mexico City’s urban population, the rate of last year alcohol dependence was found to be 4.9% (total), 9.9% (males) and 0.6% (females).10

Traditional alcoholic beverages Pulque is the national drink in Mexico, where it is claimed, it originated with the early Aztecs. Pulque is a milky, slightly foamy, and acidic beverage. It is obtained by fermentation of aguamiel, which is the name given to the juices of various cacti, notably Agave atrovirens and A. americana which are often called the ‘Century Plant’ in English. Pulque contains between 6% and 7% alcohol.11 Pulque is the beverage of choice among rural localities. The average weekly intake per household in these areas has been estimated to be 6.4 litres compared to only 3.7 litres of beer.12 Aquardientes are local beverages with high concentrations of alcohol.12

Unrecorded alcohol consumption The unrecorded alcohol consumption in Mexico is estimated to be 3.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).13

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

86 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Chronic mortality

0.5 0.9

0.45 0.8

0.4 0.7

0.35 0.6 Alcohol use disorders

0.3

Cirrhosis of the liver 0 0.5 0.25 Mouth and oropharynx 0.4 cancers 0.2 SDR per 100 Ischaemic heart disease 0.3 0.15

0.2 0.1

0.05 0.1

0 0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.45

0.4

0.35

0.3

Falls 0.25 Intentional injuries SDR per 1000 per SDR Accidental poisonings 0.2 Road traffic accidents 0.15

0.1

0.05

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001 Year

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use A study reported that 24.1% of men and 5.6% of women who drink daily or almost daily have been involved in a car accident before. This was also true for 21.2% and 2.5% respectively of men and women drinking significant amounts weekly or more often.12 A study 112 patients attending emergency rooms due to injuries caused by car accidents found that 13.4% of the patients had positive alcohol concentrations in their blood, and 14.6% of the cases admitted that they had consumed alcohol six hours prior to the accident.14

WHO Global Status Report on Alcohol 2004 87 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

A study conducted among patients attending an emergency room in a public health hospital in Pachuca, Mexico found that alcohol consumption was higher in those attending for accidents or violence than in medical patients. Positive blood alcohol levels were found in 17.7% of injured patients and 15.8% reported alcohol consumption six hours prior to the accident. According to the CAGE, 9.2% of the patients were alcohol-dependent and 10.9% were heavy drinkers according to the AUDIT.15 A study conducted in Pachuca, Mexico found that there was a significant relationship between habitual alcohol consumption and Emergency Room (ER) injuries. Injured patients in the ER sample were significantly more likely to report high frequency/high quantity of drinking during the last 12 months than the general population and to report drinking within six hours before the injury.16 A study in 2002 looking at 705 injury patients from a hospital emergency department in Mexico City found that the estimated relative risk of injury for patients who reported having consumed alcohol within six hours prior to injury (17% of the sample) was 3.97. This increase in the relative risk was concentrated within the first two hours after drinking; there was a positive association of increasing risk with increasing number of drinks consumed.17 A study looking at male drinking and violence-related injury in the emergency room found that alcohol consumption prior to injury was a more important risk factor than usual drinking for injuries resulting from violence, while quantity of usual alcohol consumption was more predictive of violence-related injuries than frequency of drinking.18 A sample of women patients seen at emergency services (ES) of the Mexican city of Pachuca, Hidalgo over the age of 18 was selected using ES forms and interviewed. Thirty-six women (5.2%) out of 717 of the total number of women were found to be heavy drinkers according to the TWEAK scale. This group of women had 2.3 times the risk of becoming depressed, 2.87 times the risk of taking other drugs, 1.95 times the likelihood of having been sexually abused and 1.57 times the risk of displaying suicidal ideation.19 A study which was part of the National School Survey on drug use by high school students found that more antisocial acts were perpetrated by alcohol users than by nonusers. In a logistic regression model, it was found that using alcohol was one of the main risk factors for perpetrating antisocial acts.20 26% of women seeking counselling services in the urban areas of Mexico reported that their partner’s abusive behaviours were fueled by intoxication.21 In Mexico, liver cirrhosis is one of the top 10 causes of death among the country’s population, and it is the most common cause of death among males between 35 and 54 years of age. The mortality rate due to alcohol has increased from 7.8/100 000 persons in 1970 to 12/100 000 persons in 1995 within the population 15 years of age and older.22

Country background information

Total population 2003 103 457 000 Life expectancy at birth (2002) Male 71.7 Adult (15+) 70 350 760 Female 76.9 % under 15 32 Probability of dying under age 5 per 1000 (2002) Male 30 Population distribution 2001 (%) Female 24 Urban 75 Gross National Income per capita 2002 US$ 5910 Rural 25

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

88 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

4. Ustun TB et al. WHO Multi-Country Survey Study on Health and Health System Responsiveness 2000– 2001. In: Murray CJL et al., eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003. 5. López-Jiménez JL. Patrón de consumo de alcohol en pacientes captados en salas de urgencias [Alcohol consumption patterns in patients attending emergency rooms]. Salud Pública de México, 1998, 40(6):487– 493. 6. Morales-Garcia JIC et al. Prevalencia de consumo riesgoso y dañino de alcohol en derechohabientes del Instituto Mexicano del Seguro Social [The prevalence of hazardous and harmful use of alcohol among the insured population]. Salud Pública de México, 2002, 44(2):113–121. 7. Health in the Americas. Pan American Health Organization, 1998 Edition. 8. Villatoro J et al. Consumo de drogas y alcohol y tabaco en estudiantes del Distrito Federal: Medición otoño 2000. Reporte Global del Distrito Fenderal, INPSEP, México. 9. Rojas-Guiot E et al. Consumo de alcohol y drogas en estudiantes de Pachuca, Hidalgo. [Alcohol and drug consumption among students in Pachuca, Hidalgo]. Salud Pública de México, 1999, 41(4):297–308. 10. Natera-Rey G et al. La influencia de la historia familiar de consumo de alcohol en hombres y mujeres [The influence of family history on alcohol intake in males and females]. Salud Pública de México, 2001, 43(1):17–26. 11. Toddy and palm wine – fermented plant saps. Technical Brief, Knowledge and Information Services, The Schumacher Centre for Technology & Development (http://www.itdg.org/html/technical_enquiries/docs/toddy_palm_wine.pdf, accessed 27 March 2004) 12. Medina-Mora E et al. Patterns of alcohol consumption and related problems in Mexico: Results from two general population surveys. In: Demers A, Room R, Bourgault C. Surveys of drinking patterns and problems in seven developing countries. Geneva, World Health Organization, 2001. 13. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 14. Casanova L et al. El alcohol como factor de riesgo en accidentes vehiculares y peatonales. Salud Mental, 2001,24(5):3–11. 15. Borges G et al. Consumo de bebidas alcohólicas en pacientes de los servicios de urgencias de la ciudad de Pachucha, Hidalgo [Alcohol consumption in emergency room patients in the city of Pachuca, Hidalgo, Mexico]. Salud Pública de México, 1999, 41(1):3–11. 16. Borges G et al. Alcohol consumption in emergency room patients and the general population: a population-based study. Alcoholism: Clinical and Experimental Research, 1998, 22(9):1986–1991. 17. Borges G et al. Episodic alcohol use and risk of nonfatal injury. American Journal of Epidemiology, 2004, 159(6):565–571. 18. Borges G, Cherpital CJ, Rosovsky H. Male drinking and violence-related injury in the emergency room. Addiction, 1998, 93(1):103–112. 19. Romero M et al. Characteristics of Mexican women admitted to emergency care units. Alcohol consumption and related problems. Salud Pública de México, 2001, 43(6):537–543. 20. Juárez F et al. Antisocial behaviour: its relation to selected sociodemographic variables and alcohol and drug use among Mexican students. Substance Use and Misuse, 1998, 33(7):1437–1459. 21. Ramírez JC, Unibe G. Mujer y violencia: un hecho cotidiano. Salud Pública de México, 1993, 35(2):148– 160. 22. Medina-Mora E, Borges G, Villatoro J. The measurement of drinking patterns and consequences in Mexico. Journal of Substance Abuse, 2000, 12(1–2):183–196.

WHO Global Status Report on Alcohol 2004 89 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

NICARAGUA

Recorded adult per capita consumption (age 15+)

4.5

3.5

3 Total 2.5 Beer 2 Spirits Wine Litres of pure alcohol 1.5

0.5

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol experts showing proportion of Total adult males and females who had 23.2% been abstaining (last year before the survey). Data is for after year 1995.1

Male 8.7% Male 37.7% Female

Youth drinking (lifetime prevalence)

Data from a 1994 survey of Total lifetime prevalence of alcohol use 41.1% among 698 students (aged from 12 to 19 years old) in Managua.2

90 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

Unrecorded alcohol consumption The unrecorded alcohol consumption in Nicaragua is estimated to be 1.0 litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Country background information

Total population 2003 5 466 000 Life expectancy at birth (2002) Male 67.9 Adult (15+) 3 170 280 Female 72.4 % under 15 42 Probability of dying under age 5 per 1000 (2002) Male 38 Population distribution 2001 (%) Female 32 Urban 57 Gross National Income per capita 2002 US$ *

Rural 43 *Estimated to be in the low income range ($735 or less)

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

WHO Global Status Report on Alcohol 2004 91 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS

PANAMA

Recorded adult per capita consumption (age 15+)

l 5

Total 4 Beer Spirits 3 Wine

Litres ofpure alcoho 2

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Youth drinking (lifetime prevalence)

Data from the 1996 National Total Youth Survey on Alcohol and 41.2% Drug Use (total sample size n = 5481; aged between 12 and 18 years).1

Male 45.5% Male Female 37.0% Female

A 1994 survey among 575 students (aged from 12 to 19 years old) in Panama City found the rate of lifetime prevalence of alcohol use to be 48.7%.2

Youth drinking (last year drinkers)

Data from the 1996 National Total Youth Survey on Alcohol and 33.6% Drug Use (total sample size n = 6477; aged between 12 and 18 years).1

Female 30.5% Female Male 36.7% Male

Chronic mortality

0.1 1.4

0.09 1.2 0.08

0.07 1 Alcohol use disorders

0.06 0.8 Cirrhosis of the liver

0.05 Mouth and oropharynx 0.6 cancers

SDR per 1000 0.04 Ischaem ic heart disease

0.03 0.4

0.02 0.2 0.01

0 0 1961 1965 1969 1973 1977 1981 1985 1989 1999

Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.25

0.2

0.15 Falls Intentional injuries

SDR per 1000 per SDR Accidental poisonings 0.1 Road traffic accidents

0.05

0 1961 1965 1969 1973 1977 1981 1985 1989 1999 Year

Source: WHO Mortality Database Note: Caution should be exercised when interpreting the results as death registration level is incomplete.

Country background information

Total population 2003 3 120 000 Life expectancy at birth (2002) Male 72.8 Adult (15+) 2 593 630 Female 78.2 % under 15 31 Probability of dying under age 5 per 1000 (2002) Male 25 Population distribution 2001 (%) Female 21 Urban 57 Gross National Income per capita 2002 US$ 4020 Rural 43

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Gonzalez GB et al. Estimated occurrence of tobacco, alcohol and other drug use among 12–18 year old students in Panama: Results of Panama’s 1996 National Youth Survey on Alcohol and Drug Use. Pan American Journal of Public Health, 1999, 5(1):9–16. 2. Drug use in the capital cities of the Dominican Republic, Panama and the countries of Central America 1992–1994: findings of the CIDAD/PAHO epidemiological surveillance project. Panama City, Inter- American Drug Abuse Control Commission (CIDAD), 1995.

PARAGUAY

Recorded adult per capita consumption (age 15+)

10 l 8 Total Beer 6 Spirits Wine 4 Litres ofpure alcoho

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Lifetime abstainers

Data from the 2003 World Health Total Survey. Total sample size n = 21.7% 4618; males n = 2110 and females n = 2508. Population aged 18 years and above.1

Male 8.5% Male 32.9% Female

Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 18% (males) and 38% (females). Data is for after year 1995.2

Heavy and hazardous drinkers

Data from the 2003 World Health Survey. Total sample size n = Total 4618; males n = 2110 and females 3.1% n = 2508. Population aged 18 years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women.1 Male 5.6% Male 1.0% Female

According to the 2003 World Health Survey (total sample size n = 3656; males n = 1938 and females n = 1718), the mean value (in grams) of pure alcohol consumed per day among drinkers was 6.2 (total), 10.1 (males) and 1.7 (females).1

Heavy episodic drinkers

Total Data from the 2003 World Health 14.3% Survey. Total sample size n = 4618; males n = 2110 and females n = 2508. Population aged 18 years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting.1

Male 27.4% Female 3.4% Female

Youth drinking (lifetime abstainers)

Data from the 2003 World Health Total Survey. Total sample size n = 13.9% 981; males n = 463 and females n = 518. Population aged 18 to 24 years old.1

Male 6.6% Male Female 20.0% Female

Youth drinking (heavy episodic drinkers)

Data from the 2003 World Health Total Survey. Total sample size n = 16.1% 981; males n = 463 and females n = 518. Population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting.1

Female 4.4% Female Male 29.2% Male

Note: These are preliminary, early-release, unpublished data from WHO's World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of these data.

Alcohol abuse in urban areas

Survey of 2504 individuals aged Total between 12 and 45 years old. 35.6% Alcohol abuse was defined according to the CAGE index.3

Traditional alcoholic beverages Abati – an alcoholic beverage made of maize is consumed.

Unrecorded alcohol consumption The unrecorded alcohol consumption in Paraguay is estimated to be 1.5 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2

Country background information

Total population 2003 5 878 000 Life expectancy at birth (2002) Male 68.7 Adult (15+) 3 644 360 Female 74.7 % under 15 38 Probability of dying under age 5 per 1000 (2002) Male 37 Population distribution 2001 (%) Female 26 Urban 57 Gross National Income per capita 2002 US$ 1170 Rural 43

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003. 2. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 3. Miguez HA, Pecci MC, Carrizosa A. Epidemiologica del abuso del alcohol y las drogas en el Paraguay. [Epidemiology of alcohol and drug abuse in Paraguay]. Acta Psiquiatrica y psicologica de America Latina, 1992, 38(1):19–29. In: WHO Global NCD InfoBase. Geneva, World Health Organization.

PERU

Recorded adult per capita consumption (age 15+)

6 l

5 Total Beer 4 Spirits 3 Wine Litres ofpure alcoho 2

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Data from the 2002 National Total Survey on Prevention and 24.9% Consumption of Drugs (total sample size n = 4850; ages 12 to 64 years).1

Male 20.2% Male Female 29% Female

Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 17% (males) and 24% (females). Data is for after year 1995.2

Frequent drinkers (focal point data)

WHO focal point data. Frequent drinking was defined as drinking on five or more days each week.3

Male 3% Male Female 1% Female

Youth drinking (last year drinkers)

Data from the 2002 National Survey on Prevention and Consumption of Drugs (total sample size n = 4850; ages 12 to Total 64 years). Data is for subsample 64.4% age group 14 to 16 years old 1 (sample size unknown). Male 64.2% Male Female 64.6% Female

In a survey of 991 male adolescent high school students in Lima, Peru (aged between 12 to 19 years), it was found that 34.6% of the students indicated that they drank alcohol approximately once a month and 28.8% indicated that they drank alcohol daily to once a week.4

Alcohol dependence

Total Data from the 2002 national 10.6% survey measuring the prevalence of alcohol dependence (according to ICD-10 definition). Total sample size n = 4850; ages 12 to 1 64 years old. Male 17.8% Male 4.3% Female

Traditional alcoholic beverages Local alcoholic drinks are grape brandy (pisco) and fermented corn juice (chicha). Sora – an alcoholic beverage based on germinated, ground, cooked and fermented maize is also consumed.5

Unrecorded alcohol consumption The unrecorded alcohol consumption in Peru is estimated to be 1.0 litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2

Morbidity, health and social problems from alcohol use According to the National Survey on Drug Consumption, 10.2% of all drug abuse cases are related to alcohol. Alcohol consumption is a grave public health problem that is associated with psychosocial factors. In Peru men have a higher rate of alcohol consumption than women, 16% and 4.9% respectively. 30% of the cases of alcohol consumption develop concomitant psychosocial problems such as aggressiveness, irritability and depression. Suicide is also associated with substance abuse and alcoholism.6 According to the National Household Survey conducted in 2001, alcohol-related problems were a major community problem afflicting the majority of the households sampled.7 A survey of 179 adults living in five towns in the remote Amazon region of Peru found that 48% drank alcohol and that alcohol use was a major behavioural risk factor in that region.8

Country background information

Total population 2003 27 167 000 Life expectancy at birth (2002) Male 67.5 Adult (15+) 18 201 890 Female 72.0 % under 15 33 Probability of dying under age 5 per 1000 (2002) Male 38 Population distribution 2001 (%) Female 34 Urban 73 Gross National Income per capita 2002 US$ 2050 Rural 27

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. II Encuesta Nacional Sobre Prevencion Y Consumo De Drogas 2002 [National survey on prevention and consumption of drugs 2002]. Comision Nacional para el Desarollo y Vida sin Drogas [National Committee for Development and Life Without Drugs], 2003. 2. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 3. WHO focal point data. Response to WHO survey on burden of disease attributable to alcohol: unrecorded alcohol consumption and drinking patterns. Geneva, World Health Organization, 2001. 4. Chirinos JL, Salazar VC, Brindis CD. Perfil de los adolescentes varones sexualmente activo en colegios secundarios de Lima, Peru [A profile of sexually active male adolescent high school students in Lima, Peru]. Cadernos de Saúde Pública, Rio de Janeiro, 2000, 16(3):733–746. 5. Haard NF et al. Fermented cereals: a global perspective. Rome, Food and Agriculture Organization of the United Nations, 1999 (http://www.fao.org/docrep/x2184e/x2184e07.htm, accessed 25 September 2004). 6. Paz OA. The Mental Health Situation in Peru. 2002 (http://www.ishhr.org/regions/perueng.php, accessed 12 February 2004). 7. National Survey of Households 2001-IV. Peruvian National Institute of Statistics and Computerized Information. In: Ibarra M. Crime victimization and reporting in Peru. July 2003 (http://www.terry.uga.edu/people/cornwl/gc/ibarra.pdf, accessed 12 February 2004). 8. Nawaz H et al. Health risk behaviours and health perceptions in the Peruvian Amazon. American Journal of Tropical Medicine and Hygiene, 2001, 65(3):252–256.

PUERTO RICO

Abstainers (lifetime abstainers)

Survey aimed at estimating rates Total of substance use disorders in a 22.8% probability sample of 4709 household residents aged 15 to 64 years.1

Youth drinking (last year alcohol use)

Data came from an island-wide Total survey of the general residential 20.8% population (15–18 year old subsample, unweighted n = 922) fielded in 1997.2

Alcohol abuse/dependence disorder (last year)

Survey aimed at estimating rates of substance use disorders in a probability sample of 4709 Total household residents aged 15 to 64 4.3% years according to CIDI and 1 DSM-IV criteria.

Data from an island-wide survey of the Puerto Rican general residential population (15–18 year old subsample, unweighted n = 922) fielded in 1997 found the rate of lifetime alcohol abuse or dependence (according to CIDI and DSM-IV) to be 6.4%.2

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.4 2

1.8 0.35

1.6 0.3 1.4 Alcohol use disorders 0.25 1.2 Cirrhosis of the liver 0.2 1 Mouth and oropharynx cancers

SDR per 1000 0.8 0.15 Ischaem ic heart disease

0.6 0.1 0.4

0.05 0.2

0 0 1961 1965 1971 1975 1980 1984 1988 1992 1996 2000 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.4

0.35

0.3

0.25 Falls Intentional injuries

SDR per 1000 per SDR 0.2 Accidental poisonings Road traffic accidents 0.15

0.1

0.05

0 1961 1965 1971 1975 1980 1984 1988 1992 1996 2000 Year

Source: WHO Mortality Database

Country background information

Total population 2003 3 879 000 Life expectancy at birth (2000–2005) Male 71.2 Adult (15+) 2 986 830 Female 80.1 % under 15 23 Infant mortality rate (2000–2005) Population distribution 2001 (%) per 1000 live births 10.3 Urban 76 Gross National Income per capita 2002 US$ 10 950 Rural 24

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database Note: Puerto Rico is an Associate Member of WHO.

References 1. Colón HM et al. Prevalence and correlates of DSM-IV substance use disorders in Puerto Rico. Boletin - Asociacion Medica De Puerto, 2001, 93(1–12):12–22. 2. Warner LA, Canino G, Colón HM. Prevalence and correlates of substance use disorders among older adolescents in Puerto Rico and the United States: a cross-cultural comparison. Drug and Alcohol Dependence, 2001, 63(3):229–243.

SAINT KITTS AND NEVIS

Recorded adult per capita consumption (age 15+)

6 Total 5 Beer

4 Spirits Wine 3 Litres of pure alcohol

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Morbidity, health and social problems from alcohol use Of all visits made to mental health services in 1995, 25% (67 patients) was due to alcohol addiction and drug- induced psychosis.1

Country background information

Total population 2003 38 763 Life expectancy at birth (2002) Male 68.7 Adult (15+) 27 521 Female 72.2 % under 15 29 Probability of dying under age 5 per 1000 (2002) Male 20 Population distribution 2001 (%) Female 24 Urban 34 Gross National Income per capita 2002 US$ 6370 Rural 66

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Health in the Americas. Pan American Health Organization, 1998 Edition.

SAINT LUCIA

Recorded adult per capita consumption (age 15+)

12 l

10 Total Beer 8 Spirits 6 Wine Litres of pure alcoho pure of Litres 4

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Alcohol consumers in Vieux Forte

A 1991–1994 urban survey conducted in Vieux Forte (males n = 491 and females n = 593; aged 25 years and above). Alcohol consumers were defined as having at least 12 drinks of any alcoholic 1 beverage in the past 12 months. Male 76.4% Male Female 47.9% Female

Country background information

Total population 2003 149 000 Life expectancy at birth (2002) Male 69.8 Adult (15+) 104 300 Female 74.4 % under 15 30 Probability of dying under age 5 per 1000 (2002) Male 14 Population distribution 2001 (%) Female 15 Urban 38 Gross National Income per capita 2002 US$ 3840 Rural 62

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Cooper R et al. The prevalence of hypertension in seven populations of West African origin. American Journal of Public Health, 1997, 87(2):160–168. In: WHO Global NCD InfoBase. Geneva, World Health Organization.

SAINT VINCENT AND THE GRENADINES

Recorded adult per capita consumption (age 15+)

Total 4 Beer Spirits 3 Wine

Litres of pure alcohol pure of Litres 2

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Youth drinking in Saint Vincent (alcohol users)

Survey of 850 adolescents from schools in Saint Vincent.1

Total 56%

Morbidity, health and social problems from alcohol use Mental Health Centre admission records for the 1992–1995 period indicate that of the 587 admissions due to substance abuse, 24.8% were for alcohol.2

Country background information

Total population 2003 120 000 Life expectancy at birth (2002) Male 67.8 Adult (15+) 84 000 Female 71.9 % under 15 30 Probability of dying under age 5 per 1000 (2002) Male 25 Population distribution 2001 (%) Female 20 Urban 56 Gross National Income per capita 2002 US$ 2820 Rural 44

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Report on Workshop on Participatory Education for Drug Abuse Prevention. Saint Vincent and the Grenadines, 2003. 2. Health in the Americas. Pan American Health Organization, 1998 Edition.

SURINAME

Recorded adult per capita consumption (age 15+)

l 7

6 Total Beer 5 Spirits 4 Wine

Litres ofpure alcoho 3

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol experts showing proportion of Total adult males and females who had 42.5% been abstaining (last year before the survey). Data is for after year 1 1995. Male 30% Female 55% Female

Unrecorded alcohol consumption The unrecorded alcohol consumption in Suriname is estimated to be 0.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Chronic mortality

0.3 1.2

0.25 1

0.2 0.8 Alcohol use disorders

Cirrhosis of the liver

0.15 0.6 Mouth and oropharynx cancers SDR 1000 per Ischaem ic heart disease 0.1 0.4

0.05 0.2

0 0 1963 1971 1976 1980 1985 1989

Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.45

0.4

0.35

0.3

Falls 0.25 Intentional injuries SDR per 1000 per SDR Accidental poisonings 0.2 Road traffic accidents

0.15

0.1

0.05

0 1963 1971 1976 1980 1985 1989 Year

Source: WHO Mortality Database

Country background information

Total population 2003 436 000 Life expectancy at birth (2002) Male 64.4 Adult (15+) 300 840 Female 70.8 % under 15 31 Probability of dying under age 5 per 1000 (2002) Male 33 Population distribution 2001 (%) Female 28 Urban 75 Gross National Income per capita 2002 US$ 1960 Rural 25

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157.

TRINIDAD AND TOBAGO

Recorded adult per capita consumption (age 15+)

6 l

5 Total Beer 4 Spirits

3 Wine Litres ofpure alcoho 2

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

Estimates from key alcohol experts showing proportion of adult males and females who had been abstaining (last year before Total the survey). Data is for after year 49.7% 1 1995. Female 70.4% Female Male 29% Male

In 1995, 80% of males and 54% of females reported that they had consumed 12 or more alcoholic drinks in their lifetime. Persons with low educational attainment reported a higher prevalence of drinking.2 A 1977–1986 urban survey conducted in the suburbs of St James and Woodbrook Park in Port-of-Spain (males n = 1340 and females n = 1046; aged 35 years and above) found that 35.4% of males and 75% of females were abstainers.3

Weekly alcohol drinkers

Data from a 1977–1986 urban survey conducted in the suburbs of St James and Woodbrook Park in Port-of-Spain (males n = 1340 and females n = 1046; aged 35 years and above). Definition used: 3 at least one drink per week. Male 64.6% Male 24.9% Female

In a 1989 study of 1448 persons, including 306 adolescents aged between 16 and 19 years old, it was found that 42.5% of adolescent males, 11.3% of adolescent females and 21.9% of adult females were drinking at least once per month. Acute heavy drinking (more than five drinks on a single occasion) was more prevalent in adolescent females than in adult females.4

High risk drinkers in north central Trinidad

Data from a 2001 survey of households in north central Trinidad (total sample size n = Total 461; males n = 202 and females n 5.4% = 259). High risk drinking was defined as having an AUDIT 5 score of eight or more.

Male 11.4% Male Female 0.8% Female

The same survey also found that 36.1% of males and 69.1% of females reported an AUDIT score of 0–1 (indicating no or very low alcohol intake).5 In 1995, heavy drinking (at least 21 units per week) was reported by 10.5% of males; the percentage rose to 13% in the central region of the country where the sugar industry is based.2

Youth drinking (lifetime prevalence of alcohol use)

Data from a questionnaire survey conducted in 1988 of 1603 secondary school students aged 14 to 18 years.6 Total 84%

The study also found that students’ first exposure to drinking alcohol was by family members in childhood or experimentation later. Transitions from primary to secondary schools and from junior to senior schools were associated with increased alcohol use. Ethnic reversals of substance abuse among high school students were observed by a high use of alcohol among Indo-Trinidadian and low use among Afro-Trinidadian students. The use of alcohol by students was also positively correlated to its use by fathers.7

Alcoholism in Tobago A study conducted in Tobago found that CAGE responses consistent with alcoholism were present in 14.3% of males and 1.1% of females.8

Traditional alcoholic beverages Babash – a home-brewed rum is consumed. It is not permitted to be made or consumed in Trinidad and Tobago in part because of its excessively high alcohol content.

Unrecorded alcohol consumption The unrecorded alcohol consumption in Trinidad and Tobago is estimated to be 0.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.25 2

1.8

0.2 1.6

1.4 Alcohol use disorders

0.15 1.2 Cirrhosis of the liver

1 Mouth and oropharynx cancers

SDR per 1000 SDR per 0.1 0.8 Ischaemic heart disease

0.6

0.05 0.4

0.2

0 0 1961 1967 1972 1976 1980 1984 1988 1992 1998

Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.3

0.25

0.2

Falls Intentional injuries 0.15 Accidental poisonings SDR per 1000 per SDR Road traffic accidents

0.1

0.05

0 1961 1967 1972 19 76 1980 1984 1988 1992 1998 Year

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use A survey carried out in December 1984 at the Casualty Department of the Port-of-Spain General Hospital found that 68% of the 38 accident victims seen had blood alcohol concentrations higher than 50 mg per 100 ml and 55% had blood alcohol concentrations higher than 80 mg per 100 ml.9 Hospital admission figures, cirrhosis death rates, per capita alcohol consumption rates and other indices have for many years indicated a high prevalence of alcoholism in Trinidad and Tobago. A six-month survey of the medical wards at the Port-of-Spain General Hospital in 1979 showed that 47% of male admissions and 5% of female admissions were alcohol-related.9 In a 2-year retrospective study, it was found that alcohol abuse was a contributory risk factor for musculo- skeletal sporting injuries.10 In a study where 40 drug users were interviewed in Trinidad and Tobago, respondents frequently reported a history of alcohol abuse within the family.11

Country background information

Total population 2003 1 303 000 Life expectancy at birth (2002) Male 67.1 Adult (15+) 1 016 340 Female 72.8 % under 15 22 Probability of dying under age 5 per 1000 (2002) Male 24 Population distribution 2001 (%) Female 18 Urban 75 Gross National Income per capita 2002 US$ 6490 Rural 25

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 2. Health in the Americas. Pan American Health Organization, 1998 Edition. 3. Miller GJ et al. Adult male all-cause, cardiovascular and cerebrovascular mortality in relation to ethnic group, systolic blood pressure and blood glucose concentration in Trinidad, West Indies. International

Journal of Epidemiology, 1988, 17(1):62–69. Additional data from personal communication. In: WHO Global NCD InfoBase. Geneva, World Health Organization. 4. Boyd P et al. Behavioural risk factors in the adolescent and adult populations of Trinidad and Tobago, 1989. West Indian Medical Journal, 1992, 41(Supplement 1):16. 5. Gulliford MC, Mahabir D, Rocke B. Socioeconomic inequality in blood pressure and its determinants: cross-sectional data from Trinidad and Tobago. Journal of Human Hypertension, 2004, 18(1):61–70. 6. Singh HN, Maharaj HD, Shipp M. Pattern of substance abuse among secondary school students in Trinidad and Tobago. Public Health, 1991, 105(6):435–441. 7. Singh HN, Maharajh HD. Alcohol and drug abuse among secondary school children in Trinidad and Tobago. West Indian Medical Journal, 1991, 40(Supplement 1):25–26. 8. Patrick AL et al. Alcohol consumption patterns in two Caribbean islands: the CAGE Questionnaire as a predictor of mortality. West Indian Medical Journal, 1996, 45(Supplement 2):34 9. Beaubrun MH et al. Blood alcohol concentrations of motor vehicle accident victims at the Port-of-Spain General Hospital Casualty Department, December 1984: a preliminary report. West Indian Medical Journal, 1986, 35(Supplement):55. 10. Ali TF, Tavares SP. Musculo-skeletal sport injuries in Trinidad and Tobago. West Indian Medical Journal, 1992, 41(Supplement 1):59. 11. Djumalieva D et al. Drug use and HIV risk in Trinidad and Tobago: qualitative study. International Journal of Sexually Transmitted Diseases and AIDS, 2002, 13(9):633–639.

UNITED STATES OF AMERICA (THE)

Recorded adult per capita consumption (age 15+)

10 l 8 Total Beer 6 Spirits Wine 4 Litres ofpure alcoho

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

2002 national survey. 68 126 interviews were obtained from subjects 12 years or older.1 Total 33.9%

Male 29.3% Male Female 38.2% Female

In the same survey, the rate of lifetime abstainers was 16.9% (total), 13.6% (males), 19.9% (females) and the rate of last month abstainers was 49% (total), 42.6% (males), 55.1% (females).1 Data from the 2001 National Household Survey (total sample size n = 68 929; aged 12 years and older) show that the rate of lifetime alcohol use among the total population sampled was 84%. The rate of last year alcohol use was 65.5% (total), 69.8% (males) and 61.5% (females).2

Heavy drinkers (last month)

2002 national survey. 68 126 interviews were obtained from subjects 12 years or older. Heavy Total drinking was defined as having 6.7% five or more drinks on the same occasion on at least five different 1 days in the past month. Male 10.8% Male Female 3.0% Female

Heavy and hazardous drinkers (among drinkers)

Data from the WHO GENACIS study. National survey conducted in 1995/1996 (age group 20 to 64 years). Total sample size n = 4044; males n = 1853 and females n = 2191. Definition used: consumption of 40 g or more of pure alcohol a day for males and 20 g or more of pure alcohol a day for females.3 Male 6.4% Male Female 5.0% Female

Heavy episodic drinkers (last month)

2002 national survey. 68 126 interviews were obtained from Total subjects 12 years or older. Heavy 22.9% episodic drinking was defined as drinking five or more drinks on the same occasion (i.e. at the same time or within a couple of hours of each other) on at least one day in the past 30 days.1 Male 31.2% Male 15.1% Female

According to the WHO GENACIS Study (1995/1996 survey; total sample size n = 857, males n = 377 and females n = 480; age range 20 to 64 years), the rate of heavy episodic drinking among drinkers was 29.1% for men and 6.9% for women. Heavy episodic drinking was defined as consumption of five or more drinks in one sitting at least once a month in the last year.3

Youth drinking (last year alcohol use)

2002 national survey. 68 126 interviews were obtained from subjects 12 years or older. Data Total shown is only for subsample of 34.6% subjects aged 12 to 17 years old (sample size unknown).1

Male 33.3% Male 36.0% Female

In the same survey, the rate of lifetime alcohol use among 12- to 17-year-olds was 43.4% (total), 43.4% (males) and 43.4% (females) whilst the rate of last month alcohol use was 17.6% (total), 17.4% (males), and 17.9% (females).1 Data from the 2003 Youth Risk Behavior Survey (total sample size n = 15 214; subjects in grades 9 to 12) show that the rate of lifetime users (students who had at least once drink of alcohol on one or more days during their life) was 74.9% (total), 73.7% (males) and 76.1% (females). The rate of last month alcohol use (students who had at least one drink of alcohol on one or more of the past 30 days) was 44.9% (total), 43.8% (males) and 45.8% (females).4 Data from the 2003 Monitoring the Future study (national results on adolescent drug use) conducted among students in eighth grade (total sample size n = 16 500), tenth grade (total sample size n = 15 800), and twelfth grade (total sample size n = 14 600) found that the rate of lifetime prevalence of alcohol use was 45.6%, 66% and 76.6% (for students in eighth grade, tenth grade and twelfth grade respectively). The rate of last year alcohol use was 37.2%, 59.3% and 70.1% (for students in eighth grade, tenth grade and twelfth grade respectively). The rate of last month alcohol use was 19.7%, 35.4% and 47.5% (for students in eighth grade, tenth grade and twelfth grade respectively).5 Data from the 2001 Harvard School of Public Health College Alcohol Study Survey (total sample size n = 10 904; 64% female; subjects were students at 119 4-year colleges) show that the rate of last year abstainers was 19.3% (total), 20.1% (males) and 18.7% (females).6 Data from the 2001 National Household Survey (total sample size n = 68 929; aged 12 years and older) show that the rate of last year alcohol use among the subsample aged 14 to 19 years (sample size unknown) was 52.7% (total), 52% (males) and 53.4% (females).2 In a recent study of 2280 youths from two juvenile justice detention facilities in Georgia (939 males and 1341 females; age range 11 to 18 years), the rate of lifetime alcohol use for the entire sample was 77.8%. Recent alcohol consumption (the month prior to the current detention) was reported by 62.6% of the participants. Of these, approximately 40% reported alcohol consumption on six or more days. Furthermore, 37.8% had five or more drinks during that time. Half of the participants who reported alcohol consumption in the month prior to the detention had had five or more alcoholic drinks in the same day, with 62.4% engaging in this behaviour between 1 and 5 days and the remaining 38.6% engaging in this behaviour (binge drinking) between 6 and 31 days.7 In a study of 314 students: 116 African American adolescents (50 boys and 66 girls) and 198 Haitian adolescents (93 boys and 105 girls) in inner-city public high schools in Boston (students were in grade 9 through 12), it was found that the rate of current drinking activity (drank in the past 6 months) was 67% (African-American boys), 45% (African-American girls), 43% (Haitian boys) and 61% (Haitian girls). The corresponding rates for lifetime alcohol use were 94%, 77%, 97% and 96% respectively.8 A study using data from the 1993 National Household Survey on Drug Abuse included 1865 Hispanic adolescents (52% male; aged 12 to 17 years; respondents are of Cuban (n = 200), Mexican (n = 1133), Puerto Rican (n = 255) and Central/South-American (n = 277) origin) found the rate of last year abstainers for males (by above-mentioned order of origin) to be 78.1%, 63.2%, 68.2% and 61.3% respectively. For females the rates were 70.2%, 66.7%, 70.2% and 65.5% respectively. The corresponding rates of frequent heavy drinking (defined as having drank four or more times in the past month and drinking five or more drinks per sitting one or more times) to be 0.5%, 6.7%, 3.1% and 5.8% for males and 1.1%, 2.5%, 0.1% and 2.3% for females.9

Youth drinking (drink at least weekly)

HBSC survey 2001/2002. Data Total shows proportion of 15-year-olds 16% who report drinking beer, wine or spirits at least weekly. Total sample size n = 1625.10

Male 21.3% Male 11.4% Female

According to the 1997/1998 HBSC survey (total sample size n = 1808), 23% of 15-year-old boys and 15% of 15- year-old girls reported drinking beer, wine or spirits at least weekly.11

Youth drinking (last month heavy drinkers)

2002 national survey. 68 126 interviews were obtained from subjects aged 12 years or older. Total Data shown is only for subsample 2.5% of subjects aged 12 to 17 years old (sample size unknown). Heavy drinking was defined as having five or more drinks on the same occasion on at least five different days in the past month.1 Male 3.1% Male Female 1.9% Female

Data from the 2003 Monitoring the Future study (national results on adolescent drug use) conducted among students in eighth grade (total sample size n = 16 500), tenth grade (total sample size n = 15 800), and twelfth grade (total sample size n = 14 600) found that the rate of last month daily use of alcohol was 0.8%, 1.5% and 3.2% (for students in eighth grade, tenth grade and twelfth grade respectively).5 Data from the 2001 National Household Survey (total sample size n = 68 929; aged 12 years and older) show that 32% of teenagers reported drinking on a monthly basis and 21.5% (24.6% of boys and 18.4% of girls) reported binge drinking five or more drinks on at least one occasion in the past month. In terms of heavy alcohol use, 6.5% of teenagers (8.4% of boys and 4.6% of girls) reported drinking five or more drinks on each of five or more days in the past month.2 In a 2002 study of 1029 (58% female) students attending a community college in California, it was found that 74% of the participants reported drinking alcohol in the past 12 months and 52% reported alcohol use in the past 30 days. About half (47%) of the sample reported lifetime use of malt liquor, and 38% reported malt liquor use in the past 12 months. Malt liquor drinkers also reported engaging in heavy drinking (i.e. five drinks in a row in a 2-hour period) more frequently and experienced intoxication more frequently than did drinkers who reported no malt liquor use. Overall, 30% of the sample reported heavy drinking in the past 30 days; among them, 71% were malt liquor drinkers. Similarly, 40% of the sample reported intoxication in the past 30 days; among these respondents, 67% were malt liquor drinkers. The study also found that prevalence rates of problem behaviours generally were highest among malt liquor drinkers, followed by drinkers who did not use malt liquor and then nondrinkers.12

Youth drinking (last month heavy episodic drinkers)

2002 national survey. 68 126 interviews were obtained from subjects aged 12 years or older. Data shown is only for subsample Total of subjects aged 12 to 17 years 10.7% old (sample size unknown). Heavy episodic drinking was defined as having five or more drinks on the same occasion at least once in the past month.1 Male 11.4% Male 9.9% Female

Data from the 2003 Youth Risk Behavior Survey (total sample size n = 15 214; subjects in grades 9 to 12) show that the rate of last month heavy episodic drinking (students who had five or more drinks of alcohol in a row, that is, within a couple of hours, on one or more of the past 30 days) was 28.3% (total), 29% (males) and 27.5% (females).4 Data from the 2001 Harvard School of Public Health College Alcohol Study Survey (total sample size n = 10 904; 64% female; subjects were students at 119 4-year colleges) show that the rate of binge drinkers was 44.4% (total), 48.6% (males) and 40.9% (females). The rate of frequent binge drinkers was 22.8% (total), 25.2% (males) and 20.9% (females). Binge drinking was defined as the consumption of at least five drinks in a row for men or four drinks in a row for women during the two weeks before completion of the survey. Frequent binge drinking was defined students who had binged (refer to above definition) three or more times in the past two weeks.6

Alcohol dependence or abuse (last year)

2002 national survey. 68 126 interviews were obtained from subjects aged 12 years or older. Total Survey measured alcohol 7.7% dependence or abuse based on criteria specified in the DSM-IV.1

Male 10.8% Male Female 4.8% Female

In a sample consisting of 2040 short-stay, general hospital admissions (1613 males and 427 females) the current (last year) prevalence for DSM-IV criteria of alcohol use disorder was found to be 7.4%.13 It is a known fact that alcohol abuse and alcoholism are leading causes of death among Native Americans. In a series of face-to-face interviews conducted with 1660 individuals from seven Native American tribes from 1998 to 2001, the lifetime prevalence of DSM-IV alcohol dependence was found to be high in six of the seven tribes (men: 21–56%, women: 17–30%).14 In a study conducted among Navajo Indians (735 men and 351 women) using the Diagnostic Interview Schedule, the rate of lifetime prevalence of alcohol dependence was found to be 70.4% for men and 29.6% for women.15 In a recent study of 198 (109 male) homeless youths aged between 13 and 19 years old, it was found that 95.4% of the total sample had used alcohol in the past year and 87.9% had used alcohol in the past month. Using the Structured Clinical Interview for DSM (SCID), 44.6% of those administered the SCID for alcohol met criteria for DSM-IV alcohol dependence in the past year; an additional 21.7% of those not meeting dependence criteria met criteria for alcohol abuse.16

Unrecorded alcohol consumption The unrecorded alcohol consumption in the United States of America is estimated to be 1.0 litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).17

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.16 3.5

0.14 3

0.12 2.5 Alcohol use disorders 0.1

2 Cirrhosis of the liver 0.08 Mouth and oropharynx 1.5 cancers SDR per1000 SDR 0.06 Ischaemic heart disease

1 0.04

0.5 0.02

0 0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.3

0.25

0.2

Falls

Intentional injuries 0.15 Accidental poisonings Road traffic accidents SDR per 1000 per SDR 0.1

0.05

0 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

Year

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use Workers are roughly two times more likely to be absent from work the day after alcohol was consumed.18 A survey found that farm residents who drank more frequently had higher farm work injury incidence rates (3.35 injuries per 10 000 person-days of observation versus 1.94 injuries per 10 000).19 A study of 6540 managers, supervisors and workers at 16 worksites found that although moderate-heavy and heavy drinkers reported more work performance problems than very light, light or moderate drinkers, the lower- level-drinking employees, since they were more plentiful, accounted for a larger proportion of work performance problems than did the heavier drinking groups.20 In a study looking at data from 1992 to 2000, it was found that there were an estimated 68.6 million emergency department visits attributable to alcohol, a rate of 28.7 per 1000 population. The number of alcohol-related visits increased 18% during this period.21 In emergency rooms, self-reported alcohol consumption within six hours of admission is higher for injured than uninjured attendees. 20–40% of emergency admissions are intoxicated; the night-time rate is higher at 80%.22 In a study evaluating a sample of emergency department patients for history of violence and substance abuse, it was found that in comparison with participants who reported no alcohol use, those drinking any alcohol were twice as likely to report that their injury sustained was related to acute violence and that there was a history of past-year violence, including violence victimization and perpetration in both partner and non-partner relationships, as well as any substance use in the past month and any substance-related consequences in the past year.23 According to the National Highway Traffic Safety Administration, during 2002, alcohol-related motor-vehicle crashes resulted in 17 419 deaths in the United States, accounting for 41% of all traffic fatalities.24 In a report released by the Centers for Disease Control and Prevention (CDC) that analysed the occurrence of child passenger deaths involving drinking drivers during 1997–2002, it was found that among the 2335 children who died in alcohol-related crashes, 1588 (68%) were riding with drinking drivers.25 Conservative estimates of sexual assault prevalence suggest that 25% of American women have experienced sexual assault, including rape. Approximately one half of those cases involve alcohol consumption by the perpetrator, victim or both.26 A study looking at data from 859 female sexual assault victims identified from the National Violence against Women Survey found that offender drinking was associated with greater likelihood of rape completion.27 A study conducted among college women (using data from three different surveys performed in 1997, 1999 and 2001) found that roughly one in 20 (4.7%) women reported being raped. Nearly three quarters (72%) of the victims experienced rape while intoxicated. Women who drank heavily in high school and attended colleges with high rates of heavy episodic drinking were at higher risk of rape while intoxicated.28 Alcohol plays an important part in intimate partner violence. A 1995 national study found that 30–40% of the men and 27–34% of the women who perpetrated violence against their partners were drinking at the time of the event.29 A study found that problem drinking significantly predicted perpetration and victimization for men and women. For women, partner drinking was strongly related to perpetration and victimization.30 In a recent study of 103 women who were arrested for domestic violence, it was found that relative to the nonhazardous drinkers (NHD) group, hazardous drinkers (HD) women reported significantly greater frequency of perpetration of physical assault, psychological abuse and sexual abuse toward their relationship partners, causing significantly more injuries. HD women also reported significantly greater frequency of physical assault victimization than NHD women. HD women reported significantly greater frequency of general violence perpetration since age 18 than NHD women. There was a trend for the HD group to report a greater frequency of general violence in the past year relative to the NHD group. Women in the HD group also reported significantly more partner alcohol problems relative to the NHD group. HD women were significantly more likely than NHD women to have used alcohol and to have been intoxicated prior to the most recent battering arrest. In addition, compared with NHD women, HD women reported a higher frequency of partner violence perpetration and victimization, and general violence perpetration, subsequent to drinking in the past year.31 A time series analysis of alcohol consumption and suicide mortality between 1934 and 1987 in the United States of America found that bivariate associations between alcohol consumption and suicide rates were not significant. However, when unemployment was included in the model, increases in per capita alcohol consumption were significantly related to increases in suicide overall, for men and women, and for the young (under age 40) and middle-aged (40 to 59 years), but not for those over age 60.32 An earlier study looking at suicide rates and

122 WHO Global Status Report on Alcohol 2004 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS alcohol consumption between 1970 and 1989 showed findings that suggested that it was not the consumption of ethanol per se but rather the consumption of ethanol in the form of spirits that is related to suicide. Rather, it would appear that a population-based preference for the consumption of spirits is associated with suicide events.33 In a study exploring the relationship between alcohol use prior to suicide among American Indian decedents in New Mexico for the years 1980 through 1998, alcohol was detected in 69% of all suicides with some variance by major tribal cultural groups (ranging from 62.1% to 84.4%). This is higher than in suicides among the overall New Mexico population (44.3%). The mean blood alcohol concentration (BAC) of the drinking Indian decedents at suicide was 0.198. Mean BACs were high for both males (0.199) and females (0.180) who had been drinking. Over 90% of the Indian decedents who had been drinking had BACs greater than the legal intoxication level of 0.08.34 A study found that a consumption increase of 1 litre of alcohol per capita brings about an increase in the divorce rate of about 20%. The results from this study provide support both for the effects of heavy drinking on divorce rates and the effect of divorce rates on expenditure for alcoholic beverages.35 A study found that from 1983 to 1998, changes in alcohol consumption were significantly associated with changes in gonorrhea and syphilis rates. Each 1% increase in alcohol consumption was associated with increases of about 0.4% to 0.7% in reported gonorrhea incidence rates and 1.8% to 3.6% in reported syphilis incidence rates.36 Alcohol is associated with motor vehicle crashes and fatal intentional injuries such as suicides and homicides. In 1994, 19 470 deaths were attributed to alcohol-induced causes.37 In 1998, chronic liver disease (CLD) was the tenth leading cause of death in the United States. Of 30 933 CLD deaths in 1998, 39% were coded as alcohol-related.38 A national study of college and university students conducted in 1999 found that compared with respondents first intoxicated at age 19 or older, those first intoxicated prior to age 19 were significantly more likely to be alcohol dependent and frequent heavy drinkers, to report driving after any drinking, driving after five or more drinks, riding with a driver who was high or drunk and, after drinking, sustaining injuries that required medical attention. Respondents first intoxicated at younger ages believed that they could consume more drinks and still drive safely and legally; this contributed to their greater likelihood of driving after drinking, and riding with high or drunk drivers.39 A national study of college students found that students with poor mental health/depression (PMHD) were less likely to report never drinking, as likely to report frequent, heavy and heavy episodic drinking, and more likely to report drinking to get drunk. Students with PMHD - especially females - were more likely to report drinking- related harms and alcohol abuse.40

Economic and social costs The costs of alcohol abuse and alcoholism were estimated to be $184.6 billion in 1998. These costs include: about $18.9 billion in medical expenditures to treat the medical consequences of alcohol abuse and alcoholism, $134.2 billion due to lost earnings, $31.6 billion for other impacts to society (such as specialty alcohol services such as alcohol abuse treatment, crime costs and social welfare administration). Compared to 1992, this was an approximately 25% increase, or an average annual increase of 3.8%.41 In 1992 the economic cost to society from alcohol abuse and alcoholism was an estimated $148 billion. Specialized services for the prevention and treatment of alcohol problems cost $5.6 billion and treatment for health problems attributed to alcohol abuse cost $13.2 billion. 107 400 people died as a consequence of alcohol abuse and the estimated cost was $31.3 billion, representing the present discounted value of expected lifetime earnings (at 6%). An estimated $67.7 billion in lost potential productivity was attributed to alcohol abuse. Total costs attributed to alcohol-related motor vehicle crashes were estimated to be $24.7 billion. This included $11.1 billion from premature mortality and $13.6 billion from automobile and other property destruction.42 In the United States of America, related absenteeism and poor job performance cost $148 billion annually (average annual cost per working adult, $2000). Although hangover is associated with alcoholism, most of its cost is incurred by the light-to-moderate drinker.43 The total cost of alcohol use by youth was $52.8 billion in 1996. This includes $19.5 billion for alcohol- attributable crashes involving drivers under the age of 21 (pedestrians and cyclists included), $29.4 billion for alcohol-attributable violent crime involving perpetrators under the age of 21, suicide attempts ($1.5 billion), unintentional drownings ($426 million), alcohol-attributable burns ($189 million), fetal alcohol syndrome ($493

WHO Global Status Report on Alcohol 2004 123 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS million), alcohol poisonings ($340 million) and alcohol treatment ($1 billion). Yet another breakdown of this $52.8 billion expense is how the money was spent: alcohol-related problems resulted in $3.7 billion in medical spending in 1996 – about 4% of total medical spending in the country; they led to future work losses, property damage, and criminal justice costs of $10.6 billion; and they caused pain and quality of life losses conservatively valued at $38.5 billion.44

Country background information

Total population 2003 294 043 000 Life expectancy at birth (2002) Male 74.6 Adult (15+) 232 293 970 Female 79.8 % under 15 21 Probability of dying under age 5 per 1000 (2002) Male 9 Population distribution 2001 (%) Female 7 Urban 77 GNI per capita 2002 US$ 35 060 Rural 23

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. 2002 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies, 2002. 2. Maxwell JC. Update: comparison of drug use in Australia and the United States as seen in the 2001 National Household Surveys. Drug and Alcohol Review, 2003, 22(3):347–357. 3. Preliminary results from the Gender, Alcohol and Culture: An International Study (GENACIS Project). International Research Group on Gender and Alcohol (for more information please see http://www.med.und.nodak.edu/depts/irgga/GENACISProject.html). 4. Youth Risk Behavior Survey 2003. Department of Health and Human Services, Centers for Disease Control and Prevention, 2004. 5. Johnston LD et al. Monitoring the Future national results on adolescent drug use: Overview of key findings, 2003 (NIG Publication No. 04-5506). Bethesda, National Institute on Drug Abuse, 2004. 6. Wechsler H et al. Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College Alcohol Study Surveys: 1993–2001. Journal of American College Health, 2002, 50(5):203–217. 7. Braithwaite RL et al. Alcohol and other drug use among adolescent detainees. Journal of Substance Use, 2003, 8(2):126–131. 8. Strunin L. Drinking perceptions and drinking behaviors among urban black adolescents. Journal of Adolescent Health, 1999, 25(4):264–275. 9. Nielsen AL, Ford JA. Drinking patterns among Hispanic adolescents: results from a national household survey. Journal of Studies on Alcohol, 2001, 62(4):448–456. 10. Currie C et al., eds. Young people's health in context. Health Behaviour in School-aged Children (HBSC) study: international report from the 2001/2002 survey. Copenhagen, WHO Health Policy for Children and Adolescents (HEPCA), 2004. 11. Health Behaviour in School-aged Children: a WHO Cross-National Study (HBSC) International Report. Copenhagen, World Health Organization, 2000. 12. Chen M, Paschall MJ. Malt liquor use, heavy/problem drinking and other problem behaviours in a sample of community college students. Journal of Studies on Alcohol, 2003, 64(6):835–842. 13. Smothers BA, Yahr HT, Sinclair MD. Prevalence of current DSM-IV alcohol use disorders in short- stay, general hospital admissions, United States, 1994. Archives of Internal Medicine, 2003, 163(6):713–719. 14. Koss MP et al. Adverse childhood exposures and alcohol dependence among seven Native American tribes. American Journal of Preventive Medicine, 2003, 25(3):238–244. 15. Kunitz SJ et al. Alcohol dependence and conduct disorder among Navajo Indians. Journal of Studies on Alcohol, 1999, 60(2):159–167. 16. Baer JS, Ginzler JA, Peterson PL. DSM-IV alcohol and substance abuse and dependence in homeless youth. Journal of Studies on Alcohol, 2003, 64(1):5–14. 17. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157.

18. McFarlin SK, Fals-Stewart W. Workplace absenteeism and alcohol use: A sequential analysis. Psychology of Addictive Behaviors, 2002, 16(1):17–21. 19. Stallones L, Xiang H. Alcohol consumption patterns and work-related injuries among Colorado farm residents. American Journal of Preventive Medicine, 2003, 25(1):25–30. 20. Mangione TW et al. Employee drinking practices and work performance. Journal of Studies on Alcohol, 1999, 60(2):261–270. 21. McDonald AJ 3rd, Wang N, Camargo CA Jr. US emergency department visits for alcohol-related diseases and injuries between 1992 and 2000. Archives of Internal Medicine, 2004, 164(5):531–537. 22. Hingson R, Howland J. Alcohol and non-fatal injury in the US general population: a risk function analysis. Accident Analysis and Prevention, 1995, 27(5):651–661. 23. Cunningham R et al. Violence and substance use among an injured emergency department population. Academic Emergency Medicine, 2003, 10(7):764–775. 24. Centers for Disease Control and Prevention. National drunk and drugged driving prevention month – December 2003. Morbidity and Mortality Weekly Report, 2003, 52(48):1173–1196. 25. Centers for Disease Control and Prevention. Child passenger deaths involving drinking drivers – United States, 1997–2002. Morbidity and Mortality Weekly Report, 2004, 53(4):77–79. 26. Abbey A et al. Alcohol and sexual assault. Alcohol Research and Health, 2001, 25(1):3–51. 27. Brecklin LR, Ullman SE. The roles of victim and offender alcohol use in sexual assaults: results from the National Violence against Women survey. Journal of Studies on Alcohol, 2002, 63(1):57–63. 28. Mohler-Kuo M et al. Correlates of rape while intoxicated in a national sample of college women. Journal of Studies on Alcohol, 2004, 65(1):37–45. 29. Caetano R, Schafer J, Cunradi CB. Alcohol-related intimate partner violence among white, black, and Hispanic couples in the United States. Alcohol Research and Health, 2001, 25(1):58–65. 30. White HR, Chen P. Problem drinking and intimate partner violence. Journal of Studies on Alcohol, 2002, 63(2):205–214. 31. Stuart GL et al. Hazardous drinking and relationship violence perpetration and victimization in women arrested for domestic violence. Journal of Studies on Alcohol, 2004, 65(1):46–53. 32. Caces FE, Harford T. Time series analysis of alcohol consumption and suicide mortality in the United States, 1934–1987. Journal of Studies on Alcohol, 1998, 59(4):455–461. 33. Gruenwald PJ, Ponicki WR, Mitchell PR. Suicide rates and alcohol consumption in the United States, 1970–89. Addiction, 1995, 90(8):1063–1075. 34. May PA et al. Alcohol and suicide death among American Indians of New Mexico: 1980–1998. Suicide and Life-Threatening Behavior, 2002, 32(3):240–255. 35. Caces MF et al. Alcohol consumption and divorce rates in the United States. Journal of Studies on Alcohol, 1999, 60(5) 647–652. 36. Chesson HW, Harrison P, Stall R. Changes in alcohol consumption and in sexually transmitted disease incidence rates in the United States: 1983–1998. Journal of Studies on Alcohol, 2003, 64(5):623–630. 37. Health in the Americas. Pan American Health Organization, 1998 Edition. 38. Vong S, Bell BP. Chronic liver disease mortality in the United States, 1990–1998. Hepatology, 2004, 39(2):476–483. 39. Hingson R et al. Age of first intoxication, heavy drinking, driving after drinking and risk of unintentional injury among U.S. college students. Journal of Studies on Alcohol, 2003, 64(1): 23–31. 40. Weitzman ER. Poor mental health, depression, and associations with alcohol consumption, harm, and abuse in a national sample of young adults in college. Journal of Nervous and Mental Disorders, 2004, 192(4):269–277. 41. Harwood H. The economic costs of alcohol and drug abuse in the United States: estimates, update methods and data. Bethesda, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, 2000. 42. Harwood H, Fountain D, Livermore G. The economic costs of alcohol and drug abuse in the United States, 1992. Bethesda, US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, 1998. 43. Wiese JG, Shlipak MG, Browner WS. The alcohol hangover. Annals of Internal Medicine, 2000, 132(11):897–902. 44. Levy DT, Miller TR, Cox KC. Costs of underage drinking. Pacific Institute for Research and Evaluation, 1999.

URUGUAY

Recorded adult per capita consumption (age 15+)

10 l 8 Total Beer 6 Spirits Wine 4 Litres ofpure alcoho

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Lifetime abstainers

Data from the 2003 World Health Survey. Total sample size n = Total 2981; males n = 1447 and females 34.3% n = 1534. Population aged 18 years and above.1

Male 25.0% Male Female 43.2% Female

A 2001 national survey (subjects aged 12 to 64 years old living in cities larger than 5000 inhabitants; n = 2382) found the prevalence rate of lifetime abstainers to be 19.5% (total) and the prevalence rate of last year abstainers to be 30.6% (total).2 Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 7% (males) and 21% (females). Data is for after year 1995.3

Heavy and hazardous drinkers

Data from the 2003 World Health Survey. Total sample size n = Total 2981; males n = 1447 and females 1.3% n = 1534. Population aged 18 years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women.1 Male 1.8% Male 0.8% Female

According to the 2003 World Health Survey (total sample size n = 1909; males n = 1074 and females n = 835), the mean value (in grams) of pure alcohol consumed per day among drinkers was 5.1 (total), 7.1 (males) and 2.7 (females).1

Heavy episodic drinkers

Data from the 2003 World Health Survey. Total sample size n = 2981; males n = 1447 and females Total n = 1534. Population aged 18 4.1% years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting.1

Male 6.7% Male Female 1.5% Female

Youth drinking (lifetime abstainers)

Data from the 2003 World Health Survey. Total sample size n = Total 297; males n = 155 and females n 23.8% = 142. Population aged 18 to 24 years old.1

Female 29.8% Female Male 18.3% Male

Youth drinking (heavy episodic drinkers)

Data from the 2003 World Health Survey. Total sample size n = 297; males n = 155 and females n Total = 142. Population aged 18 to 24 8.4% years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting.1

Male 13.5% Male Female 2.8% Female

Note: These are preliminary, early-release, unpublished data from WHO's World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of these data.

Alcohol dependence

Data from the 2001 National Survey on Prevalence and Total Consumption of Drugs (subjects 5% aged 12 to 64 years old living in cities with greater than 5000 inhabitants; n = 2382). DSM-IV criteria was used to assess alcohol dependence.2

Male 8.5% Male 1.3% Female

A national household survey of 2500 persons aged between 15 and 65 years found the rate of last month alcohol abuse to be 19.5%.4

Unrecorded alcohol consumption The unrecorded alcohol consumption in Uruguay is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).3

Chronic mortality

0.12 2

1.8 0.1 1.6

1.4 0.08 Alcohol use disorders 1.2 Cirrhosis of the liver 0.06 1 Mouth and oropharynx

SDR per 1000 per SDR cancers 0.8 Ischaemic heart disease 0.04 0.6

0.4 0.02 0.2

0 0 1960 1966 1970 1974 1978 1983 1987 1993 1999 Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.25

0.2

0.15 Falls Intentional injuries

SDR per 1000 per SDR Accidental poisonings 0.1 Road traffic accidents

0.05

0 1960 1966 1970 1974 1978 1983 1987 1993 1999 Year

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use In Uruguay, men who consume alcohol are six times more likely to abuse their families than those who do not consume or consume moderately.5 Mortality from cirrhosis of the liver rose from 8.5 per 100 000 in the 1986–1991 period to 11.0 per 100 000 in 1995, and affects men much more than women.6 In a case-control study involving 160 cases of adenocarcinoma of the lung and 520 hospitalized controls in Uruguay between January 1998 and July 2000, it was found that hard liquor intake was associated with a 40% increase in risk of adenocarcinoma of the lung.7 A case-control study involving 331 cases of stomach cancer and 622 controls conducted in Montevideo, Uruguay during the period 1992–1996 found that alcohol drinking (particularly hard liquor and beer) was

WHO Global Status Report on Alcohol 2004 129 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS associated with an odds ratio (OR) of 2.4, after controlling for the effect of tobacco, vegetables, and other types of alcoholic beverages.8 In a hospital-based case-control study involving 327 men with lung cancer and 350 male controls carried out between January 1988 and December 1990, a significant positive association was found between beer intake and the risk of lung cancer.9 In a study comparing 210 cases of stomach cancer with 630 controls afflicted with a wide variety of diseases who were admitted for treatment at the University Hospital of Montevideo, Uruguay between July 1985 and December 1988, it was found that both wine and hard liquor carried increased odds ratios, but heavy drinkers of wine displayed a sixfold increase in risk of developing gastric carcinoma.10 In a case-control study conducted in Uruguay between 1992 and 1996, it was found that pure hard liquor drinking was associated with an increased risk of 3.6 for cancer of the oral cavity and pharynx, whereas pure wine drinking showed an odds ratio of 2.1. When pure hard liquor drinkers were compared with pure wine drinkers, the odds ratio for pure liquor drinkers was 1.7. Furthermore, the risk associated with pure hard liquor drinking was analysed by subsite, and the highest odds ratios were observed for oral cavity cancer.11 A case-control study found that beer drinkers showed an increased odds ratio of 5.5 in men for risk of non- Hodgkin’s lymphoma.12

Country background information

Total population 2003 3 415 000 Life expectancy at birth (2002) Male 71.0 Adult (15+) 2 595 400 Female 79.3 % under 15 24 Probability of dying under age 5 per 1000 (2002) Male 18 Population distribution 2001 (%) Female 13 Urban 92 Gross National Income per capita 2002 US$ 4370 Rural 8

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003. 2. 2001 National Survey on Prevalence and Consumption of Drugs. Ministry of Health. 3. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157. 4. Miguez H, Magri R. National study of drug habits in Uruguay. Acta Psiquiatrica y Psicologica de America Latina, 1995, 41(1):13–23. 5. Traverso MT. La cara oculta de la relacion. Inter-American Development Bank. Washington D.C., 2000. In: Biehl ML. Domestic violence against women. Technical Note. Inter-American Development Bank. 6. Health in the Americas. Pan American Health Organization, 1998 Edition. 7. De Stefani E et al. Alcohol intake and risk of adenocarcinoma of the lung. A case-control study in Uruguay. Lung Cancer, 2002, 38(1):9–14. 8. De Stefani E et al. Tobacco smoking and alcohol drinking as risk factors for stomach cancer: a case- control study in Uruguay. Cancer Causes and Control, 1998, 9(3):321–329. 9. De Stefani E et al. The effect of alcohol on the risk of lung cancer in Uruguay. Cancer Epidemiology Biomarkers and Prevention, 1993, 2(1):21–26. 10. De Stefani E et al. Alcohol drinking and tobacco smoking in gastric cancer. A case-control study. Revue d’Epidemiologie et de Sante Publique, 1990, 38(4):297–307. 11. De Stefani E et al. Hard liquor drinking is associated with higher risk of cancer of the oral cavity and pharynx than wine drinking. A case-control study in Uruguay. Oral Oncology, 1998, 34(2):99–104. 12. De Stefani E et al. Tobacco, alcohol, diet and risk of non-Hodgkin’s lymphoma: a case-control study in Uruguay. Leukemia Research, 1998, 22(5):445–452.

BOLIVARIAN REPUBLIC OF VENEZUELA

Recorded adult per capita consumption (age 15+)

10 l 8 Total Beer 6 Spirits Wine 4 Litres ofpure alcoho

0 1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Last year abstainers

In a 1998 study of 40 patients with Diabetes Mellitus Type 2 and 30 healthy subjects with similar characteristics (age range 30 to 75 years), it was found that 15% of the sample were alcohol consumers.2

Weekly alcohol drinkers in Maracaibo

Data from an urban survey conducted in the city of Maracaibo (males n = 63 and females n = 145). Definition used: consumption of at least one unit of alcohol a week (one unit = one whiskey or one vodka or one gin (40% alcohol content) or two glasses of wine or three beers).3 Male 45.3% Male 15.9% Female

Youth drinking in Caracas (female alcohol consumers)

A 1999 urban survey of 331 female adolescents (aged between 13 and 19 years old).4

Female 82.2% Female

Alcohol dependence among doctors (lifetime prevalence)

A survey of 191 resident doctors of a large university hospital in Venezuela using the Spanish version of the Diagnostic Total Interview Schedule (DIS). The 11% same survey found the rate of lifetime alcohol abuse to be 20.9%.5

Traditional alcoholic beverages Corn liquor is consumed by an indigenous tribe in Venezuela. Several times each year, especially during the corn harvest season, the trunk of a large tree would be hollowed out and filled with corn mash by an individual specially chosen by the community. The corn mash would be allowed to ferment to create an alcoholic beverage, with a high enough alcoholic content to cause intoxication after consumption of only two glasses or gourdfuls. When the corn liquor was ready, a village festival would be held in which all adults would drink to the point of falling down. Men would typically bring their bows and arrows and fight to settle grudges. Festivals would end after two or three days, when the corn liquor ran out. There were rarely individuals who consumed alcoholic beverages at times other than festival celebrations.6

Unrecorded alcohol consumption The unrecorded alcohol consumption in the Bolivarian Republic of Venezuela is estimated to be 2.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1

Mortality rates from selected death causes where alcohol is one of the underlying risk factors

The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0.16 1.6

0.14 1.4

0.12 1.2

Alcohol use disorders 0.1 1

Cirrhosis of the liver

0.08 0.8 Mouth and oropharynx cancers SDR per 1000 perSDR 0.06 0.6 Ischaem ic heart disease

0.04 0.4

0.02 0.2

0 0 1961 1965 1969 1973 1977 1981 1986 1990 1996 2000

Year

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.

Acute mortality

0.45

0.4

0.35

0.3

Falls 0.25 Intentional injuries

SDR per 1000 per SDR Accidental poisonings 0.2 Road traffic accidents

0.15

0.1

0.05

0 1961 1965 1969 1973 1977 1981 1986 1990 1996 2000 Year

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use In a 1999 survey of 331 female adolescents aged between 13 and 19 years in Caracas, 15.44% of the adolescents sampled reported experiencing problems associated with alcohol drinking. Of these, 62.86% had problems with family, 22.86% had problems with friends, 8.57% had problems with strangers and 5.71% had problems with the police.4 A study conducted on a Latin American indigenous population found that the majority of both men (98%) and women (53%) had drunk alcohol at some time in their lives, with 94% and 26% respectively having consumed alcohol within the past 12 months. Using a cut-off score of 8 for the AUDIT, 86.5% of all men and 7.5% of all women were found to be problem drinkers. Focus group discussions revealed that traditional patterns of binge

WHO Global Status Report on Alcohol 2004 133 © World Health Organization 2004 COUNTRY PROFILES REGION OF THE AMERICAS drinking of corn liquor had gradually been replaced by consumption of commercial beer and rum at more frequent intervals and with more negative social consequences.6 With increasing contact with Creole culture, several changes occurred which resulted in changes in drinking patterns. Cash incomes were generated through the sale of cash crops, timber, and through day labour on nearby cattle ranches. Men from the villages began to frequent the bars of nearby towns and consume beer and rum. Drinking to the point of intoxication in town, at times accompanied by fighting, became a frequent pattern for men during harvest times or on payday for those working in ranches. Other alcohol-related problems which developed as a result of changes in drinking patterns include lack of food, medicine, or school supplies for children (as a result of spending all or most of cash incomes on alcohol), individual cases of trauma from falls, fights, or vehicular accidents (usually bicycles or motorcycles), medical illnesses and family problems (most commonly arguments or fights). Disorderly conduct or fighting would frequently result in individuals being put in village jails, especially on holidays, e.g. the period from 24 December to early January.6 A case-control study of 292 cases of gastric cancer and 485 controls in a high-risk area of Venezuela found that male alcohol drinkers were at higher risk than male non-drinkers for gastric cancer.7

Country background information

Total population 2003 25 699 000 Life expectancy at birth (2002) Male 71.0 Adult (15+) 17 218 330 Female 76.8 % under 15 33 Probability of dying under age 5 per 1000 (2002) Male 23 Population distribution 2001 (%) Female 19 Urban 87 Gross National Income per capita 2002 US$ 4090 Rural 13

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

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