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International Guide for Monitoring Alcohol Consumption and Related Harm

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WHO/MSD/MSB/00.4 Original: English Distribution: General INTERNATIONAL GUIDE FOR MONITORING ALCOHOL CONSUMPTION AND RELATED HARM Department of Mental Health and Substance Dependence Noncommunicable Diseases and Mental Health Cluster World Health Organization i Acknowledgments Many people have committed their time, energy and ideas to the project of developing this guide. The project was first conceived by Dr Alan Lopez when Acting Director of the Programme on Substance Abuse at WHO. Tim Stockwell and Tanya Chikritzhs of the National Drug Research Institute, Curtin University of Technology, Perth, Western Australia were commissioned by WHO to coordinate and edit the guide. They were greatly assisted in this by the following people who wrote first drafts of various of the chapters: Harold Holder (USA), Eric Single (Canada), Marina Elena Medina-Mora (Mexico), David Jernigan (USA) and Deborah Dawson (USA). In addition a number of other experts in alcohol research attended a preliminary workshop held in Perth in February 1998 to present and discuss preliminary drafts of the chapters. In addition to the authors listed above they were: Sir Richard Doll (England), Jonathan Chick (Scotland), E. Deshapriya (Sri Lanka), David Hawks (Australia), Tom Greenfield (USA), Robin Room (Canada) and Wayne Hall (Australia). Proceedings of that meeting were drafted by Tanya Chikritzhs (Australia) and circulated to participants for correction and use in redrafting of the chapters. Subsequently, each of the authors and also Robin Room, Johnathan Chick, Tom Greenfield and David Hawks provided detailed editorial feedback on the first complete draft of this Guide. A second set of revisions were then completed following input from Kim Bloomfield (Germany), Sawitri Assanangkornchai (Thailand), Isidore Obot (Nigeria), Lee Rocha-Silva (South Africa), Maria Elena Medina Mora (Mexico), Airi Värnik (Estonia), Tom Greenfield (USA), Jonathan Chick (Scotland), Shekhar Saxena (WHO) and Juergen Rehm (WHO). Finally, the document was reviewed by participants at a Thematic Meeting of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol “Measuring Drinking Patterns, Alcohol Problems, and their Connection”, held in Stockholm 3-7 April 2000. Feedback from that meeting has also been incorporated into the final document. Special thanks are due to Dr Pia Mäkelä for her detailed and helpful comments on that draft. The final draft was written largely by Tim Stockwell and Tanya Chikritzhs. There are still substantial sections, however, contributed with only minor amendment from the original authors listed above. We are indebted also to Sue Wilson of the National Drug Research Institute for many hours of work in formatting this report. Lastly, we wish to thank Dr Mary Jansen for her guidance in finalizing this project while she was Director of the Substance Abuse Department at WHO. i © World Health Organization 2000 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. ii Contents Contents Section 1: Introduction to the Guide 1 Chapter 1.1 Why monitor alcohol use and related problems? 3 Introduction 3 The global burden of alcohol-related problems 5 The social and economic costs of excessive alcohol use 8 The value of national data on alcohol use and harm 10 Contents of the guide 12 Who should monitor and how should the results be disseminated 14 References 15 Section 2: The Measurement of Volume and Pattern of Alcohol 19 Consumption Chapter 2.1 Estimating Per Capita Alcohol Consumption 21 Why estimate per capita consumption? 21 Definitions 22 Consumption-based estimate of the average amount of alcohol consumed per drinker per day equals: 22 Source of data to calculate consumption 23 Per capita consumption estimates and survey data 28 Problems inherent in the use of per capita data 29 Conclusion: Summary of key points and recommendations 33 References 34 Chapter 2.2 Estimating levels and patterns of alcohol consumption 37 from national surveys Advantages of survey over sales data on alcohol consumption 37 Sampling and other methodological issues 39 General issues related to measuring alcohol consumption 42 Volume of ethanol intake 48 Measures of High Risk drinking for acute problems 51 Measures of High Risk drinking for chronic harm 54 Measures of drinking context 55 iii Contents Recommendations for drinking questions in national surveys 56 A. Module containing minimum required items (3 Questions) 57 B. Module containing minimum required items with 58 some additions (8 Questions) C. Expanding the preceding module 59 Background reading 59 Chapter 2.3 Some additional methodological issues for national monitoring of alcohol consumption 63 The importance of estimates of typical beverage strength and serve size 63 Variations in different types of alcohol beverages 64 Research on variation in alcoholic strengths within beverage types 65 Examples of variations in typical strengths over time and country 66 Unrecorded alcohol production and consumption 67 A methodology for regularly updating estimates of typical beverage strength 68 Definitions of standard drinks used in different countries 70 Research on variation in serve sizes and container sizes 71 A methodology for estimating the alcohol content of ‘standard drinks’ in surveys 71 Conclusions 73 References 73 Section 3: 75 Measures and indicators of alcohol-related harms Chapter 3.1 How to develop indicators of alcohol-related harm 77 from health, police and other official statistics Introduction: the problem of case identification 77 Creative solutions 78 The use of death, injury and illness data to develop alcohol harm indicators 79 The Aetiologic Fraction method for quantifying alcohol-caused morbidity and mortality 80 The calculation of population rates of alcohol- related harm 88 Abstinence or Low Risk drinking as the base for estimates of Relative Risk? 89 The value of using composite alcohol harm indicators 90 The impact of converting from ICD-9 to ICD-10 90 iv Contents Estimating years of life lost due to premature death: Person-Years of Life Lost (PYLL) 91 References 93 Chapter 3.2 Indicators of problems mainly attributable to long- term use of alcohol 95 The use of alcohol-related mortality and morbidity estimates for national monitoring 96 Diseases of the liver 97 Mental health problems 100 Fetal alcohol syndrome 102 Cancers 104 Cardiovascular disease 106 Other diseases related to chronic alcohol use 108 Composite alcohol problem indicators 109 Recommendations 112 Background reading 113 Chapter 3.3 Indicators of harm attributable mainly to the short- term or acute effects of drinking alcohol 119 Impaired driving injuries and fatalities 120 Alcohol-related unintentional injuries and deaths 123 Suicide 128 Interpersonal violence 129 Composite measures of acute alcohol-related problems 131 Recommendations 136 References 139 Section 4: Summary and Recommendations 143 Chapter 4.1 Summary of key points and recommendations 145 Summary of recommendations 150 Recommendations for international data collection initiatives 156 References 157 Annex 1 Standard errors in prevalence estimates for different sample sizes: some worked examples 158 Annex 2 Alcohol conversion formulae for different international units of weight and volume 159 Annex 3 Illustration of the Last 7 Day approach to estimating recent drinking behaviour for different beverage types 162 Annex 4. Calculation of annual volumes of ethanol from beverage specific Quantity-Frequency survey questions: a worked example 164 Annex 5. The Graduated Quantity-Frequency (GQF) method of recording alcohol consumption by survey: A worked example 166 v Contents Annex 6. Preliminary conversion table for ICD-9 to ICD-10 for alcohol-related conditions identified in English et al (1995) 168 Annex 7. Calculating Person-Years of Life Lost (PYLL) using a 170 life table method Annex 8. Suggested questions for a 3 item and an 8 item set of questions about alcohol consumption 172 Annex 9. Zambia (Lusaka and Mwacisompola): percentages of respondents (aged 15 years and over) who experienced alcohol-related problems during the year preceding the interview 176 Annex 10 The measurement of alcohol consumption and harm in Mexico: a case study 177 vi Section 1: Introduction to the Guide Chapter 1.1 Why monitor alcohol use and related problems? Summary The purpose of this document is (1) to provide guidance to WHO Member States on epidemiological monitoring in order to inform and facilitate effective policy formation and (2) to improve the global and regional comparability of data on alcohol use and health consequences in order to improve monitoring and to facilitate research and risk assessment. It is intended to provide general principles and also practical guidance on the development of realistic and effective sets of indicators of alcohol consumption and harm for different countries with different levels of resources. The overall exercise is placed into the context of other WHO initiatives on alcohol and drug prevention and monitoring such as the “Global Burden of Disease” report (Murray and Lopez, 1996), “Global Alcohol Report” (WHO, 2000) and the Alcohol Policy and Public Good Project for Developing Countries. The number and
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