Missing value imputation in longitudinal measures of alcohol consumption

Attrition in longitudinal studies can lead to biased results. The study is motivated by the unexpected observation that alcohol consumption decreased despite increased availability, which may be due to sample attrition of heavy drinkers. Several imputation methods have been proposed, but rarely compared in longitudinal studies of alcohol consumption. The imputation of consumption level measurements is computationally particularly challenging due to alcohol consumption being a semi-continuous variable (dichotomous drinking status and continuous volume among drinkers), and the non-normality of data in the continuous part. Data come from a longitudinal study in Denmark with four waves (2003-2006) and 1771 individuals at baseline. Five techniques for missing data are compared: Last value carried forward (LVCF) was used as a single, and Hotdeck, Heckman modelling, multivariate imputation by chained equations (MICE), and a Bayesian approach as multiple imputation methods. Predictive mean matching was used to account for non-normality, where instead of imputing regression estimates, "real" observed values from similar cases are imputed. Methods were also compared by means of a simulated dataset. The simulation showed that the Bayesian approach yielded the most unbiased estimates for imputation. The finding of no increase in consumption levels despite a higher availability remained unaltered. Copyright (C) 2011 John Wiley & Sons, Ltd.

Alcohol MOT part one

The Alcohol MOT is designed to support those working in primary care to carry out alcohol brief interventions. There is extensive evidence to show that primary care-based brief interventions are very effective at reducing drinking at both hazardous and harmful levels. MOT Part 1 enables patients to work out if they are drinking at hazardous or harmful levels. MOT Part 2 helps motivate and support patients to reduce their drinking. Both tools are designed so that a practitioner can work through them with a patient, or a patient can work through them alone.

Alcohol MOT part two

The Alcohol MOT is designed to support those working in primary care to carry out alcohol brief interventions. There is extensive evidence to show that primary care-based brief interventions are very effective at reducing drinking at both hazardous and harmful levels. MOT Part 1 enables patients to work out if they are drinking at hazardous or harmful levels. MOT Part 2 helps motivate and support patients to reduce their drinking. Both tools are designed so that a practitioner can work through them with a patient, or a patient can work through them alone.

PHA urges 'freshers' to be smart and know their alcohol limits

As 'fresher's week' commences, the Public Health Agency is encouraging students across Northern Ireland to avoid binge drinking and to know their limits if they do choose to drink alcohol.Enjoying new freedoms, at college or university, means taking care of yourself and others and, if you choose to drink, staying within safe alcohol limits. Owen O'Neill, PHA Health and Social Wellbeing Improvement Manager for drugs and alcohol, said: "Some young people may drink more when they leave home, or join their friends in college or university for the first time. They might think that, as young people, they don't have to take care with alcohol, but staying within the safe drinking limits is important for everyone who drinks. Excessive and binge drinking can have lasting effects on health, such as damage to the liver, heart, brain and stomach. Drinking too much can also increase the risk of accidents and antisocial behaviour as well as sexually transmitted infections and unplanned pregnancy"."We would also strongly advise against drinking games. Although they are regarded as a 'bit of fun', in reality they can be very dangerous. As an extreme form of binge drinking, where large quantities of alcohol are consumed in a very short time, drinking games can result in alcohol poisoning, leading to brain damage, coma or death. The PHA encourages students to enjoy their new student life, but urges them to be aware of their alcohol intake and drink responsibly, especially throughout fresher's week, with the many cheap drink promotions currently available."Daily alcohol limits are recommended by the government in order to avoid the risks of excessive and binge drinking in any one session. These are:Men: No more than 3 to 4 units of alcohol a day and no more than 21 units over the course of the week.Women: No more than 2 to 3 units of alcohol a day and no more than 14 units over the course of the week.Examples of units:Can of extra strong lager - 4 unitsBottle of lager - 1.5 unitsPint of standard lager - 2.5 unitsPint of premium larger - 3 unitsSmall pub bottle of wine - 2.25 units70cl bottle of wine - 7 to 10 unitsStandard 275ml of alcopops - 1.5 to 1.8 units70cl bottle of alcopops - 3.75 to 4.5 unitsPub measure of spirits - 1.5 unitsPint of cider - 3 unitsPint of stout - 2.5 unitsIf you do choose to drink alcohol:DON'T:Ever drink and driveDrink on an empty stomachMix alcohol with other drugsDrink in rounds as this may speed up your drinkingLeave your drinks unattendedDO:Take sips rather than gulpsAlternate each alcoholic drink with a non alcoholic drink e.g. water or a soft drinkSet yourself a limit and try to stick to it (refer to daily alcohol limits) Take frequent breaks from drinking to give your body time to recoverTell friends and family where you are going and who you will be withRemember, that for each unit you drink over the daily limit, the risk to your health increases. It's important to spread the units throughout the week - you can't 'save up' your units for the weekend or your holiday. It is also important to drink plenty of water, ideally matching the amount of alcohol you have consumed.So students make smart choices this term - drink sensibly and know your limits!For further information on sensible drinking and alcohol units visit the Public Health Agency's website www.knowyourlimits.info

PHA reinforce sensible drinking in Alcohol Awareness Week

Recent health figures show that 20% of adults surveyed admitted to drinking over the weekly alcohol limits (1)so the Public Health Agency is using Alcohol Awareness Week (14-20th November) to reinforce the importance of drinking sensibly and staying within safe alcohol limits.Government guidelines on safe drinking are 21 units per week for males and 14 units per week for females. Staying within these limits is important as excessive and binge drinking can lead, in the short term, to increased risk of accidents, antisocial behaviour, impact on relationships, unplanned pregnancy. Longer term it can damage the liver, heart, brain and stomach, not to mention the other human costs, and costs to the economy and society as a whole.Owen O'Neill, PHA Health and Social Wellbeing Improvement Manager and Drugs and Alcohol Lead, said: "The Department of Health, Social Services and Public Safety's drinking limits are in place to encourage the public to develop safe and sensible drinking habits. However, these recent figures highlight that not everyone is adhering to these limits. It is crucial that those who do decide to have a drink do so in moderation and stick to the recommended limits to prevent any long or short term damages".The message is clear, if you drink, remember to be smart and enjoy alcohol within safe limits. People should follow the recommended daily alcohol intake. These are:Men: No more than 3 to 4 units of alcohol a day and no more than 21 units over the course of the week.Women: No more than 2 to 3 units of alcohol a day and no more than 14 units over the course of the week.Examples of units:Can of extra strong lager - 4 unitsBottle of lager - 1.5 unitsPint of standard lager - 2.5 unitsPint of premium larger - 3 unitsSmall pub bottle of wine - 2.25 unitsPub measure of spirits - 1.5 unitsPint of cider - 3 unitsPint of stout - 2.5 units. Remember, that for each unit you drink over the daily limit, the risk to your health increases. It's important to spread the units throughout the week - you can't 'save up' your units for the weekend or an upcoming holiday. It is also important to drink plenty of water, ideally matching the amount of alcohol you have consumed.For further information on sensible drinking and alcohol units visit the Public Health Agency's website www.knowyourlimits.infoReference(1) Health Survey Northern Ireland: first results from the 2010/2011 survey (2011) DHSSPS, http://dhsspsni.giv/index/stats_research/stats-public-health.htm

Personality factors and alcohol use: a mediator analysis of drinking motives.

Current evidence on the association between personality factors, drinking motives, and alcohol use comes exclusively from North America. The present study, however, is based on a sample of 2090 Swiss college students (mean age 23.5, SD = 2,9) and investigates by means of structural equation modeling whether drinking motives mediate the association between personality factors and alcohol use. The results revealed that extraversion was positively related to drinking for enhancement motives; conscientiousness was negatively related to both enhancement and coping motives; and neuroticism was positively related to drinking for coping motives. The association between extraversion and alcohol use was mediated by enhancement motives, while the negative association between conscientiousness and alcohol use was partially mediated by both enhancement and coping motives. This concurs with the findings of North American studies. However, in contrast to these findings, our study finds that coping motives attenuate the "protective" effect of neuroticism with regard to alcohol use. Taken together, the study indicates that alcohol use serves specific purposes depending on particular personality traits. The finding that personality-related effects are partially mediated by motives increases the likelihood that motive-based preventive efforts will help reduce alcohol use among young adults who display particular personality traits.

Risky single occasion drinking frequency and alcohol-related consequences: can abstinence during early adulthood lead to alcohol problems?

QUESTIONS UNDER STUDY: the main purpose of this longitudinal study was to determine the impact of risky single occasion drinking (RSOD) frequency on alcohol dependence and drinking consequences reported 15 months later. METHODS: As a baseline sample, 5,990 young men were assessed on their drinking habits including the frequency of RSOD. Of them, 5,196 were reassessed at follow-up 15 months later on RSOD frequency, alcohol dependence and alcohol related consequences in thze interceding year. Drop out biases were investigated. RESULTS: Around 45% of the baseline participants reported regular RSOD (every month or more frequently). Despite the fact that RSOD distribution was generally stable during the initial sample, 47.4% reported a variation of their RSOD frequency 15 months later. Around 25% of the sample reported reduced RSOD frequency. Nonetheless, occasional RS drinkers were more likely to become regular (monthly) RSO drinkers at follow up. Daily and weekly RSOD were associated with high proportions of alcohol dependence and detrimental consequences of drinking. Surprisingly, abstainers at baseline were more likely to be at risk of alcohol dependence and consequences at follow up than non-RSO drinkers. CONCLUSIONS: Despite the fact that alcohol abstinence is logically the best way to avoid the detrimental consequences of alcohol drinking, abstainers at baseline reported as many problems due to alcohol use at follow up as occasional or monthly RSO drinkers. The few participants who had become RSO drinkers during the follow up period were indeed likely to engage in detrimental behaviour. Non-RSO drinkers had the fewest problems due to alcohol use. This substantiates the early occurrence of drinking consequences among inexperienced RSO drinkers.

National Health and Lifestyle Surveys

Results of the National Health and Lifestyle Surveys: SLaN [Survey of Lifestyle, Attitudes and Nutrition] and HBSC [Health Behaviour in School-Aged Children] Two baseline surveys of health related behaviours among adults and schoolgoing young people were carried out across the Republic of Ireland in 1998 and again in 2002. The main aims of these surveys are to: - Produce reliable data of a representative cross-section of the Irish population in order to inform the Department of Health and Children's policy and programme planning. - Maintain a survey protocol which will enable lifestyle factors to be remeasured so that trends can be identified and changes monitored to assist national and regional setting of priorities in health promotion activities. In keeping with the health and lifestyle surveillance system of many European countries a number of related factors were measured in both surveys. These include general health, smoking, use of alcohol and other substances, food and nutrition, exercise and accidents. This work was commissioned by the Health Promotion Unit, Department of Health and Children and carried out at the Centre for Health Promotion Studies, National University of Ireland, Galway.This resource was contributed by The National Documentation Centre on Drug Use.

A Brief Cognitive Behavioural Therapy Alcohol Intervention Programme is an Effective Secondary Prevention Approach for New Employees entering an Irish Workforce: A Pilot

The prevalence of unhealthy drinking at all levels in Irish society poses serious issues in terms of the consequence to individuals concerned, as well as to society as a whole. The workplace offers a useful setting for early identification and intervention with new employees who may have pre-existing alcohol use disorder issues. This pilot study aimed to evaluate the effectiveness within the workplace of a brief Cognitive Behavioural Therapy (CBT) intervention in reducing participants binge and risky drinking behaviours. Twenty-six Irish Naval recruits volunteered to participate in this randomised controlled trial. The intervention was conducted over four consecutive one and a half hour weekly sessions. Participants completed four principle outcome measures at intake, termination of the intervention and at the two-month follow-up assessment. The Alcohol Use Disorders Identification Test (Babor, Higginis-Biddle, Saunders & Monterio, 2001) was used to measures participants’ consumption levels and frequency of binge or risky drinking. A Readiness Ruler (Miller, Zweben, Diclemente, & Rychtarik, 1992) was used to measure participants’ readiness to change drinking, while the Drinking Expectancy Questionnaire (Young & Oei, 1996) was used to measure participants’ beliefs pertaining to alcohol, and their ability to refuse alcohol in high-risk social surroundings. There were preliminary data in support of the intervention. There were interaction effects that approached statistical significance for both a reduction in participants’ binge drinking (p =. 064) and an increase in participants’ ability to refuse alcohol in high-risk social settings (p = .059). There was also a significant interaction effect (pThis resource was contributed by The National Documentation Centre on Drug Use.

A Ghost in Daylight: Making Sense of Substance Misuse

The inability to deal with substance misuse is a universal human problem. No country has discovered a failsafe way of tackling it. In Ireland there is an annual public outcry about an ever-deepening drinking culture but once the outcry is over the problem subsides below consciousness. Strategies are created and launched and quickly forgotten. Everybody is aware of the problem in their own family or neighbourhood and everybody has their own opinion on causes and remedies. Why then does nothing seem to work? After demonstrating the shortcomings of previous models of addiction, Jack Houlahan identifies a pattern that all human use of substances has in common. In A Ghost in Daylight, the general reader will find many popular stereotypes re-examined in a way that will illuminate their own experience; the specialist addiction worker or researcher will find reason to challenge first principles; a new approach to counselling and advice work is suggested; the policy-maker will find a firm foundation for what will be the first attempt at an integrated policy for dealing with the range of issues we group under the title 'substance misuse'.This resource was contributed by The National Documentation Centre on Drug Use.

A Process Analysis of Males and Females who Attended a Community Based Addiction Treatment Service: Towards an Expanded Paradigm

A process analysis was conducted in a community - based treatment programme for alcohol abuse. The aims of the study were: to evaluate assessment instruments and measures; to measure change following treatment; to monitor gender differences; to assess the importance of early and current relationships; and to evaluate the effects of therapists. Subjects (n=145, males 83/females 62) completed a semi-structured interview schedule, Severity of Alcohol Dependency Questionnaire (SADQ), Short Alcohol Dependence Data Questionnaire (SADD); General Health Questionnaire (GHQ 12), and Alcohol Problems Questionnaire (APQ). A further three non-standardised self-rated measures were devised by the author. Included was the opportunity to obtain qualitative data. Follow up data was collected at 3, 9 and 15 months following first assessment. The SADD, APQ and consumption measures using detailed drink diaries proved the most relevant assessment measures. Following treatment, there was significant reduction in clients' dependency levels at 3 months, maintained through 9 and 15 months. Key client-rated changes were progress in reducing consumption and alcohol problems leading to a better quality of life and health. Qualitative data augmented these quantitative results. Psychological and acquired cognitive behavioural skills emerged as the main reasons for positive change and the treatment programme was found to have played a significant role in their acquisition. It appears that addressing marital problems can lead to a reduction in alcohol dependency levels. Gender analysis showed that males and females were similar in demographic characteristics, alcohol history details and dependence levels. It was concluded that the differences found did not necessitate different treatment programmes for women. Early family relationships were more problematic for females. Therapist performance varied and that variance was reflected in their clients' outcomes.This resource was contributed by The National Documentation Centre on Drug Use.

A Sociological Analysis of Contemporary Irish Social Drinking Patterns

This thesis seeks to provide an understanding of contemporary Irish social drinking patterns by conducting a detailed analysis of the evolving sociological theories of alcohol consumption in Ireland. ‘Alcohol is a social drug which, to this day, evokes the divisive moral qualities that originated, or at least were solidified, in the last century with the birth of temperance movements’ (Cassidy, 1997:175). The temperance movement in Ireland under Father Mathew, a legacy which still reverberates in Irish society, served to further ingrain the ‘image of the whisky drinking Irishman’ (Ibid: 17). This is seen in such work as Stivers (1976) who uses sociological labelling theory to provide verification of a deviant Irish status, biologically, socially and culturally predisposed to alcohol. The author argues that these temperance movements sought to remove the linkages of alcohol and “Irishness” but this quasi-stigmatisation process created a “self-fulfilling prophecy”, which further abetted the legitimisation of alcohol within cultural spheres. The tourism industry, in connection with drink manufacturers, has had a monumental role in alcohol’s contemporary position within the upper echelons of Irish culture and heritage. Their hand in the commodification of “Stage Irishy”, seen as “craic”, has further entrenched the links between consumption of alcohol and the consumption of Irish Identity “McGovern, 2002). Furthermore, commercial interests are keen to cash in and maintain the dominance of alcohol in Irish society. This thesis concludes that this factor, in connection with the accelerated modernisation that Ireland has experienced since the mid-nineties, has malleable consequences for Irish society. As Keohane and Kuhling (2007) assert, post-modern consumption patterns of excess and ‘insatiability’ have been introduced into contemporary Irish drinking patterns and are affecting the nature of alcohol consumption in Ireland.This resource was contributed by The National Documentation Centre on Drug Use.

A Study of a Staff Alcohol Policy in a Large Public Health Organisation, Looking at the Policy Content, the Policy Development and the Implementation Process, and the Policy Impact

There are different approaches to dealing with alcohol related problems in the workplace. A literature review indicates that two of the models that underpin programmes to deal with alcohol related problems in the workplace are the disease model and the health promotion model. The disease model considers alcoholism as an illness and uses curative techniques to restore the individual to sobriety. The health promotion model looks at the determinants of health and promotes changes in the environment and structures, which would support healthy behaviour in relation to alcohol. Employee Assistance Programmes (EAPs) may have elements of both theses models. Dealing with alcohol problems at work involves a captive audience and the workplace as a setting can be used to influence healthier lifestyles. A workplace alcohol policy is a mechanism through which alcohol related issues might be dealt with, and the necessary resources and commitment of managers and staff channelled to this end. The policy aims should be clear and unambiguous, and specific plans put in place for implementing all aspects of the policy. In the case of the alcohol policy in the organisation under study, the policy was underpinned by a health promotion ethos and the policy document reflects broad aims and objectives to support this. The steering group that oversaw the development of the policy had particular needs of their own which they brought to the development process. The common theme in their needs was how to identify and support employees with alcohol related problems within an equitable staff welfare system. The role of the supervisor was recognised as crucial and training was provided to introduce the skills needed for an early intervention and constructive confrontation with employees who had alcohol related problems. Opportunities provided by this policy initiative to deal with broader issues around alcohol and to consider the determinants of health in relation to alcohol were not fully utilised. The policy formalised the procedures for dealing with people who have alcohol related problems in an equitable and supportive manner. The wider aspect of the health promotion approach does not appear to have been a priority in the development and implementation of the policy.This resource was contributed by The National Documentation Centre on Drug Use.

A Survey of Employees Attitudes Towards Drug Testing in the Workplace

In light of the recent publication of the safety, Health & Welfare at Work Bill 2004, which is set to target the construction industry in particular, the number of Irish employers implementing drug testing programmes in the workplace is set to increase. Little is known, however, about attitudes of Irish workers towards various aspects of drug testing. In order to address this matter, the author presents the findings of a cross-sectional survey of 148 construction trade apprentices in relation to their attitudes towards aspects of workplace drug testing. The extent to which their attitudes varied according to their levels of illegal drug use and alcohol use was also investigated. The results indicate that under some circumstances, testing is approved of. However, attitudes towards most aspects of drug testing are characterised by extreme variability. For example, nearly items were rejected by some respondents and accepted by others. It can be concluded that even if an employer designed a drug testing programme based on elements viewed more favourably, a substantial proportion of employees would still be likely to hold negative views towards some aspects of the programme. Furthermore, self-reported frequency of alcohol and drug use, particularly cannabis use, was associated to more negative reactions towards drug testing. Implications for implementing drug testing programmes in the workplace are discussed. The results of this study are intended to give employers an increased understanding of workers' attitudes towards drug testing programmes and to aid the development of effective substance-abuse prevention services.This resource was contributed by The National Documentation Centre on Drug Use.

Drug Misuse in Dublin, July 1982

In this report for the Medico Social Research Board the author provides an overview of the drug problem in Dublin's inner city. On 12-14 July 1982 the author visited the Sean Mac Dermott street area of the inner city, the Eastern Health Board, Coolmine Community, Jervis Street Drug Advisory and Treatment Centre and the Garda drug squad. From these interviews, the author concludes that Dublin's inner city has a serious problem with drug use, in particular the injecting of heroin. Heroin addicts steal on a regular basis to fund their habit, and frequently inject themselves in public spaces of local authority flat complexes. Despite the best efforts of the support services (Social workers, doctors, Gardai and clergy) there is a high prevalence of injecting heroin use. There has also been abuse of prescription services. Addicts frequently seek opiates from a small number of doctors who are willing to prescribe. Drug education is severely lacking or inappropriate, according to the author, and the Garda drug squad is severely over stretched. While cannabis use is said to be prevalent in Dublin's two universities, drug use has been most problematic in the deprived parts of the city. The author presents the drug epidemic, which has developed over the last two years, in moral terms, and wonders if Christian society, in particular the Catholic Church, and the health authorities can do anything to stop the crisis from worsening. Recommendations include; conducting epidemiological surveys to determine the true extent of the problem, cross disciplinary co-operation, greater drug awareness through education, and more rehabilitation units.This resource was contributed by The National Documentation Centre on Drug Use.