Alcohol Consumption

Lydia Gisle

Hélène Mimilidis

Presentation in the framework of the EHIS workshop, Berlin, September 30, 2010

Improvement of the European Health Interview Survey

Working processScientific literature;Existing population surveys;HIS/HES website; National – international directives; Clinical observations; Field experts’ opinionsInformation for policy leaders

Operationalization

Conceptual Frame

Variables (values)

Instruments (questions)

Indicators (measures)

Health issues (concepts)

Dimensions (aspects)

Issues considered for EHIS

Concept 1

ALCOHOL CONSUMPTION

Aspects:

• Drinking status• Volume of consumption (quantity – frequency)• Patterns of drinking

Indicators:

• Abstainers (LT + past 12 Mo)• Current – former drinkers• Overall drinking frequency• Overall volume consumption • Hazardous consumption• Frequency of RSOD (binge)

Concept 2DEPENDENCE

Concept 3RELATED PROBLEMS

Although reckoned of high importance, the choice of including this issue in NHIS is left to the MS

A variety of consequences of alcohol misuse can be explored, but not in the frame of a minimal set of questions included in the EHIS

Methodological approaches

Exact Recall Past 24h / 7 days / 4 weeks / last

drinking occasion(s)

Quantity - Frequency Summary measure over longer periods

(past 12 months)

- Prone to recall bias- Misses occasional/irregular- Higher prevalence abstainers- Not for individual level- Says nothing about usual drinking nor variability

QF index (2 questions):- Underestimation: Modal < mean drinks (ignores sporadic heavy drinking episodes)- Difficult/inadequate for irregular drinkers

- Variants of QF lead to better estimates, as:

BSQF ; WE-WD QF ; GF ; BSGF

- Add questions on RSOD/binge; maximum amount drunk,…

Retrospective measures

Proposed instrument

QF by week days and weekend days

Frequency (AL.1)EHIS-1 During the past 12 months, how often have you had an alcoholic drink of any kind (that is beer, wine, spirits, liqueurs or other alcoholic beverages)?

EHIS-2 During the past 12 months, how often have you had an alcoholic drink of any kind?

EHIS-1

NeverMonthly or less2 to 4 times a month2 to 3 times a week4 or 6 times a weekEvery day

EHIS-2

More than once a dayEvery day or almost every day5 - 6 days a week 3 - 4 days a week1 - 2 days a week2 - 3 days in a monthOnce a monthOnce every couple of months Once or twice a yearNot at all in the past 12 months

The following questions are about your use of alcoholic beverages of any kind: that is, beer, wine, cocktails, premix, spirits, liqueurs, home-made alcohol…

Quantity (EHIS-1 AL.2)

Quantity (EHIS-2 AL.2-5)

During the week days (Monday through Thursday), on how many of these 4 days do you usually drink alcohol?

On the 4 week daysOn 3 week daysOn 2 week daysOn 1 week dayNot on week days

How many drinks containing alcohol do you usually have on one of those week days when you drink alcohol (Monday to Thursday)?

24 or more drinks17-23 drinks10-16 drinks7-9 drinks6 drinks4 - 5 drinks3 drinks2 drinks1 drink

During the weekends (form Friday to Sunday), on how many of these 3 days do you usually drink alcohol?

On the 3 weekend daysOn 2 weekend daysOn 1 weekend dayNot on weekends

How many drinks containing alcohol do you usually have on one of those weekend days when you drink alcohol (Friday to Sunday)?

24 or more drinks17-23 drinks10-16 drinks7-9 drinks6 drinks4 - 5 drinks3 drinks2 drinks1 drink

WD WE

Frequency RSOD/binge (AL.7)

EHIS-1 During the past 12 months, how often did you have 6 or more drinks on one occasion?

EHIS-2 During the past 12 months, how often did you have 6 or more drinks on one occasion?

EHIS-1

NeverLess than monthly Monthly Weekly Daily or almost daily

EHIS-2

More than once a dayEvery day or almost every day5 - 6 days a week 3 - 4 days a week1 - 2 days a week2 - 3 days in a monthOnce a monthOnce every couple of months Once or twice a yearNot at all in the past 12 months

Can be adapted to match 60 g pure alcohol depending on country

standard drinks (5+, 7+)

Pathway for questions in EHIS-2

Added questions

AL.6

AL.8

How many drinks containing alcohol do you usually have on a day when you drink?

24 or more drinks17-23 drinks10-16 drinks7-9 drinks6 drinks4 - 5 drinks3 drinks2 drinks1 drink

Not counting sips or trials, have you ever in your life drunk alcohol (more than one shot of strong alcohol, a glass of wine or a bottle of beer…)?

Yes, dailyYes, every week but not dailyYes, less than every weekNo, never more than sips or trials

Less than weekly

Not in past year

Unresolved questions

• Translation of the term « drinks » in some MS• Definition of « standard drinks » in MS• Replying in terms of standard drinks…• Gender-specific threshold for binge drinking

(4+/5+ - 5+/6+ …)• Definition of hazrdous drinking (>=20g/day or

>20g/day in women, 40g in men)• …