Alcohol-Related Harms from Others' Drinking in India

Background: From 2005 to 2010, India faced a 19% increase in average adult per capita alcohol consumption. In a country where a large proportion of the population abstains from alcohol but heavy episodic consumption is common among those who drink, alcohol-related harms from others’ drinking may be substantial. Purpose: The purpose of this dissertation was to examine both the ethical issues raised in regards to harms from others drinking, and newly available epidemiological evidence about this in India. The main objectives were to: (1) apply a public health ethics framework to systematically consider the ethical implications of implementing policies to prevent alcohol-related harms to others; (2) understand the types of alcohol-related harms to children from adults’ drinking across domains of physical abuse, psychological abuse, and neglect; and (3) assess various types of tangible and intangible harm from strangers’ drinking and individuals’ characteristics that predict experiences of such harms. Methods: I examined public health ethics literature and generated evidence of harms from others’ drinking by analyzing cross-sectional data from household interviews administered in five Indian states in 2011-2012. Results: The compilation of data on harms from others’ drinking can strengthen the ethical justification for evidence-based alcohol control policies. Harms to children from adults’ drinking are a serious problem in India: 44% of respondents reported at least one alcohol-related harm to children in the past year. Sixteen percent of respondents reported physical alcohol-related harms to children. Strangers are also affected by others’ drinking: 63% of respondents experienced at least one tangible or intangible harm from strangers’ drinking, with nearly 48% of respondents experiencing tangible harm. Conclusions: Public health professionals have an obligation to consider the ethics associated with implementing alcohol control policies. The findings from this dissertation suggest that people with limited control over their exposure to another person’s drinking, including children and strangers, are burdened by others’ alcohol use. Interventions, such as increased use and enforcement of evidence-based alcohol control policies, are needed to prevent alcohol-related harms to children and strangers in India. Future research should use harms to others data for evaluating the effectiveness of alcohol policies

Evaluation of the evidence base for the alcohol industry\u27s actions to reduce drink driving globally

Objectives.To evaluate the evidence base for the content of initiatives that the alcohol industry implemented to reduce drink driving from 1982 to May 2015. Methods. We systematically analyzed the content of 266 global initiatives that the alcohol industry has categorized as actions to reduce drink driving. Results. Social aspects public relations organizations (i.e., organizations funded by the alcohol industry to handle issues that may be damaging to the business) sponsored the greatest proportion of the actions. Only 0.8% (n = 2) of the sampled industry actions were consistent with public health evidence of effectiveness for reducing drink driving. Conclusions. The vast majority of the alcohol industry\u27s actions to reduce drink driving does not reflect public health evidenced-based recommendations, even though effective drink-driving countermeasures exist, such as a maximum blood alcohol concentration limit of 0.05 grams per deciliter for drivers and widespread use of sobriety checkpoints

Estimated deaths attributable to excessive alcohol use among US adults aged 20 to 64 years, 2015 to 2019.

Importance Alcohol consumption is a leading preventable cause of death in the US, and death rates from fully alcohol-attributable causes (eg, alcoholic liver disease) have increased in the past decade, including among adults aged 20 to 64 years. However, a comprehensive assessment of alcohol-attributable deaths among this population, including from partially alcohol-attributable causes, is lacking. Objective To estimate the mean annual number of deaths from excessive alcohol use relative to total deaths among adults aged 20 to 64 years overall; by sex, age group, and state; and as a proportion of total deaths. Design, Setting, and Participants This population-based cross-sectional study of mean annual alcohol-attributable deaths among US residents between January 1, 2015, and December 31, 2019, used population-attributable fractions. Data were analyzed from January 6, 2021, to May 2, 2022. Exposures Mean daily alcohol consumption among the 2 089 287 respondents to the 2015-2019 Behavioral Risk Factor Surveillance System was adjusted using national per capita alcohol sales to correct for underreporting. Adjusted mean daily alcohol consumption prevalence estimates were applied to relative risks to generate alcohol-attributable fractions for chronic partially alcohol-attributable conditions. Alcohol-attributable fractions based on blood alcohol concentrations were used to assess acute partially alcohol-attributable deaths. Main Outcomes and Measures Alcohol-attributable deaths for 58 causes of death, as defined in the Centers for Disease Control and Prevention's Alcohol-Related Disease Impact application. Mortality data were from the National Vital Statistics System. Results During the 2015-2019 study period, of 694 660 mean deaths per year among adults aged 20 to 64 years (men: 432 575 [66.3%]; women: 262 085 [37.7%]), an estimated 12.9% (89 697 per year) were attributable to excessive alcohol consumption. This percentage was higher among men (15.0%) than women (9.4%). By state, alcohol-attributable deaths ranged from 9.3% of total deaths in Mississippi to 21.7% in New Mexico. Among adults aged 20 to 49 years, alcohol-attributable deaths (44 981 mean annual deaths) accounted for an estimated 20.3% of total deaths. Conclusions And Relevance The findings of this cross-sectional study suggest that an estimated 1 in 8 total deaths among US adults aged 20 to 64 years were attributable to excessive alcohol use, including 1 in 5 deaths among adults aged 20 to 49 years. The number of premature deaths could be reduced with increased implementation of evidenced-based, population-level alcohol policies, such as increasing alcohol taxes or regulating alcohol outlet density

Characteristics associated with alcohol consumption among emergency department patients presenting with road traffic injuries in Hyderabad, India

© 2015 Elsevier Ltd. All rights reserved. Introduction Each year in India, road traffic crashes lead to more than 200,000 deaths and the country has seen an unprecedented rate of roadway fatalities in recent years. At the same time, alcohol consumption per capita among Indians is rising. Despite these increasing trends of road traffic injuries (RTIs) and alcohol use, alcohol is not routinely assessed as a risk factor for RTIs. This study aims to examine the involvement of alcohol among emergency department patients presenting with RTIs in the Indian city of Hyderabad. Patients and methods As part of a prospective study, data were collected from 3366 patients (88.0% male) presenting with RTIs at an emergency department in Hyderabad, India, from September 2013 to February 2014. Logistic regression models were used to assess individual-level and road traffic crash characteristics associated with suspected or reported alcohol consumption six hours prior to the RTI. Results Alcohol was suspected or reported among 17.9% of the patients with RTIs. Adjusting for confounders, males experienced 9.8 times greater odds of alcohol-related RTIs than females. Compared to 15-24 year-olds, the odds of alcohol consumption was 1.4 times greater among 25-34 year-olds and 1.7 times greater among 35-44 year-olds, adjusting for confounding factors. Patients who were passengers in vehicles other than motorized two-wheelers had 90% reduced odds of an alcohol-related RTI than motorized two-wheeler drivers. Drivers of non-two-wheelers, passengers on two-wheelers, and pedestrians did not have significantly different odds of an alcohol-related RTI compared to two-wheeler drivers. Nighttime crashes were associated with nearly a threefold increase in the odds of alcohol consumption. Conclusions Given that alcohol was suspected or reported in more than one in six injured ED patients with RTIs, it is clear that alcohol is a serious risk factor for RTIs; this evidence can guide prevention efforts. These findings suggest that evidence-based interventions to reduce drink-driving, such as random breath testing (where law enforcement officials stop drivers on the road to test them for alcohol use), could be more widespread in India. Future studies should assess the effectiveness of greater implementation and enforcement of policies to decrease alcohol\u27s availability to reduce RTIs