Protecting women and girls from tobacco and alcohol promotion.

Analysis: Women have traditionally consumed less tobacco and alcohol than men because social and cultural norms have stigmatised their use of these products, particularly in low and middle income countries. The combination of changing gender norms, aggressive industry marketing, and continuing population growth in low and middle income countries, however, means that without urgent action, the number of women and girls consuming tobacco and alcohol is likely to rise substantially in the coming years...

Alcohol: equity and social determinants.

This document is printed as a background paper for the Global Expert Meeting on Alcohol, Health and Social Development (Stockholm, September 2009). The final version of this document will be published as a chapter in the book 'Priority public health conditions: from learning to action on social determinants of health' by the World Health Organization

Socioeconomic inequalities in risk factors for non communicable diseases in low-income and middle-income countries: results from the World Health Survey

Abstract Background Monitoring inequalities in non communicable disease risk factor prevalence can help to inform and target effective interventions. The prevalence of current daily smoking, low fruit and vegetable consumption, physical inactivity, and heavy episodic alcohol drinking were quantified and compared across wealth and education levels in low- and middle-income country groups. Methods This study included self-reported data from 232,056 adult participants in 48 countries, derived from the 2002–2004 World Health Survey. Data were stratified by sex and low- or middle-income country status. The main outcome measurements were risk factor prevalence rates reported by wealth quintile and five levels of educational attainment. Socioeconomic inequalities were measured using the slope index of inequality, reflecting differences in prevalence rates, and the relative index of inequality, reflecting the prevalence ratio between the two extremes of wealth or education accounting for the entire distribution. Data were adjusted for confounding factors: sex, age, marital status, area of residence, and country of residence. Results Smoking and low fruit and vegetable consumption were significantly higher among lower socioeconomic groups. The highest wealth-related absolute inequality was seen in smoking among men of low- income country group (slope index of inequality 23.0 percentage points; 95% confidence interval 19.6, 26.4). The slope index of inequality for low fruit and vegetable consumption across the entire distribution of education was around 8 percentage points in both sexes and both country income groups. Physical inactivity was less prevalent in populations of low socioeconomic status, especially in low-income countries (relative index of inequality: (men) 0.46, 95% confidence interval 0.33, 0.64; (women) 0.52, 95% confidence interval 0.42, 0.65). Mixed patterns were found for heavy drinking. Conclusions Disaggregated analysis of the prevalence of non-communicable disease risk factors demonstrated different patterns and varying degrees of socioeconomic inequalities across low- and middle-income settings. Interventions should aim to reach and achieve sustained benefits for high-risk populations.</p

Socioeconomic inequalities in risk factors for non communicable diseases in low-income and middle-income countries: results from the World Health Survey

Background: Monitoring inequalities in non communicable disease risk factor prevalence can help to inform and target effective interventions. The prevalence of current daily smoking, low fruit and vegetable consumption, physical inactivity, and heavy episodic alcohol drinking were quantified and compared across wealth and education levels in low- and middle-income country groups. Methods: This study included self-reported data from 232,056 adult participants in 48 countries, derived from the 2002-2004 World Health Survey. Data were stratified by sex and low- or middle-income country status. The main outcome measurements were risk factor prevalence rates reported by wealth quintile and five levels of educational attainment. Socioeconomic inequalities were measured using the slope index of inequality, reflecting differences in prevalence rates, and the relative index of inequality, reflecting the prevalence ratio between the two extremes of wealth or education accounting for the entire distribution. Data were adjusted for confounding factors: sex, age, marital status, area of residence, and country of residence. Results: Smoking and low fruit and vegetable consumption were significantly higher among lower socioeconomic groups. The highest wealth-related absolute inequality was seen in smoking among men of low-income country group (slope index of inequality 23.0 percentage points; 95% confidence interval 19.6, 26.4). The slope index of inequality for low fruit and vegetable consumption across the entire distribution of education was around 8 percentage points in both sexes and both country income groups. Physical inactivity was less prevalent in populations of low socioeconomic status, especially in low-income countries (relative index of inequality: (men) 0.46, 95% confidence interval 0.33, 0.64; (women) 0.52, 95% confidence interval 0.42, 0.65). Mixed patterns were found for heavy drinking. Conclusions: Disaggregated analysis of the prevalence of non-communicable disease risk factors demonstrated different patterns and varying degrees of socioeconomic inequalities across low- and middle-income settings. Interventions should aim to reach and achieve sustained benefits for high-risk population

Health and cancer risks associated with low levels of alcohol consumption.

Commentary. The overall risks and harms resulting from alcohol consumption have been systematically assessed and are well documented. According to the latest WHO estimates, alcohol consumption contributed to 3 million deaths in 2016 globally and was responsible for 5·1% of the global burden of disease and injury..

Alcohol e-Help: study protocol for a web-based self-help program to reduce alcohol use in adults with drinking patterns considered harmful, hazardous or suggestive of dependence in middle-income countries

Background and aimsGiven the scarcity of alcohol prevention and alcohol use disorder treatments in many low and middle-income countries, the World Health Organization launched an e-health portal on alcohol and health that includes a Web-based self-help program. This paper presents the protocol for a multicentre randomized controlled trial (RCT) to test the efficacy of the internet-based self-help intervention to reduce alcohol use. DesignTwo-arm randomized controlled trial (RCT) with follow-up 6 months after randomization. SettingCommunity samples in middle-income countries. ParticipantsPeople aged 18+, with Alcohol Use Disorders Identification Test (AUDIT) scores of 8+ indicating hazardous alcohol consumption. Intervention and comparatorOffer of an internet-based self-help intervention, Alcohol e-Health', compared with a waiting list' control group. The intervention, adapted from a previous program with evidence of effectiveness in a high-income country, consists of modules to reduce or entirely stop drinking. MeasurementsThe primary outcome measure is change in the Alcohol Use Disorders Identification Test (AUDIT) score assessed at 6-month follow-up. Secondary outcomes include self-reported the numbers of standard drinks and alcohol-free days in a typical week during the past 6 months, and cessation of harmful or hazardous drinking (AUDIT < 8). AnalysisData analysis will be by intention-to-treat, using analysis of covariance to test if program participants will experience a greater reduction in their AUDIT score than controls at follow-up. Secondary outcomes will be analysed by (generalized) linear mixed models. Complier average causal effect and baseline observations carried forward will be used in sensitivity analyses. CommentsIf the Alcohol e-Health program is found to be effective, the potential public health impact of its expansion into countries with underdeveloped alcohol prevention and alcohol use disorder treatment systems world-wide is considerable.World Health OrganizationUniv Zurich, Swiss Res Inst Publ Hlth & Addict ISGF, Konradstr 32, CH-8031 Zurich, SwitzerlandRamon Fuente Muniz, Natl Inst Psychiat, Mexico City, DF, MexicoRamon Fuente Muniz, Natl Inst Psychiat, Dept Social Sci Hlth, Mexico City, DF, MexicoAll India Inst Med Sci, Natl Drug Dependence Treatment Ctr, New Delhi, IndiaAll India Inst Med Sci, Dept Psychiat, New Delhi, IndiaUniv Fed Sao Paulo, Dept Psicobiol, Escola Paulista Med, Sao Paulo, BrazilBelarusian Psychiat Assoc, Informat & Training Ctr, Minsk, ByelarusRepublican Res & Practice Ctr Mental Hlth, Minsk, ByelarusWHO Dept Mental Hlth & Subst Abuse Geneva, Geneva, SwitzerlandUniv Fed Sao Paulo, Dept Psicobiol, Escola Paulista Med, Sao Paulo, BrazilWorld Health Organization: 001Web of Scienc

A multi-country study of harms to children because of others' drinking.

OBJECTIVE: This study aims to ascertain and compare the prevalence and correlates of alcohol-related harms to children cross-nationally. METHOD: National and regional sample surveys of randomly selected households included 7,848 carers (4,223 women) from eight countries (Australia, Chile, Ireland, Lao People's Democratic Republic [PDR], Nigeria, Sri Lanka, Thailand, and Vietnam). Country response rates ranged from 35% to 99%. Face-to-face or telephone surveys asking about harm from others' drinking to children ages 0-17 years were conducted, including four specific harms: that because of others' drinking in the past year children had been (a) physically hurt, (b) verbally abused, (c) exposed to domestic violence, or (d) left unsupervised. RESULTS: The prevalence of alcohol-related harms to children varied from a low of 4% in Lao PDR to 14% in Vietnam. Alcohol-related harms to children were reported by a substantial minority of families in most countries, with only Lao PDR and Nigeria reporting significantly lower levels of harm. Alcohol-related harms to children were dispersed sociodemographically and were concentrated in families with heavy drinkers. CONCLUSIONS: Family-level drinking patterns were consistently identified as correlates of harm to children because of others' drinking, whereas sociodemographic factors showed few obvious correlations