Prevalence of alcohol-interactive prescription medication use among current drinkers: United States, 1999 to 2010.

BACKGROUND: The majority of Americans consume alcoholic beverages. Alcohol interacts negatively with numerous commonly prescribed medications. Yet, on a population level, little is known about use of alcohol-interactive (AI) prescription medications among drinkers. The purpose of our study was to determine the prevalence of AI prescription medication use among current drinkers in the U.S. population. METHODS: Data were from the National Health and Nutrition Examination Survey (NHANES 1999 to 2010); 26,657 adults aged ≥20 years had data on past year alcohol consumption and past month prescription medication use. Analyses were adjusted for covariates: age, race/ethnicity, education, marital status, and smoking. Statistical procedures accounted for survey stratification, clustering, and nonresponse. Analyses were weighted to be nationally representative. RESULTS: The unadjusted total prevalence of AI medication use was 42.8% (95% confidence interval [CI] 41.5 to 44.0). Among current drinkers, adjusted prevalence was 41.5% (CI 40.3 to 42.7). Among participants aged ≥65 total prevalence of AI medication use was 78.6% (CI 77.3 to 79.9) and adjusted prevalence among current drinkers was 77.8% (CI 75.7 to 79.7). The AI medications most commonly used by current drinkers were cardiovascular agents, central nervous system agents, and metabolic agents. CONCLUSIONS: Our results suggest that there could be substantial simultaneous exposure to alcohol and AI prescription medications in the U.S. population. Given the adverse health risks of combining alcohol with AI prescription medications, future efforts are needed to collect data to determine actual simultaneous prevalence.

Measuring the burden--current and future research trends: results from the NIAAA Expert Panel on Alcohol and Chronic Disease Epidemiology.

Alcohol has a significant impact on health and well-being, from the beneficial aspects of moderate drinking to the detrimental effects of alcoholism. The broad implications of alcohol use on public health have been addressed through a wide range of epidemiological and clinical studies, many of which are described in this issue of Alcohol Research: Current Reviews. Where chronic disease is involved, alcohol use can be a risk factor that not only affects the onset of various chronic diseases but also exacerbates the ongoing extent and severity of those diseases. Lifestyle choices and genetic influences also contribute to, or help to alleviate, that risk.

Prospective study of alcohol consumption quantity and frequency and cancer-specific mortality in the US population.

Prospective associations between quantity and frequency of alcohol consumption and cancer-specific mortality were studied using a nationally representative sample with pooled data from the 1988, 1990, 1991, and 1997-2004 administrations of the National Health Interview Survey (n = 323,354). By 2006, 8,362 participants had died of cancer. Cox proportional hazards regression was used to estimate relative risks. Among current alcohol drinkers, for all-site cancer mortality, higher-quantity drinking (≥ 3 drinks on drinking days vs. 1 drink on drinking days) was associated with increased risk among men (relative risk (RR) = 1.24, 95% confidence interval (CI): 1.09, 1.41; P for linear trend = 0.001); higher-frequency drinking (≥ 3 days/week vs. <1 day/week) was associated with increased risk among women (RR = 1.32, 95% CI: 1.13, 1.55; P-trend < 0.001). Lung cancer mortality results were similar, but among never smokers, results were null. For colorectal cancer mortality, higher-quantity drinking was associated with increased risk among women (RR = 1.93, 95% CI: 1.17, 3.18; P-trend = 0.03). Higher-frequency drinking was associated with increased risk of prostate cancer (RR = 1.55, 95% CI: 1.01, 2.38; P for quadratic effect = 0.03) and tended to be associated with increased risk of breast cancer (RR = 1.44, 95% CI: 0.96, 2.17; P-trend = 0.06). Epidemiologic studies of alcohol and cancer mortality should consider the independent effects of quantity and frequency.

Alcoholic beverage consumption, nutrient intakes, and diet quality in the US adult population, 1999-2006.

BACKGROUND: Little is known about associations between alcoholic beverage consumption, nutrient intakes, and diet quality, although each has been independently associated with chronic disease outcomes. OBJECTIVE: This study examines cross-sectional relationships between alcoholic beverage consumption, nutrient intakes, and diet quality (Healthy Eating Index-2005 [HEI-2005] scores) in the US adult population. METHODS: Data were from four cycles of the National Health and Nutrition Examination Survey (1999-2006). Weighted multiple regression analyses, adjusted for age, race/ethnicity, education, smoking status, and body mass index included 8,155 men and 7,715 women aged >or=20 years who reported their past-year alcoholic beverage consumption and 24-hour dietary intake. Alcoholic beverage consumption was defined by drinking status (never, former, current drinker) and, among current drinkers, by drinking level (number of drinks per day, on average: men <1 to >or=5; women <1 to >or=3). RESULTS: Among men, there was no association between drinking status and intakes of energy, most nutrients, or total HEI-2005 score. Among women, former and current (compared to never) drinkers had significantly higher intakes of energy and several nutrients, and current drinkers had significantly lower total HEI-2005 scores (current drinkers 58.9; never drinkers 63.2). Among current drinkers of both sexes, as drinking level increased, intakes of energy and several nutrients significantly increased, whereas total HEI-2005 scores significantly decreased (from 55.9 to 41.5 in men, and from 59.5 to 51.8 in women). CONCLUSIONS: Among men and women, increasing alcoholic beverage consumption was associated with a decline in total diet quality as measured by the HEI-2005, apparently due to higher energy intake from alcohol as well as other differences in food choices. Educational messages should focus on nutrition and chronic disease risk associated with high consumption of alcoholic beverages and poor food choices, including excessive energy intake.

Client-directed interventions to increase community demand for breast, cervical, and colorectal cancer screening a systematic review.

Most major medical organizations recommend routine screening for breast, cervical, and colorectal cancers. Screening can lead to early detection of these cancers, resulting in reduced mortality. Yet not all people who should be screened are screened, either regularly or, in some cases, ever. This report presents the results of systematic reviews of effectiveness, applicability, economic efficiency, barriers to implementation, and other harms or benefits of interventions designed to increase screening for breast, cervical, and colorectal cancers by increasing community demand for these services. Evidence from these reviews indicates that screening for breast cancer (mammography) and cervical cancer (Pap test) has been effectively increased by use of client reminders, small media, and one-on-one education. Screening for colorectal cancer by fecal occult blood test has been increased effectively by use of client reminders and small media. Additional research is needed to determine whether client incentives, group education, and mass media are effective in increasing use of any of the three screening tests; whether one-on-one education increases screening for colorectal cancer; and whether any demand-enhancing interventions are effective in increasing the use of other colorectal cancer screening procedures (i.e., flexible sigmoidoscopy, colonoscopy, double contrast barium enema). Specific areas for further research are also suggested in this report.

Prospective study of alcohol consumption in the United States: quantity, frequency, and cause-specific mortality.

BACKGROUND: Alcohol average volume (quantity multiplied by frequency) has been associated with mortality in drinkers. However, average volume may mask associations due to quantity or frequency alone. METHODS: We prospectively assessed relationships between alcohol quantity and frequency, and mortality from all-causes, cardiovascular disease, cancer, and other-causes in a cohort created by linking the 1988 National Health Interview Survey (response rate 87%) to the National Death Index through 2002. Participants were 20,765 current drinkers age > or = 18 years. At 14-year follow-up 2,547 had died. RESULTS: For quantity, among men who consumed > or =5 drinks (compared to 1 drink) on drinking days, adjusted relative risks (RR) of mortality were: for cardiovascular disease, 1.30 [95% confidence interval (CI) 0.96-1.75; p for linear trend (p-trend) = 0.0295], for cancer, 1.53 (95% CI 1.11-2.09; p-trend = 0.0026), and for other-causes, 1.42 (95% CI 1.08-1.87; p-trend = 0.0029); among women for other-causes, 2.88 (95% CI 1.61-5.12; p-trend = 0.0010). For frequency, among men in the highest frequency quartile (compared to the lowest), RR were: for cardiovascular disease, 0.79 (95% CI 0.63-0.99; p-trend = 0.0330), for cancer, 1.23 (95% CI 0.95-1.59; p-trend = 0.0461), and for other-causes, 1.30 (95% CI 1.01-1.67; p-trend = 0.0070); among women, for cancer, 1.65 (95% CI 1.12-2.45, p-trend = 0.0031). Average volume obscured effects of quantity alone and frequency alone, particularly for cardiovascular disease in men where quantity and frequency trended in opposite directions. CONCLUSIONS: Alcohol quantity and frequency were independently associated with cause-specific mortality. Accumulating evidence of their differential effects may, in the future, be useful for clinical and public health recommendations.

Alcohol consumption among breastfeeding women.

PURPOSE: To determine the prevalence of alcohol consumption among breastfeeding and non-breastfeeding women at 3 months postpartum. METHODS: We analyzed the most recent data available, which were from the 1993-1994 Food and Drug Administration Infant Feeding Practices Study I, a longitudinal panel study of infant-mother pairs. Self-reported data on alcohol consumption were analyzed for 772 breastfeeding women and 776 non-breastfeeding women age > or =14 years. RESULTS: At 3 months postpartum, 36% of breastfeeding women and 40% of non-breastfeeding women consumed alcohol (p = 0.09). In multinomial regression models adjusted for age, race, education, income, marital status, region, smoking, and alcohol consumption before and during pregnancy, breastfeeding women were significantly less likely than non-breastfeeding women to consume two drinks per week (p < 0.01), or equal to or more than three drinks per week (p < 0.01), but equally likely to consume one drink (p = 0.23). CONCLUSIONS: A substantial percentage of breastfeeding women consumed alcohol. Their infants may or may not have been exposed, as some women may have used alcohol avoidance strategies. Nationally representative data are needed on alcohol consumption and infant feeding practices among breastfeeding women.

Alcohol drinking patterns and diet quality: the 1999-2000 National Health and Nutrition Examination Survey.

Associations between alcohol drinking and cardiovascular disease mortality could be confounded by diet if alcohol drinking and diet are related. Depending on the alcohol measure, alcohol-diet relations may or may not be observed. The authors examined associations between alcohol and diet quality (Healthy Eating Index (HEI) scores) using cross-sectional, nationally representative data from the 1999-2000 National Health and Nutrition Examination Survey. Weighted analyses included 3,729 participants aged > or =20 years. In adjusted analyses among current alcohol drinkers, as quantity increased from 1 to > or =3 drinks/drinking day, the mean HEI score decreased from 65.3 (95% confidence interval (CI): 63.4, 67.1) to 61.9 (95% CI: 60.5, 63.2). As frequency increased from the lowest quartile to the highest, the mean HEI score increased from 60.9 (95% CI: 58.7, 63.2) to 64.9 (95% CI: 63.4, 66.4). As average volume ((quantity x frequency)/365.25) increased from <1 drink/day to > or =3 drinks/day, the mean HEI score increased from 62.9 (95% CI: 61.2, 64.5) to 65.2 (95% CI: 62.7, 67.8). In stratified analyses, the lowest HEI score, 58.5 (95% CI: 55.5, 61.5), occurred among drinkers who consumed the highest quantity at the lowest frequency. Average volume of alcohol consumed is driven by and masks the contributions of its components. These results suggest the importance of measuring drinking patterns (quantity, frequency, and stratified combinations) in epidemiologic alcohol-diet studies.

Dairy, calcium, and vitamin D intakes and prostate cancer risk in the National Health and Nutrition Examination Epidemiologic Follow-up Study cohort.

BACKGROUND: Dairy intake may increase prostate cancer risk, but whether this is due to calcium's suppression of circulating vitamin D remains unclear. Findings on calcium and vitamin D intake and prostate cancer are inconsistent. OBJECTIVE: We examined the association of dairy, calcium, and vitamin D intake with prostate cancer. DESIGN: In a prospective study of 3612 men followed from 1982-1984 to 1992 for the first National Health and Nutrition Examination Epidemiologic Follow-up Study, 131 prostate cancer cases were identified. Dietary intake was estimated from questionnaires completed in 1982-1984. Relative risk (RR) and 95% CIs were estimated by using Cox proportional hazards models adjusted for age, race, and other covariates. RESULTS: Compared with men in the lowest tertile for dairy food intake, men in the highest tertile had a relative risk (RR) of 2.2 (95% CI: 1.2, 3.9; trend P = 0.05). Low-fat milk was associated with increased risk (RR = 1.5; 95% CI: 1.1, 2.2; third compared with first tertile; trend P = 0.02), but whole milk was not (RR = 0.8; 95% CI: 0.5, 1.3; third compared with first tertile; trend P = 0.35). Dietary calcium was also strongly associated with increased risk (RR = 2.2; 95% CI: 1.4, 3.5; third compared with first tertile; trend P = 0.001). After adjustment for calcium intake, neither vitamin D nor phosphorus was clearly associated with risk. CONCLUSIONS: Dairy consumption may increase prostate cancer risk through a calcium-related pathway. Calcium and low-fat milk have been promoted to reduce risk of osteoporosis and colon cancer. Therefore, the mechanisms by which dairy and calcium might increase prostate cancer risk should be clarified and confirmed.

Drinking patterns and body mass index in never smokers: National Health Interview Survey, 1997-2001.

Alcohol could contribute to obesity. The authors examined the relation between drinking patterns and body mass index (BMI) (weight (kg)/height (m)(2)) by pooling cross-sectional data from the 1997-2001 National Health Interview Surveys. Weighted analyses included 45,896 adult never smokers who were current alcohol drinkers. Height and weight were self-reported. In adjusted analyses, alcohol quantity and frequency had opposite associations with BMI. As quantity increased from 1 drink/drinking day to > or =4 drinks/drinking day, BMI significantly increased; in men, it increased from 26.5 (95% confidence interval (CI): 26.3, 26.6) to 27.5 (95% CI: 27.4, 27.7), and in women, it increased from 25.1 (95% CI: 25.0, 25.2) to 25.9 (95% CI: 25.5, 26.3). As frequency increased from low quintiles of drinking days/year to high quintiles, BMI significantly decreased; in men, it decreased from 27.4 (95% CI: 27.2, 27.6) to 26.3 (95% CI: 26.2, 26.5), and in women, it decreased from 26.2 (95% CI: 26.0, 26.5) to 24.3 (95% CI: 24.2, 24.5). In stratified analyses of frequency trends within quantity categories, BMI declines were more pronounced in women than in men, but all linear trends were inverse and significant (p trend < 0.001). In all respondents combined, persons who consumed the smallest quantity the most frequently were leanest, and those who consumed the greatest quantity the least frequently were heaviest. Alcohol may contribute to excess body weight among certain drinkers.

Dietary patterns and prostate cancer risk in the National Health and Nutrition Examination Survey Epidemiological Follow-up Study cohort.

Ecological studies implicate a "Western" diet in prostate cancer development, but whether dietary patterns measured in individuals are associated with risk has not been studied previously. We examined this issue using prospective data from the nationally representative United States Health Examination Epidemiological Follow-up Study. Among 3,779 men followed from 1982-84 to 1992, 136 incident cases were identified. Using principal component analysis on responses to a 105-item dietary questionnaire, the following three distinct patterns were identified: a vegetable-fruit pattern; a red meat-starch pattern characterized by red meats, potatoes, cheese, salty snacks, and desserts; and a Southern pattern characterized by such foods as cornbread, grits, sweet potatoes, okra, beans, and rice. In adjusted proportional hazards models, prostate cancer risk was not associated with the vegetable-fruit or red meat-starch pattern, but higher intake of the Southern pattern showed a reduction in risk (3rd versus 1st tertile relative risk, 0.6; 95% confidence interval, 0.4-1.1; trend P = 0.08) that approached statistical significance. The inverse association was observed in black and non-black men and was not attributable to intake of any individual foods or nutrients. A Southern dietary pattern may reflect a history of living in the South and serve as an integrative marker of sunlight exposure and protection through 1,25-dihydroxyvitamin D production. Further evaluation and better characterization of the pattern would offer more information on potentially beneficial features of the diet or its associated lifestyle.