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ABSTRACT
Objectives. This study was designed to determine the prevalence of at-risk drinking using varying alcohol use criteria.
Methods. A period prevalence survey was conducted in 22 primary care practices (n= 19372 adults).
Results. The frequency of atrisk alcohol use varied from 7.Solo (World Health Organization criteria) to 19.7% (National Institute on Alcohol Abuse and Alcoholism criteria). A stepwise logistic model using National Institute on Alcohol Abuse and Alcoholism criteria found male gender, current tobacco use, never married status, retirement, and unemployment to be significant predictors of at-risk alcohol use.
Conclusions. Public health policy needs to move to a primary care paradigm focusing on identification and treatment of at-risk drinkers. (Am J Public Health. 1998;88: 90-93)
Introduction
Alcohol use is associated with certain adverse health effects, including liver cirrhosis, cancer, cardiovascular disease, depression, and trauma. Many of these adverse effects are causally related to the quantity and pattern of alcohol use.1-4 For example, the relative risk of liver cirrhosis, based on a pooled estimate of published research, is 2.2 times greater for men who consume more than 20 g of alcohol per day5 (one standard US drink contains 12 to 14 g of alcohol). The relative risk for women is even greater.
Several studies have found a doseresponse relationship between stroke mortality and alcohol consumption.89 Shaper found that for every 10 g of alcohol consumed per day, there was an increase of 1 to 2 mm Hg in both systolic and diastolic blood pressure.10 Rowe et al. examined individuals' levels of depression in the previous 30 days and noted higher levels for men and women who consumed above 48 g per day (four US standard drinks per day).11
This dose-response relationship is the basis for the concept of at-risk alcohol use.12 The selection of alcohol use limits based on health risk is necessary to establish alcohol screening and intervention programs. A number of groups have developed specific criteria to define at-risk use. Cutoff limits range from more than 7 drinks per week to more than 21 drinks per week.13-16 This paper reports the prevalence of at-risk drinking in primary care practices using varying criteria, discusses the screening implications of these criteria, and examines differences in the prevalence of at-risk alcohol use by age,...