1. 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

2. Working process Scientific literature; Existing population surveys; HIS/HES website; National – international directives; Clinical observations; Field experts’ opinions Information for policy leaders Operationalization Conceptual Frame Variables (values) Instruments (questions) Indicators (measures) Health issues (concepts) Dimensions (aspects)

3. 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 2 DEPENDENCE Concept 3 RELATED 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

4. 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

5. Proposed instrument Comparison between EHIS-1 and EHIS-2 questionnaires QF by week days and weekend days

6. 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 Never Monthly or less 2 to 4 times a month 2 to 3 times a week 4 or 6 times a week Every day EHIS-2 More than once a day Every day or almost every day 5 - 6 days a week 3 - 4 days a week 1 - 2 days a week 2 - 3 days in a month Once a month Once every couple of months Once or twice a year Not 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…

7. Quantity (EHIS-1 AL.2)

8. 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 days On 3 week days On 2 week days On 1 week day Not 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 drinks 17-23 drinks 10-16 drinks 7-9 drinks 6 drinks 4 - 5 drinks 3 drinks 2 drinks 1 drink During the weekends (form Friday to Sunday), on how many of these 3 days do you usually drink alcohol? On the 3 weekend days On 2 weekend days On 1 weekend day Not 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 drinks 17-23 drinks 10-16 drinks 7-9 drinks 6 drinks 4 - 5 drinks 3 drinks 2 drinks 1 drink WDWE

9. 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 Never Less than monthly Monthly Weekly Daily or almost daily EHIS-2 More than once a day Every day or almost every day 5 - 6 days a week 3 - 4 days a week 1 - 2 days a week 2 - 3 days in a month Once a month Once every couple of months Once or twice a year Not at all in the past 12 months Can be adapted to match 60 g pure alcohol depending on country standard drinks (5+, 7+)

10. Pathway for questions in EHIS-2 AL.1 Weekly drinkers AL.2-AL.5 WD-QF / WE-QF AL.7 RSOD/binge AL.1 Less than weekly AL.6 Usual quantity AL.7 RSOD/binge AL.1 Not in past year AL.8 Lifetime use

11. Added questions AL.6 AL.8 How many drinks containing alcohol do you usually have on a day when you drink? 24 or more drinks 17-23 drinks 10-16 drinks 7-9 drinks 6 drinks 4 - 5 drinks 3 drinks 2 drinks 1 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, daily Yes, every week but not daily Yes, less than every week No, never more than sips or trials Less than weekly Not in past year

12. 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) …