1. A comparison of different approaches to measure alcohol consumption 26 April 2006 Ola Ekholm, Karina Christensen, Katrine Strandberg Larsen and Morten Grønbæk National Institute of Public Health

2. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 2 Background Self-reported alcohol intake Possible to link mortality and morbidity with drinking behaviour on an individual level The recommended guidelines for alcohol intake are, to a great extent, based on epidemiological studies that have used self-reported information

3. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 3 More specific questions result in higher reported alcohol intake Beverage-specific questions Large time-variation in drinking

4. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 4 Aim of the study To compare the reported intake obtained by beverage- specific questions and to compare how different reference periods and response formats influence the self-reported alcohol intake.

5. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 5 Danish Health Interview Survey 2003 Inclusion criteria: Danish citizen aged 18 years or more.

6. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 6 C haracteristics of the respondents in each sample by sex, age and marital status. Percentage

7. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 7 Question included in all four samples How many alcoholic drinks did you have during last weekday? (don’t include Friday, it is considered part of the weekend) No. of drinks Beer __ Strong beer __ Red & white wine __ Liqueurs __ Spirits __ Ready to drink products __

8. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 8 1 drink = 12 grams of alcohol

9. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 9 Alcohol intake on the most recent weekday

10. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 10 All questions were beverage-specific (beer; strong beer; red & white wine; liqueurs; spirits; ready to drink products) Four different assessment methods for alcohol consumption

11. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 11 The sex- and age-adjusted weekly mean number of alcoholic drinks

12. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 12 The age-adjusted weekly mean number of alcoholic drinks. Men

13. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 13 The age-adjusted weekly mean number of alcoholic drinks. Women

14. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 14 The Danish National Board of Health’s sensible drinking limits Men: a maximum of 21 drinks per week Women: a maximum of 14 drinks per week

15. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 15 Results from a multivariate logistic regression analysis showing the association between a high reported weekly alcohol intake and the different assessment methods

16. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 16 Conclusion A question concerning the intake in a typical week does not seem to underestimate the alcohol intake compared to the 7- day recall measure Estimating the intake for a typical week will take the large time-variation in drinking into account The average weekly intake measure was less specific than the other two measures and the lower reported intake was therefore as expected.

17. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 17 Questions concerning binge drinking

18. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 18 Close-ended response categories Never Less than once a month Approximately 1-3 times a month Approximately once a week More than once a week

19. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 19 Binged at least once a week

20. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 20 Binged at least once a month

21. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 21 Conslusion The open-ended response format is not advisable when the reference period is long The analyses showed that the reference period was important for the self-reported intake for the open-ended questions. However, this was not the case for the close-ended questions

22. A comparison of different approaches to measure alcohol consumption 26 April 2006Page 22 Summary A question concerning typical alcohol intake is feasible to use in epidemiological studies It is more appropriate to use close-ended questions compared to open-ended questions when the reference period is long The length of the reference period seems to be ignorable for the self-reported frequency of binge occasions when using close-ended questions