Lecture 13. Public Health 4: Risk Behaviours (Alcohol)

Question 1

What is an individual?

Answer 1

Relative risk to individual depending on exposure

Question 2

What is a population?

Answer 2

Importance to the population depends on the number of individuals exposed (=taking the risk)

Question 3

What is much of epidemiology about?

Answer 3

The relationship between individuals and populations

Question 4

What is the linear relationship between individuals and risk?

Answer 4

Small group taking high risk gives the same number of cases as a large group taking a smaller risk (linear relationship)

Question 5

What is the prevention paradox?

Answer 5

“More cases of disease arise from common, small risks than large, rare risks”

Question 6

How is the frequency of a risk distributed?

Answer 6

Normally distributed

Question 7

What is the relationship between exposure and disease at the individual level (Relative Risk)?

Answer 7

The individual risk of disease increases with the level of exposure

Question 8

Which individuals cause the most disease in the population?

Answer 8

Those with an intermediate individual risk (not the extremes)
Public health should be most concerned with individuals who are just above “average”

Question 9

What is the population attributable fraction (PAF)?

Answer 9

The proportional reduction in population disease or mortality that would occur if exposure to a risk factor were reduced to an alternative ideal exposure scenario (e.g no tobacco use)

Question 10

What equation is used to calculate PAF?

Answer 10

PAF = (Current average RR - Idealised average RR which often = 1)/Current average RR

Question 11

Suppose there are two levels of behaviour: L1 and L2 and that 80% and 20% of the population have these levels
respectively. The relative risks of these two levels are RR1 = 1 and RR 2=55%. What is PAF?

Answer 11

PAF = (0.81 + 0.25.5 - (0.81 + 0.21))/(0.81 + 0.25.5) = 47%

Question 12

How is relative risk calculated?

Answer 12

Chance of disease in risk factor group / chance of diseases in no risk group

Question 13

What is the prevention paradox?

Answer 13

Most disease is caused by small, common risks

Question 14

What is alcohol common in?

Answer 14

ICD codes (ICD-9 and ICD-10)

Question 15

What does the mean/average of units consumed per week not reflect?

Answer 15

The risk distribution by consumption

Question 16

What are the dinking categories of females?

Answer 16

I - 0-20ml/day
II - 20-40ml/day
III - >40ml/day

Question 17

What are the dinking categories of males?

Answer 17

I - 0-40ml/day
II - 40-60ml/day
III - >60ml/day

Question 18

How much alcohol is 1 unit?

Answer 18

1 unit = 10ml

Question 19

How much more dangerous is irregular heavy drinking?

Answer 19

Relative risk of irregular heavy drinking occasions compared with regular moderate drinking was 45% higher

Question 20

When does the cardioprotective effect of moderate alcohol consumption disappear?

Answer 20

When, on average, light to moderate drinking is mixed with irregular heavy drinking occasions

Question 21

What are the health and cancer risks associated with low levels of alcohol consumption?

Answer 21

Younger people are disproportionately affected by alcohol compared with older people, and 13.5% of all deaths among those aged 20–39 years are attributed to alcohol.
In the EU, light to moderate alcohol consumption was associated with almost 23,000 new cancer cases in 2017, accounting for 1.3% of all alcohol-attributable cancers and for 2.3% of all cases of the seven alcohol-related cancer types.
More than a third of the cancer cases attributed to light to moderate drinking (approximately 8500 cases) were associated with a light drinking level (<10 g per day).

Question 22

What may the greatest public-health benefit in preventing alcohol-related disease derive from?

Answer 22

Limiting consumption in the majority, rather than tackling the minority with the greatest risk, hence the growing pressure to introduce a minimum price per unit

Question 23

What do some studies regarding alcohol consumption indicate?

Answer 23

Some studies indicate that moderate level of alcohol consumption, but this may be confounded by the health-status of non-drinkers. This is a very difficult statistical/measurement problem.

Question 24

What do measures such as average units consumed per week hide?

Answer 24

The impact of binge drinking