EUROPEAN ALCOHOL CONSUMPTION QUESTIONNAIRE FOR EHIS WAVE II June 1, 2011 ECHI OUTCOME INDICATOR ON ALCOHOL CONSUMPTION (2008) The New ECHI indicator (2011) on alcohol consumption is not upgraded to date. The following indicator refers to 2008 final report of the ECHIM project 1. 47. HAZARDOUS ALCOHOL CONSUMPTION Definitions: Hazardous alcohol consumption is as an average rate of consumption of more than 20g pure alcohol daily for women and more than 40g daily for men. Hazardous alcohol consumption is a level of consumption or pattern of drinking that is likely to result in harm should present drinking habits persist. For the individual drinker, the higher the alcohol consumption, the greater the risk. But also: According to the WHO, morbidity and mortality due to alcohol consumption rises when the limits of 21 drinks/week (3 glasses/day) for men and 14 drinks/week (2 glasses/day) for women are exceeded. As the indicator calculation suggested in the ECHIM 2008 report is not clear due to mixed definitions, we will base our calculation regarding the specific alcohol questions proposed for the EHIS wave II questionnaire. Nonetheless, from these ECHI 2008 indicators, it comes out that hazardous alcohol consumption indicators are based on the (gender specific) volume of alcohol intake that exceeds certain thresholds (to be defined). The EHIS wave II questionnaire on alcohol consumption definitely allows to estimate the volume of alcohol intake in a given time period. Different gender specific thresholds can thus be applied a posteriori when calculating the indicator, as seen further in the present document. Moreover, various other indicators are presented as well. Questionnaire on alcohol consumption (V3) This new version (v.3) of EHIS II alcohol consumption questionnaire results from accounting for the feedback of the EU member states at the EHIS workshop held in Berlin (1/10/2010), the cognitive testing carried out in 4 countries in March 2011 (BE, DE, EE, UK) and recommendations from the EHIS core group meeting (01/03/2011). The general approach (extended QF) has remained unchanged. Field test analysis is ongoing and may still imply slight adaptations. 1 http://www.echim.org/docs/echim_final_report.pdf 1
AL.1 During the past 12 months, how often (if ever) have you had an alcoholic drink of any kind, that is, beer, wine, cider, spirits, cocktails, premix, liqueurs, home made alcohol? Every day or almost... 1 Cross your answer 5 6 days a week... 2 Go to AL.2 3 4 days a week... 3 1 2 days a week... 4 2 3 days in a month... 5 Once a month... 6 Go to AL.6 Less than once a month... 7 Not in the past 12 months, as I no longer drink alcohol... 8 Never, or only a few sips or trials, in my whole life... 9 Go to next section AL.2 Thinking of Monday to Thursday, on how many of these 4 days do you usually drink alcohol? On all 4 days... 1 On 3 of the 4 days... 2 On 2 of the 4 days... 3 On 1 of the 4 days... 4 On none of the 4 days... 5 Go to AL.4 AL.3 Still thinking about Monday to Thursday, how many drinks do you have on average on ONE of these days when you drink alcohol? 16 or more drinks... 1 10 15 drinks... 2 6 9 drinks... 3 4 5 drinks... 4 3 drinks... 5 2 drinks... 6 1 drink... 7 0 drink... 8 2
AL.4 Thinking of Friday to Sunday, on how many of these 3 days do you usually drink alcohol? On all 3 days... 1 On 2 of the 3 days... 2 On 1 of the 3 days... 3 On none of the 3 days... 4 Go to AL.6 AL.5 Still thinking about Friday to Sunday, how many drinks do you have on average on ONE of these days when you drink alcohol? 16 or more drinks... 1 10 15 drinks... 2 6 9 drinks... 3 4 5 drinks... 4 3 drinks... 5 2 drinks... 6 1 drink... 7 0 drink... 8 AL.6 During the past 12 months, how often (if ever) did you have 6 alcoholic drinks or more, even different, on one occasion (that is, during an evening, a party, a happening, alone, )? Every day or almost... 1 5 6 days a week... 2 3 4 days a week... 3 1 2 days a week... 4 2 3 days in a month... 5 Once a month... 6 Less than once a month... 7 Not in the past 12 months... 8 Never in my whole life... 9 3
Building indicators from the questionnaire on alcohol consumption Question AL1 Calculation DRINKING STATUS DRINKING FREQUENCY Lifetime abstainers = people who have never consumed (more than sips or trials of) an alcoholic beverage Former drinkers = people who have had a drink (more than sips or trial) in their lives but not in the 12 months preceding the interview Current drinkers = people who have had at least 1 drink in the past 12 months Frequency of drinking = distribution (%) of people according to usual frequency of drinking (in past 12 months only, or including abstainers in the denominator). During the past 12 months, how often (if ever) have you had an alcoholic drink of any kind, that is, beer, wine, cider, spirits, cocktails, premix, liqueurs, home made alcohol? If AL.1 = 1 to 7 then current drinker (reported as percentage of total nr of respondents); If AL.1 = 8 then former drinker (reported as percentage of total nr of respondents); If AL.1 = 9 then lifetime abstainer (reported as percentage of total nr of respondents). Frequency of drinking can be reported as percentage of respondents that fall into determined categories of drinking frequencies (often reconstructed a posteriori) AL.1 is a generic question of overall frequency of drinking. At the same time, AL1 ascertains the respondent's current drinking status: drinker; former drinker (current abstainer); lifetime abstainer. Finally, it serves as a filter/routing question. Questions AL2 AL5 VOLUME (LEVEL) OF DRINKING IN WEEKLY DRINKERS HAZARDOUS CONSUMPTION Hazardous consumption = drinking on average more than 20 g of pure alcohol daily in women, and more than 40 g daily in men. Volume can be expressed in amount per day (ADV), per week, per year, or per drinking day, weekday/weekend... but is based on weekly drinkers only. Thus, it does not capture total annual volume, which would imply taking account of infrequent drinkers as well. From Monday to Thursday: how many days do you drink (AL2) and how much (AL3)? From Friday to Sunday: how many days do you drink (AL4) and how much (AL5)? Calculation To calculate the volume for weekly drinkers (AL.1 response 1 to 4): Vol per week = (AL2 x AL3) + (AL4 x AL5) x 10 (g ethanol) Vol per year = [(AL2 x AL3) x 52] + [(AL4 x AL5) x 52] x 10 (g ethanol) Average daily volume (ADV) = Vol per year/364 (or Vol per week/7) Average volume per drinking day = Vol per week/number of drinking days per week. Hazardous consumption: If sex = F and ADV > 20 and if sex = M and ADV > 40. WHO excessive drinking: if sex = F and and ADV > 20 and if sex = M and ADV > 30. These calculations are based on standard drinks equivalent to 10 g ethanol content. Different countries can adapt the ethanol content of their standard drinks. AL.2 & AL.3 assess the frequency and average quantity of drinking on week days. AL.4 & AL.5 assess the frequency and average quantity of drinking during weekends. These four questions allow estimating the volume of consumption for the weekly drinkers. The indicator of prevalence of hazardous drinking is based on these sets of questions, setting the volume of consumption at determined thresholds. The WD/WE breakdown in AL questions was favored by the expert panel as a valid compromise against the simple QF question (AUDIT like usual quantity on typical drinking day) and the lengthier beverage specific QF or graduated frequency questions. 4
Question AL6 Calculation RISKY SINGLE OCCASION DRINKING (RSOD) Risky single occasion drinking = consuming more than 60 g ethanol on one occasion (also referred as 'binge drinking', 'risk drinking' or heavy episodic drinking' in the literature). RSOD could be integrated to the indicator on "hazardous drinking" (see definition). During the past 12 months, how often (if ever) did you have 6 alcoholic drinks or more, even different, on one occasion (that is, during an evening, a party, a happening, alone, )? Distribution of the population (in %) according to the frequency of risky single occasion drinking (60 g ethanol) in the past 12 months. Categories can be collapsed as to present daily / weekly / monthly / less than monthly risk drinking. AL.6 aims to capture part of the drinking pattern (variability), beside the usual or "modal" consumption assessed with previous questions though the WD/WE split catches variability to some extent. It is common to consider that questions about heavy or atypical drinking must be included in instruments measuring alcohol use in order to accurately evaluate a person's total alcohol consumption (ex. Sobel & Sobel, 2004). Advantages of the present alcohol consumption questionnaire (EHIS II) This EHIS II approach offers a short series of questions, though it accounts for some variation in the consumption pattern. Indeed, EHIS II questionnaire is an extended version of the Quantity Frequency (QF) method (= advantage over Audit), with fewer questions than the beverage specific quantity frequency (BSQF) (i.e. SMART project 2 ). It easily fits the EHIS questionnaire addressed to the general population in different cultures. EHIS II is suitable for a self administered form (uncertain regarding SMART) or a face to face interview and can easily be adapted to a telephone interview mode. EHIS II distinguishes between current drinkers, former drinkers (past 12 months abstainers) and lifetime abstainers. This wasn t the case with the EHIS I or the Audit C questionnaires. EHIS II allows estimating the customary indicators for alcohol consumption: frequency and volume of intake, hazardous and excessive drinking, and risky single occasion (binge) drinking, including possible heavy drinking on weekends. It leaves the opportunity to add country specific questions for national information needs (ex. consumption patterns, beverage specificities, drinking context, related disorders, ) Some difficulties remain but this can also be the case for other approaches / questionnaires: Irregular /infrequent drinkers have some problems with the usual consumption approach. Long reference period (past 12 months) could lead to artificial estimates (telescoping responses). Standard drinks. People tend to consider that a drink is a drink without any reference to the show card and subsequent conversion into standards. Total annual volume cannot be derived from this questionnaire, as it estimates quantity only among the weekly drinkers not the less frequent ones. Nevertheless, the question of RSOD is addressed to the infrequent drinkers, because of the potential acute health consequences. 2 A more detailed comparison between this EHIS II questionnaire proposal and the SMART questionnaire can be provided upon request. Mail to: lydia.gisle@wiv isp.be 5