Where do EU Contries set the limit for low risk drinking. Results from the EU RARHA survey E. Scafato,L. Galluzzo, S. Ghirini, C. Gandin Istituto Superiore di Sanità, Italy
WP5: Outline of the work (tasks) 1.Overview of drinking guidelines given in MS and their main features (ISS) 2. Overview of the uses of drinking guidelines in the context of early identification and brief interventions (EIBI) on hazardous/harmful drinking consumption (HHAC) in PHC and other settings drawing in particular on projects ODHIN and BISTAIRS (ISS) 3.Overview of guidelines on drinking by young people (LWL) 4. Overview of science underpinnings drawing on recent work done for Australian and Canadian guidelines (THL) 5. Overview of "standard drink" definitions across the EU and of main approaches to increase awareness of such tools for monitoring one s own alcohol consumption (HSE) 6. Mapping consumer views on risk/safety communication as an approach to reduce alcohol related harm by on-line surveys in 16 MS. (EUROCARE) 7. From science to practice: Expert/policymaker meeting (at the ISS) to discuss preliminary results and conclusions from the overviews and to help develop a policydelphi survey (THL) 8. Second Expert/policymaker meeting to foster dialogue on good practice principles in the use of drinking guidelines as a public health measure drawing on all previous tasks 9. Coordination and production of synthesis report (THL) Low risk drinking guidelines in Europe: results from RARHA survey
Data collection The questionnaire has been submitted by email to the country representatives of the Committee on National Alcohol Policy and Action - CNAPA as members with qualified experience and competence. Participants have been asked to check the validity of the information provided by the country questionnaire reported as review of available sources and to provide the most updated and reliable information for their Country (The RARHA survey started on May 2014). For the task participants have been provide by a PowerPoint presentation summarizing the instructions for completing the Country report/questionnaire. Low risk drinking guidelines in Europe: results from RARHA survey
The RARHA surveytask 1 and 2 The sources of available information are: Furtwaengler&Visser review [Drug and Alcohol Review (January 2013), 32, 11 18] WHO additional survey 2012 WHO Status report on alcohol and Health in 35 EU countries 2013 OECD Collection on national drinking guidelines (provisional version 19 May 2014) The four different sources of available information has been adopted in order to include into a comprehensive category the different wordings of the variables (as an example limits, recommendations, guidelines, guidance have been considered all together). Low Low risk risk drinking guidelines in in Europe: results from from RARHA survey 4
RESULTS Participation 31 European countries selected (all RARHA associated and collaborating countries + 3 additional countries). 29 out of 31 European countries replied (Austria,Belgium, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Norway, The Netherlands, Poland, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, United Kingdom). Bulgaria, andslovakia did not reply. Low risk drinking guidelines in Europe: results from RARHA survey
Standard Drink: definition and use in EU Countries 6
Standard Drink: grams of pure alcohol RARHA 20 18 16 RARHA survey SD in gramsof pure alcohol: 14 12 10 8 Mean= Median= 11 7 SWEDEN (12) SWITZERLAND (10; 12) UNITED KINGDOM (8) AUSTRIA (20) CROATIA (10; 14) CZECH REPUBLIC (16) DENMARK (12) ESTONIA (10) FINLAND (12) FRANCE (10) GERMANY (10; 12) GREECE (10; 16) HUNGARY (12; 14) ICELAND (8 ;12) IRELAND (10) ITALY (12) LATVIA (12) LITHUANIA (10) LUXEMBOURG (12) MALTA (8; 10) NETHERLANDS (THE) (10) NORWAY (12; 15) POLAND (10) PORTUGAL (10) ROMANIA (12) SLOVENIA (10) SPAIN (10)
Standard Drink current use in EU Countries Task I 8
Low Risk Guidelines(GL)/Recommendations(R) 9
LowRisk GL / Rissuedin EU Countries 5 RARHA 22 * 2 2 Yes No missing data Country not investigated * Hungary and Lithuania have recommended limits Revision (year): 10
WEEKlow risk GL/R (in g) 11
DAYlow risk GL/R (in g) 12
RARHA Low risk GL or R availability 13
RARHA: Low risk GL or R limits 50 45 40 35 30 25 20 15 10 5 0 14 Daily alcohol intake average not to be exceeded (grams of pure alcohol) AUSTRIA (24) BELGIUM BULGARIA CROATIA (40) CYPRUS CZECH REPUBLIC (40) DENMARK (24) ESTONIA (40) FINLAND (20) FRANCE (30) GERMANY (24) GREECE (30-48) HUNGARY (24-48) ICELAND IRELAND ITALY (24) LATVIA LITHUANIA (30-40) LUXEMBOURG (24) MALTA (36) NETHERLANDS (THE) (20) NORWAY POLAND (40) PORTUGAL (20) ROMANIA SLOVAKIA SLOVENIA (20) SPAIN (40) SWEDEN SWITZERLAND (20-36) UNITED KINGDOM (24-32) 50 45 40 35 30 25 20 15 10 5 0 AUSTRIA (16) BELGIUM BULGARIA CROATIA (20) CYPRUS CZECH REPUBLIC (20) DENMARK (12) ESTONIA (20) FINLAND (10) FRANCE (20) GERMANY (12) GREECE (20-32) HUNGARY (18-21) ICELAND IRELAND ITALY (12) LATVIA LITHUANIA (20-30) LUXEMBOURG (12) MALTA (27) NETHERLANDS (THE) (10) NORWAY POLAND (20) PORTUGAL (10) ROMANIA SLOVAKIA SLOVENIA (10) SPAIN (20-25) SWEDEN SWITZERLAND (10-24 ) UNITED KINGDOM (16-24) Women Men
Daily alcohol intake average not to be exceeded (grams of pure alcohol) 15
Binge Drinking : definitions 16
RARHA Binge Drinking availability of GL or R 4 4 1 6 2 3 By gender By gender and All All consumers 17
RARHA Binge Drinking definition Maximum intake per drinking occasion (g pure alcohol) 90 80 70 60 50 40 30 20 0 10 AUSTRIA BELGIUM BULGARIA CROATIA CYPRUS CZECH REPUBLIC DENMARK (60) ESTONIA FINLAND (84) FRANCE GERMANY GREECE HUNGARY ICELAND IRELAND ITALY LATVIA (60) LITHUANIA (60-80) LUXEMBOURG (60) MALTA NETHERLANDS (THE) NORWAY POLAND (60) PORTUGAL (60) ROMANIA SLOVAKIA SLOVENIA (50) SPAIN (60) SWEDEN SWITZERLAND (40-48) UNITED KINGDOM (64) 90 80 70 60 50 40 30 20 0 10 Men AUSTRIA BELGIUM BULGARIA CROATIA CYPRUS CZECH REPUBLIC DENMARK (60) ESTONIA FINLAND (60) FRANCE GERMANY GREECE HUNGARY ICELAND IRELAND ITALY LATVIA (40) LITHUANIA (40-80) LUXEMBOURG (60) MALTA NETHERLANDS (THE) NORWAY POLAND (40) PORTUGAL (50) ROMANIA SLOVAKIA SLOVENIA (30) SPAIN (40) SWEDEN SWITZERLAND (30-36) UNITED KINGDOM (48) Women 90 80 70 60 50 40 30 20 10 0 AUSTRIA BELGIUM BULGARIA CROATIA CYPRUS CZECH REPUBLIC (80) DENMARK ESTONIA FINLAND (60-72) FRANCE (40) GERMANY (50) GREECE (4 SU) HUNGARY (72-84) ICELAND IRELAND (60) ITALY (72) LATVIA (60) LITHUANIA LUXEMBOURG (60) MALTA (36) NETHERLANDS (THE) NORWAY POLAND PORTUGAL ROMANIA (72) SLOVAKIA SLOVENIA SPAIN SWEDEN SWITZERLAND UNITED KINGDOM All consumers 18
Young People: GL or R availability 24 22 20 18 16 14 12 10 AUSTRIA BELGIUM BULGARIA CROATIA (18) CYPRUS CZECH REPUBLIC DENMARK (16) ESTONIA (18) FINLAND FRANCE GERMANY GREECE HUNGARY ICELAND IRELAND ITALY (18) LATVIA LITHUANIA LUXEMBOURG (16-18) MALTA NETHERLANDS (THE)(18) NORWAY POLAND (18) PORTUGAL (10-24) ROMANIA SLOVAKIA SLOVENIA (18) SPAIN (16) SWEDEN (18-20) SWITZERLAND UNITED KINGDOM (15) Age (yrs) 19
Older People: GL or R availability 5 14 10 2 21 6 2 2 Yes No missing data Country not investigated WHO 2012 Yes No missing data Country not investigated RARHA 20
Pregnancy/ Breastfeeding GL or R RARHA 25 4 2 Yes No Country not investigated 21
Other guidelines: RHARA as the source Low risk drinking guidelines in Europe: results from RARHA survey 22
Drink driving limits 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 Low risk drinking guidelines in Europe: results from RARHA survey 23 ROMANIA AUSTRIA BELGIUM BULGARIA CROATIA CYPRUS CZECH REPUBLIC DENMARK ESTONIA FINLAND FRANCE GERMANY GREECE HUNGARY ICELAND IRELAND ITALY LATVIA LITHUANIA LUXEMBOURG MALTA NETHERLANDS (THE) NORWAY POLAND PORTUGAL National maximum BAC levels (g/litre) SLOVAKIA SLOVENIA SPAIN SWEDEN SWITZERLAND UNITED KINGDOM General population Young/novice drivers Professional/ commercial drivers
Conclusion (1/2): Standard Drink (SD) : SD expressed incl orml seem to be not a used option (or a least not reported) Alcohol Grams of pure alcohol is the the prevalent measure adopted by Countries to express SD Relevant variability in values between Countries but convergence towards an average of 11 grams (Mean=Median=11) Low RiskGuidelineor Recommendation: Prevalent use ofdaylowriskgl/r(ing) both forgr and R Gender differences of Low RiskG or R Binge drinking Guidelineor Recommendation: Prevalent use of GL and R apparently not oriented considering gender differences Relevant variability in values between Countries Target groups: Young people: 15 / 31 Countries GL or R address to subjects aged 16-18 Old people: only6/31havegr or R addressed to subjects aged 65+ Low risk drinking guidelines in Europe: results from RARHA survey 24
Conclusion (2/2): Target groups : Pregnant women: 25 /31 Countries have in charge GL or R on pregnancy being this issue the most considered all over EU (n. of countries increased from other previous examined available sources. Other guidelines Physical activity: there are few Countries with guideline on physical activities (Croatia, Lithuania and Slovenia) Nutrition and workplace: the n. of Countries with guideline on nutrition and workplace increased from the previous examined available sources. Low risk drinking guidelines in Europe: results from RARHA survey 25
Low risk drinking guidelines in Europe: results from RARHA survey E. Scafato, L. Galluzzo, S. Ghirini, C. Gandin Istituto Superiore di Sanità, Italy E-mail: emanuele.scafato@iss.it Website: www.iss.it Low risk drinking guidelines in Europe: results from RARHA survey
ISS Working Group And Rhara National Team Low risk drinking guidelines in Europe: results from RARHA survey