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Bullying, violence at work increase risk of cardiovascular disease

People bullied frequently (almost every day) in the past 12 months had 120% higher risk of cardiovascular disease, while those exposed most frequently to workplace violence had a 36% higher risk of cerebrovascular disease (such as stroke).

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People who are bullied at work or experience violence at work are at higher risk of heart and brain blood vessel problems, including heart attacks and stroke. This is according a study – “Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study” – done by Tianwei Xu et al. and published in the European Heart Journal.

It is worth stressing that the study was observational, and – as such – “cannot show that workplace bullying or violence cause cardiovascular problems”. However, it – nonetheless – shows that “there is an association (between the two),” and so the results “have important implications for employers and national governments.”

“If there is a causal link between bullying or violence at work and cardiovascular disease, then the removal of workplace bullying would mean we could avoid five per cent of all cardiovascular cases, and the eradication of violence at work would avoid more than three per cent of all cases,” said Tianwei, the lead researcher.

Bullying ‘follows’ LGB people from school to work

It is worth noting that members of the LGBTQIA community are more exposed to bullying. A study released last April 2018, for instance, investigated gender expression and victimization of youth aged 13-18, and it found that the most gender nonconforming students reported higher levels of being bullied, were more likely to report missing school because they feel unsafe, and are most likely to report being victimized with a weapon on school property.

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Sadly, for LGBTQIA people who are bullied at school, the bullying follows them to the workplace. A study released in November 2018 found that 35.2% of gay/bisexual men who had experienced frequent school-age bullying experience frequent workplace bullying. Among lesbian women, the figure was 29%.

For Tianwei’s study in particular, the researchers looked at data from 79,201 working men and women in Denmark and Sweden, aged 18 to 65, with no history of cardiovascular disease (CVD), who were participants in three studies that started between 1995 and 2011; the participants have been followed up ever since. When they joined the studies, the participants were asked about bullying and violence in the workplace and the frequency of their experience of each of them. Information on the number of cases of heart and brain blood vessel disease and deaths was obtained from nationwide registries.

The researchers also took account of other factors that could affect whether or not the participants were affected by CVD, including body mass index, alcohol consumption, smoking, mental disorders and other pre-existing health conditions, shift working and occupation.

Nine percent of participants reported being bullied at work and 13% reported experiencing violence or threats of violence at work in the past year. After adjusting for age, sex, country of birth, marital status and level of education, the researchers found that those who were bullied or experienced violence (or threats of violence) at work had a 59% and 25% higher risk of CVD, respectively, compared to people who were not exposed to bullying or violence.

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The more bullying or violence that was encountered, the greater the risk of CVD. Compared with people who did not suffer bullying, people who reported being bullied frequently (the equivalent to being bullied almost every day) in the past 12 months had 120% higher risk of CVD, while those who were exposed most frequently to workplace violence had a 36% higher risk of cerebrovascular disease (such as stroke) than those not exposed to violence, but there did not appear to be a corresponding increase in heart disease.

1-in-4 girls, 1-in-10 boys report self-injury or attempt suicide due to fighting, bullying or forced sex

“Workplace bullying and workplace violence are distinct social stressors at work. Only 10-14% of those exposed to at least one type of exposure were suffering from the other at the same time. These stressful events are related to a higher risk of cardiovascular disease in a dose-response manner – in other words, the greater the exposure to the bullying or violence, the greater the risk of cardiovascular disease,” Tianwei said. “From this study we cannot conclude that there is a causal relation between workplace bullying or workplace violence and cardiovascular disease, but we provide empirical evidence in support of such a causal relation, especially given the plausible biological pathway between workplace major stressors and cardiovascular disease.”

The effect of bullying and violence on the incidence of cardiovascular disease in the general population is comparable to other risk factors, such as diabetes and alcohol drinking, which further highlights the importance of workplace bullying and workplace violence in relation to cardiovascular disease prevention. For Tianwei, “it is important to prevent workplace bullying and workplace violence from happening, as they constitute major stressors for those exposed. It is also important to have policies for intervening if bullying or violence occurs.”

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Other interesting findings from the research included the fact that bullying in the workplace occurred mostly from colleagues (79%) rather than from people outside the organization (21%), whereas violence or threats of violence at work originated mainly from people outside the organization (91%), than from within (9%). This, combined with the fact that those exposed most frequently to workplace violence were not more likely to suffer from heart disease, suggests that workers may have received training about how to deal with violence they encounter as part of their jobs and may be better equipped to deal with it and avoid long-term consequences.

Health & Wellness

Sexual minority women more likely to engage in high-intensity binge drinking

Sexual minority women, whether defined on the basis of sexual attraction, behavior, or identity, were more likely than sexual majority women to engage in high-intensity binge drinking.

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Sexual minority women, whether defined on the basis of sexual attraction, behavior, or identity, were more likely than sexual majority women to engage in high-intensity binge drinking. This is according to a study done by Jessica N. Fish and published in LGBT Health.

The study, “Sexual Orientation-Related Disparities in High-Intensity Binge Drinking: Findings from a Nationally Representative Sample“, eyed to assess sexual orientation differences in high-intensity binge drinking using (American) nationally representative data.

Data used were from the National Epidemiologic Survey on Alcohol and Related Conditions III (N = 36,309), a nationally representative sample of US adults collected in 2012–2013. Sex-stratified adjusted logistic regression models were used to test sexual orientation differences in the prevalence of standard (4+ for women and 5+ for men) and high-intensity binge drinking (8+ and 12+ for women; 10+ and 15+ for men) across three dimensions of sexual orientation: sexual attraction, sexual behavior, and sexual identity.

As per the researcher (and as stated): “Sexual minority women, whether defined on the basis of sexual attraction, behavior, or identity, were more likely than sexual majority women to engage in high-intensity binge drinking at two (adjusted odds ratios [aORs] ranging from 1.52 to 2.90) and three (aORs ranging from 1.61 to 3.27) times the standard cutoff for women (4+).”

Sexual minority men, depending on sexual orientation dimension, were equally or less likely than sexual majority men to engage in high-intensity binge drinking.

The results suggest that differences in alcohol-related risk among sexual minority individuals vary depending on sex and sexual orientation dimension.

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LGBT-identifying females are at increased risk of substance use in early adolescence

The odds of substance use among females who identify as sexual minorities – an umbrella term for those who identify with any sexual identity other than heterosexual or who report same-sex attraction or behavior – is 400% higher than their heterosexual female peers.

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Females who identify as sexual minorities face an increased risk of substance use that shows up as early as age 13, suggesting early adolescence is a critical period for prevention and intervention efforts, a new study from Oregon State University has found.

The odds of substance use among females who identify as sexual minorities – an umbrella term for those who identify with any sexual identity other than heterosexual or who report same-sex attraction or behavior – is 400% higher than their heterosexual female peers.

“We saw this striking difference in substance use at age 13 and there was rapid increase in the rate of cigarette and alcohol use from there,” said Sarah Dermody, an assistant professor in the School of Psychological Science in OSU’s College of Liberal Arts and the study’s lead author. “That tells us we need to find ways to intervene as early as possible to help prevent substance use in this population.”

The findings were published recently in the Journal of LGBT Youth. Co-authors are James McGinley of McGinley Statistical Consulting and director of behavioral analytics at the Vector Psychometric Group; Kristen Eckstrand, a physician at the University of Pittsburgh Medical Center; and Michael P. Marshal of the University of Pittsburgh.

Among youth, alcohol, marijuana and nicotine are the three most commonly used drugs. That is a concern because youth who use those substances are at risk of negative health and social outcomes, including addiction and poor cognitive, social and academic function.

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Past research has shown that sexual minority youth reported nearly three times more substance use than heterosexual youth. The disparity may be due in part to stress from discrimination, violence and victimization rooted in their sexual minority status, Dermody said.

The pattern of increased substance use for youth who identify as sexual minorities is magnified significantly for females. In the new study, researchers hoped to gain better understanding of how substance use rates develop over time for this group in particular, Dermody said.

Using data from about 2,200 participants in the Pittsburgh Girls Study, a large, longitudinal study of the lives of urban girls, researchers examined substance use among females over time from age 13 to 20, comparing those who identified as heterosexual to those identifying as lesbian/gay or bisexual.

They looked at when disparities in use between heterosexual and sexual minority identifying females began to emerge; rates of change over time for both groups; and how rates change as the girls approach young adulthood.

The researchers found that disparities in substance use between heterosexual and sexual minority girls were already present at age 13. The difference in use between heterosexual and sexual minority girls persisted and increased as they entered their 20s.

The findings suggest that early prevention and intervention efforts may be needed to reduce initial use and slow the escalation of substance use among the population. Such efforts could also help decrease substance use disparities over time, Dermody said.

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“It’s already a risky and vulnerable period for youths’ social development, and it’s also a vulnerable time for brain development,” Dermody said.

It’s also important to remember that within the population of youths who identify as sexual minorities, there are many youths who are not using any substances at all, or who are not using them as heavily, Dermody said.

“This is a subgroup that we are concerned about,” she said. “In future research, it would useful to explore how individual youths’ experiences influence where they fall on the spectrum of substance use.”

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Health & Wellness

Hazard of smoking at a younger age greater for transgender boys

Transgender boys may be at higher risk for early and current cigarette use regardless of their sexual identity, whereas smoking varied more widely for youth across different sexual identities.

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Smoke gets in your eyes…

A study found that – with approximately 7% of sexual and gender minority (SGM) youths reported currently smoking – cisgender and transgender boys had higher odds of current smoking compared with cisgender and transgender girls (adjusted odds ratio [AOR] = 1.86; 95% confidence interval [CI]: 1.56–2.21); while pansexual-identified youth had higher odds of smoking (AOR = 1.33; 95% CI: 1.05–1.70) compared with gay/lesbian youth independent of gender identity. Pansexual-identified cisgender boys had the highest smoking prevalence (21.6%).

This is according to “Cigarette Smoking Among Youth at the Intersection of Sexual Orientation and Gender Identity” by Christopher W. Wheldon, Ryan J. Watson, Jessica N. Fish and Kristi Gamarel, published in LGBT Health.

The study eyed to identify subgroups of sexual and gender minority (SGM) youth who are most vulnerable to tobacco use. The researchers analyzed data from a national nonprobability sample of 11,192 SGM youth (ages 13–17). Age of cigarette initiation and current use were modeled using Cox proportional hazard and binomial regression. Sexual and gender identities were explanatory variables and the models were adjusted for ethnoracial identity and age.

The study noted that – surprisingly – predicted probabilities were higher among transgender boys across all sexual identities, except asexual. The hazard of smoking at a younger age was greater for transgender boys compared with cisgender boys (adjusted hazard ratio [AHR] = 1.67; 95% CI: 1.43–1.94) as well as for bisexual (AHR = 1.12; 95% CI: 1.01–1.24) and pansexual (AHR = 1.17; 95% CI: 1.03–1.33) youth compared with those who identified as gay or lesbian.

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These findings “suggest that transgender boys may be at higher risk for early and current cigarette use regardless of their sexual identity, whereas smoking varied more widely for youth across different sexual identities. The findings suggest that specific subgroups of SGM youth require focused attention in tobacco control research and practice.”

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Childhood adversity linked to early puberty, premature brain development & mental illness

The findings revealed that poverty was associated with small elevation in severity of psychiatric symptoms, including mood/anxiety, phobias, externalizing behavior (oppositional-defiant, conduct disorder, ADHD), and psychosis, as compared to individuals who did not experience poverty.

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Growing up in poverty and experiencing traumatic events like a bad accident or sexual assault can impact brain development and behavior in children and young adults.

Low socioeconomic status (L-SES) and the experience of traumatic stressful events (TSEs) were linked to accelerated puberty and brain maturation, abnormal brain development, and greater mental health disorders, such as depression, anxiety, and psychosis, according to a new study published this week in JAMA Psychiatry. The research was conducted by a team from Perelman School of Medicine at the University of Pennsylvania and Children’s Hospital of Philadelphia (CHOP) through the Lifespan Brain Institute (LiBI).

“The findings underscore the need to pay attention to the environment in which the child grows. Poverty and trauma have strong associations with behavior and brain development, and the effects are much more pervasive than previously believed,” said the study’s lead author Raquel E. Gur, MD, PhD, a professor of Psychiatry, Neurology, and Radiology at the Perelman School of Medicine at the University of Pennsylvania, and director of the Lifespan Brain Institute.

Parents and educators are split into opposing camps with regard to the question of how childhood adversity affects development into mature, healthy adulthood. Views differ from “spare the rod and spoil the child” to concerns that any stressful condition such as bullying will have a harmful and lasting effects. Psychologists and social scientists have documented lasting effects of growing up in poverty on cognitive functioning, and clinicians observed effects of childhood trauma on several disorders, though mostly in the context of post-traumatic stress disorders (PTSD).

There are also anecdotal observations, supported by some research, that adversity accelerates maturation–children become young adults faster, physically and mentally. Neuroscientists, who are aware of the complexity of changes that the brain must undergo as it transitions from childhood to young adulthood, suspected, and more recently documented that childhood adversity affects important measures of brain structure and function. But this study was the first to compare the effects of poverty (L-SES) to those who experienced TSEs in the same sample set.

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The researchers analyzed data from the Philadelphia Neurodevelopmental Cohort, which included 9,498 participants aged 8 to 21 years for the study. The racially and economically diverse cohort includes data on SES, TSEs, neurocognitive performance, and in a subsample, multimodal neuroimaging taken via MRI.

The researchers found specific associations of SES and TSE with psychiatric symptoms, cognitive performance, and several brain structure abnormalities.

The findings revealed that poverty was associated with small elevation in severity of psychiatric symptoms, including mood/anxiety, phobias, externalizing behavior (oppositional-defiant, conduct disorder, ADHD), and psychosis, as compared to individuals who did not experience poverty. The magnitude of the effects of TSEs on psychiatric symptom severity was unexpectedly large. TSEs were mostly associated with PTSD, but here the authors found that even a single TSE was associated with a moderate increase in severity for all psychiatric symptoms analyzed, and two or more TSEs showed large effect sizes, especially in mood/anxiety and in psychosis. Additionally, these effects were larger in females than in males.

With neurocognitive functioning, the case was reversed; poverty was found to be associated with moderate to large cognitive deficits, especially in executive functioning–abstraction and mental flexibility, attention, working memory–and in complex reasoning. TSEs were found to have very subtle effects, with individuals who experienced two or more TSEs showing a mild deficit in complex cognition, but demonstrating slightly better memory performance.

Both poverty and TSEs were associated with abnormalities across measures of brain anatomy, physiology, and connectivity. Poverty associations were widespread, whereas TSEs were associated with more focused differences in the limbic and fronto-parietal regions of the brain, which processes emotions, memory, executive functions and complex reasoning.

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The researchers also found evidence that adversity is associated with earlier onset of puberty. Both poverty and experiencing TSEs are associated with the child physically maturing at an earlier age. The researchers also found the same effects on the brain, with findings revealing that a higher proportion of children who experienced adversity had characteristics of adult brains. This affects development, as the careful layering of the structural and functional connectivity in the brain requires time, and early maturity could prevent the necessary honing of skills.

“Altogether our study shows no evidence to support the ‘spare the rod’ approach, to the contrary we have seen unexpectedly strong effects of TSEs on psychiatric symptoms and of poverty on neurocognitive functioning, and both are associated with brain abnormalities,” Gur said. “The study suggests that it makes sense for parents and anyone involved in raising a child to try and shield or protect the child from exposure to adversity. And for those dealing with children who were already exposed to adversity–as is sadly the case today with refugees around the world–expect an increase in symptoms and consider cognitive remediation, a type of rehabilitation treatment which aims to improve attention, memory, and other cognitive functions.”

“Traumas that happen to young children can have lifelong consequences,” said the study’s senior author Ruben C. Gur, PhD, a professor of Psychiatry, Radiology, and Neurology, and director of the Brain Behavior Laboratory. “Obviously it would be best if we could ameliorate poverty and prevent traumatic events from occurring. Short of that, the study calls for paying more attention to a child’s socioeconomic background and to effects of trauma exposure. Parents and educators should become more aware of the special needs of children who are exposed to either adversity. Additionally, mental health professionals should be particularly on notice that traumatic events are associated not only with PTSD, but with elevations across domains including mood, anxiety, and psychosis.”

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This is of concern to members of the LGBTQIA community, considering that they may face additional stress for their SOGIE. For instance, an earlier report found that 80% of lesbian, gay and bisexual athletes, and 82% of trans athletes kept their identity hidden from their coaches. Eleven percent of LGBT young people reported they never felt safe in a locker room. For those who are not cisgender, that percentage jumps to over 30%.

Meanwhile, a research from Chapin Hall at the University of Chicago in the US found that young members of the LGBTQI community are more than twice as likely to become homeless as their straight counterparts.

Additional Penn authors for the current study include Tyler M. Moore, Adon F. G. Rosen, David R. Roalf, Monica E. Calkins, Kosha Ruparel, J. Cobb Scott, Theodore D. Satterthwaite, and Russell T. Shinohara. CHOP authors include Ran Barzilay and Laura Almasy.

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Health & Wellness

Targets to reduce harmful alcohol use likely to be missed as global alcohol intake increases

Globally, alcohol intake increased from 5.9 liters pure alcohol a year per adult in 1990, to 6.5 liters in 2017, and is predicted to increase further to 7.6 liters by 2030.

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Increasing rates of alcohol use suggest that the world is not on track to achieve targets against harmful alcohol use, according to a study of 189 countries’ alcohol intake between 1990-2017 and estimated intake up to 2030, published in The Lancet.

As a result of increased alcohol consumption and population growth, the total volume of alcohol consumed globally per year has increased by 70% (from 20,999 million liters in 1990 to 35,676 million liters in 2017). Intake is growing in low- and middle-income countries, while the total volume of alcohol consumed in high-income countries has remained stable.

The estimates suggest that by 2030 half of all adults will drink alcohol, and almost a quarter (23%) will binge drink at least once a month.

Before 1990, most alcohol was consumed in high-income countries, with the highest use levels recorded in Europe. However, this pattern has changed substantially, with large reductions across Eastern Europe and vast increases in several middle-income countries such as China, India, and Vietnam.
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Alcohol is a major risk factor for disease, and is causally linked to over 200 diseases, in particular non-communicable diseases and injuries.

“Our study provides a comprehensive overview of the changing landscape in global alcohol exposure. Before 1990, most alcohol was consumed in high-income countries, with the highest use levels recorded in Europe. However, this pattern has changed substantially, with large reductions across Eastern Europe and vast increases in several middle-income countries such as China, India, and Vietnam. This trend is forecast to continue up to 2030 when Europe is no longer predicted to have the highest level of alcohol use,” says study author Jakob Manthey, TU Dresden, Germany. [1]

He continues: “Based on our data, the WHO’s aim of reducing the harmful use of alcohol by 10% by 2025 will not be reached globally. Instead, alcohol use will remain one of the leading risk factors for the burden of disease for the foreseeable future, and its impact will probably increase relative to other risk factors. Implementation of effective alcohol policies is warranted, especially in rapidly developing countries with growing rates of alcohol use.” [1]

Alcohol is a major risk factor for disease, and is causally linked to over 200 diseases, in particular non-communicable diseases and injuries.
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Monitoring alcohol use is part of several international programs, including the WHO’s Global Action Plan for the Prevention and Control of NCDs 2013-2020, the UN’s Sustainable Development Goals, and the WHO’s Global Strategy to Reduce the Harmful Use of Alcohol. These targets are based on per capita alcohol consumption in adults (the number of liters of pure alcohol consumed per person aged 15 years or more in a year taking into account recorded and unrecorded use, and tourism) [2].

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The new study measured per capita alcohol consumption using data for 189 countries between 1990-2017 from the WHO and the Global Burden of Disease study. Over the same period, it also measured prevalence of people who did not drink for their whole lives or were current drinkers (ie, drank alcohol at least once a year) using surveys for 149 countries, and binge drinkers (drinking 60g or more pure alcohol in one sitting once or more within 30 days) using surveys from 118 countries. Using estimates of gross domestic product and the religious composition of the population, the results were modeled to create estimates for all 189 countries up to 2030.

In 2017, the lowest alcohol intakes were in North African and Middle Eastern countries (typically less than 1 liter per adult per year), while the highest intakes were in Central and Eastern European countries (in some cases more than 12 liters per adult per year). At the country-level, Moldova had the highest alcohol intake (15 liters per adult per year), and Kuwait had the lowest (0.005 liters per person per year)

Globally, alcohol consumption is set to increase from 5.9 liters pure alcohol a year per adult in 1990 to 7.6 liters in 2030. However, intake varied regionally. Between 2010-2017, consumption increased by 34% in southeast Asia (from 3.5 liters to 4.7 liters), with increases in India, Vietnam and Myanmar. In Europe [3], consumption reduced by 12% (from 11.2 to 9.8 liters), mainly due to decreases in former Soviet Republics such as Azerbaijan, Kyrgyzstan, Ukraine, Belarus, and Russia. Intake levels remained similar in African, American, and Eastern Mediterranean regions.

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In the UK, consumption decreased from 12.3 liters in 2010 to 11.4 liters in 2017, compared to increases of 38% in India (from 4.3 to 5.9 liters). Over the same timescale, consumption increased slightly in the USA (9.3-9.8 liters) and in China (7.1-7.4 liters).

Globally, alcohol consumption is set to increase from 5.9 liters pure alcohol a year per adult in 1990 to 7.6 liters in 2030.
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Globally, the prevalence of lifetime abstinence decreased from 46% in 1990 to 43% in 2017, while the prevalence of current drinking increased from 45% in 1990 to 47% in 2017, and the prevalence of heavy episodic drinking increased from 18.5% to 20%. However, the authors note that the changes in abstinence and heavy episodic drinking are not statistically significant.

They estimate these trends to continue, and that by 2030 40% of people will abstain from alcohol, 50% of people will drink alcohol, and almost a quarter (23%) will binge drink at least once a month.

They note that, globally, and in most regions, the volume of alcohol consumed grows faster than the number of drinkers (for example, alcohol per capita is expected to grow by 17.8% from 6.5-7.6 liters globally between 2018-2030, while the number of current drinkers is estimated to grow by just 5% from 47.3% to 49.8% in the same timeframe), meaning the average alcohol intake per drinker is forecasted to increase. Increased alcohol intake per drinker not only results in a growing proportion of heavy episodic drinkers, but also inevitably leads to an increased alcohol-attributable disease burden.

“Alcohol use is prevalent globally, but with clear regional differences that can largely be attributed to religion, implementation of alcohol policies, and economic growth. Economic growth seems to explain the global increase in alcohol use over the past few decades – for example, the economic transitions and increased wealth of several countries – in particular, the transitions of China and India – were accompanied by increased alcohol use. The growing alcohol market in middle-income countries is estimated to more than outweigh the declining use in high-income countries, resulting in a global increase,” says Manthey. [1]

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The authors note some limitations, including that there is uncertainty around estimates of unrecorded alcohol consumption, in addition to scarcity of data in certain regions. In addition, drinking status estimates were based on surveys, where individuals often under-report their intake. Their estimates for 2018-2030 are based on economic conditions and religion only, and cannot take future policy changes or behavior changes into account.

Alcohol use is prevalent globally, but with clear regional differences that can largely be attributed to religion, implementation of alcohol policies, and economic growth.
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Writing in a linked Comment, Dr Sarah Callinan, La Trobe University, Australia, notes that the shift in alcohol consumption globally from high-income to lower income countries could lead to disproportionate increases in harm, as the harm per liter of alcohol is substantially higher in low-income and middle-income countries than in high-income countries. She says: “An increasingly robust evidence base supports use of key alcohol policy levers such as increasing price and restricting availability to curtail growing alcohol consumption beyond Europe and North America. However, this evidence comes largely from high-income countries, and the potential efficacy of such policies in lower-middle-income countries, where more than half of alcohol consumption is unrecorded, is likely to be limited without substantial reductions in unrecorded alcohol consumption (although previous studies show that unrecorded consumption tends to decline with economic development). Thus, although price or availability-based policies are important, strict restrictions on advertising and other promotional activities are crucial to slow the growing demand for alcohol in these countries. Similarly, rigorous drink-driving countermeasures are necessary so that increasing consumption does not lead to increases in road traffic injury. Supporting evidence-based policies outside high-income countries, despite anticipated strong industry resistance, will be a key task for public health advocates in the coming decades.”


[1] Quote direct from author and cannot be found in the text of the Article.

[2] Pure alcohol in liters can be converted into grams using the specific weight of alcohol (0.789 g/mL), where a liter of pure alcohol equals 789g. How many drinks this becomes varies by country as the definition of a standard drink varies internationally – for example, in the UK it is 8g of alcohol, compared with 10g in Australia, 12g in Germany, and 14g in the USA.

5.9 liters of pure alcohol per year is equivalent to about 1 standard drink per day containing 12g pure alcohol. This would be roughly 1 can of 330ml beer per day per adult (not per drinker).

6.5 liters = 14g pure alcohol per day = 360mL beer per day per adult

7.6 liters = 16g pure alcohol per day = 410mL beer per day per adult

[3] The study uses WHO world regions. This means that Europe includes countries which may be considered Asian by other classifications.

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Lesbian, gay and bi adolescents at elevated risk for engaging in polysubstance use

Lesbian, gay and bisexual adolescents were more likely than heterosexual adolescents to be polysubstance users versus non-users across multiple classes of use: experimental users, marijuana-alcohol users, tobacco-alcohol users, medium-frequency three-substance users, and high-frequency three-substance users.

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Lesbian, gay and bisexual adolescents were more likely than heterosexual adolescents to be polysubstance users versus non-users across multiple classes of use: experimental users, marijuana-alcohol users, tobacco-alcohol users, medium-frequency three-substance users, and high-frequency three-substance users. In general, sexual orientation identity differences in polysubstance use class membership were larger for females, especially bisexual females, than for males.

These are the findings reported in “Latent Classes of Polysubstance Use Among Adolescents in the United States: Intersections of Sexual Identity with Sex, Age, and Race/Ethnicity”, an article published in LGBT Health, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers.

The study by Robert W.S. Coulter, Deanna Ware, Jessica N. Fish, and Michael W. Plankey aimed to estimate latent classes of concurrent polysubstance use and test for sexual orientation differences in latent class memberships with representative data from adolescents (in this case, living in 19 US states). The researchers also tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships.

The researchers analyzed data from 119,437 adolescents who participated in the 2015 Youth Risk Behavior Survey. Latent class analysis characterized polysubstance use patterns based on self-reported frequency of lifetime and past-month use of alcohol (including heavy episodic drinking), tobacco (cigarettes, cigars, and smokeless tobacco), and marijuana. Multinomial logistic regression models tested differences in latent class memberships by sexual identity. Interaction terms tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships.

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A six-class model of polysubstance use fit the data best and included nonusers (61.5%), experimental users (12.2%), marijuana-alcohol users (14.8%), tobacco-alcohol users (3.8%), medium-frequency three-substance users (3.6%), and high-frequency three-substance users (4.1%). Gay/lesbian- and bisexual-identified adolescents had significantly higher odds than heterosexual-identified adolescents of being in all of the user classes compared with the nonuser class. These sexual identity differences in latent polysubstance use class memberships were generally larger for females than for males, varied occasionally by race/ethnicity, and were sometimes larger for younger ages.

“Compared with their heterosexual peers, gay/lesbian and bisexual adolescents—especially females—are at heightened risk of engaging in multiple types of polysubstance use,” the researchers concluded, recommending that “designing, implementing, and evaluating interventions will likely reduce these sexual orientation disparities.”

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