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Biomedical subjects

E Single

Publications and source records attributed to E Single.

At least 19 recordsLinked to original sources
PubMed2000

The relative risks and etiologic fractions of different causes of death and disease attributable to alcohol, tobacco and illicit drug use in Canada.

BACKGROUND: In 1996 the number of deaths and admissions to hospital in Canada that could be attributed to the use of alcohol, tobacco and illicit drugs were estimated from 1992 data. In this paper we update these estimates to the year 1995. METHODS: On the basis of pooled estimates of relative risk, etiologic fractions were calculated by age, sex and province for 90 causes of disease or death attributable to alcohol, tobacco or illicit drugs; the etiologic fractions were then applied to national mortality and morbidity data for 1995 to estimate the number of deaths and admissions to hospital attributable to substance abuse. RESULTS: In 1995, 6507 deaths and 82,014 admissions to hospital were attributed to alcohol, 34,728 deaths and 194,072 admissions to hospital were attributed to tobacco, and 805 deaths and 6940 admissions to hospital were due to illicit drugs. INTERPRETATION: The use and misuse of alcohol, tobacco and illicit drugs accounted for 20.0% of deaths, 22.2% of years of potential life lost and 9.4% of admissions to hospital in Canada in 1995.

Alcohol Drinking↗
PubMed2000

The impact of cannabis decriminalisation in Australia and the United States.

This paper summarises and compares the impacts of cannabis decriminalisation measures in two countries. In Australia, an expiation model of decriminalisation succeeded in avoiding the imposition of criminal convictions for many offenders, but substantial numbers of offenders received criminal convictions because of a general "net-widening" in cannabis offence detections, and the failure of many offenders to pay expiation fees and thus avoid criminal prosecution. Despite these problems, the expiation approach has been cost-effective, reducing enforcement costs without leading to increased cannabis use. In the United States, cannabis decriminalisation similarly reduced enforcement costs, with enforcement resources generally redirected toward trafficking and other illicit drugs. There were no increases in cannabis use or substantial problems that could be ascribed to decriminalisation. The implications for other countries are discussed, with particular attention to the importance of implementation issues, monitoring, and evaluation. Although decriminalisation has succeeded in reducing enforcement and other costs without increasing the problems associated with cannabis use, the same impacts would not necessarily result from the legalisation of cannabis or the decriminalisation of other illicit drugs.

Adult↗
PubMed1999

The economic consequences of smoking in Ontario.

Smoking causes health and social problems such as sickness, death, fire, injury, pain and suffering. This paper provides an estimate of the economic burden imposed by the adverse health and social consequences of smoking in Ontario in 1992. The cost-of-illness method, in particular, the human-capital approach is used to estimate the prevalence-based economic costs of smoking. The direct and indirect components of smoking-related costs are estimated and the total cost in Ontario is US$2.91 billion. Associated with these economic costs are health-related harms: 69,318 hospital separations; 1,007,647 days stay in hospitals; 11,648 deaths resulting in more than 171,443 person-years lost.

Adolescent↗
PubMed1999

Assessment methods for alcohol consumption, prevalence of high risk drinking and harm: a sensitivity analysis.

BACKGROUND: There are no standardized ways to assess alcohol consumption in epidemiological studies. The main objective of the present study was to compare three widely used methods for assessing alcohol consumption with respect to resulting prevalence estimates for high risk drinking and harm as defined by morbidity and mortality indicators. METHODS: A within-subjects design was used to compare a quantity frequency, a graduated frequency, and a weekly drinking recall measure. Data consisted of a representative sample of 3961 adult residents of the province of Ontario, Canada, who participated in a multi-wave cross-sectional survey between 1990-1994. Cross-tabulation, Spearman correlation, and standard methodologies for prevalence-based cost-of-illness studies were used. RESULTS: The graduated frequency measure consistently yielded higher estimates of the prevalences of high risk drinking and harm. Differences were marked on all indicators, but were most pronounced for harmful drinking as defined by consuming an average of >60 g pure alcohol per day for males, and >40 g per day for females. Prevalence estimates of harmful drinking were almost five times higher for graduated frequency versus weekly drinking measures, and almost three times higher for graduated frequency versus quantity frequency measures. CONCLUSIONS: The characteristics of different measures of alcohol consumption should be considered in future research in epidemiology.

Adult↗
PubMed1999

Morbidity and mortality attributable to alcohol, tobacco, and illicit drug use in Canada.

OBJECTIVES: This study estimated morbidity and mortality attributable to substance abuse in Canada. METHODS: Pooled estimates of relative risk were used to calculate etiologic fractions by age, gender, and province for 91 causes of disease or death attributable to alcohol, tobacco, or illicit drugs. RESULTS: There were 33,498 deaths and 208,095 hospitalizations attributed to tobacco, 6701 deaths and 86,076 hospitalizations due to alcohol, and 732 deaths and 7095 hospitalizations due to illicit drugs in 1992. CONCLUSIONS: Substance abuse exacts a considerable toll on Canadian society in terms of morbidity and mortality, accounting for 21% of deaths, 23% of years of potential life lost, and 8% of hospitalizations.

Adult↗
PubMed1999

Harm reduction: concepts and practice. A policy discussion paper.

This paper provides an overview of the context, definition, and key features of the harm reduction approach, and provides several examples of current programs in various countries. Both licit and illicit drugs are included in these illustrations. Some of the critical issues, and the strategies needed to advance harm reduction, are discussed. [Translations are provided in the International Abstracts Section of this issue.]

Canada↗
PubMed1998

The economic costs of illicit drug use in Ontario, 1992.

The use of illicit drugs causes health and social problems which imply economic costs to society. This paper uses the cost-of-illness method, in particular, the human-capital approach to estimate the prevalence-based economic costs of illicit drug use in Ontario in 1992. This methodology is consistent with international guidelines formulated at the 1994 International Symposium on Economic and Social Costs of Substance Abuse. The economic cost of illicit drug use is estimated at $489.29 million (Canadian dollars) in 1992. Associated with these costs are health-related harms: 211 deaths, half of which occur before the age of 35; and 20 690 days stay in public hospitals.

Cost of Illness↗
PubMed1998

The economic costs of alcohol abuse in Ontario.

The abuse of alcohol causes health and social problems, such as sickness, death, injury, pain, suffering and crime. These harms impose an economic burden on society. Resources are used or foregone as a consequence of alcohol abuse. This article provides an estimate of the economic cost of alcohol abuse in Ontario in 1992. It uses the cost-of-illness method, in particular, the human-capital approach to estimate the prevalence-based economic costs of alcohol abuse. This methodology is consistent with international guidelines formulated at the 1994 International Symposium on Economic and Social Costs of Substance Abuse. The direct and indirect economic costs of alcohol abuse are identified and estimated. The total economic cost of alcohol abuse, from a societal perspective, is estimated to be US$2261.10 million in Ontario in 1992.

Alcoholism↗
PubMed1998

Current directions in research on understanding and preventing intoxicated aggression.

The present paper describes promising research directions that emerged from a recent international conference on intoxication and aggression and from the scientific literature generally. In this overview, intoxicated aggression is seen as arising from an interactional process involving multiple contributing factors or causes. This model helps to define research directions that can further understanding and prevention. First, the societal/cultural framing of intoxication and aggression exerts a powerful influence on drinking behaviour and needs to be better understood. Another important area for research is the moderating role on alcohol-related aggression of personal factors such as predisposition to aggression and individual differences in expectations about alcohol and aggression. Research on the role of basic pharmacological effects of alcohol in increasing the likelihood of aggressive behaviour is also a critical aspect of understanding intoxicated aggression. Drinking contexts and environments play a considerable role in the relationship between intoxication and aggressive behaviour and need to be better understood. Another critical direction for future research is the study of intoxicated aggression as a process involving the interaction of the person, the situation and the effects of alcohol in natural and experimental settings. Finally, the paper highlights promising directions for research on interventions to prevent intoxicated aggression and violence.

Aggression↗
PubMed1998

The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992.

UNLABELLED: AIMS, DESIGN AND SETTING: The economic costs of alcohol, tobacco and illicit drugs in Canadian society in 1992 are estimated utilizing a cost-of-illness framework and recently developed international guidelines. MEASUREMENTS: For causes of disease or death (using ICD-9 categories), pooled relative risk estimates from meta-analyses are combined with prevalence data by age, gender and province to derive the proportion attributable to alcohol, tobacco and/or illicit drugs. The resulting estimates of attributable deaths and hospitalizations are used to calculate associated health care, law enforcement, productivity and other costs. The results are compared wit other studies, and sensitivity analyses are conducted on alternative measures of alcohol consumption, alternative discount rates for productivity costs and the use of diagnostic-specific hospitalization costs. FINDINGS: The misuse of alcohol, tobacco and illicit drugs cost more than $18.4 billion in Canada in 1992, representing $649 per capita or 2.7% of GDP. Alcohol accounts for approximately $7.52 billion in costs, including $4.14 billion for lost productivity, $1.36 billion for law enforcement and $1.30 billion in direct health care costs. Tobacco accounts for approximately $9.56 billion in costs, including $6.82 billion for lost productivity and $2.68 billion for direct health costs. The economic of illicit drugs are estimated at $1.4 billion. CONCLUSIONS: Substance abuse exacts a considerable toll to Canadian society in terms of illness, injury, death and economic costs.

Alcohol Drinking↗
PubMed1997

Alcohol disorders in Canada as indicated by the CAGE questionnaire.

OBJECTIVE: To describe alcohol disorders in the general Canadian population, using as a standard indicator the CAGE questionnaire (Have you felt you needed to cut down on your drinking? Have you felt annoyed by criticism of your drinking? Have you felt guilty about drinking? Have you felt you needed a drink first thing in the morning [eye-opener]?). DESIGN: Secondary analysis of data from Canada's Alcohol and Other Drugs Survey (CADS), a national telephone survey conducted in 1994 of a representative sample of 12,155 people aged 15 years or more. PARTICIPANTS: The CAGE questionnaire was administered to 5894 drinkers who had consumed alcohol in the 12 months before the CADS survey. MAIN OUTCOME MEASURES: Respondents with positive (2 or more affirmative responses) and negative results on the CAGE questionnaire were compared as to demographic characteristics, alcohol consumption and harmful consequences of their drinking. Independent predictors of a positive result were identified by means of logistic regression analysis. RESULTS: A total of 5.8% of CAGE-tested current drinkers had a positive result on the past-year CAGE in 1994. The proportion of respondents reporting alcohol-related problems in one or more areas of their life was 7 times greater among drinkers with a positive result on the CAGE questionnaire than among those with a negative result (66.8% v. 9.5%) (p < 0.0001). When all demographic characteristics were controlled for simultaneously, male sex, residence in the Atlantic provinces, Quebec or the Prairies, single/never married or divorced/separated marital status, and low education level were found to be independent risk factors for a positive result on the CAGE questionnaire. About 85% of the respondents with a positive result had not sought help for their drinking. Applying the estimated sensitivity and specificity of the CAGE questionnaire in detecting alcohol dependence, as per criteria of the Diagnostic and Statistical Manual, in a general US population, the authors estimated that 4.1% of Canadians had an alcohol dependence in 1994. CONCLUSION: The large proportion of current drinkers with a positive result on the CAGE questionnaire who did not seek help for their drinking underscores the need for identification and brief interventions by physicians. Further research is needed to elucidate the underlying reasons for regional differences in CAGE status.

Adolescent↗
PubMed1997

Moderate drinking and health. Implications of recent evidence.

OBJECTIVE: To address three questions (Is moderate drinking good for health? Should people drink to prevent heart disease? What is moderate drinking?) and to examine and compare two recent Canadian guidelines on low-risk drinking in the context of counseling patients. DATA SOURCES: English-language data sources were searched, particularly peer-reviewed health and social science literature and recent expert reports. STUDY SELECTION: Studies and reports were selected for their scientific merit and direct relevance to the three questions addressed and to the formulation of guidelines on low-risk drinking. SYNTHESIS: While moderate drinking might protect some older people against coronary heart disease, it is associated with increased risk of hemorrhagic stroke, certain cancers, accidents and injuries, and a range of social problems. For most health outcomes, risk increases as consumption of alcohol increases. CONCLUSIONS: While the data have limitations, they provide a basis for formulating guidelines on low-risk drinking. The two Canadian guidelines, one developed from the perspective of health recovery, the other from the perspective of health promotion, complement each other in the context of counseling patients.

Accidents↗
PubMed1997

Estimating the economic costs of the abuse of tobacco, alcohol and illicit drugs: a review of methodologies and Canadian data sources.

The study of economic costs of substance abuse, namely, abuse of tobacco, alcohol and illicit drugs, can provide important information for setting good public health policies. This review paper provides a list of previous cost studies of substance abuse, compares the cost categories considered by various methodologies and describes an inventory of data sources for obtaining relevant information for cost studies. Investigators will find this paper useful as an introduction to the literature in this area, for designing a list of cost categories to consider in a particular study and for identifying relevant data sources.

Alcoholism↗
PubMed1996

On the emerging paradigm of drinking patterns and their social and health consequences.

Recent epidemiological and social studies have increasingly pointed to the importance of drinking patterns in explaining consequences of alcohol consumption. This paper presents recommendations for research in the area based on the presentations and discussions of the first "International Conference on Social and Health Effects of Different Drinking Patterns" held in Toronto in November 1995. In particular, the social dimension in pattern research, and the relationship between patterns of drinking and casualties as well as social harm, are stressed. The paper also argues for better theories, incorporating knowledge from related basic disciplines. In addition, we emphasize the need for improved methodologies and standardized methods for assessing drinking patterns. Finally, implications of research on drinking patterns for policy and programme development are discussed.

Alcohol Drinking↗
PubMed1995

Defining harm reduction.

Harm reduction attempts to reduce the adverse consequences of drug use among persons who continue to use drugs. It developed in response to the excesses of a "zero tolerance approach". Harm reduction emphasizes practical rather than idealized goals. It has been expanded from illicit drugs to legal drugs and is grounded in the evolving public health and advocacy movements. Harm reduction has proved to be effective and it has gained increasing official acceptance; for example, it is now the basis of Canada's Drug Strategy. However, the concept is still poorly defined, as virtually any drug policy or programme, even abstinence-oriented programmes, attempt to reduce drug-related harm. The principle feature of harm reduction is the acceptance of the fact that some drug users cannot be expected to cease their drug use at the present time. Harm reduction is neutral about the long term goals of intervention while according a high priority to short-term realizable goals. Harm reduction should be neutral about legalization. The essence of the concept is to ameliorate adverse consequences of drug use while, at least in the short term, drug use continues.

Journal Article↗