Search PubMed⌕ Search

Biomedical subjects

R Room

Publications and source records attributed to R Room.

At least 19 recordsLinked to original sources
PubMed2000

Typologies of the cultural position of drinking.

OBJECTIVE: Typologies of the cultural position of drinking from the social science literature are reviewed. METHOD: The article reviews significant studies and literature on the topic. RESULTS: Starting in the 1940s, two research traditions considered variations in the cultural position of drinking as explanations of rates of drinking problems. A "holocultural" tradition coded and analyzed ethnographic data on tribal and village societies, starting in the 1940s, with each study identifying a different social dimension as crucial. A "sociocultural" tradition distinguished abstinent cultures from prescriptive cultures, in which drinking was integrated with daily life, and expected, but drunkenness was prohibited. These types were implicitly contrasted with American drinking, which was variously characterized. Other dimensional and typological approaches in the literature are considered, including a little-known Jellinek typology. Problems with the widely used distinction between "wetter" and "drier" (or "temperance") cultures are discussed. CONCLUSIONS: Four ideal types of the cultural position of drinking can be readily distinguished: abstinent societies, constrained ritual drinking, banalized drinking and fiesta drunkenness. A large residual category remains, however, and a dimensional approach to typology building may be more fruitful. Two basic dimensions are proposed--regularity of drinking and extent of drunkenness--and further dimensions are described that may be added to fit the requirements of the particular study.

Alcohol Drinking↗
PubMed2000

Towards a global alcohol policy: alcohol, public health and the role of WHO.

In 1983 the World Health Assembly declared alcohol-related problems to be among the world's major health concerns. Since then, alcohol consumption has risen in developing countries, where it takes a heavy toll. Alcohol-related problems are at epidemic levels in the successor states of the Soviet Union and are responsible for 3.5% of disability-adjusted life years (DALYs) lost globally. Substantial evidence exists of the relationship between the levels and patterns of alcohol consumption on the one hand and the incidence of alcohol-related problems on the other. Over the past 20 years, research has demonstrated the effectiveness of public policies involving, for example, taxation and restrictions on alcohol availability, in reducing alcohol-related problems. In the wake of rapid economic globalization, many of these policies at national and subnational levels have been eroded, often with the support of international financial and development organizations. Development agencies and international trade agreements have treated alcohol as a normal commodity, overlooking the adverse consequences of its consumption on productivity and health. WHO is in a strong position to take the lead in developing a global alcohol policy aimed at reducing alcohol-related problems, providing scientific and statistical support, capacity-building, disseminating effective strategies and collaborating with other international organizations. Such leadership can play a significant part in diminishing the health and social problems associated with alcohol use.

Alcohol Drinking↗
PubMed1999

Multiple-informant ranking of the disabling effects of different health conditions in 14 countries. WHO/NIH Joint Project CAR Study Group.

BACKGROUND: The Global Burden of Disease study provided international statistics on the burden of diseases, combining mortality and disability, that can be used for priority setting and policy making. However, there are concerns about the universality of the disability weights used. We undertook a study to investigate the stability of such weighting in different countries and informant groups. METHODS: 241 key informants (health professionals, policy makers, people with disabilities, and their carers) from 14 countries were asked to rank 17 health conditions from most disabling to least disabling. Kruskal-Wallis ANOVA was used to test for differences in ranking between countries or informant groups and Kendall tau-B correlations to measure association between different rank orders. FINDINGS: For 13 of 17 health conditions, there were significant (p<0.05) differences in ranking between countries; in the comparison of informant groups, there were significant differences for five of the 17 health conditions. The overall rank order in the present study was, however, almost identical to the ranking of the Global Burden of Disease study, which used a different method. Most of the rank correlations between countries were between 0.50 and 0.70 (average 0.61 [95% CI 0.59-0.64]). The average correlation of rank orders between different informant groups was 0.76. INTERPRETATION: Rank order of disabling effects of health conditions is relatively stable across countries, informant groups, and methods. However, the differences are large enough to cast doubt on the assumption of universality of experts' judgments about disability weights. Further studies are needed because disability weights are central to the calculation of disability-adjusted life years.

Analysis of Variance↗
PubMed1999

Community effects of the opening of the Niagara casino.

AIMS: The impacts on the community of the opening of a casino in Niagara Falls are studied. DESIGN: The study uses a pre/post design for the community data, with pre/post data from Ontario as a whole as a comparison. SETTING: The study site is the city of Niagara Falls, Ontario, where a casino opened in early December, 1996. PARTICIPANTS: Using random-digit dialing, telephone interviews were conducted with adult residents of Niagara Falls in 1996 and 1997, and with adult residents of Ontario in 1995 and 1997. MEASUREMENTS: Aside from demographic variables, measures included general attitudes to gambling, expectations about (1996) and experiences with (1997) the casino's opening, extent of participation in 11 types of gambling and 18 items on problems with gambling: five key items from a standard gambling problems score (SOGS), five life-area problems items, and items on pressures from others concerning the respondent's gambling and on gambling problems among family and friends. FINDINGS: Attitudes to gambling remained stable in Niagara Falls, while there was some evidence of decline in approval in Ontario as a whole. While strong majorities of 1996 respondents had expected many positive and negative effects on The Community of the Casino's opening, Significantly fewer respondents in 1997 reported actually experiencing most of these effects. While a small increase in employment was found, it fell far below projections, a result probably reflecting displacement effects. The rate and level of casino gambling increased in Ontario, but increased even more in Niagara Falls, with little displacement of other gambling. Reported gambling problems increased significantly in Niagara Falls for two of 10 gambling problem items and for the short SOGS score, while rates were generally stable or declining in the province. Pressure from others about gambling rose significantly in Niagara Falls (in contrast to the province), and reported rates of family members or friends with gambling problems also rose substantially. There was an increasing trend in Niagara Falls for all 18 problem indicators. CONCLUSIONS: The casino's opening brought more gambling by local residents, and an increase in reported gambling problems; yet support for the casino, already strong, if anything grew. At least in the short term, problems from the increased availability of gambling manifested themselves not in the public arena but rather in the arena of private life.

Adult↗
PubMed1999

Privatizing alcohol sales and alcohol consumption: evidence and implications.

AIM: To provide an overview of recent privatization/deregulation experiences in North America and other settings, in order to draw conclusions about the impacts that might be expected from such changes on rates of alcohol consumption and related problems. METHODS: Critical review of research evidence on the effect of changes in availability, particularly changes in physical availability and economic availability that typically accompany privatization of alcohol retail monopolies. FINDINGS: Deregulation/privatization experiences commonly involve higher density of outlets, longer hours or more days of sale, changes in price, a strong orientation to commercial aspects of alcohol sales and the introduction of new vested economic interests into alcohol management arrangements in the jurisdiction. In many instances these changes in access to alcohol are accompanied by an increase in the per capita rates of consumption. In the short term changes in prices are likely to either increase or demonstrate opposite patterns for beverages with different base prices. Longer-term patterns point to a decline in real price with privatization, which very probably stimulates per capita alcohol sales. CONCLUSION: The existing evaluation literature on the subject of privatization has tended to focus on examining the net short-term results in terms of alcohol consumption levels. Overall, there are too few studies employing adequate statistical methodologies to explore the underlying causes of changing alcohol consumption and alcohol-related harm. Finally, seven specific suggestions that may assist future studies are discussed.

Alcohol Drinking↗
PubMed1999

Cross-cultural applicability in international classifications and research on alcohol dependence.

OBJECTIVE: Underlying cultural differences in the meaning of alcohol problems and dependence symptoms can lead people from different societies to systematically vary in their responses to a diagnostic interview, in ways that may be difficult for researchers to quantify or control. We identify four different ways that cultures can vary in their accounts of dependence symptoms, potentially leading to problems with the cross-cultural applicability of diagnostic criteria: (1) in terms of thresholds of symptom severity, or the point at which respondents from different societies recognize a symptom of dependence as something serious; (2) in the problematization of drinking-related states, or whether the symptoms described in official nomenclature on addiction even count as alcohol problems in all cultures; (3) in causal assumptions about how alcohol-related problems arise; and (4) in the extent to which there exist culture-specific manifestations of symptoms not adequately captured by official disease nomenclature. METHOD: Comparable data on the meaning of alcohol dependence criteria were collected from key informants in nine sites worldwide under the auspices of the WHO/NIH Cross-Cultural Applicability Research Project. Qualitative analysis compares and contrasts descriptions of ICD-10 dependence criteria across sites along the above four dimensions of cultural variation. RESULTS: While descriptions of dependence symptoms were quite similar among key informants from sites that share norms around drinking and drunkenness, they varied significantly in comparisons between sites with markedly different drinking cultures. Contrary to expectation, descriptions of physical dependence criteria appeared to vary across sites as much as the more subjective symptoms of psychological dependence. CONCLUSIONS: Problems with the cultural applicability of international nomenclature warrant careful consideration in future comparative research on addiction, although comparisons of dependence made across some cultural boundaries are likely to be much more problematic than comparisons made across others. Findings on dependence should be interpreted in light of what is known about the drinking cultures and norms of the societies involved. Future nosologies and diagnostic interview schedules should take into account a broad base of cultural experiences in conceptualizing alcohol dependence, in developing criteria and operationalizations and in determining the diagnostic significance of these.

Adolescent↗
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↗
PubMed1999

The rhetoric of international drug control.

The Commission on Narcotics Drugs, a United Nations political organ, meets every year in Vienna. Country statements from the Commission's general debate in 1994 and 1995 are analyzed in terms of their rhetorical framing. The dominant frame is of drugs as a scourge or menace against which a war must be waged. There is consensus that the war is being lost. International cooperation and solidarity are proposed as what will turn the tide; in the context of a losing battle, calls for decriminalization are seen as an unacceptable surrender. Fairly uniformly, this rhetorical framing is put forward by a majority of countries, and no clear alternative framing is presented. Historical resonances of the framing and possible future developments are considered.

Global Health↗
PubMed1998

Implications of privatizing/deregulating alcohol retail sales: projections of alcohol consumption in Ontario.

PURPOSE: To project the consequences of privatizing or deregulating current alcohol retail monopolies in Ontario, Canada. METHODS: The projection is based on a multiplicative model and applied to estimate per capita alcohol consumption for four hypothetical scenarios, including both partial and complete privatization for the Province of Ontario, Canada. Those scenarios are mainly focused on the two dimensions of changes affected by privatization: alcohol physical availability and economic availability (i.e., retail prices). Various assumptions involving availability and prices are largely based on the Canadian and international research literature on deregulation/privatization. RESULTS AND IMPLICATIONS: The study showed that per capita alcohol consumption in the short/medium term is expected to increase in all four hypothetical scenarios examined, with the magnitude ranging from 11% to 27%. The sensitivity analysis also revealed a similar increase in alcohol consumption, even though the magnitude of the increase would be less for some scenarios. Therefore, any deliberations on modifying alcohol control policies are well advised to proceed with caution, since an increase in alcohol consumption is likely to be associated with elevated levels of drinking-related problems.

Adult↗
PubMed1998

Alcohol and aggression: general population views about causation and responsibility.

The purpose of this paper is to explore the public's perceptions about alcohol as a causal agent in aggressive behavior, and to assess how these beliefs are associated with notions of responsibility and the excuse-function of alcohol. In a 1995 probability survey, 994 adults across Ontario (50.3% female; mean age = 41.5, SD = 5.9) were asked questions about: alcohol-aggression expectancies; alcohol as an excuse; responsibility; personal drinking behavior; alcohol-aggression victimization; and demographics. Descriptive and regression analyses were conducted. Over three-quarters of respondents believed that alcohol is associated with aggression, with females, older respondents, those with less education, and those who do not drink heavily more likely to hold this view. A majority (92%) believed that an intoxicated person is responsible for any behavior, with very little subgroup variation. Analyses showed that the perception of alcohol as a causal agent was not associated with decreased personal responsibility attributions. In fact, the stronger the belief in the alcohol-aggression link, the more likely one was to hold the view that an intoxicated person is responsible for behavior. Beliefs that alcohol causes violence do not translate into the acceptance of intoxication as an excuse. Reasons as to why intoxication does not alleviate responsibility for the drunken actor--a result inconsistent with attribution theory--are discussed. The consistency of these results with the "New Temperance" movement in the United States is also discussed.

Adult↗
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

Alcohol and the U.S.-Canada border: trade disputes and border traffic problems.

The public health interest in trade and in cross-border traffic of alcoholic beverages is considered in general terms. Within this framework, three specific issues in U.S.-Canada trade and borders are discussed: cross-border drinking and driving in both directions, particularly by youth; smuggling from the U.S. to Canada; and the "beer wars" and other U.S.-Canada trade disputes involving alcoholic beverages. While problems can be alleviated on each of these fronts, it is concluded that an important step internationally would be to establish that, because of the problems they entail, alcoholic beverages should be exempt from trade agreements, or else provision should be made for the public health interest to be represented in negotiations and dispute resolution involving alcoholic beverage controls.

Alcoholic Beverages↗
PubMed1997

WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results.

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments in an international study which has taken place in centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, kappa) were very good for dependence disorders (0.7-0.9), but were somewhat lower for the abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.

Adult↗