Low risk drinking guidelines in Europe: overview of RARHA ... WP5_T1... · Low risk drinking...
Transcript of Low risk drinking guidelines in Europe: overview of RARHA ... WP5_T1... · Low risk drinking...
Low risk drinking guidelines in Europe:
overview of RARHA survey results
E. Scafato, L. Galluzzo, S. Ghirini, C. Gandin, S. Martire Istituto Superiore di Sanità, Italy
ISS Work Group and
RARHA Italian National Team
WP5: Outline of the work (tasks)
1. Overview of drinking guidelines given in MS and of 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 Alcohol 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 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 ISS) to discuss preliminary
results and conclusions from the overviews and to help develop a policy Delphi 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: overview of RARHA survey results
ISS Data collection The questionnaire has been submitted by email (July 2014) to the country
representatives of the Committee on National Alcohol Policy and Action - CNAPA as experts with qualified experience and competence on the specific topic
Participants were asked to:
check the validity of the information derived from a preliminary ISS review of sources of information on low risk drinking guidelines (“review of available sources”)
provide the most updated and reliable information for their Country (“RARHA survey”)
Detailed instructions to fill in the Country report/Questionnaire, standardizing the data collection, were provided
The present version of this overview has been amended (May 2016) with all corrections suggested by respondents to the 2014 survey. Data on guidelines/recommendations issued after the data collection were not included.
Low risk drinking guidelines in Europe: overview of RARHA survey results
The RARHA survey questionnaire
5
The four different sources of available information has been adapted/harmonized in order to include into a comprehensive category the different wordings of the variables (i.e. limits, recommendations, guidelines,
guidance have been considered all together).
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)
Low risk drinking guidelines in Europe: overview of RARHA survey results
PARTICIPATION
31 European countries addressed (all RARHA associated and collaborating countries + 1 additional country*).
30 out of 31 European countries replied (Austria, Belgium, Bulgaria, 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).
Slovakia did not reply
Low risk drinking guidelines in Europe: overview of RARHA survey results
7 Low risk drinking guidelines in Europe: results from RARHA survey
Standard Drink definition and use in EU countries
Low risk drinking guidelines in Europe: overview of RARHA survey results
Standard Drink in EU countries, in grams of pure alcohol
Low risk drinking guidelines in Europe: overview of RARHA survey results
9 Low risk drinking guidelines in Europe: results from RARHA survey
Standard Drink in grams of pure alcohol
RARHA
RARHA survey
SD in grams of pure
alcohol:
19
2 91
19
2 101
30
21
21 7
0
31Y
es
No
mis
sing
dat
a
Coun
try
not
inve
stig
ated Ye
s
No
mis
sing
dat
a
Coun
try
not
inve
stig
ated Ye
s
No
mis
sing
dat
a
Coun
try
not
inve
stig
ated Ye
s
No
mis
sing
dat
a
Coun
try
not
inve
stig
ated
Review WHO 2012 WHO 2013 OECD 2014
no
. o
f C
ou
ntr
ies
Mean=11 Median=11
Mode=10
29
11
Yes No Country not investigated
8
10
12
14
16
18
20
AU
STR
IA (
20
)
CR
OA
TIA
(10
)
CZE
CH
REP
UB
LIC
(1
6)
DEN
MA
RK
(1
2)
ESTO
NIA
(1
0)
FIN
LAN
D (
12
)
FRA
NC
E (1
0)
GER
MA
NY
(10
; 1
2)
GR
EEC
E (1
0; 1
6)
HU
NG
AR
Y (1
2; 1
4)
ICEL
AN
D (
8 ;
12
)
IREL
AN
D (
10
)
ITA
LY (
12
)
LATV
IA (1
2)
LITH
UA
NIA
(1
0)
LUX
EMB
OU
RG
(1
2)
MA
LTA
(8; 1
0)
NET
HER
LAN
DS
(TH
E) (
10
)
NO
RW
AY
(12
; 15
)
PO
LAN
D (1
0)
PO
RTU
GA
L (1
0)
RO
MA
NIA
(1
2)
SLO
VEN
IA (
10
)
SPA
IN (
10
)
SWED
EN (
12
)
SWIT
ZER
LAN
D (
10
; 12
)
UN
ITED
KIN
GD
OM
(8
)
Low risk drinking guidelines in Europe: overview of RARHA survey results
10 Low risk drinking guidelines in Europe: results from RARHA survey
Standard Drink current use in EU countries
57 6
41
11
21
1119
1
1
1
5
14
261
0
31
WHO 2012 RARHA WHO 2012 RARHA WHO 2012 RARHA
SD, In advice (brief interv.) provided by health care
professionals
SD, In public education messages
SD, On alcoholic bev packages to indicate the alcoholic
content
no
. of
Co
un
trie
s
To a large extent To some extent Not at all Do not know
Low risk drinking guidelines in Europe: overview of RARHA survey results
11 Low risk drinking guidelines in Europe: results from RARHA survey
Low Risk Guidelines (GL)/Recommendations (R)
Low risk drinking guidelines in Europe: overview of RARHA survey results
12 Low risk drinking guidelines in Europe: results from RARHA survey
Low Risk Guidelines/Recommendations in EU
RARHA
Latest revision
(year)
1994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018
AU
STR
IA
BEL
GIU
M
BU
LGA
RIA
CR
OA
TIA
CYP
RU
S
CZE
CH
REP
UB
LIC
DEN
MA
RK
ESTO
NIA
FIN
LAN
D
FRA
NC
E
GER
MA
NY
GR
EEC
E
HU
NG
AR
Y
ICEL
AN
D
IREL
AN
D
ITA
LY
LATV
IA
LITH
UA
NIA
LUX
EMB
OU
RG
MA
LTA
NET
HER
LAN
DS
(TH
E)
NO
RW
AY
PO
LAN
D
PO
RTU
GA
L
RO
MA
NIA
SLO
VA
KIA
SLO
VEN
IA
SPA
IN
SWED
EN
SWIT
ZER
LAN
D
UN
ITED
KIN
GD
OM
Latest revision Revision planned for
20
10
1
12
8
1
107
24
20
31
7
0
31Ye
s
No
mis
sin
g d
ata
Co
un
try
no
t
inve
stig
ate
d
Yes
No
mis
sin
g d
ata
Co
un
try
no
t in
vest
igat
ed
Ye
s
No
mis
sin
g d
ata
Co
un
try
no
t
inve
stig
ate
d
Yes
No
mis
sin
g d
ata
Co
un
try
no
t
inve
stig
ate
d
Review WHO 2012 WHO 2013 OECD 2014
no
. of C
ou
ntr
ies
Low risk drinking guidelines in Europe: overview of RARHA survey results
21
6
3
1
Yes No missing data Country not investigated
*
* Hungary and Lithuania have recommended limits
13 Low risk drinking guidelines in Europe: results from RARHA survey
Weekly Low Risk Guidelines/Recommendations (in g)
Low risk drinking guidelines in Europe: overview of RARHA survey results
14 Low risk drinking guidelines in Europe: results from RARHA survey
Daily Low Risk Guidelines/Recommendations (in g)
Low risk drinking guidelines in Europe: overview of RARHA survey results
15 Low risk drinking guidelines in Europe: results from RARHA survey
RARHA Low Risk Guidelines/Recommendations availability
16
613
5
Guidelines (GL) Recommendations (R) Not investigated Countries Missing data No GL or R
95 2
Day D+W Week
Guidelines
2 4
Day D+W Week
Recommendations
Low risk drinking guidelines in Europe: overview of RARHA survey results
16 Low risk drinking guidelines in Europe: results from RARHA survey
RARHA Low Risk Guidelines/Recommendations limits D
ail
y a
lco
ho
l in
take
ave
rag
e n
ot
to b
e e
xce
ed
ed
(g
ram
s o
f p
ure
alc
oh
ol)
05
101520253035404550
AU
STR
IA (2
4)
BEL
GIU
M
BU
LGA
RIA
CRO
ATI
A (2
0)
CYP
RU
S
CZ
EC
H R
EP
UB
LIC
(40
)
DEN
MA
RK
(24)
ESTO
NIA
(40)
FIN
LAN
D (2
0)
FRA
NCE
(30)
GER
MA
NY
(24)
GR
EEC
E (3
0-4
8)
HU
NG
AR
Y (2
4-4
8)
ICEL
AN
D
IREL
AN
D
ITA
LY (2
4)
LATV
IA
LITH
UA
NIA
(30
-40
)
LUX
EM
BO
UR
G (
24
)
MA
LTA
(36)
NET
HER
LAN
DS
(TH
E) (2
0)
NO
RW
AY
PO
LAN
D (
40
)
PO
RTU
GA
L (2
0)
RO
MA
NIA
SLO
VA
KIA
SLO
VEN
IA (2
0)
SP
AIN
(4
0)
SW
ED
EN
SW
ITZ
ER
LAN
D (
20
-3
6)
UN
ITED
KIN
GD
OM
(24
-32)
Men
05
101520253035404550
AU
STR
IA (1
6)
BEL
GIU
M
BU
LGA
RIA
CRO
ATI
A (1
0)
CY
PR
US
CZEC
H R
EPU
BLI
C (2
0)
DEN
MA
RK
(12)
ESTO
NIA
(20)
FIN
LAN
D (1
0)
FR
AN
CE
(2
0)
GE
RM
AN
Y (
12
)
GR
EECE
(20
-32)
HU
NG
AR
Y (1
8-2
1)
ICEL
AN
D
IREL
AN
D
ITA
LY (1
2)
LATV
IA
LITH
UA
NIA
(20
-30)
LUXE
MB
OU
RG
(12)
MA
LTA
(27)
NET
HER
LAN
DS
(TH
E) (1
0)
NO
RW
AY
PO
LAN
D (
20
)
POR
TUG
AL
(10)
RO
MA
NIA
SLO
VA
KIA
SLO
VE
NIA
(1
0)
SP
AIN
(2
0 -
25
)
SW
ED
EN
SWIT
ZER
LAN
D (1
0 -2
4 )
UN
ITED
KIN
GD
OM
(16
-24)
Women
Low risk drinking guidelines in Europe: overview of RARHA survey results
17 Low risk drinking guidelines in Europe: results from RARHA survey
RARHA Daily alcohol intake not to be exceeded (g pure alcohol)
Low risk drinking guidelines in Europe: overview of RARHA survey results
18 Low risk drinking guidelines in Europe: results from RARHA survey
Binge Drinking definitions
Low risk drinking guidelines in Europe: overview of RARHA survey results
11
9
10
1
Guidelines Recommendations No GL/R Not investigated
19 Low risk drinking guidelines in Europe: results from RARHA survey
RARHA availability of Guidelines/Recommendations for Binge Drinking
4
6
14 3 2
By
gen
de
r
By
all
con
sum
ers
Bo
th
Low risk drinking guidelines in Europe: overview of RARHA survey results
20 Low risk drinking guidelines in Europe: results from RARHA survey
RARHA Binge Drinking Maximum intake per drinking occasion (g pure alcohol)
0
10
20
30
40
50
60
70
80
90
AU
STR
IA
BE
LGIU
M
BU
LGA
RIA
CRO
ATI
A
CYPR
US
CZ
EC
H R
EP
UB
LIC
DEN
MA
RK
(60)
ESTO
NIA
FIN
LAN
D (8
4)
FRA
NCE
GER
MA
NY
GR
EE
CE
HU
NG
AR
Y
ICEL
AN
D
IREL
AN
D
ITA
LY
LAT
VIA
(60
)
LITH
UA
NIA
(60
-80)
LUXE
MB
OU
RG
(60)
MA
LTA
NE
TH
ER
LAN
DS
(T
HE
)
NO
RW
AY
POLA
ND
(60)
POR
TUG
AL
(60)
RO
MA
NIA
SLO
VA
KIA
SLO
VEN
IA (
50)
SP
AIN
(60
)
SWED
EN
SWIT
ZER
LAN
D (4
0-4
8)
UN
ITED
KIN
GD
OM
(64)
Men
0
10
20
30
40
50
60
70
80
90
AU
STR
IA
BEL
GIU
M
BU
LGA
RIA
CRO
ATI
A
CYPR
US
CZEC
H R
EPU
BLI
C
DEN
MA
RK
(60)
ESTO
NIA
FIN
LAN
D (6
0)
FRA
NCE
GER
MA
NY
GR
EECE
HU
NG
AR
Y
ICEL
AN
D
IREL
AN
D
ITA
LY
LATV
IA (
40)
LITH
UA
NIA
(40-
80
)
LUXE
MB
OU
RG
(60)
MA
LTA
NET
HER
LAN
DS
(TH
E)
NO
RW
AY
POLA
ND
(40)
POR
TUG
AL
(50)
RO
MA
NIA
SLO
VA
KIA
SLO
VE
NIA
(3
0)
SPA
IN (4
0)
SWED
EN
SWIT
ZER
LAN
D (3
0-3
6)
UN
ITED
KIN
GD
OM
(48
)
Women
0
10
20
30
40
50
60
70
80
90
AU
STR
IA
BEL
GIU
M
BU
LGA
RIA
CRO
ATI
A
CYPR
US
CZEC
H R
EPU
BLI
C (8
0)
DE
NM
AR
K
ESTO
NIA
FIN
LAN
D (6
0-7
2)
FRA
NCE
(40)
GER
MA
NY
(50
)
GR
EECE
(4 S
U)
HU
NG
AR
Y (7
2-8
4)
ICEL
AN
D
IREL
AN
D (6
0)
ITA
LY (7
2)
LATV
IA (
60)
LITH
UA
NIA
LUXE
MB
OU
RG
(60)
MA
LTA
(36)
NET
HER
LAN
DS
(TH
E)
NO
RW
AY
PO
LAN
D
POR
TUG
AL
RO
MA
NIA
(72)
SLO
VA
KIA
SLO
VEN
IA
SPA
IN
SWED
EN
SWIT
ZER
LAN
D
UN
ITED
KIN
GD
OM
All consumers
Low risk drinking guidelines in Europe: overview of RARHA survey results
10
12
14
16
18
20
22
24
AU
ST
RIA
BEL
GIU
M
BU
LGA
RIA
CR
OA
TIA
(18
)
CY
PR
US
CZ
EC
H R
EP
UB
LIC
DEN
MA
RK
(16)
ESTO
NIA
(18
)
FIN
LAN
D
FR
AN
CE
GER
MA
NY
GR
EECE
HU
NG
AR
Y
ICEL
AN
D
IREL
AN
D
ITA
LY (1
8)
LATV
IA
LITH
UA
NIA
LUX
EM
BO
UR
G (1
6-1
8)
MA
LTA
NET
HER
LAN
DS
(TH
E) (1
8)
NO
RW
AY
POLA
ND
(18)
POR
TUG
AL
(10
-24
)
RO
MA
NIA
SLO
VA
KIA
SLO
VEN
IA (
18)
SPA
IN (
16
)
SWED
EN (1
8-2
0 )
SWIT
ZER
LAN
D
UN
ITE
D K
ING
DO
M (
15
)
Age
(yrs
)
21 Low risk drinking guidelines in Europe: results from RARHA survey
Availability of Guidelines/Recommendations for Young People
6
10
510 12
19
1514
1 1
0
31
Yes
No
mis
sing
dat
a
Coun
try
not
inve
stig
ated Ye
s
No
mis
sing
dat
a
Coun
try
not
inve
stig
ated Ye
s
No
mis
sing
dat
a
Coun
try
not
inve
stig
ated
WHO 2012 WHO 2013 RARHA
no
. o
f C
ou
ntr
ies
WHO 2012 WHO 2013 RARHA
Low risk drinking guidelines in Europe: overview of RARHA survey results
22 Low risk drinking guidelines in Europe: results from RARHA survey
Availability of Guidelines/Recommendations for Older People
7
21
21
Yes No missing data Country not investigated
RARHA
214
5
10
Yes No missing data Country not investigated
WHO 2012
Low risk drinking guidelines in Europe: overview of RARHA survey results
255
1
Yes No Country not investigated
RARHA
23 Low risk drinking guidelines in Europe: results from RARHA survey
Availability of Guidelines/Recommendations for Pregnancy/Breastfeeding
8
0
22
1 7 7 710
7
0
24
0
31
Yes
No
mis
sing
dat
a
Coun
try
not
inve
stig
ated Ye
s
No
mis
sing
dat
a
Coun
try
not
inve
stig
ated Ye
s
No
mis
sing
dat
a
Coun
try
not
inve
stig
ated
Review WHO 2012 WHO 2013
no
. of C
ou
ntr
ies
WHO 2012 WHO 2013REVIEW
Low risk drinking guidelines in Europe: overview of RARHA survey results
24
Alcohol in other guidelines
25
Drink driving limits in EU countries
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
AU
STR
IA
BEL
GIU
M
BU
LGA
RIA
CR
OA
TIA
CYP
RU
S
CZE
CH
REP
DEN
MA
RK
ESTO
NIA
FIN
LAN
D
FRA
NC
E
GER
MA
NY
GR
EEC
E
HU
NG
AR
Y
ICEL
AN
D
IREL
AN
D
ITA
LY
LATV
IA
LITH
UA
NIA
LUX
EMB
OU
RG
MA
LTA
NET
HER
LAN
DS
NO
RW
AY
PO
LAN
D
PO
RTU
GA
L
RO
MA
NIA
SLO
VEN
IA
SPA
IN
SWED
EN
SWIT
ZER
LAN
D
UN
ITED
KIN
GD
OM
Nat
ion
al m
axim
um
BA
C l
eve
ls (
g/lit
re)
General population Young/novice drivers Professional/ commercial drivers
Low risk drinking guidelines in Europe: overview of RARHA survey results
26
Conclusions (1/2)
Standard Drink (SD): • SD limits expressed in cl or ml seem to be not used (or at least not reported) • Grams of pure alcohol is the prevalent measure adopted by countries • Relevant variability in values among countries (Mode=10) but convergence towards
an average of 11 grams (Mean=Median=11)
Low Risk Guidelines or Recommendations: • Prevalent use of daily low risk GL/R (in g) instead of weekly • Low Risk GL/R are usually gender oriented
Binge drinking Guidelines or Recommendations: • Binge drinking GL/R are usually not gender oriented • Relevant variability in values among countries
Target groups: • Young people: 15/31 countries have GL/R addressed to subjects aged 16-18 • Old people: only 7/31 countries have GL/R addressed to subjects aged 65+ • Pregnant women/Breastfeeding: 25/31 countries have GL/R on this issue, which is
the most considered all over EU (number of countries increased from previous available sources).
Low risk drinking guidelines in Europe: overview of RARHA survey results
27
Conclusions (2/2)
Other guidelines:
• Alcohol in GL/R for Physical activity: only in Lithuania and Slovenia
• Alcohol in GL/R for Nutrition: the number of countries (17/31) has more than doubled in comparison with previous available sources.
• Separate GL/R for alcohol and Workplace: the number of countries (14/31) increased in comparison with previous available sources.
Drink driving:
According to WHO 2013, all investigated countries have specific limits
• General population: mode=0.5 [0.0-0.8]; no changes over time
• Young/novice drivers: mode=0.2 [0.0-0.8]; reduction for Portugal and Switzerland
• Professional/ commercial drivers: mode=0.2 [0.0-0.8]; reduction for France, Latvia, Portugal and Switzerland and consequent reduction in modal value (from 0.5 to 0.2)
Low risk drinking guidelines in Europe: overview of RARHA survey results
Low risk drinking guidelines in Europe:
overview of RARHA survey results
E. Scafato, L. Galluzzo, S. Ghirini, C. Gandin, S. Martire
Istituto Superiore di Sanità, Italy
E-mail: [email protected] Website: www.iss.it