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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.


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)


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


7 Low risk drinking guidelines in Europe: results from RARHA survey

Standard Drink definition and use in EU countries


Standard Drink in EU countries, in grams of pure alcohol



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

)



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 Guidelines (GL)/Recommendations (R)



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


21

6

3

1

Yes No missing data Country not investigated

*

* Hungary and Lithuania have recommended limits


Weekly Low Risk Guidelines/Recommendations (in g)



Daily Low Risk Guidelines/Recommendations (in g)



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



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



RARHA Daily alcohol intake not to be exceeded (g pure alcohol)



Binge Drinking definitions


11

9

10

1

Guidelines Recommendations No GL/R Not investigated


RARHA availability of Guidelines/Recommendations for Binge Drinking

4

6

14 3 2

By

gen

de

r

By

all

con

sum

ers

Bo

th



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


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

)


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



Availability of Guidelines/Recommendations for Older People

7

21

21


RARHA

214

5

10


WHO 2012


255

1

Yes No Country not investigated

RARHA


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


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


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).


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

E. Scafato, L. Galluzzo, S. Ghirini, C. Gandin, S. Martire

Istituto Superiore di Sanità, Italy

E-mail: [email protected] Website: www.iss.it

mailto:[email protected]

http://www.iss.it

low risk drinking guidelines in europe: overview of rarha ... wp5_t1... · low risk drinking...

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