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      The burden of alcohol-related morbidity and mortality in Ottawa, Canada

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          Abstract

          Objectives

          Alcohol-related morbidity and mortality are significant public health issues. The purpose of this study was to describe the prevalence and trends over time of alcohol consumption and alcohol-related morbidity and mortality; and public attitudes of alcohol use impacts on families and the community in Ottawa, Canada.

          Methods

          Prevalence (2013–2014) and trends (2000–2001 to 2013–2014) of alcohol use were obtained from the Canadian Community Health Survey. Data on paramedic responses (2015), emergency department (ED) visits (2013–2015), hospitalizations (2013–2015) and deaths (2007–2011) were used to quantify the acute and chronic health effects of alcohol in Ottawa. Qualitative data were obtained from the “Have Your Say” alcohol survey, an online survey of public attitudes on alcohol conducted in 2016.

          Results

          In 2013–2014, an estimated 595,300 (83%) Ottawa adults 19 years and older drank alcohol, 42% reported binge drinking in the past year. Heavy drinking increased from 15% in 2000–2001 to 20% in 2013–2014. In 2015, the Ottawa Paramedic Service responded to 2,060 calls directly attributable to alcohol. Between 2013 and 2015, there were an average of 6,100 ED visits and 1,270 hospitalizations per year due to alcohol. Annually, alcohol use results in at least 140 deaths in Ottawa. Men have higher rates of alcohol-attributable paramedic responses, ED visits, hospitalizations and deaths than women, and young adults have higher rates of alcohol-attributable paramedic responses. Qualitative data of public attitudes indicate that alcohol misuse has greater repercussions not only on those who drink, but also on the family and community.

          Conclusions

          Results highlight the need for healthy public policy intended to encourage a culture of drinking in moderation in Ottawa to support lower risk alcohol use, particularly among men and young adults.

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          Most cited references28

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          Regional alcohol consumption and alcohol-related mortality in Great Britain: novel insights using retail sales data

          Background Regional differences in population levels of alcohol-related harm exist across Great Britain, but these are not entirely consistent with differences in population levels of alcohol consumption. This incongruence may be due to the use of self-report surveys to estimate consumption. Survey data are subject to various biases and typically produce consumption estimates much lower than those based on objective alcohol sales data. However, sales data have never been used to estimate regional consumption within Great Britain (GB). This ecological study uses alcohol retail sales data to provide novel insights into regional alcohol consumption in GB, and to explore the relationship between alcohol consumption and alcohol-related mortality. Methods Alcohol sales estimates derived from electronic sales, delivery records and retail outlet sampling were obtained. The volume of pure alcohol sold was used to estimate per adult consumption, by market sector and drink type, across eleven GB regions in 2010–11. Alcohol-related mortality rates were calculated for the same regions and a cross-sectional correlation analysis between consumption and mortality was performed. Results Per adult consumption in northern England was above the GB average and characterised by high beer sales. A high level of consumption in South West England was driven by on-trade sales of cider and spirits and off-trade wine sales. Scottish regions had substantially higher spirits sales than elsewhere in GB, particularly through the off-trade. London had the lowest per adult consumption, attributable to lower off-trade sales across most drink types. Alcohol-related mortality was generally higher in regions with higher per adult consumption. The relationship was weakened by the South West and Central Scotland regions, which had the highest consumption levels, but discordantly low and very high alcohol-related mortality rates, respectively. Conclusions This study provides support for the ecological relationship between alcohol-related mortality and alcohol consumption. The synthesis of knowledge from a combination of sales, survey and mortality data, as well as primary research studies, is key to ensuring that regional alcohol consumption, and its relationship with alcohol-related harms, is better understood.
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            Status of implementation of Framework Convention on Tobacco Control (FCTC) in Ghana: a qualitative study

            Background The Framework Convention on Tobacco Control (FCTC), a World Health Organization treaty, has now been ratified by over 165 countries. However there are concerns that implementing the Articles of the treaty may prove difficult, particularly in the developing world. In this study we have used qualitative methods to explore the extent to which the FCTC has been implemented in Ghana, a developing country that was 39th to ratify the FCTC, and identify barriers to effective FCTC implementation in low income countries. Methods Semi-structured interviews with 20 members of the national steering committee for tobacco control in Ghana, the official multi-disciplinary team with responsibility for tobacco control advocacy and policy formulation, were conducted. The Framework method for analysis and NVivo software were used to identify key issues relating to the awareness of the FCTC and the key challenges and achievements in Ghana to date. Results Interviewees had good knowledge of the content of the FCTC, and reported that although Ghana had no explicitly written policy on tobacco control, the Ministry of Health had issued several tobacco control directives before and since ratification. A national tobacco control bill has been drafted but has not been implemented. Challenges identified included the absence of a legal framework for implementing the FCTC, and a lack of adequate resources and prioritisation of tobacco control efforts, leading to slow implementation of the treaty. Conclusion Whilst Ghana has ratified the FCTC, there is an urgent need for action to pass a national tobacco control bill into law to enable it to implement the treaty, sustain tobacco control efforts and prevent Ghana's further involvement in the global tobacco epidemic.
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              Gender differences in risk factors and consequences for alcohol use and problems.

              Women drink less alcohol and have fewer alcohol-related problems than men. Women appear to be less likely than men to manifest certain risk factors for alcohol use and problems and are more likely to have certain protective factors against these problems: women perceive greater social sanctions for drinking; women are less likely to have characteristics associated with excessive drinking including aggressiveness, drinking to reduce distress, behavioral undercontrol, sensation-seeking and antisociality; and women are more likely to have desirable feminine traits (e.g., nurturance) protective against excessive drinking. In addition, consequences of heavy alcohol use, or alcohol use disorders, appear to be more negative for women than men, at least in some domains: women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men, and some studies suggest women suffer more cognitive and motor impairment due to alcohol than men; women may be more likely than men to suffer physical harm and sexual assault when they are using alcohol; heavy alcohol use in women is associated with a range of reproductive problems. Implications of these findings for future research and public health education campaigns are discussed.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: Project administrationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: Project administrationRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                28 September 2017
                2017
                : 12
                : 9
                : e0185457
                Affiliations
                [001]Ottawa Public Health, Ottawa, Ontario, Canada
                National Institue on Drug Abuse, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-17-17994
                10.1371/journal.pone.0185457
                5619783
                28957368
                14241bf9-9014-4d62-9992-4cb07d5e0211
                © 2017 Willmore et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 10 May 2017
                : 13 September 2017
                Page count
                Figures: 6, Tables: 3, Pages: 19
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Biology and Life Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Medicine and Health Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Biology and Life Sciences
                Psychology
                Addiction
                Alcoholism
                Social Sciences
                Psychology
                Addiction
                Alcoholism
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Substance-Related Disorders
                Alcoholism
                Medicine and Health Sciences
                Public and Occupational Health
                Substance-Related Disorders
                Alcoholism
                Medicine and Health Sciences
                Critical Care and Emergency Medicine
                Research and Analysis Methods
                Research Design
                Survey Research
                Surveys
                Medicine and Health Sciences
                Health Care
                Health Statistics
                Morbidity
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Medicine and Health Sciences
                Health Care
                Health Care Policy
                Medicine and Health Sciences
                Public and Occupational Health
                Behavioral and Social Aspects of Health
                Custom metadata
                The alcohol prevalence and alcohol attributable morbidity and mortality were calculated from government data sets provided for the purpose of analysis and surveillance. Interested researchers can access the third party data. Below are the contact for specific data sources: Canadian Community Health Survey Data were acquired from Statistics Canada. Researchers may request access to data as detailed on the Statistics Canada website ( http://www.statcan.gc.ca/eng/health/acces); Paramedic responses were obtained from the Ambulance Dispatch Reporting System of Ottawa Paramedic Service. Interested persons would need to contact directly this service at www.ottawaparamedicservice.ca; Emergency department visits and Hospitalizations data are available through the Canadian Institute for Health Information ( https://www.cihi.ca/en/data-and-standards/access-data); Mortality data are from the Vital Statistics database (Ontario Office of the Registrar General), distributed by the Ontario Ministry of Health and Long Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH). ( https://intellihealth.moh.gov.on.ca/). Qualitative data from Ottawa Public Health's Survey cannot be publicly shared because of the sensitive nature of the data and the risk of identifying information for some of the 2000 participants. This aligns with Municipal Freedom of Information and Protection of Privacy Act Section 14. 2(f) – criteria for invasion of privacy, we considered whether the information was: (f) the personal information is highly sensitive. The author may be contacted for frequency data at Darcie.Taing@ 123456ottawa.ca or special request to the privacy consultant at Ottawa Public Health Catherine Cox at CatherineJ.Cox@ 123456ottawa.ca .

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