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Background Acute alcohol consumption and chronic alcohol consumption increase the burden placed on emergency departments (EDs) by contributing to injury and disease. Whether the prevalence of alcohol-related ED visits in the United States has changed in recent years is unknown. The purpose of this study was to examine trends in ED visits involving acute and chronic alcohol consumption in the United States by age and sex between 2006 and 2014. Methods Data from the Nationwide Emergency Department Sample (NEDS), the largest all-payer ED database in the United States involving 945 hospitals in 33 states and Washington, DC, were analyzed to assess changes in prevalence and rates of ED visits involving acute and chronic alcohol consumption by age and sex over time among persons aged ≥12 between 2006 and 2014. Results Between 2006 and 2014, the number of ED visits involving alcohol consumption increased 61.6%, from 3,080,214 to 4,976,136. The rate increased 47% from 1,223 to 1,802 per 100,000 population and the total cost of such visits increased 272% from $4.1 billion to $15.3 billion. The number of acute alcohol-related ED visits increased 51.5% from 1,801,006 to 2,728,313 and the rate increased 40% from 720.9 to 1,009.6 per 100,000 population. The number chronic alcohol-related visits increased 75.7% from 1,279,208 to 2,247,823 and the rate increased 57.9% from 502.2 to 792.9 per 100,000. The annual percentage change in rates of all alcohol-related ED visits was larger for females than for males (5.3% vs. 4.0%). Other drug involvement increased the likelihood of admission for inpatient treatment. Conclusions Alcohol consumption contributed to an increasing number of ED visits in the United States between 2006 and 2014, especially among females. Increased utilization of evidence-based interventions is needed.

Background The majority of U.S. older adults consume alcoholic beverages. The older population is projected to almost double by 2050. Substantially more drinkers are likely. Purpose To describe gender-specific trends (1997 to 2014) in prevalence of drinking status (lifetime abstention, former drinking, current drinking [including average volume], and binge drinking) among U.S. adults ages 60+ by age group and birth cohort. Methods In the 1997 to 2014 National Health Interview Surveys, 65,303 respondents ages 60+ (31,803 men, 33,500 women) were current drinkers; 6,570 men and 1,737 women were binge drinkers. Prevalence estimates and standard errors were computed by age group (60+, 60 to 64, 65 to 69, 70 to 74, 75 to 79, 80+) and birth cohort (

INTRODUCTION: We examined diet quality and intake of pregnancy-specific micronutrients among pregnant American Indian women in the Northern Plains. METHODS: We conducted an analysis of nutrition data from the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network Safe Passage Study and the PASS Diet Screener study (N = 170). Diet intake, including dietary supplementation, was assessed by using three 24-hour recalls conducted on randomly selected, nonconsecutive days. Diet intake data were averaged across the participant’s recalls and scored for 2 dietary indices: the Healthy Eating Index 2010 (HEI-2010) and the Alternate Healthy Eating Index for Pregnancy (AHEI-P). We also assessed nutrient adequacy with Dietary Reference Intakes for pregnancy. RESULTS: On average, participants were aged 26.9 (standard deviation [SD], 5.5) years with a pre-pregnancy body mass index of 29.8 (SD, 7.5) kg/m(2). Mean AHEI-P and HEI-2010 scores (52.0 [SD, 9.0] and 49.2 [SD, 11.1], respectively) indicated inadequate adherence to dietary recommendations. Micronutrient intake for vitamins D and K, choline, calcium, and potassium were lower than recommended, and sodium intake was higher than recommended. CONCLUSION: Our findings that pregnant American Indian women are not adhering to dietary recommendations is consistent with studies in other US populations. Identifying opportunities to partner with American Indian communities is necessary to ensure effective and sustainable interventions to promote access to and consumption of foods and beverages that support the adherence to recommended dietary guidelines during pregnancy.

BACKGROUND: The majority of Americans consume alcoholic beverages. Alcohol interacts negatively with numerous commonly prescribed medications. Yet, on a population level, little is known about use of alcohol-interactive (AI) prescription medications among drinkers. The purpose of our study was to determine the prevalence of AI prescription medication use among current drinkers in the U.S. population. METHODS: Data were from the National Health and Nutrition Examination Survey (NHANES 1999 to 2010); 26,657 adults aged ≥20 years had data on past year alcohol consumption and past month prescription medication use. Analyses were adjusted for covariates: age, race/ethnicity, education, marital status, and smoking. Statistical procedures accounted for survey stratification, clustering, and nonresponse. Analyses were weighted to be nationally representative. RESULTS: The unadjusted total prevalence of AI medication use was 42.8% (95% confidence interval [CI] 41.5 to 44.0). Among current drinkers, adjusted prevalence was 41.5% (CI 40.3 to 42.7). Among participants aged ≥65 total prevalence of AI medication use was 78.6% (CI 77.3 to 79.9) and adjusted prevalence among current drinkers was 77.8% (CI 75.7 to 79.7). The AI medications most commonly used by current drinkers were cardiovascular agents, central nervous system agents, and metabolic agents. CONCLUSIONS: Our results suggest that there could be substantial simultaneous exposure to alcohol and AI prescription medications in the U.S. population. Given the adverse health risks of combining alcohol with AI prescription medications, future efforts are needed to collect data to determine actual simultaneous prevalence. Language: en

Background: Alcohol may affect dietary intake. However, little is known about diets on drinking days in the US population. Objective: We determined whether the diets of drinkers differ on drinking compared with nondrinking days. Design: Data were from the 2003–2008 NHANES Mobile Examination Center interview. We identified 1864 current drinkers (1126 men and 738 women) who completed two 24-h dietary recalls, one of which was on a drinking day and the other of which was on a nondrinking day. Sex-specific repeated-measures analyses that were adjusted for dietary recall order and recall day of the week were used to compare within-individual differences in energy, nutrient, and food-group intakes. Analyses were weighted to produce representative estimates. Results: On their drinking (compared with nondrinking) days, men consumed an excess 168 nonalcohol kcal (P < 0.01), which was reflected in higher intakes of nutrients including total protein (P < 0.001), total fat (P < 0.01), saturated fat (P < 0.01), monounsaturated fat (P < 0.01), potassium (P < 0.001), and sodium (P < 0.05). Men also had higher intakes of food groups including meat (P < 0.001), white potatoes (P < 0.05), and discretionary oil and solid fat (P < 0.05) and lower intakes of total fruit (P < 0.05) and milk (P < 0.05). Women did not consume excess nonalcohol kilocalories but had higher intakes of total fat (P < 0.05), monounsaturated fat (P < 0.05), polyunsaturated fat (P < 0.05), potassium (P < 0.01), and discretionary oil and solid fat (P < 0.05) and lower intakes of milk (P < 0.01) and milk products (P < 0.01). Conclusions: These mostly moderate drinkers had poorer diets on drinking days. Same-day associations between alcohol and diet could be useful targets for public health efforts to improve dietary intake.

these deaths were due to lung (31%), prostate (10%), and colorectal cancers (10%). Among women, most deaths were from lung (25%), breast (15%), and colorectal cancers (10%), with an additional 1% from cervical cancers. For breast, cervical, and colorectal cancers, routine screening is recommended by the U.S. Preventive Services Task Force (USPSTF) 3 –6 —an independent panel of experts in primary care and prevention that systematically reviews evidence of effectiveness—and by most major medical organizations. 7 Screening recommendations from the USPSTF for breast, cervical, and colorectal cancers are shown in Table 1. A 2003 report from the National Cancer Policy Board 8 noted that screening all eligible people not currently screened with USPSTFrecommended mammography, Pap smears, and colorectal cancer screening tests could prevent an additional 4475 deaths from breast cancer, 3644 deaths from cervical cancer, and 9632 deaths from colorectal cancer per year. At present, the USPSTF does not recommend screening for lung and prostate cancers because no convincing evidence shows that benefits outweigh harms. 3,9

Most major medical organizations recommend routine screening for breast, cervical, and colorectal cancers. Screening can lead to early detection of these cancers, resulting in reduced mortality. Yet not all people who should be screened are screened, either regularly or, in some cases, ever. This report presents the results of systematic reviews of effectiveness, applicability, economic efficiency, barriers to implementation, and other harms or benefits of interventions designed to increase screening for breast, cervical, and colorectal cancers by increasing community demand for these services. Evidence from these reviews indicates that screening for breast cancer (mammography) and cervical cancer (Pap test) has been effectively increased by use of client reminders, small media, and one-on-one education. Screening for colorectal cancer by fecal occult blood test has been increased effectively by use of client reminders and small media. Additional research is needed to determine whether client incentives, group education, and mass media are effective in increasing use of any of the three screening tests; whether one-on-one education increases screening for colorectal cancer; and whether any demand-enhancing interventions are effective in increasing the use of other colorectal cancer screening procedures (i.e., flexible sigmoidoscopy, colonoscopy, double contrast barium enema). Specific areas for further research are also suggested in this report.

Most major medical organizations recommend routine screening for breast, cervical, and colorectal cancers. Screening can lead to early detection of these cancers, resulting in reduced mortality. Yet not all people who should be screened are screened, either regularly or, in some cases, ever. This report presents the results of systematic reviews of effectiveness, applicability, economic efficiency, barriers to implementation, and other harms or benefits of interventions designed to increase screening for breast, cervical, and colorectal cancers by increasing community demand for these services. Evidence from these reviews indicates that screening for breast cancer (mammography) and cervical cancer (Pap test) has been effectively increased by use of client reminders, small media, and one-on-one education. Screening for colorectal cancer by fecal occult blood test has been increased effectively by use of client reminders and small media. Additional research is needed to determine whether client incentives, group education, and mass media are effective in increasing use of any of the three screening tests; whether one-on-one education increases screening for colorectal cancer; and whether any demand-enhancing interventions are effective in increasing the use of other colorectal cancer screening procedures (i.e., flexible sigmoidoscopy, colonoscopy, double contrast barium enema). Specific areas for further research are also suggested in this report. (Am J Prev Med 2008;35(1S):S34-S55) © 2008 American Journal of Preventive Medicine

Associations between alcohol drinking and cardiovascular disease mortality could be confounded by diet if alcohol drinking and diet are related. Depending on the alcohol measure, alcohol-diet relations may or may not be observed. The authors examined associations between alcohol and diet quality (Healthy Eating Index (HEI) scores) using cross-sectional, nationally representative data from the 1999-2000 National Health and Nutrition Examination Survey. Weighted analyses included 3,729 participants agedor =20 years. In adjusted analyses among current alcohol drinkers, as quantity increased from 1 toor =3 drinks/drinking day, the mean HEI score decreased from 65.3 (95% confidence interval (CI): 63.4, 67.1) to 61.9 (95% CI: 60.5, 63.2). As frequency increased from the lowest quartile to the highest, the mean HEI score increased from 60.9 (95% CI: 58.7, 63.2) to 64.9 (95% CI: 63.4, 66.4). As average volume ((quantity x frequency)/365.25) increased from1 drink/day toor =3 drinks/day, the mean HEI score increased from 62.9 (95% CI: 61.2, 64.5) to 65.2 (95% CI: 62.7, 67.8). In stratified analyses, the lowest HEI score, 58.5 (95% CI: 55.5, 61.5), occurred among drinkers who consumed the highest quantity at the lowest frequency. Average volume of alcohol consumed is driven by and masks the contributions of its components. These results suggest the importance of measuring drinking patterns (quantity, frequency, and stratified combinations) in epidemiologic alcohol-diet studies.

Background Dairy intake may increase prostate cancer risk, but whether this is due to calcium's suppression of circulating vitamin D remains unclear. Findings on calcium and vitamin D intake and prostate cancer are inconsistent. Objective We examined the association of dairy, calcium, and vitamin D intake with prostate cancer. Design In a prospective study of 3612 men followed from 1982-1984 to 1992 for the first National Health and Nutrition Examination Epidemiologic Follow-up Study, 131 prostate cancer cases were identified. Dietary intake was estimated from questionnaires completed in 1982-1984. Relative risk (RR) and 95% CIs were estimated by using Cox proportional hazards models adjusted for age, race, and other covariates. Results Compared with men in the lowest tertile for dairy food intake, men in the highest tertile had a relative risk (RR) of 2.2 (95% CI: 1.2, 3.9; trend P = 0.05). Low-fat milk was associated with increased risk (RR = 1.5; 95% CI: 1.1, 2.2; third compared with first tertile; trend P = 0.02), but whole milk was not (RR = 0.8; 95% CI: 0.5, 1.3; third compared with first tertile; trend P = 0.35). Dietary calcium was also strongly associated with increased risk (RR = 2.2; 95% CI: 1.4, 3.5; third compared with first tertile; trend P = 0.001). After adjustment for calcium intake, neither vitamin D nor phosphorus was clearly associated with risk. Conclusions Dairy consumption may increase prostate cancer risk through a calcium-related pathway. Calcium and low-fat milk have been promoted to reduce risk of osteoporosis and colon cancer. Therefore, the mechanisms by which dairy and calcium might increase prostate cancer risk should be clarified and confirmed.

Alcohol could contribute to obesity. The authors examined the relation between drinking patterns and body mass index (BMI) (weight (kg)/height (m)(2)) by pooling cross-sectional data from the 1997-2001 National Health Interview Surveys. Weighted analyses included 45,896 adult never smokers who were current alcohol drinkers. Height and weight were self-reported. In adjusted analyses, alcohol quantity and frequency had opposite associations with BMI. As quantity increased from 1 drink/drinking day to > or =4 drinks/drinking day, BMI significantly increased; in men, it increased from 26.5 (95% confidence interval (CI): 26.3, 26.6) to 27.5 (95% CI: 27.4, 27.7), and in women, it increased from 25.1 (95% CI: 25.0, 25.2) to 25.9 (95% CI: 25.5, 26.3). As frequency increased from low quintiles of drinking days/year to high quintiles, BMI significantly decreased; in men, it decreased from 27.4 (95% CI: 27.2, 27.6) to 26.3 (95% CI: 26.2, 26.5), and in women, it decreased from 26.2 (95% CI: 26.0, 26.5) to 24.3 (95% CI: 24.2, 24.5). In stratified analyses of frequency trends within quantity categories, BMI declines were more pronounced in women than in men, but all linear trends were inverse and significant (p trend < 0.001). In all respondents combined, persons who consumed the smallest quantity the most frequently were leanest, and those who consumed the greatest quantity the least frequently were heaviest. Alcohol may contribute to excess body weight among certain drinkers.

The objective of this study was to estimate the quantity and frequency of alcohol consumption among current drinking Americans age 60 years and older, by gender and age.Five years (1997-2001) of cross-sectional National Health Interview Survey data were pooled. Quantity (number of drinks consumed, on average, on drinking days), frequency (number of drinking days per year) and a composite quantity-frequency measure (average number of drinks per day) were defined. Age trends (between age 60 and 84 years) were tested using logistic regression. Analyses were weighted to produce national estimates.Among 40,556 adults age 60 years and older, 52.8% (n = 8,136) of men and 37.2% (n = 8,710) of women were current drinkers. Over increasingly older age groups of current drinking men and women (1) proportions consuming higher quantities of alcohol (two drinks or more) decreased (p trend.001), whereas proportions consuming lower quantities (one drink) increased (p trend.001); and (2) proportions drinking least frequently (12 days per year) and most frequently (260-365 days per year) increased (p trend.05), whereas proportions drinking at intermediate frequencies remained stable or decreased. Differences in patterns for quantity alone and frequency alone were obscured by the composite quantity-frequency measure.In a nationally representative survey, quantity and frequency of alcohol consumption showed strikingly different patterns of cross-sectional age-related change. In epidemiologic studies, quantity and frequency have been differentially associated with medical conditions prevalent in older populations. Investigators studying alcohol consumption in older people should consider reporting results separately by quantity and frequency.

Ecological studies implicate a “Western” diet in prostate cancer development, but whether dietary patterns measured in individuals are associated with risk has not been studied previously. We examined this issue using prospective data from the nationally representative United States Health Examination Epidemiological Follow-up Study. Among 3,779 men followed from 1982–84 to 1992, 136 incident cases were identified. Using principal component analysis on responses to a 105-item dietary questionnaire, the following three distinct patterns were identified: a vegetable-fruit pattern; a red meat-starch pattern characterized by red meats, potatoes, cheese, salty snacks, and desserts; and a Southern pattern characterized by such foods as cornbread, grits, sweet potatoes, okra, beans, and rice. In adjusted proportional hazards models, prostate cancer risk was not associated with the vegetable-fruit or red meat-starch pattern, but higher intake of the Southern pattern showed a reduction in risk (3rd versus 1st tertile relative risk, 0.6; 95% confidence interval, 0.4–1.1; trend P = 0.08) that approached statistical significance. The inverse association was observed in black and non-black men and was not attributable to intake of any individual foods or nutrients. A Southern dietary pattern may reflect a history of living in the South and serve as an integrative marker of sunlight exposure and protection through 1,25-dihydroxyvitamin D production. Further evaluation and better characterization of the pattern would offer more information on potentially beneficial features of the diet or its associated lifestyle.

Alcohol has a significant impact on health and well-being, from the beneficial aspects of moderate drinking to the detrimental effects of alcoholism. The broad implications of alcohol use on public health have been addressed through a wide range of epidemiological and clinical studies, many of which are described in this issue of Alcohol Research: Current Reviews. Where chronic disease is involved, alcohol use can be a risk factor that not only affects the onset of various chronic diseases but also exacerbates the ongoing extent and severity of those diseases. Lifestyle choices and genetic influences also contribute to, or help to alleviate, that risk.

The number of cancer survivors in the United States is increasing, but little is known about this population, including its use of vitamin/mineral supplements. We combined data on vitamin/mineral use from the 1987 and 1992 National Health Interview Survey Cancer Epidemiology Supplement (CES) for cancer survivors: persons reporting a diagnosis of cancer other than nonmelanoma skin cancer >5 yr before their interviews [n = 461 (1987) and 228 (1992)] and persons reporting no history of cancer [n = 20,851 (1987) and 11,186 (1992)]. For both groups, we calculated gender-specific proportions (adjusted for age, race/ ethnicity, education, smoking status, and poverty index) for use of multivitamins, vitamins A, C, and E, and calcium during the year before each survey. Supplement use was similar in survivors and persons reporting no history of cancer. Among survivors, calcium use was significantly higher among women (34.9%) than men (13.8%), and vitamin A use was higher among men than women (P < 0.05). Over three-fourths of both groups used multivitamins, and about one-half used vitamin C. No differences were found in vitamin/ mineral use between male survivors and men with no cancer history or between female survivors and women with no cancer history. These first nationally representative estimates suggest that persons who have survived cancer and those who report that they never had the disease do not differ appreciably in their use of vitamin/mineral supplements. Results were based on small numbers of survivors, however, and require replication.

Objectives: To study the association between diet and lung cancer mortality in the United States. Methods: Records from 20,195 participants with usable dietary data in the 1987 National Health Interview Survey were linked to the National Death Index. Baseline diet was assessed with a 59-item food-frequency questionnaire. Food groups (fruits, vegetables, total meat/poultry/fish, red meats, processed meats, dairy products, breakfast cereals, other starches, added fats, and alcohol) were analyzed in cause-specific Cox proportional hazard regression models adjusted for age, gender and smoking. Results: There were 158 deaths from lung cancer (median follow-up 8.5 years). Frequencies of meat/poultry/fish intake (relative risk [RR] (highest compared to lowest quartile) = 2.0; 95% confidence interval [CI] 1.2-3.5, p for trend [p] < 0.027), and red meat intake (RR = 1.6; CI 1.0-2.6, p < 0.014), were positively and significantly associated with lung cancer mortality. Specifically, the red meats, including pork (RR = 1.6; CI 1.0-2.7, p < 0.028), and ground beef (RR = 2.0; CI 1.1-3.5, p < 0.096) were associated with increased risk, although for ground beef the trend was not significant. Dairy products (RR = 0.5; CI 0.3-0.8, p < 0.009) were inversely associated with lung cancer mortality. There was no statistically significant association between intake of fruits and vegetables and lung cancer mortality. Conclusions: In this nationally representative study, intake of red meats was positively associated with lung cancer mortality while intake of dairy products was inversely associated. While smoking is the major risk for lung cancer

PURPOSE: We prospectively investigated the association between alcohol consumption and prostate cancer in the Epidemiologic Followup Study (NHEFS) of the first National Health and Nutrition Examination Survey (NHANES I). METHODS: There were two cohorts: 1) Cohort I, followed from baseline (1971–75) through 1992, included 5766 men ages 25–74 years (median follow-up = 17 years); and 2) Cohort II, followed from the first follow-up round for Cohort I (1982–84) through 1992, included the 3868 men in Cohort I free of prostate cancer in 1982–84 (median follow-up = 9 years). Alcohol consumption was assessed at baseline as usual consumption, and at follow-up as usual consumption and as distant past consumption at the ages of 25, 35, 45, and 55. RESULTS: There were 252 incident cases of prostate cancer. Consistent with most previous studies, we found no significant associations between usual total alcohol consumption and prostate cancer in Cohorts I or II [p = non significant (NS)], except for a significant inverse association at the heaviest level of drinking in Cohort II [relative risk (RR) = 0.23, 95% confidence interval (CI) = 0.06–0.95]. Further study of heavy drinkers in Cohort II revealed significant inverse associations between distant past heavy drinking (defined as > 25 drinks/week) and prostate cancer at age 25 (RR = 0.20, 95% CI = 0.06–0.63), age 35 (RR = 0.30, 95% CI = 0.12–0.77), and age 45 (RR = 0.39, 95% CI = 0.17–0.93), but not at age 55 (RR = 0.43, 95% CI = 0.17–1.10). CONCLUSIONS: These results suggest that it may be important to consider distant past alcohol consumption in etiologic studies of prostate cancer. However, our results were based on small numbers of cases who were heavy drinkers and require replication.

Background. There are more than 500,000 deaths from cancer each year in the United States. This study examines Americans' knowledge of risk factors for breast, cervical, colon, and prostate cancers, which account for over 130,000 of these deaths, and their knowledge of the prospects of surviving these cancers following early detection. Methods. Data were obtained from 12,035 subjects who completed the 1992 National Health Interview Survey Cancer Control Supplement which includes questions about cancer risk factors and survival. Results. The majority of respondents were unable to identify major cancer risk factors when prompted with a list. Approximately two-thirds did not recognize that age increased the risk for breast and colon cancer, that diet increased the risk for colon cancer, or that multiple sex partners increased the risk for cervical cancer. Knowledge about survival was also poor. Only about half thought they had a good chance of survival following early detection of colon and cervical cancers, for which 5-year relative survival exceeds 90%. Conclusions. Americans lack knowledge about major risk factors for common cancers and about the prospects of survival following early detection. Knowledge about risk factors and about survival from cervical and colon cancers was poor at all ages, among all races, at all income levels, and at all educational levels. It was poorest among blacks and Hispanics and among those with the lowest income and least education. Americans need education about cancer risk factors and survival.

Prospective associations between quantity and frequency of alcohol consumption and cancer-specific mortality were studied using a nationally representative sample with pooled data from the 1988, 1990, 1991, and 1997-2004 administrations of the National Health Interview Survey (n = 323,354). By 2006, 8,362 participants had died of cancer. Cox proportional hazards regression was used to estimate relative risks. Among current alcohol drinkers, for all-site cancer mortality, higher-quantity drinking (≥ 3 drinks on drinking days vs. 1 drink on drinking days) was associated with increased risk among men (relative risk (RR) = 1.24, 95% confidence interval (CI): 1.09, 1.41; P for linear trend = 0.001); higher-frequency drinking (≥ 3 days/week vs.

Background Little is known about associations between alcoholic beverage consumption, nutrient intakes, and diet quality, although each has been independently associated with chronic disease outcomes. Objective This study examines cross-sectional relationships between alcoholic beverage consumption, nutrient intakes, and diet quality (Healthy Eating Index-2005 [HEI-2005] scores) in the US adult population. Methods Data were from four cycles of the National Health and Nutrition Examination Survey (1999-2006). Weighted multiple regression analyses, adjusted for age, race/ethnicity, education, smoking status, and body mass index included 8,155 men and 7,715 women aged ≥20 years who reported their past-year alcoholic beverage consumption and 24-hour dietary intake. Alcoholic beverage consumption was defined by drinking status (never, former, current drinker) and, among current drinkers, by drinking level (number of drinks per day, on average: men Results Among men, there was no association between drinking status and intakes of energy, most nutrients, or total HEI-2005 score. Among women, former and current (compared to never) drinkers had significantly higher intakes of energy and several nutrients, and current drinkers had significantly lower total HEI-2005 scores (current drinkers 58.9; never drinkers 63.2). Among current drinkers of both sexes, as drinking level increased, intakes of energy and several nutrients significantly increased, whereas total HEI-2005 scores significantly decreased (from 55.9 to 41.5 in men, and from 59.5 to 51.8 in women). Conclusions Among men and women, increasing alcoholic beverage consumption was associated with a decline in total diet quality as measured by the HEI-2005, apparently due to higher energy intake from alcohol as well as other differences in food choices. Educational messages should focus on nutrition and chronic disease risk associated with high consumption of alcoholic beverages and poor food choices, including excessive energy intake.

Objectives The aim of this study was to determine the association of alcohol consumption and cardiovascular mortality in the U.S. population. Background Alcohol consumption has been associated with a lower risk of cardiovascular disease in cohort studies, but this association has not been prospectively examined in large, detailed, representative samples of the U.S. population. Methods We analyzed 9 iterations of the National Health Interview Survey, an annual survey of a nationally representative sample of U.S. adults between 1987 and 2000. Exposures of interest included usual volume, frequency, and quantity of alcohol consumption and binge drinking. Mortality was ascertained through linkage to the National Death Index through 2002. Relative risks were derived from random-effects meta-analyses of weighted, multivariable-adjusted hazard ratios for cardiovascular mortality from individual survey administrations. Results Light and moderate volumes of alcohol consumption were inversely associated with cardiovascular mortality. Compared with lifetime abstainers, summary relative risks were 0.95 (95% confidence interval [CI]: 0.88 to 1.02) among lifetime infrequent drinkers, 1.02 (95% CI: 0.94 to 1.11) among former drinkers, 0.69 (95% CI: 0.59 to 0.82) among light drinkers, 0.62 (95% CI: 0.50 to 0.77) among moderate drinkers, and 0.95 (95% CI: 0.82 to 1.10) among heavy drinkers. The magnitude of lower risk was similar in subgroups of sex, age, or baseline health status. There was no simple relation of drinking pattern with risk, but risk was consistently higher among those who consumed ≥3 compared with 2 drinks/drinking day. Conclusions In 9 nationally representative samples of U.S. adults, light and moderate alcohol consumption were inversely associated with CVD mortality, even when compared with lifetime abstainers, but consumption above recommended limits was not.

This study compares the nutritional status and dietary intake of 14 tubefed nursing home patients with pressure sores (age: 70 +/- 5 years, mean +/- SEM) to 12 tubefed patient-controls without sores (age: 60 +/- 7 years). Patients tended to have higher calorie intake (32 +/- 3 kcal/kg) than patient-controls (26 +/- 2 kcal/kg, p = 0.11). Protein intake was significantly higher in patients (1.4 +/- 0.2 g/kg) than patient-controls (0.9 +/- 0.1 g of protein per kg, p less than 0.05). Despite increased calorie and protein intake, biochemical measures of nutritional status were worse in the patients. Serum albumin was lower in patients (33 +/- 1 g/L) than in patient-controls (37 +/- 1 g/L, p less than 0.05) as was level of hemoglobin (patients: 117 +/- 5; patient-controls: 132 +/- 5 g/L, p less than 0.05). Patients with stage IV (severe) sores had lower serum cholesterol levels (3.46 +/- 0.31 mmol/L, n = 5) than patients with stage II/III (milder) sores (4.58 +/- 0.23 mmol/L, n = 9, p less than 0.05). Plasma zinc was low in both patients (11.2 +/- 0.6 mumol/L) and patient-controls (11.5 +/- 0.7 mumol/L, p = NS). Pressure sore surface area was positively correlated with calorie intake per kilogram of body weight (r = +0.59, p less than 0.04) and negatively correlated with body mass index (r = -0.70, p less than 0.03), hemoglobin (r = -0.55, p less than 0.07) and serum cholesterol (r = -0.57, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Background: Alcohol average volume (quantity multiplied by frequency) has been associated with mortality in drinkers. However, average volume may mask associations due to quantity or frequency alone. Methods: We prospectively assessed relationships between alcohol quantity and frequency, and mortality from all-causes, cardiovascular disease, cancer, and other-causes in a cohort created by linking the 1988 National Health Interview Survey (response rate 87%) to the National Death Index through 2002. Participants were 20,765 current drinkers age ≥ 18 years. At 14-year follow-up 2,547 had died. Results: For quantity, among men who consumed ≥5 drinks (compared to 1 drink) on drinking days, adjusted relative risks (RR) of mortality were: for cardiovascular disease, 1.30 [95% confidence interval (CI) 0.96–1.75; p for linear trend (p-trend) = 0.0295], for cancer, 1.53 (95% CI 1.11–2.09; p-trend = 0.0026), and for other-causes, 1.42 (95% CI 1.08–1.87; p-trend = 0.0029); among women for other-causes, 2.88 (95% CI 1.61–5.12; p-trend = 0.0010). For frequency, among men in the highest frequency quartile (compared to the lowest), RR were: for cardiovascular disease, 0.79 (95% CI 0.63–0.99; p-trend = 0.0330), for cancer, 1.23 (95% CI 0.95–1.59; p-trend = 0.0461), and for other-causes, 1.30 (95% CI 1.01–1.67; p-trend = 0.0070); among women, for cancer, 1.65 (95% CI 1.12–2.45, p-trend = 0.0031). Average volume obscured effects of quantity alone and frequency alone, particularly for cardiovascular disease in men where quantity and frequency trended in opposite directions. Conclusions: Alcohol quantity and frequency were independently associated with cause-specific mortality. Accumulating evidence of their differential effects may, in the future, be useful for clinical and public health recommendations.

To determine the prevalence of alcohol consumption among breastfeeding and non-breastfeeding women at 3 months postpartum.We analyzed the most recent data available, which were from the 1993-1994 Food and Drug Administration Infant Feeding Practices Study I, a longitudinal panel study of infant-mother pairs. Self-reported data on alcohol consumption were analyzed for 772 breastfeeding women and 776 non-breastfeeding women ageor =14 years.At 3 months postpartum, 36% of breastfeeding women and 40% of non-breastfeeding women consumed alcohol (p = 0.09). In multinomial regression models adjusted for age, race, education, income, marital status, region, smoking, and alcohol consumption before and during pregnancy, breastfeeding women were significantly less likely than non-breastfeeding women to consume two drinks per week (p0.01), or equal to or more than three drinks per week (p0.01), but equally likely to consume one drink (p = 0.23).A substantial percentage of breastfeeding women consumed alcohol. Their infants may or may not have been exposed, as some women may have used alcohol avoidance strategies. Nationally representative data are needed on alcohol consumption and infant feeding practices among breastfeeding women.

Most major medical organizations recommend routine screening for breast, cervical, and colorectal cancers. Screening can lead to early detection of these cancers, resulting in reduced mortality. Yet not all people who should be screened are screened, either regularly or, in some cases, ever. This report presents the results of systematic reviews of effectiveness, applicability, economic efficiency, barriers to implementation, and other harms or benefits of interventions designed to increase screening for breast, cervical, and colorectal cancers by increasing community demand for these services. Evidence from these reviews indicates that screening for breast cancer (mammography) and cervical cancer (Pap test) has been effectively increased by use of client reminders, small media, and one-on-one education. Screening for colorectal cancer by fecal occult blood test has been increased effectively by use of client reminders and small media. Additional research is needed to determine whether client incentives, group education, and mass media are effective in increasing use of any of the three screening tests; whether one-on-one education increases screening for colorectal cancer; and whether any demand-enhancing interventions are effective in increasing the use of other colorectal cancer screening procedures (i.e., flexible sigmoidoscopy, colonoscopy, double contrast barium enema). Specific areas for further research are also suggested in this report.

Background: Alcohol consumption has the potential to affect dietary intakes of nutrients; however, little is known about fatty acid intakes among alcohol consumers in the U.S. population. Method: We examined the relation between self-reported alcohol consumption and dietary fatty acid intake in 4,168 adults in the cross-sectional National Health and Nutrition Examination Survey 2001–2002. Fatty acid intake was determined from a single, interviewer-administered 24-hour recall. The adjusted, weighted mean level of dietary fatty acid intakes, as characterized by nutrient density, was calculated as grams of fatty acid per 1,000 kcal of energy consumed according to average daily alcohol consumption and binge-drinking episodes. Results: Energy intake showed a significant increasing trend across alcohol consumption categories in both genders and binge-drinking categories in men. Women binge drinkers also showed a higher energy intake compared with nonbinge drinkers. Among men, decreased nutrient densities of saturated, monounsaturated, polyunsaturated, linoleic, and α-linolenic acids were associated with increasing alcohol consumption. Binge-drinking men but not women had significantly decreased intakes of total saturates, monounsaturates, polyunsaturates and linoleic, α-linolenic, eicosapentaenoic, and docosahexaenoic acid. When alcohol energy was excluded from calculation of nutrient densities, the results were similar to those with alcohol energy included, except that total saturated and monounsaturated fatty acid differences were no longer significant. In addition, there was an inverse relationship among men between binge-drinking frequency and total polyunsaturates, linoleic, α-linolenic, and eicosapentaenoic acids. Conclusion: Our cross-sectional results suggest that alcohol consumption may impact the dietary intake of essential fatty acids (EFAs). Given the public health importance of both alcohol consumption and intakes of EFAs, prospective studies of the relation should be considered.

The purpose of this study was to estimate the prevalence of alcohol consumption in Americans age 65 years and older using data from three nationally representative cross-sectional surveys: the National Health Interview Survey (NHIS-2000), the Behavioral Risk Factor Surveillance System (BRFSS-2001) and the National Household Survey on Drug Abuse (NHSDA-2000).Alcohol consumption levels were defined as none, moderate (or = 1 drink a day) and heavier (1 drink a day). The NHIS assessed alcohol consumption in the past year, and the BRFSS and NHSDA assessed alcohol consumption in the past 30 days. Differences between the BRFSS and NHSDA were tested using multinomial logistic regression. Age trends in alcohol consumption (between age 65 and 84 years) were tested using logistic regression. All analyses were weighted to produce national estimates.In men, the prevalence of moderate drinking was 37.6% (95% confidence interval [CI]: 35.2-40.0) in the NHIS, 38.7% (CI: 37.3-40.1) in the BRFSS and 27.2% (CI: 23.6-30.8) in the NHSDA. The prevalence of heavier drinking among men was 10.1% (CI: 8.7-11.5), 10.1% (CI: 9.3-10.9) and 9.2% (CI: 7.2-11.3), respectively. In women, the prevalence of moderate drinking was 32.3% (CI: 30.4-34.2) in the NHIS, 27.7% (CI: 26.7-28.6) in the BRFSS and 21.5% (CI: 18.9-24.2) in the NHSDA. The prevalence of heavier drinking among women was 2.2% (CI: 1.6-2.7), 2.6% (CI: 2.3-2.9) and 2.4% (CI: 1.4-3.3), respectively. In increasingly older groups of men, moderate drinking remained stable (all surveys, p for age trend [p trend] = NS), while heavier drinking significantly decreased in two of three surveys (NHIS and BRFSS, p trend.05; NHSDA, p = NS). Conversely, in increasingly older groups of women, moderate drinking significantly decreased (all surveys, p trend = .001), while heavier drinking remained stable (all surveys, p trend = NS).In the years 2000 to 2001 approximately one third of the U.S. elderly population, about 11 million persons, consumed alcohol. The risks and benefits of drinking by elderly Americans will become an increasingly important public health issue as this segment of the population expands over the coming decades.

Individuals are increasingly involved in decisions about their health care. Shared decision making (SDM), an intervention in the clinical setting in which patients and providers collaborate in decision making, is an important approach for informing patients and involving them in their health care. However, SDM cannot bear the entire burden for informing and involving individuals. Population-oriented interventions to promote informed decision making (IDM) should also be explored. This review provides a conceptual background for population-oriented interventions to promote informed decisions (IDM interventions), followed by a systematic review of studies of IDM interventions to promote cancer screening. This review specifically asked whether IDM interventions (1) promote understanding of cancer screening, (2) facilitate participation in decision making about cancer screening at a level that is comfortable for individuals; or (3) encourage individuals to make cancer-screening decisions that are consistent with their preferences and values. Fifteen intervention arms met the intervention definition. They used small media, counseling, small-group education, provider-oriented strategies, or combinations of these to promote IDM. The interventions were generally consistent in improving individuals' knowledge about the disease, accuracy of risk perceptions, or knowledge and beliefs about the pros and cons of screening and treatment options. However, few studies evaluated whether these interventions resulted in individuals participating in decision making at a desirable level, or whether they led to decisions that were consistent with individuals' values and preferences. More research is needed on how best to promote and facilitate individuals' participation in health care. Work is especially needed on how to facilitate participation at a level desired by individuals, how to promote decisions by patients that are consistent with their preferences and values, how to perform effective and cost-effective IDM interventions for healthcare systems and providers and in community settings (outside of clinical settings), and how to implement these interventions in diverse populations (such as populations that are older, nonwhite, or disadvantaged). Finally, work is needed on the presence and magnitude of barriers to and harms of IDM interventions and how they might be avoided.

Prostate cancer is the most common cancer among American men, with few established risk factors. The association between prostate cancer and alcohol, a potentially modifiable risk factor, has been examined in numerous studies. We systematically reviewed the literature on alcohol and the incidence of prostate cancer by searching for published cohort and case-control studies using computerized databases, references, and experts, by evaluating studies for validity, and by summarizing the results and providing research recommendations. We found compelling evidence for no association between low-to-moderate alcohol consumption and prostate cancer. Most studies, however, did not assess the risk of heavy drinking, where there has been some suggestion of increased risk, or of lifetime patterns of drinking. None of the studies have used genetic markers, nor have they been conducted in populations with known familial risk. Further studies in some populations may be warranted.

To examine food intake trends in the US population, cross-sectional nationally representative food intake data were obtained from the 1987 and 1992 National Health Interview Survey Cancer Control Supplements. In each of these years, approximately 10,000 respondents completed methodologically consistent food frequency questionnaires containing the same 57 food items. Between 1987 and 1992, the proportion of Americans consuming high-fat foods, including fried fish, fried chicken, bacon, eggs, whole milk, and butter, decreased. The proportion of Americans drinking alcoholic beverages also decreased: fewer drank wine and hard liquor in 1992. The proportion of fruit and vegetable consumers remained stable over time. These results are similar to those obtained from more detailed national surveys. National guidelines urge Americans to avoid intake of high-fat foods, increase consumption of fruits and vegetables, and practice moderation when drinking alcoholic beverages to prevent cancer and other chronic diseases. The direction of Americans' apparent changes in food usage between 1987 and 1992, evaluated using limited data from food frequency questionnaires, suggests greater behavioral changes in the direction of guidelines recommending avoidance of foods that may increase the risk of cancer than in the direction of guidelines recommending increased consumption of foods that may confer protection.

This article focuses on nutritional risk factors that predict the development of pressure ulcers in hospital and nursing home patients. Cross-sectional studies associate inadequate energy and protein intake; underweight; low triceps skinfold measurement; and low serum albumin, low serum cholesterol, and low hemoglobin levels with pressure ulcers. Prospective studies identify inadequate energy and protein intake, a poor score on the Braden scale (a risk assessment instrument that includes a nutrition component), and possibly low serum albumin level as risk factors for developing a pressure ulcer. Nutritionists should provide a high-energy, high-protein diet for patients at risk of development of pressure ulcers to improve their dietary intake and nutritional status.

Objective: To determine whether a 1-day calorie count can replace the labor-intensive 3-day calorie count commonly performed in hospitalized patients when estimates of caloric and protein intake are required. Design: Pilot study using prospective, non-concurrent review of medical records. Setting: Hospital. Participants: Thirty patients (mean age 67 years). Results: Mean 3-day intake (952 ± 91 calories, 41 ± 4 g protein) was about half of calculated requirements; first-day intake was similar (918 ± 116 calories, 40 ± 5 g protein). The first day had high sensitivity (calories 96%; protein 93%) and positive predictive value (calories 100%; protein 96%). Malnutrition was evident; three-fourths of patients had weights below recommended ranges, and 83% were hypoalbuminemic. Conclusions: Three-day calorie counts are frequently performed in patients suspected of eating poorly. Results of this pilot study suggest that 1-day calorie counts may be a valid alternative. However, readily available anthropometric and biochemical data may be as good an indicator of inadequate dietary intake.

Objective: To determine the effect of dietary protein on healing of pressure ulcers in malnourished patients. Design: Nutritional intervention trial with the non-randomized assignment of patients by pressure ulcer stage and bed type. Setting: Long-term care facility. Patients: Twenty-eight malnourished patients (age = 72 ± 18 years, mean ± SD) with a total of 33 truncal pressure ulcers. Nine patients had stage II ulcers, eight had stage III ulcers, and 16 had stage IV ulcers. Methods: Patients received liquid nutritional formulas as tubefeedings or meal supplements containing either 24% protein (61 g protein/L; n = 15) or 14% protein (37 g protein/L; n = 13) for 8 weeks. Results: There was a significant decrease in total truncal pressure ulcer surface area of the 15 patients in the 24% protein group (-4.2 ±7.1 cm2, P < 0.02), but not in the 13 patients in the 14% protein group (-2.1 ±11.5 cm2, P = NS). The change in total ulcer area correlated with both dietary protein intake per kg body weight (rs = −0.50, P < 0.01) and caloric intake per kg body weight (rs = −0.41, P < 0.03). The decrease in stage IV ulcer area in eight patients in the 24% protein group (-7.6 ± 5.8 cm2, P < 0.02) was significantly greater (P < 0.05) than in eight patients in the 14% protein group (-3.2 ± 16.4, P = NS). In these 16 patients, the decrease in ulcer size also correlated with dietary protein intake per kg body weight (rs = −0.63, P < 0.01). Conclusion: High protein diets may improve the healing of pressure ulcers in malnourished nursing home patients.

In the table below, we present estimated relative risks for lung cancer mortality according to quartiles of alcohol intake, computed separately for non-smokers and ever-smokers in models adjusted for age, sex, and (for smokers) packs-per-day. Although the risk for mortality appears to be high among non-smokers in the highest quartile of alcohol intake, there is no obvious trend, possibly because of the small numbers of cases. Although we attempted to run similar models for beer, wine, and liquor, we believed that these results were too unreliable to present by smoking status, given the high number of non-drinkers for each beverage and the small number of lung cancer cases among non-smokers. The data presented in this letter result from a different analysis from that done for the original paper. Here, we fit separate models for non-smoking and smoking; for the original paper, we had a single model that included an interaction term between smoking and drinking. As a result, the relative risk of the highest quartile of drinking for non-smoking presented above, RR= 2.89, differs numerically from that in the original paper, RR = 2.3. This difference is probably due to the variability of the estimates but could also be due to differences in the modeling. We hope this clarifies our methods and presents some additional useful data on the non-smoker group.