The negative impact of harmful substance use on societies physical and mental wellbeing is a global issue. Substance use disorders are associated with a significant disease burden.

In recognition of this, Addiction is initiating a new series of commissioned reviews, Clinical issues: substance use disorders and the body.

The first in the series, Alcohol use disorders and the heart, gives an overview of the impact of low, medium and high levels of alcohol consumption on the heart. 

The researchers also focus in on the clinical presentation, pathological mechanisms, assessment, management and prognosis of people who consume alcohol at higher levels or in a binge pattern.

There is a particular focus on:

• Hypertension- increased blood pressure;
• Cardiac arrhythmias- irregular heartbeat ; 
• and alcoholic cardiomyopathy - due to excessive alcohol consumption the heart becomes unable to pump blood efficiently around the body. 

Both alcohol and tobacco use is an increasing public health concern in low- or middle-income countries. Due to an annual economic growth rate of approximately 10%, Ethiopia is a target for both the alcohol and tobacco industries.

Although data is limited, trends suggest that alcohol consumption is a particular problem among secondary school students.

A recent study, published in the Journal of Public Health, has sought to measure the prevalence of alcohol and tobacco consumption in young people living in Ethiopia, and the risk factors associated with alcohol and tobacco initiation.

3967 young people from ten rural and ten urban schools completed questionnaires which asked for information about the use of alcohol and tobacco products and their access to the Internet and frequency of watching football on television.

Results from the study found that:

• A total of 323 (8.5%) respondents reported that they had ever smoked

• The risk of ever smoking was higher in urban schools, among boys, and tended to increase with age. The risk of having ever smoked was more likely in those with parents who smoke, and who had access to the internet at home.

• Twenty-nine per cent of the young people reported ever having used alcohol, and 14% were current users.

• There was a very strong positive association between ever having smoked cigarettes and ever having tried alcohol

• Risk factors for currently drinking alcohol included parent alcohol use, home Internet access and regular watching of televised football

Overall the results show that tobacco and alcohol use among Ethiopian teenagers increases among those exposed to family and peer and among those accessing the Internet and, for alcohol, those watching televised football. The study highlights the potential risk that advertising, both through the internet and watches football, poses to young people in Ethiopia.  

Although alcohol consumption among young people in the UK has been declining there remains a concerning level of binge drinking amongst 16–24-year-olds.

One intervention, that is cost-effective and has a wide reach, is the inclusion of health messaging and product-related information on alcohol packaging. It is important therefore to understand how much information is being processed and recalled by young people.

A cross-sectional study, published in the Journal of Public Health, has examined awareness and recall of product information among adolescents and young adults aged 11–19 years old.

Participants were asked:

‘Have you seen any information, health messages or warnings on alcohol packaging over the last month?

‘What messages do you remember seeing?’

‘Have you ever had a whole alcoholic drink? Not just a sip.

‘Do you think you will drink alcohol at any time during the next year?’

Analysis of the questionnaire responses found that just one-third of participants had seen information on alcohol packaging. Awareness of product-related information was greater for current drinkers compared to non-drinker and higher-risk drinkers than lower-risk drinkers. 47% of the young people responded ‘none’ when asked the number of health messages recalled.

The top messages young people remembered were:

• Drink responsibly
• Don’t drink during pregnancy
• Know and stick to your limits

Overall the results show that most young drinkers did not recall seeing any information, health messages or warnings on alcohol packaging in the past month, implying that current labelling is failing to reach this key audience. This suggests the need for alterations to be made to the current intervention to improve the chances of message comprehension and recall.

Abstract

Background

Alcohol use during pregnancy can have a variety of harmful consequences on the fetus. Lifelong effects include growth restriction, characteristic facial anomalies, and neurobehavioral dysfunction. This range of effects is known as fetal alcohol spectrum disorders (FASD). There is no amount, pattern, or timing of alcohol use during pregnancy proven safe for a developing embryo or fetus. Therefore, it is important to screen patients for alcohol use, inform them about alcohol's potential effects during pregnancy, encourage abstinence, and refer for intervention if necessary. However, how and how often nurses and midwives inquire about alcohol drinking during pregnancy or use recommended screening tools and barriers they perceive to alcohol screening has not been well established.

Methods

This survey was sent to about 6,000 American midwives, nurse practitioners, and nurses who provide prenatal care about their knowledge of the effects of prenatal alcohol exposure, the prevalence of alcohol use during pregnancy, and practices for screening patients’ alcohol use. Participants were recruited by e‐mail from the entire membership roster of the American College of Nurse‐Midwives.

Results

There were 578 valid surveys returned (about 9.6%). Analyses showed that 37.7% of the respondents believe drinking alcohol is safe during at least one trimester of pregnancy. Only 35.2% of respondents reported screening to assess patient alcohol use. Only 23.3% reported using a specific screening tool, and few of those were validated screens recommended for use in pregnant women. Respondents who believe alcohol is safe at some point in pregnancy were significantly less likely to screen their patients.

Conclusions

Respondents who reported that pregnancy alcohol use is unsafe felt more prepared to educate and intervene with patients regarding alcohol use during pregnancy and FASD than respondents who reported drinking in pregnancy was safe. Perceived alcohol safety and perceived barriers to screening appeared to influence screening practices. Improving prenatal care provider knowledge about the effects of prenatal alcohol exposure and the availability of valid alcohol screening tools will improve detection of drinking during pregnancy, provide more opportunities for meaningful intervention, and ultimately reduce the incidence of FASD.