1. NACDD National Mentorship Program in Applied Chronic Disease Epidemiology 2013 CSTE Conference, Pasadena, CA June 10 th, 2013

2. Topic: Prevalence of chronic diseases among excessive alcohol drinkers Presenter: Nimisha Bhakta, MPH Office of Surveillance, Evaluation, and Research Texas Department of State Health Services Mentor: Timothy Naimi, MD, MPH Associate Professor, Boston University School of Medicine and Boston University School of Public Health, Boston, MA Clinician-Investigator, Boston Medical Center, Boston MA Staff Physician, Codman Square Health Center, Boston MA

3. Current Job Responsibilities Oversees the initiation, planning and development of advanced epidemiological projects related to obesity and other chronic diseases within Health Promotion and Chronic Disease Prevention Section (HPCDP). As the HPCDP Section Epi Team Lead, oversees and coordinates epidemiological activities across the section. Trains, leads, assigns and prioritizes work across the HPCDP epidemiology team. Coordinates the development of grant applications and is responsible for the implementation and monitoring of epidemiology team work plan activities.

4. Overview & Background Excessive drinking is not widely appreciated as an important risk factor for many chronic diseases. However, excessive drinking is a risk factor for, or can exacerbate existing chronic diseases, including: hypertension, diabetes, overweight/obesity; mental health problems, cancer, and chronic liver disease/cirrhosis, and other conditions. Physicians are recommended to screen their primary care patients about their alcohol use (to identify excessive drinking) but they rarely do. There is a belief among many that those who drink too much don’t come to the doctor and/or that patients with chronic medical conditions are unlikely to drink excessively.

5. Overview & Background Excessive alcohol consumption kills approximately 75,000 people annually in the United States. 2 Low screening rates by primary care providers among excessive drinkers are mostly due to missed screening opportunities rather than a lack of screening opportunities. 2 Binge drinking generally results in acute impairment and has numerous adverse health consequences. 4 In 2009, six of the seven leading causes of death in Texas were chronic diseases, including heart disease, cancer, stroke, diabetes, chronic lower respiratory disease, and Alzheimer’s disease. 6

6. Methodology 2011 Texas BRFSS data are used for this project SAS 9.2 used for analysis Analyses are performed on general adult population and some by applying restrictions for adults who went for routine check-up in past 2 years, among adults who drank alcohol at least once in past 30 days etc. Most of the chronic conditions are binary (yes/no) Demographic characteristics are examined for adults who practice any one of the three excessive alcohol consumption behavior and have chronic diseases

7. Methodology Definitions of excessive alcohol consumption patterns and chronic diseases of interest were finalized Three patterns of alcohol consumptions examined are binge drinking, heavy drinking and drinking more than U.S. dietary guideline recommended by U.S. Department of Agriculture U.S. Department of Health and Human Services Chronic diseases selected to explore are obesity, diabetes, hypertension, cardiovascular disease, cancer, depression, current smoking and mental health. In addition, having any of these conditions and categorical variable on number of chronic conditions are included.

8. Results Tables are prepared and some charts are created.

9. Results An example of a table Prevalence of measures of excessive alcohol consumption among adults with chronic diseases that can be caused or exacerbated by excessive alcohol consumption and who have had routine checkup within past 2 years, Texas BRFSS 2011

10. Conclusions Project is still in progress High prevalence of chronic diseases was observed among adults who practice one of the three excessive alcohol consumption patterns explored Males and low income adults were more likely to practice any one of three excessive alcohol consumption behavior and have multiple chronic diseases

11. Competency Areas An objective self-assessment of the applicant’s current competencies and skills was requested in program application The competency areas rated: Planning, Analytic Knowledge, Communication, Basic Public Health Sciences, Informatics and Computer Knowledge, Cultural Diversity, & Evaluation Area selected by me: Analytic Knowledge By participating in this program, I expected to learn advanced level skills within this competency including statistical, scientific/ research process, design and conduct of scientific investigations, as well as literature reviews, and appropriate assessment and use of data sources

12. Reflections Great opportunity to work “out of the box” - in terms of working with risk factor like excessive alcohol consumption in relation to chronic diseases within Health Promotion and Chronic Disease Prevention Section Seemingly simple things may take time! Recoding variables, deciding which variables to keep in analysis and denominator population, developing tables, charts etc. Good collaboration among mentees, nice to know individuals with similar interests Final product of the project – manuscript publication

13. References 1.Marissa B. Esser, MPH, Dafna Kanny, PhD, Robert D. Brewer, MD, MSPH, Timothy S. Naimi, MD, MPH. Binge Drinking Intensity - A Comparison of Two Measures. American Journal of Preventive Medicine 2012;42(6):625–629 2.Town M, Naimi TS, Mokdad AH, Brewer RD. Health care access among U.S. adults who drink alcohol excessively: missed opportunities for prevention. Preventing Chronic Disease 2006 Apr. Available from: http://www.cdc.gov/pcd/issues/2006/apr/05_0182.htm http://www.cdc.gov/pcd/issues/2006/apr/05_0182.htm 3.Timothy S. Naimi, Ziming Xuan, David W. Brown & Richard Saitz. Confounding and studies of ‘moderate’ alcohol consumption: the case of drinking frequency and implications for low-risk drinking guidelines. Addiction 2012. 4.Timothy S. Naimi, MD, MPH, Robert D. Brewer, MD, MSPH, Ali Mokdad, PhD, Clark Denny, PhD, Mary K. Serdula, MD, MPH, James S. Marks, MD, MPH. Binge Drinking among US Adults. JAMA 2003, 289:70-75. 5.Timothy S. Naimi, MD, MPH; Leslie E. Lipscomb, MPH; Robert D. Brewer, MD, MSPH; and Brenda Colley Gilbert, PhD, MSPH. Binge Drinking in the Preconception Period and the Risk of Unintended Pregnancy: Implications for Women and Their Children. PEDIATRICS Vol. 111 No. 5 May 2003 6.Texas Health Status Report, 2011. Center for Health Statistics, Texas Department of State Health Services

14. Acknowledgements To my supervisor, Dr. Lisa Wyman for bringing this program information to us, supporting to apply for it and allowing to dedicate the time A big thank you to my mentor Dr. Naimi for kindly providing his time and expertise for this project and keeping me on track Mentee team – friendly, peer learning opportunity And of course to NACDD for having this program! Great platform for state health department epidemiologists to work on research projects that otherwise may not be possible