1. Public Health Alcohol impacts health: A rapid review of the evidence Simone Kaptein, PhD Peel Public Health May 28 th, 2013

2. Public Health Evidence Informed Decision Making – Peel context Teams would need to conduct a full rapid review of the literature when: adding a program discontinuing a program refocusing/changing a program reviewing new guidelines/protocols Source: NCCMT

3. Public Health Peel’s Rapid Review Methodology Our approach uses: Synthesized research Narrow search strategy Limit number of resources Critical appraisal Tools for rapid reviews: http://www.peelregion.ca/health/library/tools-for-rapid- reviews.asphttp://www.peelregion.ca/health/library/tools-for-rapid- reviews.asp Source: NCCMT

4. Public Health Issue – alcohol impacts health New Canadian LRADG released in 2011 Higher limits than old ON guidelines Critically appraised Difficulty accessing methodology Source: CCSA

5. Public Health Rapid review question What is the impact of different levels of alcohol consumption on mental and physical health? PECO: Population: Healthy, non-pregnant adults Exposure: Various levels of alcohol consumption Comparison: None, abstainers Outcome: Beneficial or harmful impacts of alcohol

6. Public Health Literature search & Article selection Search strategy  Limited to studies published in English  Ovid Medline, PsycInfo (2008-2012)  TRIP (2000-2012)  Grey literature (e.g., CDC, WHO, NIAAA) 885 potentially relevant articles 72 papers after relevance assessment 3 resources selected and critically appraised

7. Public Health Synthesis – number and type of resources Australian Drinking Guidelines American Dietary Guidelines Babor - Book Chapter Systematic reviews/meta- analyses 101234 Primary studies 343221 Other ( methodology papers/datasets ) 500 Total = 148 494455

8. Public Health Synthesis Tables

9. Public Health Effect sizes for health impacts for women (g/day) Disease conditions 10g20g30g40g All-cause mortality (>45 years) RR=0.87 (>0-10g) RR=1.01 (>10-30g) RR=1.40 (>30-50g) RR=1.40 (>30-50g) Liver cirrhosis (mortality) RR=1.32RR=1.73RR=2.25RR=2.89 Bone healthRR=0.84RR=0.91 (14-28g) RR=1.39 Breast cancer (mortality) RR=1.08RR=1.17RR=1.26RR=1.36

10. Public Health Effect sizes for health impacts for men (g/day) Disease Conditions 10g20g30g40g50g All-cause mortality (<45 years) RR=1.09 (>0-10g) RR=1.40 (>10- 20g) RR=1.78 (>20- 30g) RR=1.89 (>30- 40g) RR=2.86 (>40- 70g) All-cause mortality (>45 years) RR=0.85 (>0-10g) RR=0.80 (>10- 20g) RR=0.91 (>20- 30g) RR=0.96 (>30- 40g) RR=1.04 (>40- 70g) Liver cirrhosis (mortality) RR=1.21RR=1.45RR=1.72RR=2.02RR=2.35 Hypertensive disease RR=1.15RR=1.33RR=1.53RR=1.77RR=2.04

11. Public Health Results Alcohol a risk factor for wide- range of conditions Detrimental effects are seen at <10g/day Volume of drinking and dose-response relationship Source: Rehm et al. (2009). Evidence base for the development of the Canadian LRDG.

12. Public Health Results Irregular drinking patterns result in harms

13. Public Health Results Sex/Gender differences Women – physiological Men – risky behaviours

14. Public Health Conclusions Alcohol has detrimental effects, even at low levels of consumption Alcohol data has limitations (i.e., self report, quality of data/research) There is a lack of international consensus across LRADGs Focus on mortality as an outcome; morbidity and disability are important measures for public health

15. Public Health Acknowledgements Many individuals assisted in the completion of the rapid review, including: Teresa Wan Pat Bromby Elizabeth Amorim Suzanne Smith Lori Greco Dr. Megan Ward Cathy Granger Julie Stratton and Monali Varia

16. Public Health Questions??? Contact information: Simone Kaptein Simone.kaptein@peelregion.ca (905) 791-7800 x2016 Rapid reviews: http://www.peelregion.ca/health/lib rary/literature-reviews.asp