Objective: Previous reviews have reported inconsistent relationships between alcohol use and risk of pancreatic cancer (PC). We investigated associations between alcohol consumption and PC in a meta-analysis. Methods: PubMed and Web of Science were searched for cohort studies of alcohol and PC incidence/mortality up to January 1, 2024. Studies were coded for former drinker misclassification, extent of control for confounding, and other study characteristics. Mixed models were used to model the meta-data and calculate the summarized hazard ratio as relative risk (RR) of PC incidence/mortality. Former drinker misclassification and other study-level covariates were examined and controlled using adjustments, quality weighting and stratification. Results: Thirty-seven cohort studies provided 279 PC incidence/mortality risk estimates for drinkers versus “non-drinkers”. In pooled analyses with and without adjustment for study-level covariates, there was no significant protection at any level, and significantly increased risk at >24 grams/day. Significant dose-response relationships were observed; e.g., there was a 2.4% increase in PC risk for each 10g ethanol/day increment in the adjusted model (P=0.0001). In stratified analyses, studies with former drinking bias showed significantly reduced PC risk for those drinking >14-24g/day and no significant increase in risk for people drinking >24-44g/day; neither finding was observed among studies with reduced former drinker bias. Conclusion: Alcohol consumption and pancreatic cancer exhibits a dose-response risk relationship; consumption of >24 grams/day is significantly associated with increased risk. Failing to separate former drinkers from lifetime abstainers may yield spurious protective associations at low levels of consumption and may suppress risk estimates at higher levels.
In early December 2025. members of the Kettil Bruun Society learned of the very sad news that our friend and colleague, Professor Sharon Wilsnack had passed away. Sharon was a longtime member of KBS and had a prominent role in the society beginning in 1993 when she started the KBS working group on alcohol and gender, the International Research Group on Gender and Alcohol (IRGGA). From this group grew other networks and multinational research projects, funded by the US National Institute on Alcohol and Alcohol Abuse (NIAAA), the European Commission, the World Health Organization (WHO), the Pan American Health Organization (PAHO) and various funding agencies from collaborating countries (https://www.kettilbruun.org/projects/genacis/). For over 30 years, Sharon helped to maintain a strong focus on women, gender and alcohol within our society and helped to make the KBS a truly international research society. As described in the tributes, she was also a dedicated mentor to many young researchers coming up within KBS. The many posts on the KBS listserv following news of Sharon’s death made it clear that members of KBS wished to share their sorrow and show their appreciation for Sharon’s contributions both to the body of knowledge on women and alcohol and to the careers of so many people around the world. Accordingly, after consultation with the Editors of IJADR, we started to collect these tributes for publication in this, the KBS journal. Then, very shortly before a memorial service was to be held for Sharon on 12 April 2026 in Minneapolis, MN, USA, we received the news that Professor Richard Wilsnack, Sharon’s spouse of many decades, had passed away from a long illness. This was yet another blow to the IRGGA community and to KBS members generally, many of whom had also benefitted from Richard’s leadership, advice and depth of knowledge. To have both members of this wonderful couple depart so soon after each other was heartbreaking, especially to the Wilsnack children and grandchildren. Some who were part of the IRGGA community worked mainly with Sharon. However, others worked closely with Richard, too. Therefore, we and the editors decided to invite people to revise their tributes to include their memories and the accomplishments of both Richard and Sharon, if they wished. What follows is a collection of tributes written by some of the many KBS researchers who were touched by both Sharon’s and Richard’s guidance, wisdom, support and collaboration. We hope that the reader will enjoy reminiscing and appreciating these very special lives.
Aims: This study examines the determinants of household alcohol purchase decisions and expenditure intensity in Vietnam, addressing the potential sample selection bias arising from the high proportion of non-purchasing households. Methods: The analysis uses cross-sectional data from the 2020 Vietnam Household Living Standards Survey (VHLSS) with a sample of 9,389 households. A Heckman two-step selection model is employed to jointly estimate the probability of purchasing alcohol and the level of expenditure conditional on purchase. Results: The Wald test of independent equations confirmed significant sample selection bias (p = 0.035), validating the use of the Heckman selection framework. Male-headed households were 7.6 percentage points (pp) more likely to purchase alcohol and spent an additional 325.3 thousand Vietnamese Dong (VND) annually (conditional on purchase) than female-headed households. Income demonstrated the strongest gradient: the richest quintile was 13.3 pp more likely to purchase alcohol and spent 2,608,000 VND more annually among purchasers compared to the poorest group. Geographically, households in the Mekong River Delta were 16.8 pp less likely to purchase alcohol than those in the Red River Delta, yet purchasers in this region recorded the highest spending intensity nationwide (+1,649,9000 VND), indicating a pattern of high-intensity consumption events. Conclusion: Household alcohol expenditure in Vietnam is shaped by marked demographic, income, and regional disparities. We propose a multi-layered policy framework that combines stronger excise taxation to reduce affordability with interventions targeting gender norms. Region-specific strategies remain essential, including cooperative-based formalization support in the Northern mountainous areas and stricter supply-side controls in high-intensity Southern markets.
Aims: Alcohol contributes to 2,6 million deaths globally. A promising policy option to address this health burden is the use of health warning labels on alcoholic products. However, the important perspectives of primary healthcare providers on this strategy have not been investigated until now. This study explored Dutch primary healthcare providers perspectives on alcohol health warning labels in general, and in particular on their content and format, and their influence on alcohol-related professional practices. Methods: This qualitative study used semi-structured interviews with Dutch primary healthcare providers aged 18-67 years. Participants were recruited via convenience sampling. A coding scheme was developed guided by the I-Change Model. Thematic analysis was used for data analysis. Themes were predetermined using the I-Change Model and adapted according to the data. Results: Thirteen Dutch primary healthcare providers were included. Results showed that although most participants doubted the effectiveness of alcohol health warning labels in changing consumers behavior, the majority supported their use and believed they would influence consumers’ awareness of alcohol-related risks. For the content and format, they preferred a specific, clear, and a more visible label. Participants believed health warning labels would positively impact their alcohol discussions with patients. Conclusion:Primary healthcare providers generally support alcohol health warning policies, and these labels may positively influence their discussion of alcohol with patients. They should be considered important stakeholders in strengthening label policies.
Introduction: Alcohol excise taxation is one of the World Health Organization’s (WHO) “best buys” for reducing alcohol consumption and attributable harms. Despite its proven effectiveness, alcohol taxation remains globally underused, partly due to Member States’ concerns about potential revenue losses. Robust estimation methods are essential to predict future revenues after policy changes. This study compares two approaches for estimating alcohol excise tax revenue per capita and assesses their validity against reported figures. Methods: Reported alcohol excise tax revenue per capita for 2022 was retrieved from official government sources for 17 countries in the European Union and the United Kingdom. These figures were compared to estimated values generated using two different methods: 1) a tax-and-consumption-based approach using beverage-specific tax and consumption data, and 2) an excise share-based approach using the linear relationship between excise tax share and revenue. Comparisons were made using visual inspection of scatterplots, relative error plots, and Bland-Altman plots, correlation analysis and linear regression models. Results: Both methods showed strong correlation with reported revenue (tax-and-consumption-based: r = 0.959; excise share-based: r = 0.857) and high explained variance of the reported revenue. The tax-and-consumption-based method demonstrated higher precision, narrower limits of agreement, and significantly better model fit. Conclusions: Both methods provide useful alternatives in the absence of reported data, but the tax-and-consumption-based approach offers a more accurate and consistent estimate of alcohol excise tax revenue per capita. These findings support its use in global monitoring and fiscal modelling, particularly in the context of WHO technical support to Member States.
Aim: This study examined changes in binge drinking prevalence and odds before and after the 2020 COVID-19 pandemic declaration in the United States (US) among individuals with prior history of alcohol use, and explores the interaction effects of sociodemographic, behavioral, and health-related factors on the association. Methods: A cross-sectional analysis was conducted using data from the Health Information National Trends Survey (HINTS) collected between February and June 2020 from adults reporting alcohol use in the past 30 days (n = 1,948). The primary outcome was binge drinking, defined as consuming five or more drinks (men), or four or more drinks (women) on one occasion in the past month. Weighted multivariable logistic regression models estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for binge drinking after the pandemic declaration, versus before the declaration, adjusting for sociodemographic, behavioral, and health-related factors. Results: Binge drinking prevalence was similar before (44.39%) and after (44.13%) the declaration, with no significant overall difference (AOR = 0.77; 95% CI [0.54-1.10]). Cardiometabolic outcomes significantly moderated the association (p = .022), with lower probabilities among those with cardiometabolic conditions and higher probabilities among those without. Increased odds of binge drinking were observed among Hispanic adults (AOR = 2.10; 95% CI [1.08, 4.07]), lesbian/gay or bisexual individuals (AOR = 2.89; 95% CI [1.11, 7.54]), and former (AOR = 1.78; 95% CI [1.15, 2.76]) or current (AOR = 3.45, 95% CI [1.71, 6.98]) smokers. Conclusions: While overall binge drinking remained stable, disparities emerged across subpopulations. These findings underscore the need for targeted interventions addressing alcohol use among vulnerable groups during public health emergencies.
Background: South Africa has high levels of alcohol consumption, and the availability of alcohol outlets plays a significant role in shaping drinking patterns. Alcohol outlets are typically concentrated in specific small areas, and their density and trading hours can influence alcohol-related harm. Several studies have shown that greater outlet density and extended trading hours are linked to higher levels of alcohol consumption and associated harm. However, community-centred approaches to mapping these factors are less common, especially in low- to middle- income countries (LMICs) such as South Africa. Aim: To test the feasibility of participatory mapping of alcohol availability, to map this availability and gain stakeholder and community views in selected South African communities. Methods: This mixed-method study included desktop research to identify known data sources for licensed alcohol outlets; geo-location and mapping of alcohol outlets by local community mappers; and focus group discussions (FGDs) and key informant interviews (KIIs) with community representatives. Study findings: Alcohol outlets were densely distributed within residential areas, a large proportion of surveyed alcohol outlets were unlicensed, several had long trading times, many opening seven days a week in contravention of municipal by-laws. Spatial analysis showed marked variation in alcohol outlet density across zones, with several high-density hotspots. Outlet density per 1,000 population was substantially higher in Thembalethu than in Ga-Rankuwa. Community voices revealed that alcohol accessibility, long outlet trading times, outlet density, and poor licensing and enforcement contributed to alcohol’s ubiquitous availability. Conclusion: Participatory, community-centred mapping is a feasible and valuable approach for mapping alcohol availability. Findings highlight high outlet density, widespread unlicensed and informal sales, and the need for stronger regulation and enforcement alongside community involvement in mapping, monitoring, and supporting alcohol regulations.
Purpose: Trends in heavy drinking among Hispanic young adults are shifting in the United States. Despite elevated risks for alcohol use disorder (AUD) and related problems among Hispanic populations, little work has examined cultural mechanisms to alcohol outcomes in the context of their neighborhood environments. This study examines how neighborhood environment factors (ethnic density and distance to the nearest border port of entry) and cultural factors (acculturative stress and ethnic identity) relate to AUD. Methods: The sample of 575 Mexican American men and women (aged 18 to 30) was recruited from San Diego County, California, USA. We assessed indirect effects of Mexican American ethnic density and distance to the nearest border port of entry on AUD through acculturative stress and ethnic identity. Multiple group path analysis was used to test sex differences. Results: While sex differences were not observed in the overall model, there were differential associations with focal variables for each group. For women, greater proportions of ethnic density and greater distance to the nearest port of entry both were negatively associated with AUD. For both women and men, acculturative stress was positively associated with AUD, and neighborhood environment indicators were not related to acculturative stress nor ethnic identity. Conclusions: These data may inform further studies to integrate social and cultural mechanisms in creation of place-based strategies for AUD prevention.
Introduction: Thailand’s alcohol control laws include an extensive ban on alcohol marketing. However, loopholes exist in online marketing, yet online marketing of alcohol targeting audiences in Thailand has not yet been systematically described. The objective of this study was to describe online alcohol marketing activities in the Thai language. Methods: We used an artificial intelligence (AI) platform to collect alcohol marketing content on the internet. We prepared a database of search terms related to alcohol marketing. The platform automatically searched and filtered alcohol marketing content that violated control and regulatory measures. We analyzed data using descriptive statistics. Results: Our analyses included data from 13,301 posts generated by 4,638 users. The most common violation of the Alcoholic Beverage Control Act of 2008 was the use of alcohol brand trademarks or symbols (70%). The most common content producers were restaurants, pubs, and bars, followed by wholesale/retail stores and influencers. Content materials focused on driving awareness and drinking methods. Content materials did not mention the location of sales, shipping methods, discounts, free products, or giveaways. Discussion: We found violations of regulations for alcohol control measures in Thailand among online media posts in the Thai language. Potential selection bias from search engine algorithms and the limited generalizability should be considered as caveats in the interpretation of the study findings.
Introduction: Economic development leads to higher life expectancy, and in most countries is also associated with a higher level of alcohol consumption, as more people start to consume alcohol. As alcohol consumption is a major risk factor for many diseases, this increased consumption of alcohol reduces life expectancy, and in turn slows down economic development. However, alcohol control policies may reduce consumption and mitigate the detrimental effects of alcohol use on life expectancy and the economy. The objectives of this study are to quantify the interrelations between alcohol control policies, levels and patterns of consumption, life expectancy, and economic development for the Association of South East Asian Nations (ASEAN) countries between 2000 and 2023. Methods and analysis: Secondary data analysis of available data will be undertaken, using a cross-sectionally correlated and time-wise autoregressive model for the main conceptual model. In addition, the detrimental effects of alcohol consumption on economic development will be estimated directly and indirectly via its effect on health indicators. Ethics and Dissemination: As a secondary analysis study of publicly available data, this research does not require approval by a research ethics board. Its results will be disseminated via peer-reviewed publications, webinars, and other forms available to decision-makers. Strengths and limitations: We selected a region, the ASEAN countries, which experienced high growth in economic growth wealth as measured by increases in per capita Gross Domestic Product in Purchasing Power Parity since the turn of the century. We were able to use standardized comparable data from international agencies (World Bank, World Health Organization). The study is based on a on a strong conceptual model; i.e., the framework of Angus Deaton, expanded to include the impact of alcohol. We have sufficient data points available to conduct the cross-sectionally correlated and time-wise autoregressive model. However, there may be difficulties in modeling feedback loops within a system in which a change in one variable can eventually lead back to affect the original variable. Finally, there are important potential practical implications for health policy.
Purpose: Trends in heavy drinking among Mexican American young adults are shifting in the United States. Despite elevated risks for alcohol use disorder (AUD) and related problems among Mexican American populations, little work has examined mechanisms contributing to alcohol outcomes in the context of their neighborhood environments. This study examines how neighborhood environment factors (ethnic density and distance to the nearest border port of entry) and cultural factors (acculturative stress and ethnic identity) relate to AUD. Method: The sample of 575 Mexican American men and women (aged 18 to 30) was recruited from San Diego County, California, USA. We assessed the indirect effects of Mexican American ethnic density and distance to the nearest border port of entry, on AUD through acculturative stress and ethnic identity. Multiple group path analysis was used to test sex differences. Results: While sex differences were not observed in the overall model, there were differential associations with focal variables for each group. For women, greater proportions of ethnic density and greater distance to the nearest port of entry were both negatively associated with AUD. For both women and men, acculturative stress was positively associated with AUD, and neighborhood environment indicators were not related to acculturative stress nor ethnic identity. Conclusions: These data may inform further studies to integrate social and cultural mechanisms in creation of placebased strategies for AUD prevention.
Aims: To assess changes in total alcohol consumed over time and changes in consumption of different alcoholic beverages in South Africa. In addition, to assess the utility of industry sales data for evaluating the impact of policy changes related to a packaging ban on wine products in September 2007, and bans on alcohol sales during the COVID19 pandemic in 2020 and 2021. Design. Alcohol industry sales data as a proxy for consumption were assessed using statistics presented in South African Wine Industry Information & Systems (SAWIS) booklets released annually between 1995 and 2022, and used to describe changes over time in consumption overall, and by product, and the impact of policy changes on consumption. Results. Per capita consumption of alcoholic beverages overall in South Africa has held steady or declined over time, but declines in the market share of wine and beer (especially) and a massive increase for Ready-To-Drinks (RTDs) were noted. The consumption data also indicated short term effects of Covid-19 interventions (especially in 2020) in terms of reducing overall alcohol consumption, with a return to prior levels in 2022. Industry data on packaging for wine was able to show the immediate and longer-term impact of the 2007 ban on wine sold in foil bags. Conclusion. Industry data are a useful adjunct to consumer measures of alcohol use, as well as for detecting the impact of policy changes related to alcohol availability and packaging, notwithstanding gaps in information on illicit/unrecorded sales and other limitations.
Background:Family burden has not been studied in relation to alcohol and other drug harms from others. We adapted a family burden scale from studies of caring for those with mental health conditions for use in the US Alcohol and Drug Harm to Others Survey (ADHTOS). We investigated associations between a seven-item summative burden scale and different types of harms attributed to someone else's use of alcohol, cannabis, or another drug: (a) being assaulted/physically harmed; (b) having family/partner problems; (c) feeling threatened or afraid; and (d) being emotionally hurt/neglected due to others' substance use. Methods:A survey of adults aged 18 years and over conducted between October 2023 and July 2024 (n = 8,311), involved address-based sampling (n = 3,931 including 193 mail-backs) and web panels (n = 4,380), oversampling Black (n = 951), Latinx (n = 790) and sexual or gender minority (SGM) respondents (n = 309). Data from seven items on types of burdens experienced from other people's alcohol or drug use were provided by those harmed by someone else's alcohol or drug use and were used to create a burden scale. Analyses used negative binomial regression on burden sum adjusting for covariates, such as age, gender, race and ethnicity, marital status and years of education. Results:The single factor burden scale showed good internal consistency (α = .91). Components assessing being emotionally drained/exhausted and family friction/arguments were endorsed by 38-39% of participants; finding stigma of the other's substance use upsetting was affirmed by 33%. Fewer endorsed feeling trapped in caregiving roles (22%), problems outside the family (26%), neglect of other family members' needs (16%), and having to change plans (14%). In adjusted regression models, seven of eight harm exposures were significantly associated with burden scores. Discussion:People reported substantial burden from others' use of alcohol, cannabis, and other drugs. Family support interventions and policy remedies to mitigate these burdens are needed.
Background: In North Karelia, Finland, a comprehensive integration of health and social services was implemented in 2017. This study sought to evaluate the impact of integration on the utilisation of health services among patients with alcohol use disorders (AUDs). Methods: Data from 2016 to 2020 were gathered from the electronic health records, encompassing both primary and specialised care, for patients with AUDs (n = 4344). Patients were identified based on AUD-related International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnosis codes. The data included information on the type of contact, reason for contact (ICD-10 code), and professional providing the service. Results: The proportion of patients with any annual contact with health services was approximately 90%, and this proportion remained unaffected by the integration. Decreases in AUD contacts were noted across the entire patient cohort, except for those diagnosed with AUD already in 2016. Emergency care use increased among patients treated in substance abuse services after the integration of services. Remote online and telehealth contacts increased across service domains, but these changes were unrelated to the integration year. Conclusion: The decrease in AUD contacts may be attributed to the improved identification of patients with less severe conditions, as the recording of diagnosis codes has improved. However, notable unmet care needs continue to exist.
Introduction: Alcohol-free mock beverages are consumed by Muslims in the deep south region of Thailand, but the extent to which such consumption was associated with attitude toward alcohol and subsequent alcohol consumption is unknown. The objectives of our study were: (1) to describe the extent to which the consumption of alcohol-free mock beverages is associated with alcohol consumption among Muslim youths in the deep south of Thailand; and (2) to describe the extent to which attitude towards alcohol mediates the stated association. Methods: We conducted a mixed-methods cross-sectional study. We used convenience sampling to source self-identified Muslims aged 18 to 40 years from Pattani Province, Thailand. We invited them to participate in a face-to-face survey interview and/or a qualitative study, with either a focus group discussion or in-depth interviews. Quantitative survey data was analyzed using descriptive statistics. We then performed mediation analysis using the mediation package in R. Qualitative data was analyzed using thematic analysis. Results: A total of 407 persons participated in our study. Approximately 33% of the participants reported lifetime consumption of alcohol-free mock beverages and 6% reported a history of alcohol consumption. Current mock beverage consumers were significantly more likely to be current drinkers of alcohol than those who never consumed mock beverages (7.0% vs. 0.4%). Mediation analysis, however, showed that the association was not significantly mediated by attitude toward alcohol. Discussion and conclusion: We found a strong association between alcohol-free mock beverage consumption and alcohol consumption. The findings have implications for stakeholders in public health, alcohol control, and religious leadership. However, limitations regarding the selection of participants and social desirability bias should be considered as caveats in the interpretation of the study findings.
Background and aims: The aim of the present study is to examine the associations between parenting practices and adolescent alcohol use in a longitudinal sample of adolescents from Sweden. Data and methods: A prospective longitudinal sample of 3,999 adolescents in a nationwide study (2017-2019) in Sweden filled out questionnaires. Baseline data (T1) was collected at age 15/16 and a two-year follow-up (T2) was conducted at age 17/18. Alcohol use was measured with AUDIT-C. Parental support and monitoring was measured at both time points with two questions for each dimension. Cross-sectional and prospective associations are examined using linear regressions. Findings: A significant negative association was found for both support and monitoring at both time-points in the crude models. Only monitoring remained significant in the adjusted models. Monitoring at T1 had a significant negative association with alcohol use at T2. Increases in both parenting practices between T1 and T2 was significantly associated with lower alcohol use at T2. Conclusions: Parenting factors during adolescence are closely associated with adolescent drinking. These findings underscore the importance of ongoing parental engagement, particularly in terms of parental monitoring, throughout mid- and late adolescence to prevent drinking.
Introduction: Intimate partner violence (IPV) is a threat to the health and well-being of women globally. Harmful alcohol use is identified as a risk factor for both the perpetration and experience of IPV and for the severity of such violence. Severe intimate partner violence (SIPV) is extreme physical, emotional, and sexual violence within intimate relationships that causes significant harm to survivors. This paper aims to explore the role of male partner alcohol use in women's experiences of SIPV in South Africa. Methods: We conducted a qualitative study, using six focus group discussions and 20 in-depth interviews with 62 demographically diverse adult women from three provinces in South Africa (Gauteng, KwaZulu-Natal, and the Western Cape) who experienced SIPV. Findings: Women reported alcohol-related SIPV; their abuse included controlling and coercive behaviour restricting their movement and ability to participate in daily activities, economic abuse, severe physical and sexual IPV, and attempted femicide. Women framed men's alcohol consumption as a 'right' tied to masculinity, frequently intersecting with expressions of dominance, control, aggression, and the perceived role of the male provider. Alcohol was often portrayed as an enabler that reinforces a sense of power and control, both in individual behaviour and in interactions with intimate partners. Conclusions: Alcohol-related severe intimate partner violence has profound and damaging impacts on women, manifesting in controlling, coercive, and violent behaviours. The intersection of alcohol misuse and masculinity reinforces power imbalances and perpetuates cycles of violence, embedding gendered power dynamics within intimate relationships. Addressing both alcohol misuse and gender-based inequality is critical in efforts to combat alcohol-related intimate partner violence.
