Background Evidence suggests that people who abstain from alcohol have a higher mortality rate than those who drink low to moderate amounts. However, little is known about factors that might be causal for this finding. The objective was to analyze former alcohol or drug use disorders, risky drinking, tobacco smoking, and fair to poor health among persons who reported abstinence from alcohol drinking in the last 12 months before baseline in relation to total, cardiovascular, and cancer mortality 20 years later. Methods and findings A sample of residents aged 18 to 64 years had been drawn at random among the general population in northern Germany and a standardized interview conducted in the years 1996 to 1997. The baseline assessment included 4,093 persons (70.2% of those who had been eligible). Vital status and death certificate data were retrieved in the years 2017 and 2018. We found that among the alcohol-abstinent study participants at baseline (447), there were 405 (90.60%) former alcohol consumers. Of the abstainers, 322 (72.04%) had met one or more criteria for former alcohol or drug dependence or abuse, alcohol risky drinking, or had tried to cut down or to stop drinking, were daily smokers, or self-rated their health as fair to poor. Among the abstainers with one or more of these risk factors, 114 (35.40%) had an alcohol use disorder or risky alcohol consumption in their history. Another 161 (50.00%) did not have such an alcohol-related risk but were daily smokers. The 322 alcohol-abstinent study participants with one or more of the risk factors had a shorter time to death than those with low to moderate alcohol consumption. The Cox proportional hazard ratio (HR) was 2.44 (95% confidence interval (CI), 1.68 to 3.56) for persons who had one or more criteria for an alcohol or drug use disorder fulfilled in their history and after adjustment for age and sex. The 125 alcohol-abstinent persons without these risk factors (27.96% of the abstainers) did not show a statistically significant difference from low to moderate alcohol consumers in total, cardiovascular, and cancer mortality. Those who had stayed alcohol abstinent throughout their life before (42; 9.40% of the alcohol-abstinent study participants at baseline) had an HR 1.64 (CI 0.72 to 3.77) compared to low to moderate alcohol consumers after adjustment for age, sex, and tobacco smoking. Main limitations of this study include its reliance on self-reported data at baseline and the fact that only tobacco smoking was analyzed as a risky behavior alongside alcohol consumption. Conclusions The majority of the alcohol abstainers at baseline were former alcohol consumers and had risk factors that increased the likelihood of early death. Former alcohol use disorders, risky alcohol drinking, ever having smoked tobacco daily, and fair to poor health were associated with early death among alcohol abstainers. Those without an obvious history of these risk factors had a life expectancy similar to that of low to moderate alcohol consumers. The findings speak against recommendations to drink alcohol for health reasons.

Background The Patient Health Questionnaire-8 (PHQ-8) is a screening questionnaire of depressive symptoms. However, it is unknown whether it is equivalent across time and between groups of individuals. The aim of our paper was to test whether the PHQ-8 has the same meaning in two groups of individuals over time. Methods Primary care patients were proactively recruited from three German cities. PHQ-8 data from a baseline assessment (n = 588), two assessments during the intervention (n = 246/225), and a six (n = 437) and 12 months (n = 447) follow-up assessment were first used to examine the factor structure of the PHQ-8 by confirmatory factor analysis (CFA). The best fitting factor solution was then used to test longitudinal invariance across time and between intervention and control group by Multiple Group CFA. Results A two-factor structure consistently showed the best model fit. Only configural longitudinal invariance was evidenced when the baseline assessment was included in the analysis. Without the baseline assessment, strict longitudinal invariance was shown across the intervention and the follow-up assessments. Scalar invariance was established between the intervention and control group for the baseline assessment and strict invariance between groups and across the 6- and 12-month follow-up assessments. Conclusions The lack of longitudinal invariance might be attributed to various differences between the baseline assessments and all following assessments, e.g., assessment mode (iPad vs telephone), potential changes in symptom perception, and setting. Trial registration DRKS00011635, date of trial registration: 20.01.2017; DRKS00011637, date of trial registration: 25.01.2017.

Background: Many young people in England do not use services associated with delivery of alcohol IBA (also called screening and brief intervention). The project tested whether IBA can be delivered to 18-30 year-old, on busy city streets, by trained workers who were not healthcare professionals, without framing it as an 'alcohol reduction' intervention. This approach may be referred to as 'IBA Direct'. Materials and methods: Numbers of participants in the intervention were recorded on a monitoring sheet, along with the individual's gender, age and AUDIT score. The evaluator asked some participants to complete a brief, anonymous feedback form about their experience of the intervention. Results: The project was delivered over 3 days, amassing a total of 24 h across 2 Saturdays and 1 Sunday in August 2015. Four workers were present on all days. In total, 402 brief interventions were completed; however, data from 379 participants were recorded. Forty-one percent were female (21 % missing data) and 42 % were aged in their teens or twenties. A participant feedback form was completed by 61 people. Ninety-three percent (n = 57) rated the service as 'Excellent' or 'Good'. All respondents who answered the question on the suitability of the setting of the service (n = 58) said it was suitable. Nine out of ten respondents (n = 55) stated they would participate in this service in a public setting again. Conclusions: The evaluation of this project has demonstrated the feasibility and high acceptability of IBA Direct being delivered by non-health workers to the public on the streets of London. There were high levels of engagement at each location and among those aged 18-30. Important facilitators were considered to be the 'branding' of the intervention and materials, for example, framed as a 'health quiz' not 'alcohol reduction' and incentives to draw people in such as free 'mocktails' (soft drinks).

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