New figures show that the UK’s alcohol-related death rate continues to rise, with men particularly at risk. Nerys Hairon reports on what nurses can do to tackle this problem
Recent figures suggest that some patients are failing to heed warnings concerning the health-related risks of excessive alcohol consumption.
The figures, from the Office for National Statistics, show that the alcohol-related death rate in the UK continued to increase in 2006 (ONS, 2008a). Data also reveals that men are drinking twice as much alcohol as women (ONS, 2008b; Goddard, 2008a).
In addition, the ONS has updated methods for calculating alcohol consumption to reflect the trend towards larger measures and stronger alcoholic drinks. While latest data suggests there may be a downward trend in overall alcohol consumption, nurses clearly have a role in reinforcing public-health messages about alcohol misuse.
To help tackle increasing worries over alcohol use by children and young people, and its associated risks, NICE recently published guidance on school-based interventions on alcohol (NICE, 2007).
The alcohol-related death rate in the UK continued to increase in 2006, rising from 12.9 deaths per 100,000 in 2005 to 13.4 in 2006 (ONS, 2008a). Rates have almost doubled from 6.9 per 100,000 in 1991, while the number of alcohol-related deaths more than doubled from 4,144 in 1991 to 8,758 in 2006.
In 2006 the male death rate (18.3 per 100,000) was more than twice the rate for females (8.8 per 100,000), and males accounted for two-thirds of the total number of alcohol-related deaths.
For men, the death rates in all age groups increased from 1991–2006. The biggest increase was in men aged 35–54. Rates in this age group more than doubled, from 13.4 to 31.1 deaths per 100,000 over this period. However, the highest rates in each year were for men aged 55–74.
The data shows that death rates by age group for females were consistently lower than those for males, but trends showed a broadly similar pattern by age.
The death rate for women aged 35–54 doubled between 1991 and 2006, from 7.2 to 14.8 per 100,000. This was a larger increase than the rate for women in any other age group.
According to the ONS (2008a), in 2005–2006 death rates remained the same for those aged 15–34 for both sexes. They increased for those aged 35–54 and 55–74. Meanwhile, there were small decreases in the rates for those aged over 75, down 8% for men and 6% for women.
Other data reveals that men are drinking twice as much alcohol as women – 18.7 units a week on average, compared with 9.0 units (ONS, 2008b).
A report on smoking and drinking among adults, which used data from the 2006 general household survey, found that men were more likely than women to have drunk alcohol on at least one day in the previous week – 71% of men and 56% of women had done so (ONS, 2008b; Goddard, 2008a).
It was also found that men drank on more days of the week than women – 21% of men compared with 11% of women had consumed alcohol on at least five of the previous seven days.
This report found alcohol consumption in 2006 was higher in England and Wales than in Scotland. This stood at 13.7 and 13.5 units a week on average respectively, compared with 11.6 units in Scotland. In addition, the report found that men and women in managerial and professional households drank the most alcohol on average (15.1 units a week).
Those classified as ‘routine and manual’ drank less (11.6 units a week) on average than those in other types of household.
MEASURING ALCOHOL CONSUMPTION
Methods for calculating alcohol consumption have been updated to reflect the trend towards larger measures and stronger alcoholic drinks, especially wine (ONS, 2008b; Goddard, 2008a).
To update the method for calculating estimates of alcohol consumption, the following factors were taken into account:
Increases in the size of glass in which wine is served on licensed premises;
The increased alcoholic strength of wine;
Better estimates of the alcoholic strengths of beers, lagers and ciders.
From 2008, the general household survey will include additional questions to establish the size of wine glass, but in the interim a proxy conversion factor counting one glass of wine as two units will be used. For full details on sizes of glass and the updated factors for converting alcohol volume to units, see the report (Goddard, 2008a) at www.statistics.gov.uk
However, Goddard points out that changing the way alcohol consumption estimates are derived does not in itself reflect a real change in drinking among the adult population.
The year 2006 was the first in which this new methodology was applied to data from the general household survey, and for this reason it is not possible to compare like-with-like figures from previous years.
However, estimates from the past 10 years using the previous methodology suggest that the trend in alcohol consumption may be downward.
The proportion of men drinking over 21 units a week on average fell from 29% in 2000 to 23% in 2006. The proportion of women drinking over 14 units a week also fell, from 17% in 2000 to 12% in 2006 (ONS, 2008b).
However, updating the estimates and using the new method increases the proportion of men in 2006 drinking over 21 units from 23% to 31%, and the proportion of women drinking over 14 units from 12% to 20%.
The ONS has also published a report on adults’ behaviour and knowledge relating to alcohol, which details what people drink, patterns of drinking, drinking-related knowledge and behaviour, and purchase of alcoholic drink (Goddard, 2008b).
The report, which is based on the ONS omnibus survey, found that 85% of adults had heard of measuring alcohol consumption in units in 2007, compared with 79% 10 years earlier. To see this report in full, visit www.statistics.gov.uk
ACTION FOR NURSES
NICE (2007) states that there are no national guidelines on what constitutes safe and sensible alcohol consumption for children and young people, so the recommendations in its public health guidance focus on:
Encouraging children not to drink;
Delaying the age at which young people start drinking;
Reducing the harm alcohol can cause among those who do drink.
Three main recommendations for school nurses and others working in schools focus on education, one-to-one advice and referral for those drinking harmful amounts, and developing partnerships.
Nurses working in hospitals and care homes should be aware of recent research, which found that young or confused people and those dependent on alcohol could be at risk from ingestion of alcohol handrubs (Archer et al, 2007).
The authors recommended that large handrub dispensers are placed in secure holders to prevent accidental or intentional removal by high-risk patients.
While figures suggest there could be a downward trend in weekly alcohol consumption, many groups are still at risk from the effects of excessive alcohol use, particularly men. Nurses are vital in reinforcing the public-health message on safe alcohol consumption to prevent complications and alcohol-related deaths.
Archer, J.R.H. et al (2007) Alcohol handrubs: hygiene and hazard. British Medical Journal; 335: 1154–1155.
Goddard, E. (2008a) Smoking and Drinking Among Adults, 2006. London: ONS.
Goddard, E. (2008b) Drinking: Adults’ Behaviour and Knowledge in 2007. London: ONS.
NICE (2007) School-based Interventions on Alcohol. Quick Reference Guide. London: NICE. www.nice.org.uk
Office for National Statistics (2008a) Alcohol Deaths: Rates in the UK Continue to Rise. London: ONS. www.statistics.gov.uk
Office for National Statistics (2008b) News Release: Men Drink Twice as Much Alcohol as Women. London: ONS. www.statistics.gov.uk
SUMMARY OF NICE RECOMMENDATIONS
School nurses should ensure alcohol education is an integral part of the curriculum, in line with government guidance. This should be tailored for different age groups and learning needs.
They should also offer parents/carers information about where they can get help to develop parenting skills, where necessary.
Where appropriate, school nurses should offer brief, one-to-one advice on the harmful effects of alcohol use, how to reduce risks and where to find support, to children and young people thought to be drinking harmful amounts. If appropriate, they should make a direct referral to external services (without providing advice).
School nurses should work on developing and maintaining partnerships to support alcohol education in schools as part of the curriculum. They should also find ways to consult with families so that initiatives to reduce alcohol use can be explained.
Source: NICE (2007)