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Questions on alcohol included 1) weekly intake of beer, wine and spirits (asking about a usual week at the base line and the last week during re-examination); 2) the graduated frequency questionnaire (Greenfield, 2000, Appendix 1); 3) the largest amount of alcohol consumed on a single occasion in the last month; 4) frequency of intoxication;

and 5) alcohol related problems in the last year.

4.4.4.1 The graduated frequency questionnaire

The graduated frequency (GF) questionnaire asked about the amount of alcohol in local units of beer, wine or spirits and the number of times it was consumed in the past 12 months (Appendix 3). The amount of alcohol ranged from about half a drink to 10 or more drinks. One drink was defined as 500ml of beer, 200ml of wine or 50ml of spirits.

The number of times alcohol was consumed was categorized into nine mutually

exclusive options: every day or almost every day, 3-4 times per week, 1-2 per week, 2-3 per months, about once a month, 6-11 in past year, 3-5 in past year, 1-2 in past year, never in past year. An example of the highest consumption row is shown in Figure 6.

Figure 6: Example of the highest consumption row in the Graduated Frequency 1. How often in the last year did you have 10 drinks or more during one day?

10 drinks or more 5 l (10 x 0.5 l) of beer or 2 l (10 x 2 dl) of wine or 0.5 l (10 x 5 cl) of spirits

The GF was used to assess the patterns of drinking during the last 12 months, the annual number of drinking occasions, the annual intake of alcohol, the mean dosage of ethanol for drinking occasion, and binge drinking (see below). Alcohol intake was calculated in grams of ethanol in following way: litres of beer x 0.04; litres of wine x 0.01; litres of vodka x 0.40.

4.4.4.2 The largest amount of alcohol in the last month and frequency of intoxication

The largest amount of alcohol in the last month was assessed by asking the question:

“What was the largest amount of alcohol you had on a single occasion during the last 4 weeks?” Respondents then were asked to identify number of units they consumed in each of the following options: 0.5L bottles or glasses of beer AND; 2 dl glasses of wine AND; 5 cl glasses of spirits (double shots). The total consumption was calculated in grams of ethanol as described above.

The frequency of intoxications was assessed by the question: “During the last 12 months, how often did you drink enough to feel drunk?” Following answer options were suggested: every day or at least 5 times a week; about 1-4 times a week; about 1-3 times a month; 3-11 times a year; once or twice a year; and never in the past year.

Binge and heavy binge drinking

Binge drinking was defined as drinking five or more drinks per session at least once a month for men (which is equal to 100 grams of pure ethanol) and three or more drinks per session at least once a month for women, an equivalent of 60 grams of pure ethanol.

A similar cut-off point for men was previously used in many studies on different

populations including Russia and Novosibirsk (National Institute on Alcohol Abuse and Alcoholism, 2004, Wechsler & Nelson, 2001, Malyutina, 2001, 2002, Bobak 1999, 2004). For women, many studies consider binge drinking as four or more drinks per occasion (International Centre of Alcohol Policies, NIAAA, 2004). Because our study used the GF questionnaire in establishing alcohol intake where three and four drinks are combined in one category, three or more drinks was defined as the cut-off point for women.

Heavy binge drinking was defined as having ten or more drinks in one session at least once a month for men (which is equal to 200 grams of pure ethanol). These cut-off points were used taking into account the high prevalence of binge drinking in Russia, especially among men. This definition was previously used in several studies in Russia (Malyutina, 2001, 2002, Bobak 1999, 2004)

These measures were calculated from the graduated frequency questionnaire described above and in Appendix 3.

Problem drinking and negative consequences of drinking

Problem drinking was measured by the CAGE questionnaire (Ewing, 1986), and alcohol related problems were measured by asking whether alcohol affected the life of the individual in some negative way.

Eight questions were asked to assess possible negative consequences from alcohol: 1) problems with marriage/partner or home life; 2) friendship or social life; 3) work; 4) police or other authorities; 5) physical health; 6) any injury or accident; 7)

psychological or mental health; and 8) financial circumstances. There were Yes/No answer options for each of the questions. Each positive answer was assigned a point. A

scale from zero to eight points was then created and used in further analysis. In addition, dichotomised variables were created by assigning negative consequences of drinking if two or more positive answers on the scale were given.

Problem drinking was assessed using the CAGE questionnaire (Ewing, 1984). CAGE is an acronym derived from the first letters of the key words in following four questions:

“Have you ever felt you should Cut down on your drinking?”, “Have people ever Annoyed you by criticising your drinking?”, “Have you ever felt bad or Guilty about your drinking?”, “Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (as an “Eye opener”)?” Each positive answer was assigned a point. Then 0-4 score was calculated using the sum of the points. As persons with two or more positive answers are usually considered problem drinkers, a

dichotomised variable was created by recoding the scales and assigning problem drinking if two or more positive answers on the scales were given.

Surrogate consumption (drinking non-beverage substances)

Additional questions on drinking frequency including drinking non-beverage substances (surrogates) in the last year were added during re-examination of the cohort (Table 10).

Participants were asked whether they “consumed substances which are not intended to be drunk in the last 12 months” such as cologne or antifreeze. If the answer was positive, the frequency of consumption was asked with following answering options:

every day or almost every day, about 2-4 times per week, about once a week; about 1-3 times a month; less than once a month; never in the past year.

The data from the baseline and re-examination data were merged into a final dataset which included all alcohol related variables.

Table 10: Drinking measures

How much beer/wine/spirits Do you usually drink per week

Did you drink in the last week

The largest amount of alcohol

(beer/wine/spirits) on a single occasion during the last 4 weeks?

+ -

How often did you drink enough to feel drunk in the past year?

+ -

Surrogates

People sometimes drink alcoholic substances NOT intended to be drunk.

Have you drunk anything like this in the last 12 months? For example lotion, cologne, antifreeze

- +

Surrogate drinking Patterns

1) How often did you drink alcoholic substances NOT intended to be drunk?

2) On which day of the week did you drink alcoholic substances NOT intended to be drunk?

- +

For abstainers last 12 months only:

How often did you drink when you used to drink more frequently?

How much did you drink during one session when you were drinking most often?

Why did you cut down on your drinking or stop drinking?

+ -

Problem drinking

In last 12 months, did your drinking cause you difficulties with the following aspects of your life?

(aspects: health, social and family life, finances, police)

+ -

CAGE past 12 months + +

4.4.4.4 Change in drinking over time

Change in drinking patterns over time was assessed by: 1) asking directly whether respondents drank more often than in the past year, and their drinking frequencies when they drank most; 2) analysing drinking patterns across different age groups at one time;

3) exploring drinking patterns at the baseline and at the time of re-examination using the

GF questionnaire, and 4) comparing problem drinking (CAGE) at the baseline and at the time of re-examination.

Drinking patterns in the past among abstainers

People who reported “Never in the past year” to each of the six options of the GF were defined as abstainers in the past 12 months. They were asked questions on the frequency and amount of drinking in the past, and reasons for quitting drinking. The frequency of drinking in the past was related to “the most frequent drinking period” in the

respondent’s life. The answer options were: several times a year, but not every month;

once or twice a month; once a week; 2 to 4 times a week, and 5 to 6 times a week.

Furthermore, the amount of alcohol during the period when respondent drank most often was asked in local units. The reasons for quitting alcohol included both health related such as CVD, liver disease, stomach ulcer, and not-health-related reasons such as problems with family, age, work.