The need to protect young people Peter Anderson MD, MPH, PhD, FRCP Professor, Alcohol and Health, Maastricht University

1. The need to protect young people Peter Anderson MD, MPH, PhD, FRCP Professor, Alcohol and Health, Maastricht University Netherlands Visiting Professor, Alcohol and Health, Newcastle University, England Brussels, 17 March 2011

2. A point about alcohol Why alcohol matters to young people But, what about us? Alcohol’s impact on health And, what does this all mean

3. A point about alcohol Why alcohol matters to young people But, what about us? Alcohol’s impact on health And, what does this all mean

4. WHO: Disability adjusted life year (DALY) Measures a combination of ill-health (adjusted for the severity of ill-health) or premature death). It measures a gap between how healthy we are and how healthy we could be

5. WHO: Top 10 risk factors for DALYs (world)

6. A point about alcohol Why alcohol matters to young people But, what about us? Alcohol’s impact on health And, what does this all mean

7. Brain function Problems in later life Death

8. Brain function Problems in later life Death

9. As we know, adolescents are vulnerable to the effects of alcohol In fact, taxi drivers in London have increased hippocampal size Let, us look at the example of the hippocampus, a structure of the forebrain involved in memory and spatial navigation

10. alcohol use disorders in adolescence and volume of the hippocampus Source: DeBellis et al 2000

11. alcohol use disorders in adolescence lead to reduced volume of the hippocampus 10% reduction Source: DeBellis et al 2000

12. Brain function Problems in later life Death

13. Prevalence of past-year alcohol and substance use disorders (AUDs and SUDs), by minimum legal drinking age (MLDA) exposure in US. • Source: Norberg et al 2009

14. Brain function Problems in later life Death

15. Male alcohol-related deaths by age group, England

16. A point about alcohol Why alcohol matters to young people But, what about us? Alcohol’s impact on health And, what does this all mean

17. WHO: Top 10 risk factors for DALYs (age group 25-59 years)

18. Female alcohol-related deaths by age group, England

19. A point about alcohol Why alcohol matters to young people But, what about us? Alcohol’s impact on health And, what does this all mean

20. Alcohol as an intoxicant Alcohol as a teratogen Alcohol as a carcinogen Heart attacks and strokes How much do you need to drink to die

21. Alcohol as an intoxicant Alcohol as a teratogen Alcohol as a carcinogen Heart attacks and strokes How much do you need to drink to die

22. The risk of a non-motor vehicle accident injury related to the amount of alcohol consumed during the last 3 hours. The risk of a motor vehicle accident injury related to the amount of alcohol consumed during the last 3 hours. Source: Taylor et al, 2009

23. Alcohol as an intoxicant Alcohol as a teratogen Alcohol as a carcinogen Heart attacks and strokes How much do you need to drink to die

25. Alcohol as an intoxicant Alcohol as a teratogen Alcohol as a carcinogen Heart attacks and strokes How much do you need to drink to die

26. Overall evaluation Alcoholic beverages are carcinogenic to humans Ethanol in alcoholic beverages is carcinogenic to humans

27. As a carcinogen, alcohol increases the risk of cancers of the oral cavity and pharynx, oesophagus, stomach, colon, rectum, liver and female breast in a linear dose–response relationship

28. Risk of female breast cancer by alcohol consumption Source: Allen et al, 2009

29. Alcohol as an intoxicant Alcohol as a teratogen Alcohol as a carcinogen Heart attacks and strokes How much do you need to drink to die

30. Relation with cardiovascular disease • The more you drink, the greater the risk of: • Hypertension • Arial fibrillation • Haemorrhagic stroke

31. Relation with cardiovascular disease • There is a J-shaped-relationship between alcohol and: • Ischaemic heart disease • Ischaemic stroke • Compared with abstainers, light drinkers have reduced risk; beyond the bottom of the the risk increases with a dose-response relationship J

32. Relation with cardiovascular disease • In young people, alcohol increases the risk of ischaemic events • In old people, the protection tapers off with age

33. Relation with cardiovascular disease • For the middle aged, the protective effect • Is no different between exclusively beer or wine drinkers • Disappears the more the abstaining comparison group includes ex-drinkers • Disappears when light drinkers report at least one heavy drinking occasion per month

34. Relation with cardiovascular disease • Most of the protective effect can be achieved by a consumption of 5g alcohol (half a drink) a day • More protection can be achieved by engaging in other healthier behaviours (e.g., healthy diet, more physical activity)

35. Alcohol as an intoxicant Alcohol as a teratogen Alcohol as a carcinogen Heart attacks and strokes How much do you need to drink to die

36. Lifetime risk of dying from alcohol-related death by gram alcohol/day or /week for Australian men and women. Source: National Health and Medical Research Council, Australia, 2009

37. A point about alcohol Why alcohol matters to young people But, what about us? Alcohol’s impact on health And, what does this all mean

38. Did you know: • Alcohol damages the adolescent brain?

39. Did you know: • 25% of male and 15% of female adolescent deaths are due to alcohol?

40. Did you know: • Amongst us, alcohol is the top cause of ill-health and premature death?

41. Did you know: • That alcohol in pregnancy increases the risk of early childhood acute myeloid leukaemia nearly three-fold?

42. Did you know: • That alcohol produces cancer in at least 8 major organs?

43. Did you know: • Drinking a bottle of wine a day means a 10% chance that your death is due to alcohol?

44. I do not think people know these facts • Shouldn’t we use every opportunity to inform them?

45. Alcohol produces cancer • Shouldn’t we use every opportunity to warn people about this?