Italy Between Drinking Culture and Control Policies for Alcoholic Beverages

Abstract

This paper focuses on whether the on-going dramatic decrease in alcohol consumption in Italy, especially of wine, during 1961–2008, was associated with which parallel sociodemographic and economic changes and with alcohol control policies.

The study, using both time series (TS) and artificial neural network (ANN)-based analyses documents that its selected sociodemographic and economic factors, and particularly urbanization, had a definite connection with wine consumption decrease, spirits decrease, and the increase in beer consumption over time. On the other hand, control policies showed no effect on the decline in alcohol consumption, since no alcohol control policy existed in Italy between 1960 and 1987. A few policies introduced since 1988 (BAC and sale restrictions during mass events) may have contributed to reducing or to maintaining the on-going reduction. Study limitations are noted and future needed research is suggested.

Keywords :

• sociodemographic and economic factor
• alcohol control policies
• time series analysis
• artificial neural network analysis
• alcoholic beverage as symbol

THE AUTHORS

Allaman Allamani, M.D., Psychiatrist; Family Therapist; Researcher. He has been coordinator of the Alcohol Centre, Florence Health Agency (1993–2009); since 2009 he has been consultant to the Region of Tuscany Health Agency for research on social epidemiology and prevention policy First non-alcoholic trustee of Italian Alcoholics Anonymous (1997–2003). He is a member of the editorial board of “Substance Use and Misuse.” Coordinator of a few Italian projects on alcohol prevention and policies, he has co-lead work package 3 of the European Commission-funded AMPHORA project. Author and co-author of more than 170 articles, editor, and co-editor of 16 books.

Fabio Voller, Ph.D., is a Sociologist at the Epidemiology Observatory of the Region of Tuscany Health Agency. He has worked on epidemiological studies of lifestyle, alcohol consumption, and psychoactive drug use in the Tuscan population. Among his publications, he is the co-author of a number of monographs about the health consequences of alcohol consumption in Italy. He is a work package 3 leader of the AMPHORA project.

Pasquale Pepe, MSc, is a Senior Statistician at the Epidemiology Observatory of the Region of Tuscany Health Agency. He has worked for several years on medical statistics, clinical trials, and epidemiological studies. He has co-authored more than 30 papers. He has worked in the statistical analysis of the AMPHORA project.

Michela Baccini, Ph.D., is researcher in medical statistics at the University of Florence. Author of several papers in the field of environmental epidemiology and biostatistics, she worked on time series analysis, meta-analysis, health impact assessment, multiple imputation.

Giulia Massini, Senior Researcher of Semeion—Research Center of Sciences of Communication, Rome (Italy). She is inventor of new algorithms of Neural Networks and Adaptive Artificial Systems. She is responsible of the application of Neural Computation mainly in medical and social field. She is the author of many research software packages. She has published several scientific papers in peer reviewed journals and book chapters.

Francesco Cipriani, MD, Medical epidemiologist, nutritionist, and gastroenterologist, is Director of the Regional Health Agency (ARS) for Tuscany (Italy) since October 2011, where he also has been chief of the Epidemiology Observatory since January 2009. He was Director of the Epidemiology Unit of the Local Health Authority in Prato, Italy, and also worked in the epidemiology services of the Florence Local Health Authority and the Centre for Oncological Study and Prevention, carrying out regional, national, and international multi-centric epidemiological studies about nutrition, life styles, addictions, alcohol and alcoholism, tumors, injuries, road traffic accidents, and environmental problems. He has published more than 130 papers.

Notes

2 The National Institute of Heath defines a hazardous drinker, in terms of average grams of pure alcohol per day, as any man 22–65 years old drinking more than 20 g (2 units); any woman 22–65, and any person aged 18–21 and over 65 drinking more than 10 (1 unit); and any adolescent below age 18 who drink any amount of alcoholic beverage (Scafato, Gandin, Galluzzo et al., 2013).

3 The reader is reminded that the concepts of “risk factors,” as well as “protective factors,” are often noted in the literature, without adequately noting their dimensions (linear, non-linear; rates of development and decay; anchoring or integration, cessation, etc.), their “demands,” the critical necessary conditions (endogenously as well as exogenously; from a micro to a meso to a macro level) which are necessary for either of them to operate (begin, continue, become anchored and integrate, change as de facto realities change, cease, etc.) or not to and whether their underpinnings are theory-driven, empirically based, individual and/or systemic stake holder- bound, based upon “principles of faith doctrinaire positions “personal truths,” historical observation, precedents and traditions that accumulate over time, conventional wisdom, perceptual and judgmental constraints, “transient public opinion.” or what. This is necessary to consider and to clarify if these term are not to remain as yet additional shibboleth in a field of many stereotypes, tradition-driven activities, “principles of faith” and stakeholder objectives. Editor's note.

4 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

5 The reader is referred to Hills's criteria for causation that were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated (Hill, A. B. (1965). The environment and disease: associations or causation? Proceedings of the Royal Society of Medicine 58: 295–300.) as well as to Tilly, Charles (2008). Credit and Blame Princeton Univ. Press. Princeton, NJ for an important analysis about “blame.” Editor's note.

6 The non-governmental Clubs of Treated Alcoholics (CAT), are an adaptation of Alcoholic Anonymous in the context of socialist Yugoslavia that was developed in Zagreb during the 1960s, spread to Italy in the 1980s and subsequently to Spain and to a few other European countries (Patussi, Tumino, & Poldrugo, 1996).

7 The reader is asked to consider the cyberneticist Heinz Von Foerster's thesis that there are two types of questions; legitimate and illegitimate ones. The former are those for which the answer is not known and is, perhaps, even unknowable during a given state of knowledge and technology An illegitimate question is one for which the answer is known, or, at the very least consensualized.The asking of illegitimate questions has been, and remains, by and large, the acculturated norm. Heinz Von Foerster, Patricia M. Mora, and Lawrence W. Amiot, “Doomsday; Friday, 13 November, A.D, 2026,” Science, 132, 1960. pp. 1291–1295. The reader is referred to Pablo Neruda's The Book of Questions for a poetic exploration of legitimate questions. Editor's note.

8 This relatively new term, introduced into the intervention literature by Friedman et al (Samuel R. Friedman, Diana Rossi, Peter L. Flom. (2006). “Big events” and networks: Thoughts on what could be going on. Connections 27(1): 9–14.) refers to major events, such as mega –disasters, natural, as well as man-made, famine, conflict, genocide, disparities in health, epidemics, mass migrations, economic recessions, etc., which effect adaptation, functioning and quality-of-life of individuals as well as systems. Existential threat, instability and chaos are major dimensions and loss of control over one's life is experienced. Editor's note.