title: Subjective measures of binge drinking, suboptimal subjective health and alcohol-specific hospitalizations among working-aged adults: a prospective cohort study.
abstract: OBJECTIVE
  The purpose of this prospective study was to determine how subjective measures of binge drinking predict suboptimal subjective health. In order to contribute to the understanding of potential causal mechanisms, we also aimed to determine the factors through which subjective health predicts alcohol-specific hospitalizations.
  
  
  METHODS
  A total of 16,111 alcohol-drinking men and women, aged 20-54 years, participated in the Health and Social Support baseline postal survey in 1998, and also responded to the repeated measurement 5 years later in 2003 (T2). Suboptimal subjective health was defined as self-reported overall health status being fair, rather poor or poor. Subjective measures of binge drinking were frequency of subjective intoxications/drunkenness, frequency of hangovers and frequency of alcohol-induced pass-outs.
  
  
  RESULTS
  Frequency of intoxications, hangovers and alcohol-induced pass-outs, all predicted suboptimal subjective health regardless of several potential confounders, including beverage-specific total intake. Those reporting suboptimal subjective health at baseline had a 5-fold odds ratio (5.08, 95% confidence interval: 3.43, 6.48) for alcohol-related hospitalizations, compared with those rating their health above fair, when gender and age were controlled. Binge drinking, together with concurrent symptoms of depression, explained over 50% of this relationship, and when additionally taking into account smoking, over two-thirds of this relation was explained.
  
  
  CONCLUSIONS
  Mental health is an important mediating factor between binge drinking, suboptimal subjective health and alcohol-specific hospitalizations, and symptoms of depression should therefore be taken into account in prevention of alcohol-related adverse health outcomes.
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London W6 8RP, UK. tapio.paljarvi@helsinki.fi
authors.forename: Tapio
authors.initials: T
authors.lastname: Paljärvi
authors.forename: Sakari
authors.initials: S
authors.lastname: Suominen
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.forename: Pia
authors.initials: P
authors.lastname: Mäkelä
authors.forename: Markku
authors.initials: M
authors.lastname: Koskenvuo
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology / Q000378:metabolism / Q000523:psychology; D000435:Alcoholic Intoxication / Q000473:pathology / Q000523:psychology; D000437:Alcoholism / Q000453:epidemiology* / Q000473:pathology / Q000523:psychology; D002492:Central Nervous System Depressants / Q000506:poisoning*; D015331:Cohort Studies; D003625:Data Collection; D004651:Employment; D000431:Ethanol / Q000506:poisoning*; D005260:Female; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012649:Self Concept; D012647:Self-Assessment; D055815:Young Adult
chemical_list: D002492:Central Nervous System Depressants; D000431:Ethanol