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Background: The relationship between average alcohol consumption and heart disease is well researched, showing a substantial cardioprotective association. This dissertation examined the epidemiological evidence for an effect of heavy episodic drinking (HED) over and above the effect of average alcohol consumption on heart disease. Methods: Electronic databases were systematically searched for epidemiological studies on the effect of HED on heart disease and identified articles were quantitatively summarized in a meta-analysis. Meta-regression models were used to examine the effect of characteristics of primary studies. Using individual-level data, semi-parametric Cox regression models were used to investigate HED exposure within narrow categories of average alcohol consumption in a US national population sample (n = 9,937) in relation to heart disease mortality in an 11-22 year follow-up. Frequency of heavy drinking episodes was used to identify latent classes of drinking history using growth mixture modeling in a sub-sample of this US cohort. Retrieved classes were used as independent variables in Cox regression models with heart disease mortality as the outcome event. Results: A pooled relative risk of 1.45 (95% confidence interval (CI): 1.24-1.70) for HED compared with non-HED drinkers with average alcohol consumption between 0.1-60 g/day was derived in a meta-analysis. A strong and consistent association with HED was found among current drinkers consuming an average of 1-2 drinks per day in the US cohort. There was no evidence of increased heart disease mortality resulting from the frequency of heavy drinking episodes before the age of forty. Conclusions: There is reasonable and consistent evidence for an association of HED and heart disease in current drinkers, negating any beneficial effect from alcohol consumption on heart health. History of frequency of heavy drinking episodes, however, showed no evidence for such an effect modification.

Background: The relationship between average alcohol consumption and heart disease is well researched, showing a substantial cardioprotective association. This dissertation examined the epidemiological evidence for an effect of heavy episodic drinking (HED) over and above the effect of average alcohol consumption on heart disease. Methods: Electronic databases were systematically searched for epidemiological studies on the effect of HED on heart disease and identified articles were quantitatively summarized in a meta-analysis. Meta-regression models were used to examine the effect of characteristics of primary studies. Using individual-level data, semi-parametric Cox regression models were used to investigate HED exposure within narrow categories of average alcohol consumption in a US national population sample (n = 9,937) in relation to heart disease mortality in an 11-22 year follow-up. Frequency of heavy drinking episodes was used to identify latent classes of drinking history using growth mixture modeling in a sub-sample of this US cohort. Retrieved classes were used as independent variables in Cox regression models with heart disease mortality as the outcome event. Results: A pooled relative risk of 1.45 (95% confidence interval (CI): 1.24-1.70) for HED compared with non-HED drinkers with average alcohol consumption between 0.1-60 g/day was derived in a meta-analysis. A strong and consistent association with HED was found among current drinkers consuming an average of 1-2 drinks per day in the US cohort. There was no evidence of increased heart disease mortality resulting from the frequency of heavy drinking episodes before the age of forty. Conclusions: There is reasonable and consistent evidence for an association of HED and heart disease in current drinkers, negating any beneficial effect from alcohol consumption on heart health. History of frequency of heavy drinking episodes, however, showed no evidence for such an effect modification.

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Cette thèse porte sur la forte alcoolisation ponctuelle des étudiantes irlandaises. Il s’agit en premier lieu de comprendre la progression récente de cette pratique en l’envisageant à partir d’échelles différentes : une perspective à la fois « macro » et comparative à l’aide d’une revue de littérature et une autre « micro », grâce à une recherche empirique qualitative. Celle-ci a été menée à partir de 40 entretiens individuels semi-directifs avec des étudiantes d’un même établissement. L’analyse de leurs perceptions quant à leurs pratiques, leurs prises de risque associées, leurs motivations et des facteurs socio-culturels facilitera l’élaboration de futurs programmes de prévention. Une philosophie de recherche de type écologique a été adoptée, suivant le principe que seule une approche multidisciplinaire permettrait une compréhension globale de ce fait social. Parmi les principaux résultats, nous retenons que la majorité des participantes irlandaises pratiquent le « binge drinking » de façon hebdomadaire. Ceci constitue un obstacle à leur socialisation avec celles d’origine étrangère qui, elles, ne s’y adonnent pas. Le « boire irlandais », en tant que revendication identitaire nationale, s’est en fait utilisé que comme prétexte par des étudiantes qui souhaitent avant tout reculer les échéances de la vie adulte en se cantonnant dans une « post-adolescence ». De plus, cette forme d’alcoolisation correspond moins à une quête d’égalité avec les garçons qu’à un désir de faciliter les rapports de séduction. Enfin, en buvant ainsi, elles cherchent davantage à s’affirmer comme jeunes que comme femmes ou Irlandaises. / This thesis focuses on the heavy episodic alcohol consumption of Irish female students. Firstly, it aims to understand the recent increase of this type of drinking by considering it from different perspectives. A macro and comparative analysis was provided by the literature review as well as a micro one through a qualitative research. Semi-guided individual interviews of 40 female students from the same third-level educational establishment were conducted. A research philosophy of an ecological nature was selected, following the principle that only a multi-disciplinary approach could provide an overall understanding of such a social fact. The key findings reveal that the majority of participants “binge drink » on average twice weekly. This represents an obstacle to their socialisation with female students from foreign origins, who tend not to drink heavily when they socialise. The “Irish drinking”, as a celebration of a national identity, is being used by many participants as an excuse. They try, in fact, to postpone as long as possible, adult roles and responsibilities by shutting themselves away in a “post-adolescence” period. Furthermore, for them, this type of alcohol consumption signifies less a search for equality with their male counterparts than a desire to interact with and seduce them. Finally, by drinking this way, they attempt to affirm themselves as youth rather than as women or Irish.

No description available.