A Vulnerable Population:

People who abuse ETOH

(PWAETOH)
Natali Knight, John Oller, Marissa Jones, & Emily Healy
Definition: PWAETOH
Definition: The population of adolescents and adults who suffer from
alcohol abuse.
(National Institute of Alcohol Abuse and Alcoholism, n.d.)

NOTE:

-Excessive alcohol use is defined as binge drinking (4 or more drinks during a single occasion
for women, 5 or more for men)

-Heavy drinking (8 or more drinks per week for women, 15 or more drinks for men)

-Drinking by pregnant women or those under age 21 underage drinking and binge drinking

(Centers for Disease Control and Prevention, 2016)

Demographics: PWAETOH
Alcohol Use Disorder (AUD) in the United States:
- An estimated 15.1 million adults ages 18 and older were found to have
AUD in 2015.
- This includes 9.8 million men and 5.3 million women
- An estimated 623,000 adolescents ages 12-17 had AUD in 2015
- This includes 298,000 males and 417,000 females

(National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2017)

 Demographics: PWAETOH
Drinking patterns
vary by age group

Binge and heavy

alcohol use among
individuals 12 and
older

(SAMSHA, 2013)
 Demographics: PWAETOH
Drinking patterns
vary by gender
Binge alcohol use
among adults age
18-25, by gender
2002-2013
(SAMSHA, 2013)
Demographics:
PWAETOH
Drinking patterns
vary by ethnicity
Percent of binge and
heavy alcohol use
among people 12
and older by
Race/Ethnicity
(SAMSHA, 2013)
Health Disparities
General Mortality Rates
Cardiovascular Diseases
Cerebrovascular Accidents (Strokes)
Health Disparity #1
Increased Mortality (Stahre, 2014)

Excessive alcohol use is 4th leading preventable cause of death

in U.S. and major cause of premature mortality,
30 years average of life lost per alcohol attributed death (AAD)
From 2006-2010 27.9 deaths per 100,000 (highest rate in NM
@51.2 and lowest in NJ @ 19.1)
AADs account for 9.8% of total deaths and 11.5% of years of
potential life lost, among working-age
Of AADs
44% due to chronic conditions (liver disease)
56% due to acute (motor-vehicle crashes)
Health Disparity #2
Cardiovascular diseases
Alcohol abuse is a risk factor for the development of
hypertension (AHA, 2015, McCance et al., 2015)
Increased pressure leads to vascular and cardiac remodeling
2-3 time increase in atheroclerotic disease (McCance et al., 2015)
Coronary Artery Disease
Alcohol is toxic to cardiac tissues(McCance et al., 2015)
Myocardial hypertrophy
Left-sided heart failure
Bell et al. (2017) identified increased cardiovascular risk among
heavy drinkers
Health Disparity #3
Cerebrovascular Accidents (Strokes)
Increased risk of hemorrhagic and ischemic stroke with
heavy drinking (Klatsky & Tran, 2016)
Heavy Drinkers more likely to experience stroke
(RR=1.20) (Zhang et al., 2014)
Increased Stroke Mortality
Heavy Drinkers more than 2x likely to die from stroke
compared to non-drinkers (Rantakmi et al., 2014)
Nursing Intervention of Culturally
Competent Care of PWAETOH
Implementation (SOP #5): The PHN provides health teaching and
coordinates care, once alcohol dependency has been identified.
As part of implementing the plan of care, the PHN coordinates with other
health professionals and ensures the patient receives necessary referrals.
Proper documentation and evaluation of care plan are performed.

Rationale: Turner (2009) identified that of the 3200 individuals who

screened positive for an alcohol during primary care visits, 8.5%
reported that they had been recommended to cut down on alcohol or
drugs, only 6.5% received a specialty referral, and 33% received
primary or specialty care. Lack of early intervention contributes to
cardiovascular disease,strokes, and mortality among PWAETOH.
References
American Heart Association (2015). Lifestyle changes for heart attack prevention. Retrieved from:
http://www.heart.org/HEARTORG/Conditions/HeartAttack/LifeAfteraHeartAttack/Lifestyle-Changes-for-Heart-Attac
k-Prevention_UCM_303934_Article.jsp#.WPBVldLyuUk

Bell, S., Daskalopoulou, M., Rapsomaniki, E., George, J., Britton, A., Bobak, M., Casas, J. P., Dale, C. E., Denaxas,
S., Shah, A., Hemingway, H. (2017). Association between clinically recorded alcohol consumption and initial
presentation of 12 cardiovascular diseases: population
based cohort study using linked health records. The BMJ, 356. doi: 10.1136/bmj.j909

Klatsky, A. L., Tran, H. N. (2016). Alcohol and stroke: The splitters win again. BMC Medicine, 14(193). doi:
10.1186/s12916-016-0750-z
References
McCance, K. L., & Huether, S. E. (2015). Pathophysiology: The biologic basis for disease in adults and children (7th
ed.). St. Louis: Mosby.

Rantakomi, S. H., Kurl, S., Sivenius, J., Kauhanen, J., Laukkanen, J. A. (2014). The frequency of alcohol
consumption is associated with the stroke mortality. Acta Neurological Scandinavia, 130(2), 118-124. doi:
10.1111/ane.12243

Stahre, M. (2014). Contribution of excessive alcohol consumption to deaths and years of potential life lost in the
United States. Preventing chronic disease, 11.

Turner, B. (2009). Gaps in addressing problem drinking: overcoming primary care and alcohol treatment
deficiencies. Current psychiatry reports, 11(5), 345-352. doi:10.1007/s11920-009-0052-7

Zhang, C., Qin, Y., Chen, Q., Jiang, H., Chen, X., Xu, C., Mao, P., He, J. & Zhou, Y. (2014). Alcohol intake and risk
of stroke: A dose-response meta-analysis of prospective studies. International Journal of Cardiology, 174(3),
669-677. doi: 10.1016/j/ijcard.2014.04.225
Include all information in the slides, including citations and
references. There should be nothing in the notes section.
Spell out acronyms the first time they are used unless they are well
recognized, such as HIV and AIDS.
Use a minimum of 3 sources, either professional journals or credible

websites, published in the last 7 years (or for HBM, anything 2000 and
later). Dont use your textbook.
 Sample Assignment:
A Vulnerable Population:
People living with HIV/AIDS
(PLWHA)
Patty Goldsmith, MS, RN, APHN-BC
Nursing Intervention for Culturally
Competent Care of PLWHA
Planning (SOP #4): Keep outside signage for
programs for PLWHA either subdued or
nonexistent (HRSA, 2013).

Rationale: Every attempt must be made to

maximize confidentiality. Because of the stigma
of HIV/AIDS, many PLWHA may not share their
diagnosis with family, friends and other
community members. Sensitivity to privacy
issues should be helpful in retaining HIV
patients in care and addressing health problems
Nursing Intervention for Culturally
Competent Care of PLWHA
The PHN includes assessment (SOP #1) of a clients health
beliefs about HIV/AIDS treatment as part of general
assessment of PLWHA
How do you think you are going to do with this new medication
regime?
What do you see as the main benefits of taking this
medications?
Rationale: Barclay (2007) found components of the HBM
(self-efficacy and perceived benefits of care) were able to
predict medication adherence among younger PLWHA.
Non-adherence to antiviral medications contributes to
increased morbidity and mortality among PLWHA.