Analysis Of Alcohol Policy In Nigeria: Multi-sectoral Action And The .
Abiona et al. BMC Public Health(2019) EARCH ARTICLEOpen AccessAnalysis of alcohol policy in Nigeria:multi-sectoral action and the integrationof the WHO “best-buy” interventionsOpeyemi Abiona* , Mojisola Oluwasanu and Oladimeji OladepoAbstractBackground: Harmful alcohol use is a modifiable risk factor contributing to the increasing burden of non-communicablediseases and deaths and the implementation of policies focused on primary prevention is pivotal to address thischallenge. Policies with actions targeting the harmful use of alcohol have been developed in Nigeria. This study is anin-depth analysis of alcohol-related policies in Nigeria and the utilization of WHO Best Buy interventions (BBIs) andmulti-sectoral action (MSA) in the formulation of these policies.Methods: A descriptive case study design and the Walt and Gilson framework of policy analysis was utilized for theresearch. Components of the study included a scoping review consisting of electronic search of Google and threeonline databases (Google Scholar, Science Direct and PubMed) to identify articles and policy documents with nolanguage and date restrictions. Government institution provided documents which were not online. Thirteen policydocuments, reports or articles relevant to the policy formulation process were identified. Other components of thestudy included interviews with 44 key informants (Bureaucrats and Policy Makers) using a pretested guide. Thequalitative data were coded and analyzed using thematic analysis.Results: Findings revealed that policy actions to address harmful alcohol use are proposed in the 2007 Federal RoadSafety Act, the Non-communicable Diseases Prevention and Control Policy and the Strategic Plan of Action. Only oneof the best buy interventions, (restricted access to alcohol) is proposed in these policies.Multi-sectoral action for the formulation of alcohol-related policy was low and several relevant sectors with critical rolesin policy implementation were not involved in the formulation process. Overall, alcohol currently has no holistic,health-sector led policy document to regulate the marketing, promotion of alcohol and accessibility. A major barrier isthe low government budgetary allocation to support the process.Conclusions: Nigeria has few alcohol-related policies with weak multi-sectoral action. Funding constraint remains amajor threat to the implementation and enforcement of proposed policy actions.Keywords: Alcohol, Health policy, Public health, NigeriaBackgroundThe health, social and economic costs of alcohol-relatedharm and diseases are well-documented [1–4] and over3 million deaths have been attributed to alcohol intakeevery year [4]. In Nigeria, alcohol is the sixth leading riskfactor contributing to most death and disability [5] andthe alcohol-attributable deaths in both sexes for liver cirrhosis, road traffic accidents, and cancer in 2016 was 42,* Correspondence: bopeyemi@ymail.comDepartment of Health Promotion and Education, Faculty of Public Health,College of Medicine, University of Ibadan, Ibadan, Nigeria120; 15,365 and 4687 respectively [4]. Odueme et al.,2008 reported that drink driving accidents are the majorcauses of injuries and several deaths to Nigerians [6] andthe country has one of the highest fatalities of roadtraffic accidents estimated at 21.4% per 100,000 populations every year [7] and other sequelae include the costassociated with damage of infrastructures and medicaltreatment [8].Nigeria currently ranks 27th globally in respect ofadults alcohol drinking (age 15 ) in liters per year,making it one of the leading African countries in alcohol The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication o/1.0/) applies to the data made available in this article, unless otherwise stated.
Abiona et al. BMC Public Health(2019) 19:810consumption [9]. These ranking fails to take intocognizance, the unrecorded production and consumptionof illicit and locally made alcoholic beverages sold freely atvarious places within the society including institutions ofhigher learning [10]. It has been reported that alcohol isthe most commonly used drug in Nigeria characterized by“heavy episodic drinking” [11]. Alcohol consumption byfemales in Nigeria has been on the increase and this hasbeen associated with civilization, globalization and the expansion of women’s liberation in the country [12].The World Health Organization urged countries toprioritize and accelerate the development of policies totackle the risk factors for NCDs. Specifically, in 2010,the WHO proposed the Global Strategy to reduce theharmful use of alcohol as well as the 2008 and 2013Global Action Plans for the prevention and control ofNCDs [13–15]. These documents stipulate the adoptionof multi-sectoral action (explained as “actions undertaken by sectors outside the health sector, possibly, butnot necessarily, in collaboration with the health sector,on health or health-related outcomes or the determinantsof health”) for the development of national policies andstrategic plans to reduce the burden of NCDs. Inaddition, the WHO also recommended specific best buyinterventions (defined as “an intervention for which thereis compelling evidence that is not only highly costeffective but is also feasible, low-cost and appropriate toimplement within the constraints of the local health system”) which member states are expected to mainstreaminto their policies and implement [16]. Specific best buysfor alcohol include tax increases, restricted access toretailed alcohol and ban on alcohol advertising. Membercountries are expected to adopt these global strategies todevelop national policies and guidelines for alcohol control using underlying principles such as multi-sectoral actions and integration of the WHO Best Buy interventions.A number of Member States have developed nationalalcohol policies and implemented actions to decreasedrink– driving prevalence, limit access to alcohol andimplement restrictions on alcohol marketing [15]. Thisencouraging trend is expected to continue in light of thereadiness to combat NCDs and their risk factors, including unsafe use of alcohol, as “a precondition for, anoutcome of and an indicator of all three dimensions ofsustainable development: economic development, environmental sustainability, and social inclusion” [15].Nigeria has developed some alcohol-related policieshowever, the extent to which these addressed the recommended WHO “Best Buy Interventions” and utilizedthe multi-sectoral action (MSA) is unknown. This studyis an in-depth analysis of alcohol-related policies inNigeria, and the extent to which the WHO Best Buyinterventions (BBIs) and multi-sectoral action (MSA)were used in the formulation of these policies.Page 2 of 9MethodsDesignThis manuscript presents the findings from Nigeria froma study titled “Analysis for Non-Communicable DiseasePrevention Policies in Africa (ANPPA)”. The study designand data collection procedures have been published [17].Descriptive case study design was adopted and guidedby the Walt and Gilson framework of policy analysis.This framework focuses on four policy factors: (i) policycontent which outlines how issues are formed and framed,and how it features on the agenda. It also details the policyobjectives, actions, programs, targets and required resources; (ii) the policy actors and their influence onpolicy-making under various conditions; (iii) proceduresused in building and implementing the policy; and (iv) themilieu which influences policy-making such as epidemiological and demographic transition, methods of economicand social and changes, financial and economic and policy, the political system and peripheral causes [18, 19].Study siteThe study was conducted largely in Abuja- Nigeria’scapital city.Sample sizeThe aim of the qualitative study was to generate rich information on the phenomenon under study. Forty-four(44) policy actors identified from diverse sectors whoshould have participated in the development of the alcohol- inclusive NCD prevention policy were identified.This was done by weighing the importance of such bodies to NCD policy development. Additional ones identified during interviews with the index key informantsconstituted the sample size for the Key InformantInterviews.Sampling strategy/interview including inclusion/exclusioncriteria and frequency of sampling strategyThe team identified 44 individuals from different sectorsbased on relative significance and potential roles in theformulation and implementation of the National NCDprevention policies. The study population for the Keyinformant interview comprised policy actors and bureaucrats who either contributed or should have participatedin the NCD policy process. The range of sectors for policyformulation on NCDs as suggested by Meiro-Lorenzo etal., 2011 guided the identification and selection ofpotential interviewees [20]. We used a snowball samplingtechnique in which stakeholders identified after interviewswould recommend additional individuals pertinent to thestudy. A total of 44 policy actors were interviewed (35index key informants and an additional 9 identifiedthrough snowballing). There were 20 interviewees fromdiverse government sectors (Information, Health, Sports
Abiona et al. BMC Public Health(2019) 19:810Page 3 of 9Data collection comprised a scoping review and keyinformant interviews among the relevant stakeholders.lasted between 50 and 75 min. At the end of each interview, the names, addresses, and telephone numbers ofpotential stakeholders who are germane to the studywere requested from those interviewed for inclusion inthe list of interviewees. Those suggested were contactedand followed up for the interview. At the end of thisprocess, a total of 44 interviewees of policymakers(Bureaucrats and Policy Makers) in the private and public sectors were conducted. The composition is shown inTable 1.Scoping reviewData extraction and analysisA scoping review was conducted by two members of theteam (OA and MO) and involved an electronic search ofGoogle and 3 online databases (Google Scholar, ScienceDirect and PubMed) and Google using the followingsearch terms: multi-sectoral approach, policy, best buys,alcohol, taxation, marketing or endorsement, sponsorship, information, warning, access, marketing and promotion and Nigeria to identify policy documents andarticles written in English language with no date restriction. In addition, government ministries, departmentsand agencies were contacted to provide policy documents that were not online. There was a desk review byall members of the team (OA, MO, and OO) and analysisof extracted data from 13 documents (Three reports froman international organization, 6 published articles, 1 mediapublication and three national policy documents/acts)focusing on MSA and BBI. The three national policy documents/acts were the 2007 Federal Road Safety CommissionAct [21], the 2013 National Policy and Strategic Plan ofAction on Non-Communicable Diseases and 2015 NationalStrategic Plan of Action on Prevention and Control ofNCDs [22, 23].Information from alcohol policy documents obtainedwas extracted and imputed into a matrix with thepresent data-showing name of the policy, PublicationYear, Names of divisions/sector involved in policy formulation type of Best buy interventions present and extent of MSA.Multi-sectoral action was determined by counting thesectors and their level of involvement in the policy formulation process. Multi-sectoral action was categorizedas “low” if less than five relevant sectors were involvedin the policy formulation process, “moderate” if five tonine and “high” if ten or more sectors participated in theprocess respectively.and Youth, Education, Food regulatory agency, WomenAffairs Trade and Investment, Labor, Finance, Legislatureand Justice); 9 from academic and research institutions; 2from the food /hospitality industry, 6 from NCDs professional bodies, 1 each from a religious organization, civilsociety/ NGOs and international organization.Data collection method and processesTable 1 Types of stakeholders interviewedRespondent typeGovernment sectorsTotal number24Health (9)Education (2)Trade and Investment (1)Labor (1)Justice (1)Key informant interviewsThe key informant interview guide (see Additional file 1)was used to obtain perspectives of 44 policy actors andbureaucrats in public and private sectors who participated or should have contributed in the NCD policyprocess from the various sectors. Key themes exploredthe availability of alcohol policies, policy content, policycontext, and actors in policy formulation, policy Implementation and financing mechanism. The guide waspre-tested by research assistants and finalized.In respect to the data collection process, study participants from the different sectors were contacted in writing. This was followed by a telephone conversation thatenables us to fix dates and times for each proposedinterview. On the day of the interview, agreed uponvenues were used and consent to conduct the interviewsobtained from each participant at the commencement ofthe interview. The interview discussion was tape recorded based upon participant approval. Each interviewInformation (2)Finance (2)Youth and Sports (2)Women Affairs (1)Food, Drug Administration and Control (2)Legislature (1)Research/Academic institutions (9)9International Organizations (1)1NCD Associations/Alliance (3)3Professional bodies/Associations (3)3DonorsNGOs/Civil Society (1)1Hospitality Industry (1)1Food and Beverage Manufacturing Industry1Religious Body (1)Total144
Abiona et al. BMC Public Health(2019) 19:810Audio recordings of interviews were transcribed verbatim and analyzed using thematic analysis. The teamcoded the transcripts and entered it into NVIVO 10using a coding structure based on the interview guide.Codes were afterward organized by theme.After data analysis, the preliminary findings from theanalyzed data were validated by presenting them tosome interviewed stakeholders or their representativesand others who were not part of those interviewed including the press, NGO representatives on February 8,2016, in Abuja, Nigeria. Participants of the preliminarydissemination forum were briefed and also requested toprovide information on missing information and references that need to be included as well as seek necessaryclarifications. At the end of the meeting, the findingswere adjudged by participants to reflect the summary ofthe data in line with the objectives.Ethical considerationsApproval was given by the University of Ibadan /University College Hospital Ethical Committee, Nigeria in 2013before the commencement of data collection. Writtenconsent was obtained from all participants.The information provided by research participantswere kept confidential. To this end, each participant wasassigned a unique identifier number and s/he was identified by it in all documents and the project database. Participants’ demographic data and ID number were kept ina locked cabinet and access to this file was restricted toauthorized personnel.ResultsNigeria status on the development of comprehensivealcohol control policiesAccording to 39 of the 44 interviewees, comprehensivepolicies to control the production, advertisement, marketing, and availability of alcohol in Nigeria in line withWHO recommendations are not available. Nigeria hasparticipated in global meetings on alcohol control overthe years but this has not translated into comprehensivepolicies on alcohol control. Rather, preliminary discussions are ongoing which might lead to policy formulation. This finding is substantiated by quotes from keyinformant interviewees as outlined below:“We have gone for international forum or fora onalcohol control . my boss had to go for thatmeeting, of course, we don’t have a policy, but he cameback with some documents that we can adapt inNigeria. As I speak to you now we have a proposal. Wehave done a proposal in the past couples of years butnothing was done about it, so of course, we’ve done theproposal again to call stakeholders together to developa comprehensive policy on alcohol control and widePage 4 of 9range of stakeholders will be involved. I don’t have thenames of all the stakeholders but l knows that thealcohol companies will also be invited .” (Official fromthe Health sector).“To be honest with you, do we really have policies onalcohol in this country? we don’ t. I can walk into anybar parlor any garden and if I want to take a cartonof beer, nobody would prevent me from doing so. . It’snot punishable, you are allowed to drink whateverquantity you want, ., nobody restricts you, it’s a freething. So, I don’t think the government has a policy onalcohol” (Official from the Finance sector).Though the country has not developed a comprehensive policy in line with the WHO global strategy to reduce the harmful use of alcohol, there are existing policydocuments from health and non-health sector that proposes actions for alcohol control. These are the 2013and 2015 National Policy and Strategic Plan of Actionon Non-Communicable Diseases from the health sector[21, 22] and the Federal Road Safety Act (2007) from thesafety and traffic management sector [24].Beyond the Nigerian government, International Centerfor Alcohol Policies1 [ICAP] (a non- governmentalorganization recognized and sponsored by global alcohol producers) had worked with the Beer Sector Groupof Manufacturers Association and the AdvertisingPractitioners Council of Nigeria to advocate for selfregulation [23].Policy content of existing policies and best buysaddressedFindings from the document review of the 2013 and2015 National Policy and Strategic Plan of Action onNon-Communicable Diseases showed that six actionsare proposed to limit the harmful use of alcohol. Specifically, they are–“discourage alcohol use among women;prevent underage alcohol consumption; discourage bingedrinking with consumption of toxic local brew; preventconsumption of illegally brewed and distributed alcoholicbeverages; prevent driving or operating machinery underalcohol influence and identify and manage alcohol usedisorders” [21, 22].The only best buy interventions for Alcohol delineatedin the documents is restricted access to retailed alcoholto prevent underage alcohol consumption. Other bestbuy interventions such as increased taxation and alcoholadvertisement bans were not addressed.The document review of the Federal Road Safety Act(2007) also revealed similar findings. This document wasenacted by the National Assembly to guide and regulatethe activities and functions of the Federal Road SafetyCommission- a government paramilitary agency established
Abiona et al. BMC Public Health(2019) 19:810in 1988 with the statutory functions of ensuring safety andtraffic management in Nigeria. The Act only outlines actions aimed at promoting restricted access and availabilityof alcohol to counter drink-driving aside several othermandates for the agency. Only one of the WHO bestbuys- restricted access to retailed alcohol, was outlined inthis document. Actions which relate to alcohol control inthe Federal Road Safety Act (2007) are the prosecution orpenalty for persons who “(i) hawk or take alcoholic drinkor hard drug within radius of 200 m to a motor park,motorcycle park or bus stop (ii) drive or attempt to driveon the road under the influence of drugs or alcohol”. Theproposed actions are in tandem with actions recommended in the World Health Organization global strategyto reduce the harmful use of alcohol [13].Multi-sectoral involvementThe extent of use of MSA for the formulation of the 2007Federal Road Safety Act is low. Findings from the reviewof the 2009 FRSC Corporate Road map [25] that wasdeveloped to guide the implementation of the FederalRoad Safety Act revealed that only listed seven organizations representing three sectors had input into the development of the road map. Three key sectors were theFinance and Administration (Bureau of Public Enterprises,National Planning Commission, Budget Office of theFederal Government of Nigeria and Office of the EconomicAdviser to the President), regulatory bodies for emergencyservices and road safety (National Emergency Management Agency and the Federal Road Safety Commission),Legislature and Presidency (Secretary to the Governmentof the Federation).This indicates the low level of participation of important sectors. A probable reason accounting for this is theparamilitary mode of operation of the institution.However, 2009 FRSC Corporate road map proposedoutlined activities to involve other relevant sectors in theimplementation of the Act [25]. Proposed stakeholders included Ministry of Health and Justice, theChairman, Governors Forum, Secretary General of theFederation, representatives of the Nigerian Union of RoadTransport Workers, Nigerian Union of Journalist, NationalAutomotive Council, Ministry of Works, Ministry ofEducation, and Federal Republic of Nigeria Vice President.However there is no information on the constitution andfunctionality of the proposed committee of stakeholders.The extent of use of MSA for the alcohol policy actionsoutlined in the 2013 National Policy and Strategic Plan ofAction on Non-Communicable Diseases was originallyvery low. However, with the recommendation of theWHO, the committee that developed the policy documentwas expanded with a broader representation in 2015 andan increase in the number of sectors/organizations from45 to 80. For the initial development in 2013, six sectorsPage 5 of 9-health, transport, research and academic, professionalassociations, civil society organization, and industry wereinvolved. This increased to 15 in 2015 with the formulation of the 2015 National Policy and Strategic Plan ofAction on Non-Communicable Diseases. Specifically,these were civil society organizations, industry, information, agriculture, finance, trade, women affairs, legislature,health, education, transport, academic and research, professional associations, regulatory agencies and the privatesector. Significant sectors which were not involved in thereconstituted committee but who had a role to play in thepolicy implementation include Urban and Regional Planning, Sports; Environment and transportation unions.Facilitators and barriers to use of MSAThe interviewees did not identify any major facilitatingfactors for MSA in the formulation of the 2013 and2015 National Strategic Plan of Action on Preventionand Control of Non-Communicable Diseases policy, except for the participation of some sectors. Other factorswhich have potential to enhance MSA use were confirmed by some of the participants from the health andnon-health sector such as empowerment through regulations and financial back-up, joint conference/workshopsand training as reflected in the quotes below:“Government should empower them [Actors/government institution involved in implementingpolicy actions] with regulations and financial back-up”(Representative of Professional Body, code 018) “should be having a joint conference or a summitwhereby issues will be discussed to let them see thehavoc or implications of the product or whatever theyproduce there are statistics to show the mortality ratecoming out of the consumption of alcohol alright andthe implication if they distribute or disseminate thisinformation to people concerned and then they knowwhen they sit themselves they will see the importanceof what the government is saying or whatever thepolicy say about production” (Academic and medicalsector code 025)However, the significant challenges associated withMSA use include poor understanding by stakeholders ofthe roles and contributions of different sectors to NCDprevention as well as the tussle between governmentministries on which anchor sector is to assume leadership of the process.Implementation monitoring and evaluation statusCurrently the status of alcohol policy implementation isextremely poor for both the FRSC Act and the 2015National Policy on the Control and Prevention of
Abiona et al. BMC Public Health(2019) 19:810Non-Communicable Diseases. According to 32 out ofthe 44 respondents, one of the major barriers facing theimplementation of strong legislations and regulations wasthe relevance of alcohol as a social substance. The quotebelow highlights these points.“Well, alcohol is a social substance and many culturespermit the usage . so, it becomes a little bitdifficult if there is no awareness about what to do andI think it had been the major factor limiting theimplementation [of the FRSC act] which has been nearzero” [Representative of the Academic and MedicalSector code 027)Aside from the failure of the government to strengthensystems and structures for alcohol control, other challenges identified by 23 of the interviewees include funding limitations and poor literacy, poor deployment of thelaw enforcement and regulatory agencies and the lack ofa legislation to regulate the alcohol industry. The quotebelow succinctly illustrates this:“. of course, [we have] a few acts of parliamentprohibit for example drunken driving. Outside that, Idon’t know whether that act also prevents excessivealcohol use in public places but I know that ofcourse, we have not even implemented that one in thesense that we don’t have kits where we can check theblood levels of alcohol , we don’t have them, Then ofcourse for the alcoholic breweries in Nigeria thatproduce alcohol, I don’t see a proactive way to try andenforce\government policies [among them]. Some ofthem [the labeling of alcoholic drinks content] are notlaws such as having extra information on theirlabel- For example, alcohol is dangerous to yourhealth and all those things, . I have really not seenthat like the tobacco ones, you know. I am not satisfiedreally with policies regarding alcohol in Nigeria. It isan area we need to push forward .” [Member of theHouse of Representative code 011]According to the views expressed by the respondents,many Nigerian cultures permit the use of alcohol thusconstituting a limitation for the enforcement of the implementation of the FRSC act. Studies have also documentedthat the Alcohol Industry has leveraged on the influenceof this permissive culture for alcohol consumptioncoupled with custom and traditions which permit its useas a promotion strategy in Nigeria [12, 26]. An example isthe advertisement of Seamans Schnapps as a libationdrink. Also on a similar note, Orijin, an herbal alcoholicdrink was introduced and launched across Nigeria in thepalaces of traditional rulers [26]. These findings reveal thesignificant challenge linked to the permissive culturalPage 6 of 9inclination for use of alcohol which has been identified asa challenge for the implementation of the 2007 FRSC actand a bane for the formulation of stronger legislation tocurtail the unsafe use of alcohol in Nigeria.As detailed in the 2007 Federal Road Safety Act, subsidyfor the implementation of the 2007 Act proceedings is expected to be through the Federal Road Safety Commissionand consists of any subsidy or fiscal allocation, Loans fromthe federal government and monies realized by way of gifts,fines, testamentary disposition or grants-in-aid. However,in reality, funding for these actions has been minimal.According to interviewees from the health sector, theimplementation of the alcohol component of the 2015National Strategic Plan of Action on Prevention andControl of NCDs is yet to commence.DiscussionStatus of alcohol policy formulation in NigeriaThe World Health Organization has delineated urgentactions to guide countries’ efforts to reduce harmful alcohol ue, its associated health, and social consequences[13]. Unfortunately, Nigeria has not made much progress in articulating and implementing policies to decrease harmful alcohol use. According to the WHOGlobal status reports on health and alcohol, Nigeria hasno comprehensive, stand-alone policy document toregulate the production, advertisement, availability andpromotion of alcohol in line with WHO recommendations. Furthermore, there are no national and state levelmonitoring systems to track alcohol consumption andmonitor its health and social consequences [9] despitethe country’s contribution and approval of the declarations at the 2008 World Health Assembly [12].WHO inclusion “best buy” interventions in existing healthand non-health sector policies with components foralcohol controlThe alcohol component of the Strategic Plan and NationalPolicy of Action on NCDs has been formulated and theonly WHO “best buy” interventions addressed is “restrictedaccess to retailed alcohol specifically the prevention ofunderage alcohol consumption”. Other best buy interventions such as prohibitions on alcohol marketing and taxincrease were not addressed. Furthermore, the policy remains in limbo as the document, has not been publishedand disseminated. The actions proposed in the 2007Federal Road Safety Act (a non-health – sector legal actdeveloped to reduce the occurrence of highway accident)only address one of the best buy interventions on limitedaccess to alcohol but there are no legal actions to controlthe activities of the Alcohol industry. This is a major gapand underscores the low political priority for the control ofharmful alcohol use. There remains an urgent need forNigeria to develop a comprehensive alcohol policy in line
Abiona et al. BMC Public Health(2019) 19:810with the 10 proposed targets of WHO 2010 global st
Conclusions: Nigeria has few alcohol-related policies with weak multi-sectoral action. Funding constraint remains a major threat to the implementation and enforcement of proposed policy actions. Keywords: Alcohol, Health policy, Public health, Nigeria Background The health, social and economic costs of alcohol-related
The metabolism of alcohol is primarily dependent on the activity of ADH, and the average adult blood alcohol concentration decreases 15 - 20 mg/dL/hour. A drink of alcohol is defined as 14 grams of alcohol. Fourteen grams of alcohol are contained in 12 ounces of beer (5% alcohol content), 5 ounce
7)The alcohol which contains only one carbon atom and has the common name of wood alcohol is A)methanol. B)glycol. C)glycerol. D)ethanol. E)phenol. 7) 8)The common name of CH3OH is A)antifreeze. B)grain alcohol. C)wood alcohol. D)rubbing alcohol. E)glycerol. 8) 9)The alcohol which contains two carbon atoms and has the common name of grain .
7 A number of studies on alcohol-related morbidity have found a J-shaped curve, i.e. those who drink no alcohol appear to have a greater risk of death from conditions linked to alcohol than those who drink a small amount of alcohol per week, but as drinking gets heavier, the risk of alcohol-related death increases steadily.
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2.4.2 Setting the level of the alcohol excise duty 56 2.4.3 Alcohol excise duty coordination 58 2.5 Alcohol regulation 60 2.6 Implications for the EU's alcohol tax policy 63 Discussion 64 3 Gambling policy in the European Union: too many losers? 69 3.1 Introduction 69 3.2 Similarities and differences in the analysis of gambling and other .
alcohol environment. The problems associated with Wisconsin’s culture of alcohol have been widely reported and discussed in the media, while a vision of a healthy alcohol environment in Wisconsin has remained unclear. Wisconsin’s alcohol environment has evolved over time, community by community. Wisconsin residents are
Oct 01, 2020 · F10.130 - Alcohol abuse with withdrawal, uncomplicated F10.131 - Alcohol abuse with withdrawal delirium F10.132 - Alcohol abuse with withdrawal with perceptual disturbance F10.139 - Alcohol abuse with withdrawal, unspecified F10.930 - Alcohol use, un
3 CLEFS The clef, a symbol that sits at the leftmost side of the staff, specifies which lines and spaces belong to which notes. In a sense, the clef calibrates or orients the staff to specific notes. The three most common clefs are: The Treble clef for high range notes The Bass clef for low range notes The Alto clef for middle range notes The Treble clef (also called the G Clef because it .
