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A multi-method approach will be utilised to formulate conclusions on (i) weekly (ie, average) thresholds to minimise long-term and short-term risks of morbidity and mortality, (ii) daily thresholds to minimise the short-term risk of injury or acute illness due to per occasion drinking, (iii) alcohol use among vulnerable populations (eg, pregnant women) and (iv) situations and circumstances that are hazardous for alcohol use. To inform expert decisions, this project will also include a systematic review of existing low-risk drinking guidelines, a systematic review of meta-analyses which examine alcohol\u2019s impact on key attributable disease and mortality outcomes, and of estimates of the lifetime absolute risk of alcohol-attributable mortality and morbidity based on a person\u2019s sex and average level of alcohol use. The systematic reviews were designed in accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). The preliminary conclusions produced as a result of this project will undergo public consultation, and data from these consultations will be qualitatively analysed. The results of the public consultations will be used to further revise and refine the project\u2019s conclusions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and registration<\/jats:title>\n                    <jats:p>The study was granted an ethics exemption as only secondary data sources and unidentifiable public consultation will be utilised. Systematic reviews are pre-registered with PROSPERO (registration numbers CRD42024584924 and CRD42024584948).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Dissemination<\/jats:title>\n                    <jats:p>\n                      This project will establish a scientific consensus concerning alcohol\u2019s impact on health. This consensus is imperative for informing the upcoming\n                      <jats:italic>Dietary Guidelines for Americans, 2026\u20132030<\/jats:italic>\n                      , and for better informing individuals about the health risks associated with alcohol use.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-093389","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T03:50:20Z","timestamp":1764215420000},"page":"e093389","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Health impact of alcohol use in the USA: a protocol of a systematic review and modelling study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1871-8849","authenticated-orcid":false,"given":"Kevin","family":"Shield","sequence":"first","affiliation":[{"name":"Centre for Addiction and Mental Health, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Keyes","sequence":"additional","affiliation":[{"name":"Mailman School of Public Health, Columbia University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"Martinez","sequence":"additional","affiliation":[{"name":"Public Health Institute, Oakland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam J","family":"Milam","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Rehm","sequence":"additional","affiliation":[{"name":"Centre for Addiction and Mental Health, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinead","family":"George","sequence":"additional","affiliation":[{"name":"Centre for Addiction and Mental Health, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy S","family":"Naimi","sequence":"additional","affiliation":[{"name":"Canadian Institute for Substance Use Research, Victoria, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"2025112619501176000_15.11.e093389.1","unstructured":"Substance Abuse and Mental Health Services Administration . 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