The relative strength of attitudes versus perceived drinking norms as predictors of alcohol use

Social cognitive factors such as perceived norms and personal attitudes toward alcohol consumption are reliable predictors of alcohol use and related problems. The current study aimed to evaluate the relative importance of one's attitude toward alcohol use as a unique and important predictor of drinking related outcomes when directly compared to perceived descriptive and injunctive norms. Participants were mandated students (n=568; 28% female) who violated a campus alcohol policy and received a Brief Motivational Intervention. Analyses included the use of linear regression for prospective predictions to evaluate the relative importance of predictors which included perceived descriptive norms and injunctive norms, and attitudes toward moderate and heavy alcohol use. Overall, the results indicate that one's attitude toward heavy alcohol use is a stronger predictor of drinks per week, binge frequency, as well as alcohol related problems when directly compared to norms. Thus, the findings of the current study provide a compelling rationale for incorporating attitudes in the development and refinement of intervention strategies.

Does quality of drinking water matter in kidney stone disease: A study in West Bengal, India

Purpose

The combined interaction of epidemiology, environmental exposure, dietary habits, and genetic factors causes kidney stone disease (KSD), a common public health problem worldwide. Because a high water intake (>3 L daily) is widely recommended by physicians to prevent KSD, the present study evaluated whether the quantity of water that people consume daily is associated with KSD and whether the quality of drinking water has any effect on disease prevalence.

Materials and Methods

Information regarding residential address, daily volume of water consumption, and source of drinking water was collected from 1,266 patients with kidney stones in West Bengal, India. Drinking water was collected by use of proper methods from case (high stone prevalence) and control (zero stone prevalence) areas thrice yearly. Water samples were analyzed for pH, alkalinity, hardness, total dissolved solutes, electrical conductivity, and salinity. Average values of the studied parameters were compared to determine if there were any statistically significant differences between the case and control areas.

Results

We observed that as many as 53.6% of the patients consumed <3 L of water daily. Analysis of drinking water samples from case and control areas, however, did not show any statistically significant alterations in the studied parameters. All water samples were found to be suitable for consumption.

Conclusions

It is not the quality of water, rather the quantity of water consumed that matters most in the occurrence of KSD.

Silencing the insular-striatal circuit decreases alcohol self-administration and increases sensitivity to alcohol

Internal drug states/cues can impact drug taking, as pretreatment with a moderate to high alcohol dose (i.e., loading dose) can decrease subsequent alcohol self-administration, alcohol-seeking, and relapse-like drinking. The insular cortex (IC) is implicated in processing information about internal states and findings show that silencing the IC and its projections to the nucleus accumbens core (AcbC) enhance sensitivity to the interoceptive effects of alcohol. Therefore, the goal of the present work was to determine the functional role of IC-AcbC projections in modulating the effects of alcohol pretreatment on operant alcohol self-administration. Long-Evans rats were trained to self-administer a sweetened alcohol solution (15% alcohol (v/v) + 2% sucrose (w/v)) and on test sessions received pretreatment with an alcohol loading dose. A chemogenetic strategy (i.e., hM4D Designer Receptors Exclusively Activated by Designer Drugs [DREADDs]) was implemented to silence the IC-AcbC projections and test the functional role of the insular-striatal circuitry in regulating self-administration following the alcohol loading doses. Alcohol self-administration decreased following pre-session treatment with alcohol, confirming titration of alcohol drinking following a loading dose of alcohol. Chemogenetic silencing of IC-AcbC projections decreased alcohol self-administration under baseline conditions (i.e., water loading dose) and the reduction in self-administration of an alcohol loading dose, implicating a role for this circuit in the maintenance of alcohol self-administration and suggesting increased sensitivity to the alcohol loading dose. These findings provide evidence for the critical nature of insular-striatal circuitry in ongoing alcohol self-administration, and specifically in relation to interoceptive/internal cues that can impact alcohol drinking.

Inhibition of Glyoxalase 1 reduces alcohol self-administration in dependent and nondependent rats

Previous studies showed that the glyoxalase 1 (Glo1) gene modulates anxiety-like behavior, seizure susceptibility, depression-like behavior, and alcohol drinking in the drinking-in-the-dark paradigm in nondependent mice. Administration of the small-molecule GLO1 inhibitor S-bromobenzylglutathione cyclopentyl diester (pBBG) decreased alcohol drinking in nondependent mice, suggesting a possible therapeutic strategy. However, the preclinical therapeutic efficacy of pBBG in animal models of alcohol dependence remains to be demonstrated. We tested the effect of pBBG (7.5 and 25 mg/kg) on operant alcohol self-administration in alcohol-dependent and nondependent rats. Wistar rats were trained to self-administer 10% alcohol (v/v) and made dependent by chronic intermittent passive exposure to alcohol vapor for 5 weeks. Pretreatment with pBBG dose-dependently reduced alcohol self-administration in both nondependent and dependent animals, without affecting water self-administration. pBBG treatment was more effective in dependent rats than in nondependent rats. These data extend previous findings that implicated Glo1 in alcohol drinking in nondependent mice by showing even more profound effects in alcohol-dependent rats. These results suggest that the pharmacological inhibition of GLO1 is a relevant therapeutic target for the treatment of alcohol use disorders.

Alcohol Use and Psychosocial Stressors in the Norwegian Workforce

BACKGROUND

Although alcohol use can have detrimental effects for employees, little is known about the prevalence, distribution, and correlates in the Norwegian workforce.

AIMS

To determine the overall and the work-related prevalence of weekly alcohol use, and to establish associations between psychosocial work stressors and alcohol use among Norwegian employees.

METHODS

Data were from a 2015 national probability sample of 1,608 Norwegian employees (response rate 32%). Job demands, lack of job control, role expectations, workplace bullying, and leadership were examined as correlates of several dimensions of alcohol use.

RESULTS

Average weekly alcohol consumption was 4.28 units (SD = 7.91). Male workers reported significantly higher consumption than female workers. Also, 2.6% of male and 2.0% of female workers reported problematic alcohol use. Only 0.1% of workers reported weekly alcohol use before the workday, 0.4% reported weekly use during the workday, 20.1% reported weekly use after ending the work day, and 80% reported use during weekends/days off. Alcohol intake increased with age, but was not related to marital status, educational level, work schedule, or leadership position. Problematic alcohol use was related to job demands and workplace bullying. Alcohol use after work was positively related to lack of job control and role ambiguity and negatively related to bullying. Conclusions/importance: Weekly alcohol use before and during the workday is not prevalent among Norwegian workers. Interventions to reduce job demands and workplace bullying may reduce problematic alcohol intake, whereas increasing job control and reducing role ambiguity may reduce after work use.

Social support predicts reductions in PTSD symptoms when substances are not used to cope: A longitudinal study of sexual assault survivors

BACKGROUND

After sexual assault, many college women develop symptoms of posttraumatic stress disorder (PTSD), and those who engage in substance use coping are at heightened risk for this outcome. Positively-perceived social support has been identified as an important protective factor against the development of PTSD, but received social support could involve problematic behaviors-like the encouragement of coping through use of alcohol and/or drugs-that could worsen symptoms.

METHODS

In the current study, 147 undergraduate women with a lifetime history of sexual assault completed two waves of self-report measures assessing their symptoms. We test main and interaction effects for social support and substance use coping at baseline on PTSD symptoms one month later.

RESULTS

Results suggest that social support is longitudinally associated with decreases in PTSD. Although substance use coping did not evidence a direct association with PTSD, the relationship between social support and PTSD was significantly weaker as substance use coping increased. Only support from friends (but not family members or a "special person") was associated with later PTSD, and this relationship was moderated by substance use coping.

LIMITATIONS

Substance use coping was assessed via a brief measure, and peer encouragement of coping by using alcohol and/or drugs was not directly assessed.

CONCLUSIONS

Clinicians should consider ways to increase access to social support from friends in patients with PTSD and evaluate ways that substance use coping may interfere with social support's benefits.

An examination of heavy drinking, depressed mood, drinking related constructs, and consequences among high-risk college students using a person-centered approach

INTRODUCTION

Research has identified college students who experience depressed mood and consume alcohol are at an increased risk for experiencing alcohol problems. The present study identified profiles of differential alcohol use, depression, key psychosocial indicators of drinking (e.g., normative perceptions) and examined the relationship between these profiles and alcohol-related consequences.

METHOD

Students with a history of risky drinking and elevated depressed mood (n=311; 62.4% female) completed a web-based survey assessing typical and peak drinking, depressive symptoms, descriptive norms, drinking to cope motives, protective behavioral strategies, and alcohol-related consequences.

RESULTS

Latent profile analysis was used to classify participants into distinct profiles focusing on alcohol use patterns and level of depressed mood and drinking related constructs. Profiles were then compared based on their association with reported rates of alcohol-related consequences. Four profiles emerged: 1) Mild Depression, Heavy Drinkers; 2) Mild Depression, Severe Drinkers; 3) Moderate Depression, Heavy Drinkers; and 4) Moderate Depression, Severe Drinkers. Findings revealed significant differences between the four profiles on both risky drinking and alcohol-related consequences.

CONCLUSION

These findings suggest the importance of assessing and addressing depressive symptoms among college students in order to reduce rates of risky drinking and alcohol-related consequences.

Predictors of short-term change after a brief alcohol intervention for mandated college drinkers

OBJECTIVE

Brief motivational interventions (BMIs) reduce problematic drinking for some, but not all, college students. Identifying those students who are less responsive can help to guide intervention refinement. Therefore, we examined demographic, personality, and cognitive factors hypothesized to influence change after a BMI.

METHOD

Students mandated for intervention following a campus alcohol violation (N=568; 28% female, 38% freshmen) completed a baseline assessment, then received a BMI, and then completed a 1-month follow-up. At both assessments, alcohol use (i.e., drinks per week, typical BAC, binge frequency) and alcohol-related problems were measured.

RESULTS

Latent change score analyses revealed significant decrease in both alcohol use and problems 1month after the BMI. In the final model that predicted change in alcohol use, four factors (male sex, a "fun seeking" disposition, more perceived costs and fewer perceived benefits of change) predicted smaller decreases in alcohol use over time. In the final model that predicted change in alcohol-related problems, three factors (stronger beliefs about the centrality of alcohol to college life, more perceived costs and fewer perceived benefits of change) predicted smaller decreases in problems over time.

CONCLUSIONS

Participation in a BMI reduced alcohol use and problems among mandated college students at 1-month follow-up. We identified predictors of these outcomes, which suggest the need to tailor the BMI to improve its efficacy among males and those students expressing motives (pro and cons, and fun seeking) and beliefs about the centrality of drinking in college.

Explicit drinking identity and alcohol problems: The mediating role of drinking to cope

Drinking identity, or the tendency to view one's self as a drinker, is a unique predictor of alcohol use and related consequences among young adults; yet the mechanism by which it leads to alcohol problems is poorly understood. Based on self-presentation and self-verification perspectives, we examined drinking to cope as a mediator of the association between explicit drinking identity and alcohol-related problems among two samples of young adults. Study data come from two large, longitudinal studies. Participants from Sample 1 and Sample 2 included undergraduates (55% and 59% female, respectively) who reported drinking in the previous three months. Tests of the indirect effects indicated that 3-month drinking to cope significantly mediated the positive association between baseline drinking identity and 6-month alcohol-related problems in both samples. In contrast, 3-month drinking identity did not mediate the association between baseline drinking to cope and 6-month alcohol-related problems. Findings indicate that individuals with a stronger drinking identity are more likely to use alcohol to cope and, subsequently, experience more problems. Thus, drinking identity may be an important intervention target for college students as it appears to temporally proceed drinking to cope in the prediction of alcohol-related problems.

Nicotine as a discriminative stimulus for ethanol use

Abused drugs reinforce behavior; i.e., they increase the probability of the behavior preceding their administration. Abused drugs can also act as discriminative stimuli; i.e., they can set the occasion for responding reinforced by another event. Thus, one abused drug could come to set the occasion for the use of another and this functional relationship may play a role in polysubstance abuse, where common patterns of use could result in this relationship. Here we establish nicotine (0.4mg/kg, ip 5-min pre-session) as a discriminative stimulus for behavior reinforced by ethanol (0.1ml 8% w/v po, versus food) and determine the ability of nicotine (0.02-0.4mg/kg), varenicline (0.1-3.0mg/kg), and ethanol (250 and 500mg/kg) to control responding for ethanol. We compare these results to those from rats where nicotine signaled food was available (and ethanol was not). Nicotine came to function as a discriminative stimulus. Nicotine and varenicline produced dose-dependent increases in responding on the nicotine-appropriate lever while ethanol produced responding on the vehicle-appropriate lever. Whether this responding occurred on the lever that produced ethanol or food access depended on the training condition. These results demonstrate that a drug can come to set the occasion for use of another and suggest that this behavioral mechanism could play an important role in the maintenance of and recovery from polysubstance abuse, depending on the pattern of use.

Water intake reverses dehydration associated impaired executive function in healthy young women

INTRODUCTION

Healthy women do not always consume Recommended Daily Levels of fluid intake ad libitum. We hypothesized that 1) women lose≥1.0% BW during daily activities, 2) that mild body water loss impairs memory and executive function, 3) water intake to recommended daily levels will improve cognitive function.

METHODS

We tested 12 women (26±5yr, 22.5±2.6kg/m² BMI). Session 1 was a control (CON) session, during which subjects monitored their food and fluid intake (diary) and activity (Fitbit®). The next two sessions were applied in balanced order: dehydration (DEH) session, where subjects minimized drinking, and a euhydration (EUH) session, where subjects drank Recommended Daily Levels of fluid for their age and sex, or 2500ml/24h. We compared emotion, sensory perception and cognition with computer based visual analog tests and computer based cognitive tasks (Cogstate) at 5PM, i.e. baseline (BL) on the evening prior to the session, and at 7AM, 12PM, and 5PM during the session.

RESULTS

Urine specific gravity (USG) was similar at BL across conditions (CON 1.013±0.002, DEH 1.015±0.002, EUH 1.014±0.002) and increased with dehydration (CON 1.011±0.003, DEH 1.021±0.002, EUH 1.010±0.002, P<0.05) by 5PM of the session. Uncontrolled fluid intake and physical activity were similar across sessions. The water challenges did not impact Detection, Identification, One-Card Learning, but EUH improved visual and working memory (Groton Maze Learning Test) errors: CON 40.1±11.1, DEH 40.5±10.1, EUH 33.9±10.9, P<0.05. Executive function [Set Shifting (SETS)] also improved under EUH, errors: BL 22.5±12.7 vs. 5PM 17.8±6.2, P<0.05.

CONCLUSIONS

Mild dehydration caused deficits in visual and working memory and executive function in healthy young women. These deficits were reversed by drinking water to the European Food Safety Authority and Institute of Medicine requirements of 2.5l/day for adult women.

Estimate of undergraduate university student alcohol use in China: a systematic review and meta-analysis

OBJECTIVE

To develop an estimate of self-reported last 30 day alcohol use by university students in China.

METHODS

A search of papers published in English and Chinese between 2006 and 2015, following pre-established selection criteria, identified 30 papers that were included in this meta-analysis. Nine moderator variables were preselected for this analysis.

RESULTS

A total of 749 papers were identified in the keyword search, and 30 studies (28 in Chinese, 2 in English) met all selection criteria and were included in the meta-analysis. The self-reported last-30-day alcohol use for undergraduate university students was 66.8% for males and 31.7% for females. Meta-regression identified three moderators associated with the different drinking rates reported: the definition of drinking, the origin of the questionnaire used in the survey, and the geographic region where the survey was conducted. These three moderators explained 56% of the heterogeneity of reported drinking rates for the male students and 47% of the heterogeneity of reported drinking rates for the female students.

CONCLUSIONS

The results of this meta-analysis provide an estimate of last 30 day alcohol use by university students (age 18-23) and increase our understanding of drinking by young people in China. The meta-analysis suggested three variables that could have affected the results and which are worthy of further study. The discussion places these results in the context of Chinese drinking culture and university life.

Insomnia moderates the association between alcohol use and consequences among young adult veterans

OBJECTIVE

Symptoms of insomnia and heavy alcohol use tend to co-occur among military and veteran samples. The current study examined insomnia as a moderator of the association between alcohol use and related consequences among young adult veterans in an effort to extend and replicate findings observed in samples of civilian young adults.

METHOD

Young adult veterans (N=622; 83% male; age M=29.0, SD=3.4) reporting alcohol use in the past year completed measures of insomnia severity, alcohol use, and alcohol-related consequences as part of a larger intervention trial. Participants were classified as screening 'positive' (n=383, 62%) or 'negative' (n=239, 38%) for insomnia using the Insomnia Severity Index. Hierarchical regression was used to examine the interaction between drinking quantity and insomnia on alcohol-related consequences. Predictor and outcome variables were measured concurrently.

RESULTS

Both a greater number of drinks per week and a positive insomnia screen were associated with more alcohol-related consequences. Drinks per week and insomnia screen interacted to predict alcohol-related consequences, such that the effect of drinking on alcohol-related consequences was stronger in the context of a positive versus negative insomnia screen.

CONCLUSION

Drinking is associated with more alcohol-related consequences in the presence of clinically significant insomnia symptoms. These findings replicate those documented in civilian young adults and indicate that insomnia may be an appropriate target for alcohol prevention and intervention efforts among young adult veterans.

The short- and long-run effects of smoking cessation on alcohol consumption

This paper examines the short- and long-term effects of quitting smoking on alcohol consumption using the Lung Health Study, a randomized smoking cessation program. The paper estimates the relationship between smoking and alcohol consumption using several self-reported and objective smoking measures, while also implementing a two-stage least squares estimation strategy that utilizes the randomized smoking cessation program assignment as an instrument for smoking. The analysis leads to three salient findings. First, self-reported and clinically verified smoking measures provide mixed evidence on the short-term impact of quitting smoking on alcohol consumption. Second, the long-term impact of smoking on alcohol consumption, measured with the historic 5 years smoking behavior, suggests that those with the highest average cigarette consumption and those with the longest smoking history see the largest increase in alcohol consumption. Specifically, abstaining from smoking or reducing the average cigarette consumption to the mean level lowers alcohol consumption by roughly 25% per week. As a result, these findings present comprehensive evidence that smoking and drinking are complements in the long-term and that the public health and finance benefits in smoking cessations treatments are undervalued.

Insomnia treatment in the context of alcohol use disorder: A systematic review and meta-analysis

PURPOSE

To determine the efficacy of behavioral and pharmacological interventions for insomnia among individuals with alcohol use disorder (AUD).

PROCEDURES

Comprehensive literature searches of psychological, medical, and educational databases were conducted through October 2016. Eligible studies evaluated the efficacy of an insomnia intervention, included a comparison condition, sampled individuals with AUD and either insomnia disorder or complaints of insomnia, assessed sleep-related outcomes, and provided relevant statistics to calculate between-group effect sizes. Effect sizes were estimated for sleep quality, days of alcohol abstinence, and symptoms of depression. Type of intervention (behavioral versus pharmacological) was tested as a moderator of intervention efficacy.

MAIN FINDINGS

Nine studies met eligibility criteria and were included in the final review and meta-analysis. Random-effects models indicated that intervention participants reported greater improvements in sleep quality (d+=0.62, 95% CI=0.28, 0.97) and symptoms of depression (d+=0.52, 95% CI=0.06, 0.98) than control participants. Participants reported significantly greater improvements in sleep quality in response to behavioral (d+=1.20, 95% CI=0.70, 1.70) as opposed to pharmacological (d+=0.43, 95% CI=0.19, 0.67) interventions. Behavioral (d+=0.74, 95% CI=0.31, 1.18) and pharmacological (d+=0.08, 95% CI=-0.64, 0.78) interventions did not have significantly different effects on depressive symptoms. Neither behavioral nor pharmacological interventions improved rates of alcohol abstinence.

CONCLUSIONS

Insomnia interventions improve sleep quality and reduce symptoms of depression among individuals with comorbid AUD. Given the methodological weaknesses of studies reviewed, additional research is needed to determine the efficacy of insomnia treatment in improving rates of alcohol relapse within this population.

Predicting early onset of intoxication versus drinking-A population-based prospective study of Norwegian adolescents

AIMS

Recent research suggests that early onset of intoxication (EOI) may be of greater importance for a wide range of subsequent adverse outcomes than early drinking experiences without intoxication. However, research on antecedents of EOI is scarce. The present study identifies predictors of EOI and whether they differ from those of early onset of drinking (EOD).

METHODS

Data was drawn from the prospective Tracking Opportunities and Problems (TOPP) study of Norwegian families (n = 382), which followed up mothers and their children with six data collections from childhood (age 1.5) to adolescence (age 14.5). Self-reports from the adolescents (parenting practices, adolescent's conduct problems and friends' deviant behaviour) and their mothers (adolescent temperament, socio-economic factors and household alcohol problems) were used to identify predictors of EOI and EOD.

FINDINGS

A variety of temperamental, socio-economic, and family factors predicted EOI, whereas EOD was predicted of substantially fewer variables. Particularly, when controlling for relevant covariates, low levels of shyness, own conduct problems and having friends with deviant behaviour prospectively predicted EOI, but not EOD.

CONCLUSIONS

Future research and prevention efforts should take into consideration that EOI and EOD without getting drunk appear to be predicted by different risk factors in childhood and adolescence.

Exposure to Alcohol Content in Movies and Initiation of Early Drinking Milestones

BACKGROUND

Exposure to alcohol content in movies has been shown to be associated with adolescent use of alcohol, including earlier onset. This study examined the influence of movie alcohol exposure on subsequent alcohol onset, considering the social context (whether the movie was viewed with a friend or parent). We examined whether media's influence holds across a spectrum of early drinking milestones: sipping (but not consuming a full drink of) alcohol, consuming a full drink of alcohol, and engaging in heavy episodic drinking (HED).

METHODS

Data were taken from a sample of 882 middle school youth (52% female; 24% non-White) enrolled in an ongoing study on alcohol initiation and progression. Exposure to alcohol content in films was measured using a method that combines content analysis and random assignment of movie titles to youth surveys. The hazard of initiating alcohol use (sip, full drink, HED) as a function of exposure was estimated using survival analysis. Associations were adjusted for demographic, personality, and social influence factors known to be associated with both movie exposure and alcohol use.

RESULTS

Exposure to alcohol content was common. Hours of exposure prospectively predicted earlier onset of alcohol involvement across all outcomes. Viewing movies with friends appeared to augment the media exposure effect, in contrast to viewing movies with parents, which was not a significant predictor of initiation.

CONCLUSIONS

Exposure to alcohol in films is involved in the entry into early stages of alcohol involvement. Findings support further investigation into the role of the media in underage drinking, especially in the context of consuming media with friends and peers. Limiting media exposure and/or stronger Federal Trade Commission oversight of movie ratings should be a priority for preventing underage drinking.

Lifestyle factors are significantly associated with the locomotive syndrome: a cross-sectional study

Background

The Japanese Orthopedic Association first proposed the concept of “locomotive syndrome” in 2007. It refers to circumstances in which elderly people need nursing care services or are at high risk of requiring such services within a short time. Recently, the public health burden of providing nursing care for elderly individuals has increased. Therefore, locomotive syndrome, and the means of preventing it, are a major public health focus in Japan. The purpose of this study was to investigate the relationships of lifestyle factors, such as smoking, alcohol consumption, sleep duration, and dental health, with locomotive syndrome.

Methods

We conducted a cross-sectional study using an internet panel survey. The participants comprised 747 individuals aged 30–90 years. Factors related to demographics (age, sex), general health (number of teeth, presence of periodontal disease), and lifestyle (smoking, alcohol consumption, sleep duration) were assessed. We also used the 25-question Geriatric Locomotive Function Scale to determine whether each participant had locomotive syndrome. Multivariate analysis was conducted using logistic regression to investigate the independent relationships between locomotive syndrome and lifestyle factors after adjusting for sex and age.

Results

A greater proportion of women (17.7%) than men (11.2%) had locomotive syndrome (p < 0.05). Participants aged ≥65 years showed significantly higher percentages (men: 21.4%, women: 75.7%) of locomotive syndrome compared with those aged <65 years (p < 0.05). Logistic regression analysis revealed that older age (≥ 65 years), sex, current smoking status, number of existing teeth, and presence of periodontal disease were associated with locomotive syndrome, whereas sleep duration was not. The frequency of alcohol consumption, except for daily drinking, was also associated with locomotive syndrome.

Conclusion

Our study indicates that lifestyle factors, such as smoking and number of existing teeth, may partly affect the prevalence of locomotive syndrome. Hence, lifestyle modifications, such as improving oral hygiene and promoting cessation of smoking, are important means to reduce the risk of locomotive syndrome and should be promoted by public health staff.

Carbohydrate-Deficient Transferrin as a Biomarker for Screening At-Risk Drinking in Elderly Men

Background

Carbohydrate-deficient transferrin (CDT) is a useful biomarker to identify excessive alcohol consumption; however, few studies have validated the %CDT cut-off value in elderly men. This study estimated the optimal %CDT cut-off value that could identify excessive alcohol consumption in men aged ≥65 years.

Methods

This retrospective study included 120 men who visited the department of family medicine at Chungnam National University Hospital for health check-up between January 2010 and August 2013. At-risk drinking included heavy- and binge drinking. Heavy drinking was defined as more than seven standard drinks/wk, and binge drinking was defined as more than three standard drinks/d. The cut-off %CDT values for at-risk drinking were determined using receiver operating characteristic (ROC) curves.

Results

Based on the ROC curves, the optimal %CDT cut-off values in ≥65-year-old men were 1.95% for at-risk drinking, 1.81% for heavy drinking, and 2.07% for binge drinking. The sensitivity, specificity, and positive and negative predictive values were 58.7%, 83.6%, 69.2%, and 76.2% for at-risk drinking, respectively. The AUROC were >0.7 for all three evaluated cut-offs.

Conclusion

Our results suggest that the %CDT cut-off value for at-risk drinking in elderly Korean men (≥65 years) should be readjusted to a lower value of 1.95%.

The effects of a patient activation intervention on smoking and excessive drinking cessations: results from the PAADRN randomized controlled trial

Patients may exhibit risky bone health behaviors. In a large pragmatic clinical trial, we tested whether a tailored patient activation DXA result letter accompanied by a bone health brochure led to smoking and excessive drinking cessations. The intervention did not, however, alter these risky bone health behaviors.

INTRODUCTION

Besides dual-energy x-ray absorptiometry (DXA) screening and pharmacotherapy when indicated, beneficial bone health behaviors including proper calcium and vitamin D intake and weight-bearing and muscle-strengthening exercise should be encouraged. Similarly, risky bone health behaviors like smoking and excessive drinking should be discouraged. We examined whether a direct-to-patient activation intervention led to smoking and excessive drinking cessations.

METHODS

The Patient Activation after DXA Result Notification (PAADRN) pragmatic clinical trial enrolled 7749 patients between February 2012 and August 2014. Interviews occurred at baseline and 12 and 52 weeks later. Intervention subjects were mailed an individually tailored DXA results letter accompanied by a bone health educational brochure 4 weeks post-DXA. Usual care subjects were not sent these materials. Smoking and excessive drinking were assessed by self-report at each interview. Intention-to-treat linear probability models were used.

RESULTS

Mean age was 66.6 years, 83.8% were women, and 75.3% were Non-Hispanic-Whites. Smoking was reported at baseline by 7.6% of the intervention group vs. 7.7% of the usual care group (p = 0.873). Excessive drinking was reported at baseline by 6.5% of the intervention group vs. 6.5% of the usual care group (p = 0.968). Intention-to-treat analyses indicated no significant differences between the intervention vs. usual care groups at either 12 or 52 weeks post-DXA (all p values ≥ 0.346).

CONCLUSION

An individually tailored DXA result letter accompanied by an educational brochure did not lead to smoking or excessive drinking cessations in patients who received DXA.

TRIAL REGISTRATION

clinicaltrials.gov identifier NCT01507662.

Safety Assessment of Human Bone Marrow-derived Mesenchymal Stromal Cells Transplantation in Wistar Rats

Introduction

Bone Marrow-derived Mesenchymal Stromal Cells (BM-MSCs) are multipotent stem cells isolated from adult human bone marrow. Properties of MSCs make them potentially ideal candidates for regenerative medicine. The preclinical data available in the literature regarding the safety assessment of MSCs at different dosage group is scanty.

Aim

To evaluate the safety of BM-MSCs transplantation in Wistar rats.

Materials and Methods

Eighteen adult female Wistar rats were used in the study. They were randomly divided into normal control, low dose MSCs and high dose MSCs groups. Low dose group received 3.25 million BM-MSCs/kg body weight; high dose group received 9.75 million BM-MSCs/kg body weight intravenously. Body weight, food and water intake of each rat were measured statistically using SPSS version 16.0; animals were observed for changes in behaviour, general clinical signs, presence of any abnormal response, mortality for thirty days.

Results

Repeated measures ANOVA indicated a significant increase in body weight, food, and water intake of all animals at all weeks of the study period compared to week zero (p<0.05). Between the low dose and high dose MSCs group, increase in absolute body weight was seen at the end of the 30^th day which was statistically significant (p=0.01). There was no significant difference in body weights, food and water intake in MSCs group when compared to normal control. All the animals survived for the entire duration of the study. Further, there was no change in the behaviour of the animals, no adverse clinical signs or complications following the MSCs treatment.

Conclusion

Results indicate that administration of BM-MSCs is safe when given by a slow intravenous infusion as it did not alter the food and water intake behaviour of the animals and did not have any negative effect on its body weight.

Mild exercise in female subjects impairs complex learning independent of hydration status and emotion

INTRODUCTION

Depending on type, intensity and duration, exercise can have both beneficial and detrimental effects on cognitive function. The impact of exercise on learning and memory is also sensitive to hydration status, so we hypothesized that mild hypohydration induced with exercise, will adversely impact executive and complex memory function tasks and that these changes in cognitive function are independent of changes in emotion.

METHODS

Using a cross over design, on separate days 11 women exercised on a recumbent bicycle. On day 1, women exercised to 1.5% hypohydration at 34°C, and <10% rh, on day 2, water loss from sweating was replaced by drinking water (euhydration). Pre- and post-euhydration and hypohydration, subjects underwent computer based cognitive tasks (simple, learning, memory, executive function) and visual analog testing to determine emotion.

RESULTS

Exercise increased Groton Maze Learning Test errors within both conditions: [Pre: 41.5±11.8, Post: 46.8±12.4, and Pre: 41.9±9.2, Post: 46.5±12.9, hypohydrated and euhydrated, respectively, Pre vs Post, ANOVA, time effect, P=0.007], a test of acquisition, storage, and use of new knowledge. None of the measures of emotion were affected by exercise under either hydration condition.

CONCLUSIONS

A bout of mild aerobic exercise compromised performance on a complex learning and memory task, but this change was unaffected by hydration status or emotion.

Decisions to Attend and Drink at Party Events: The Effects of Incentives and Disincentives and Lifetime Alcohol and Antisocial Problems

BACKGROUND

Alcohol use disorders are associated with patterns of impulsive/risky decision making on behavioral economic decision tasks, but little is known about the factors affecting drinking-related decisions.

METHODS

The effects of incentives and disincentives to attend and drink at hypothetical alcohol-related party events as a function of lifetime (LT) alcohol and antisocial problems were examined in a sample of 434 young adults who varied widely in LT alcohol and antisocial problems.

RESULTS

Moderate and high disincentives substantially discouraged decisions to attend the party events and were associated with decisions to drink less at the party events. High versus low party incentives were associated with more attendance decisions. LT antisocial problems were associated with being less deterred from attending by moderate and high disincentives. LT alcohol problems were associated with greater attendance at high party incentive contexts. LT alcohol problems were associated with drinking more at the majority of events; however, the results indicate that young adults with high levels of alcohol problems moderate their drinking in response to moderate and high disincentives. Finally, attendance and drinking decisions on this hypothetical task were significantly related to actual drinking practices.

CONCLUSIONS

The results suggest that antisocial symptoms are associated with a reduced sensitivity to the potential negative consequences of drinking, while alcohol problems are associated with a greater sensitivity to the rewarding aspects of partying. The results also underline the value of directly assessing drinking-related decisions in different hypothetical contexts as well as assessing decisions about attendance at risky drinking events in addition to drinking amount decisions.

Associative learning contributes to the increased water intake observed after daily injections of angiotensin II

Daily injections of angiotensin II (AngII) cause a progressive increase of water intake that resembles a classically ascribed non-associative sensitization. Consistent with the presumption that the observed increase in intake was sensitization, we hypothesized that it resulted from a pharmacological interaction between AngII and its receptor. To test this hypothesis, and remove the influence of drinking itself, we implemented a delay in water access after injection of AngII (icv) on four consecutive 'induction days,' and then measured intake on the next day ('test day') when rats were allowed to drink immediately after AngII. The delay in water access effectively reduced water intake on the four induction days, and rats with longer delays in access drank less on the test day than did rats allowed to drink immediately after AngII on the induction days. Additional experiments ruled out a role for a conditioned drinking response to the injection alone, and demonstrated a lack of conditioned appetition after pairing injections of AngII with water given by intragastric catheter. Taken together, these findings suggest that the increased drinking observed after daily injections of AngII is a conditioned appetition after repeated pairings of AngII and water intake. We further conclude that repeated stimulation of the AngII receptor alone is not sufficient to drive appetition.

The dynamic impact of retirement on health: Evidence from a nationwide ten-year panel survey in Japan

Retirement is a major life-course transition that is closely related to changes in health. This study examined the dynamic impact of retirement on health and health behaviors, distinguishing an immediate change in the level of health at retirement and a change in the rate of change after retirement. We used panel data from 9283 individuals (4441 men and 4842 women) who had retired during a nationwide ten-year panel survey in Japan conducted in 2005-2014. We focused on three health behaviors (current smoking, heavy alcohol drinking, and leisure-time physical activity) and two health indicators (self-rated health and psychological distress). We estimated regression models that controlled for both time-invariant individual attributes and the endogeneity of retirement, using panel data collected during the five years before and after retirement. Results generally confirmed that the transition was accompanied by favorable changes in health and health behaviors with some gender differences. Among men, retirement immediately promoted leisure-time physical activity and reduced poor self-rated health and psychological distress. Retirement also accelerated smoking cessation and leisure-time physical activity and decelerated reporting poor health. Among women, retirement immediately promoted leisure-time physical activity and reduced psychological distress, while it did not affect the rate of change in any health variable after retirement. The current study underscores the need for more in-depth knowledge of the dynamic impact of retirement on health. This will assist in developing policy measures to help the middle-aged population make healthy transitions from work to retirement.

The epidemiology of alcohol use in Izmir, Turkey: drinking pattern, impairment and help-seeking

PURPOSE

There is no report on various patterns of alcohol drinking and related impairment, help-seeking in Turkey. We investigated the 12-month prevalence and correlates of drinking patterns and alcohol use disorders in the general population of Izmir-Turkey, with further analyses on role impairment and help-seeking.

METHOD

A multi-stage clustered area probability sample of adult household residents in the Izmir Metropolitan Area was assessed using the Composite International Diagnostic Interview 2.1 (n  = 4011). Estimation focused on prevalence and correlates of 12-month drinking pattern and DSM-IV alcohol use disorders. The 12-month drinking pattern included groups of non-regular users, regular non-heavy drinkers, regular heavy drinkers, and alcohol abuse disorder and alcohol dependence. All respondents were questioned about receiving 12-month treatment for any psychological complaints, the route of help-seeking, and were assessed with Short Form-36 for functional impairments. Multinomial logistic regression was used for underlying associations between the covariates and the drinking patterns.

RESULTS

The rate of lifetime alcohol abstinence was 52.3% while the prevalence of past-year users was 14.8%. The 12-month prevalence estimates of regular heavy drinkers, and alcohol abuse disorder and dependence were 2.5%, 3.2 and 1.6%, respectively. Any of the drinking patterns and alcohol use disorders was associated with male gender, and higher levels of education, monthly income and socioeconomic status. Alcohol dependence was associated with mental health impairment but not with physical impairment. The 12-month rates of help-seeking in alcohol abuse and dependence were 11.6 and 16.5%.

CONCLUSION

Although alcohol use disorders are lower than estimates of Western countries, alcohol use constitute a major reason of disability with prominent treatment gap.

Bidirectional relationship between time preference and adolescent smoking and alcohol use: Evidence from longitudinal data

INTRODUCTION

Scholarly interest in time preference as a potential predictor of risky health behaviors in adolescents has increased in recent years. However, most of the existing literature is limited due to the exclusive reliance on cross-sectional data, precluding the possibility of establishing the direction of causality. Using longitudinal data from the Korea Youth Panel Survey (2003-7), which followed up a nationally representative sample of 3449 adolescents aged 14years for five years, this study examines a bidirectional relationship between time preference and smoking and drinking behaviors among adolescents.

METHODS

We used discrete time hazard models of smoking and drinking initiation as a function of time preference measured at the baseline and fixed-effects ordered logit model of time preference, respectively. Our measure of time preference was derived from the survey question on a hypothetical choice between immediate enjoyment today and likely higher scores on an exam tomorrow.

RESULTS

The overall results provide evidence on the bidirectional relationship; that is, higher time discounting (i.e., greater relative preference for present utility over future utility) results in an increased risk of engaging in smoking and drinking, and conversely, adopting such behaviors leads to a higher discount rate.

CONCLUSIONS

The bidirectional relationship may function as a mechanism for adolescents to engage in increased smoking and drinking or additional negative health behaviors via gateway effects, strengthening the case for preventing the initiation of risky health behaviors among adolescents.

Drinking despite health problems among individuals with liver disease across the United States

BACKGROUND

Heavy drinking is harmful for individuals with liver disease. However, some of these individuals drink despite knowledge of the risks. The current study aims to identify factors underlying drinking despite health problems among individuals with liver disease.

METHODS

The current study utilizes a subsample of individuals reporting past-year liver disease and at least one drink in the past year (n=331), taken from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a large nationally representative survey of the United States. Participants reported on drinking despite health problems, symptoms of psychopathology, and family history of alcohol problems in a cross-sectional survey.

RESULTS

Drug use disorders (Adjusted Odds Ratio [AOR]=2.68), as well as borderline, antisocial, and schizotypal personality disorders (AORs=2.50-4.10), were associated with increased likelihood of drinking despite health problems among individuals with liver disease, all ps<0.05. Any anxiety disorder trended toward significance (AOR=2.22), p=0.06, but major depressive disorder was not associated with increased risk, (AOR=0.99), ps=0.97. Individuals with a family history of alcohol problems were also more likely to drink despite health problems (AOR=2.79), p<0.05.

CONCLUSIONS

Several types of psychopathology, as well as a family history of alcohol problems, increased the likelihood of drinking despite health problems among individuals with liver disease. These findings highlight the need to intervene with heavily drinking individuals with liver disease, who may be drinking due to familial risk and/or comorbid psychopathology.

Friends' Alcohol-Related Social Networking Site Activity Predicts Escalations in Adolescent Drinking: Mediation by Peer Norms

PURPOSE

Adolescents' increased use of social networking sites (SNS) coincides with a developmental period of heightened risk for alcohol use initiation. However, little is known regarding associations between adolescents' SNS use and drinking initiation nor the mechanisms of this association. This study examined longitudinal associations among adolescents' exposure to friends' alcohol-related SNS postings, alcohol-favorable peer injunctive norms, and initiation of drinking behaviors.

METHODS

Participants were 658 high-school students who reported on posting of alcohol-related SNS content by self and friends, alcohol-related injunctive norms, and other developmental risk factors for alcohol use at two time points, 1 year apart. Participants also reported on initiation of three drinking behaviors: consuming a full drink, becoming drunk, and heavy episodic drinking (three or more drinks per occasion). Probit regression analyses were used to predict initiation of drinking behaviors from exposure to alcohol-related SNS content. Path analyses examined mediation of this association by peer injunctive norms.

RESULTS

Exposure to friends' alcohol-related SNS content predicted adolescents' initiation of drinking and heavy episodic drinking 1 year later, controlling for demographic and known developmental risk factors for alcohol use (i.e., parental monitoring and peer orientation). In addition, alcohol-favorable peer injunctive norms statistically mediated the relationship between alcohol-related SNS exposure and each drinking milestone.

CONCLUSIONS

Results suggest that social media plays a unique role in contributing to peer influence processes surrounding alcohol use and highlight the need for future investigative and preventive efforts to account for adolescents' changing social environments.

Cognitive control in young heavy drinkers: An ERP study

Substance use disorders have been frequently linked to an impaired cognitive control system. Whether this impaired control is also present in young adults who heavily drink alcohol is still subject to debate. The present study investigated possible impairments in cognitive control in heavy drinkers using behavioral and electrophysiological (EEG) measures. We studied behavioral performance on an inhibitory control and an error-processing task, using a GoNogo task and an Eriksen Flanker task respectively, while ERPs (Nogo-N2/P3 and ERN/Pe) were measured in a group of heavy alcohol drinkers (n=48) and a healthy control group of light drinkers (n=49). Results showed very few impairments in the heavy drinking group either at the behavioral or physiological level. One exception was the error-related Pe amplitude. This ERP component was reduced in heavy drinkers as compared to controls. Given that the Pe reflects a motivational component (i.e., the salience attributed to the making of errors) rather than a basic cognitive deficit, it can be concluded that heavy drinking in this population is not associated with major impaired cognitive control, but rather with impairments that are associated with aberrant attribution of salience to the making of errors. The present EEG findings are consistent with recent reviews and large scale epidemiological studies showing that heavy drinking, in contrast to substance use disorders, in young persons is not necessarily associated with major behavioral impairments in cognitive control.

Reduced water intake deteriorates glucose regulation in patients with type 2 diabetes

Epidemiological research has demonstrated that low daily total water intake is associated with increased diagnosis of hyperglycemia. Possible mechanisms for this increase include hormones related to the hypothalamic pituitary axis as well as the renin-angiotensin-aldosterone system (RAAS). Therefore, the hypothesis of the present study was that acute low water intake would result in differential hormonal profiles and thus impaired blood glucose regulation during an oral glucose tolerance test (OGTT) in people with type 2 diabetes mellitus (T2DM). Nine men (53 ± 9 years, 30.0 ± 4.3 m∙kg^-2, 32% ± 6% body fat) diagnosed with T2DM completed OGTTs in euhydrated (EUH) and hypohydrated (HYP) states in counterbalanced order. Water restriction led to hypohydration of -1.6% of body weight, with elevated plasma (EUH: 288 ± 4, HYP: 298 ± 6 mOsm·kg^-1; P < .05) and urine (EUH: 512 ± 185, HYP: 994 ± 415 mOsm·kg^-1; P < .05) osmolality. There was a significant main effect of condition for serum glucose (at time 0 minute 9.5 ± 4.2 vs 10.4 ± 4.4 mmol∙L^-1 and at time 120 minutes 19.1 ± 4.8 vs 21.0 ± 4.1 mmol∙L^-1 for EUH and HYP, respectively; P < .001) but not insulin (mean difference between EUH and HYP -12.1 ± 44.9 pmol∙L^-1, P = .390). An interaction between time and condition was observed for cortisol: decrease from minute 0 to 120 in EUH (-85.3 ± 82.1 nmol∙L^-1) vs HYP (-25.0 ± 43.0 nmol∙L^-1; P = .017). No differences between conditions were found within RAAS-related hormones. Therefore, we can conclude that 3 days of low total water intake in people with T2DM acutely impairs blood glucose response during an OGTT via cortisol but not RAAS-mediated glucose regulation.

How community-level social and economic developments have changed the patterns of substance use in a transition economy?

Most social changes take place at the community level before indirectly affecting individuals. Although the contextual effect is far-reaching, few studies have investigated the important questions of: how do community-level developments affect drinking and smoking, and how do they change the existing gender and income patterns of drinking and smoking, particularly in transition economies? In this study, I used a Chinese panel dataset between 1991 and 2011 to reveal the moderating effects of community developments. Through multilevel growth curve modeling that controls for age, period, and cohort effects, as well as individual- and community-level covariates, I found that community-level economic development and social development are negatively associated with drinking and smoking. Moreover, economic and social developments also moderate the important influences of income and gender: women start to drink more in communities with higher economic development; the traditionally positive association between income and smoking/drinking is also reversed, i.e. the rich start to smoke and drink less in communities with higher social development. This study concludes that the rapid changes in communal social and economic structures have created new health disparities based on the gender and socioeconomic hierarchy.

Positive alcohol expectancies mediate associations between ADHD behaviors and alcohol-related problems among college students

An increasing percentage of college students report being affected by ADHD behaviors, and this population is at increased risk of experiencing negative consequences associated with alcohol consumption. However, specific factors motivating alcohol consumption and contributing to negative outcomes among these individuals are not well understood. Recent work suggests alcohol expectancies may interact with ADHD behaviors to influence negative drinking-related outcomes among those with elevated inattention and/or hyperactivity-impulsivity. Seven-hundred-forty emerging adults (M age = 19.13 [SD = 2.25] years; 72.1% female; 85.8% Caucasian) enrolled in two public universities in the Southeast and Midwest USA completed the Brief Comprehensive Effects of Alcohol Survey (B-CEOA) and provided self-reports of ADHD symptoms and drinking-related outcomes. Multiple mediation analyses were conducted to evaluate effects of ADHD behaviors (i.e., hyperactivity-impulsivity, and inattention) and related impairment in major life domains (e.g., social interactions, occupational and educational activities, fulfillment of daily responsibilities) on drinking-related outcomes via positive and negative alcohol expectancies, controlling for sex, age, co-occurring oppositional behaviors, and data collection site. Inattention, hyperactivity-impulsivity, and impairment directly predicted both personal and social problems consequent to alcohol use. Effects of ADHD behaviors and impairment on drinking-related personal and social problems were partially mediated by positive expectancies. Findings are consistent with and extend prior work supporting a role of positive alcohol expectancies in alcohol-related negative outcomes among college students experiencing mild to moderate symptoms of ADHD.

Gratitude, abstinence, and alcohol use disorders: Report of a preliminary finding

Gratitude is a central component of addiction recovery for many, yet it has received scant attention in addiction research. In a sample of 67 individuals entering abstinence-based alcohol-use-disorder treatment, this study employed gratitude and abstinence variables from sequential assessments (baseline, 6months, 12months) to model theorized causal relationships: gratitude would increase pre-post treatment and gratitude after treatment would predict greater percent days abstinent 6months later. Neither hypothesis was supported. This unexpected result led to the theory that gratitude for sobriety was the construct of interest; therefore, the association between gratitude and future abstinence would be positive among those already abstinent. Thus, post-treatment abstinence was tested as a moderator of the effect of gratitude on future abstinence: this effect was statistically significant. For those who were abstinent after treatment, the relationship between gratitude and future abstinence was positive; for those drinking most frequently after treatment, the relationship between gratitude and future abstinence was negative. In this preliminary study, dispositional tendency to affirm that there is much to be thankful for appeared to perpetuate the status quo-frequent drinkers with high gratitude were drinking frequently 6months later; abstinent individuals with high gratitude were abstinent 6months later. Gratitude exercises might be contraindicated for clients who are drinking frequently and have abstinence as their treatment goal.

Assessment reactivity: A randomized controlled trial of alcohol-specific measures on alcohol-related behaviors

INTRODUCTION

Completion of alcohol assessments influences treatment outcomes, yet little is known about the aspects of assessment that may contribute to this response. The present study is a randomized controlled trial examining how the themes of alcohol assessments (e.g., assessment of alcohol-related consequences as opposed to drinking patterns) may affect drinking behaviors.

METHODS

Undergraduate students (N=290, Mage=19.97, SDage=1.81, 61.7% female), reporting at least one binge drinking episode during the past month, completed one of five baseline assessment batteries that varied thematically: (a) Control (e.g., minimal drinking quantity and frequency questions), (b) Consequences (e.g., College Alcohol Problems Scale; CAPS-r), (c) Norms (e.g., Drinking Norms Rating Form), (d) Diagnostic (e.g., Alcohol Use Disorders Identification Test), and (e) Combined (all themes). Participants completed a one-month follow-up of drinking quantity/frequency and the CAPS-r.

RESULTS

All groups decreased their self-reported peak drinks consumed (p<0.001, ηp2=0.05) and past month frequency of drinking (p=0.002, ηp2=0.03; except for the consequences group) from baseline to follow-up. There were no between-group differences. No changes emerged in drinks per week (p=0.09, ηp2=0.01) or alcohol-related consequences (p=0.06, ηp2=0.03) from baseline to follow-up.

CONCLUSION

Minimal assessment of drinking quantity and frequency may result in assessment reactivity. Reductions in markers of risky drinking behaviors did not differ as a function of the type of assessments completed (e.g., Consequences vs Diagnostic). Continued research is needed to determine what other important variables (e.g., treatment seeking) may affect assessment reactivity.

Alcohol Use in College: The Relationship Between Religion, Spirituality, and Proscriptive Attitudes Toward Alcohol

Developing interventions to address the problem of college drinking requires the identification of contributing factors to drinking behavior. It is believed that religion and spirituality (R/S) play a role, but the mechanism is unclear. Using a multi-dimensional R/S measure, an alcohol behavior inventory, and a religious affiliation proscription question, this study was designed to dive deeper into this connection. This study found that religious singing/chanting and reading sacred text were the best predictors of lower alcohol consumption. Furthermore, participants who perceive their religious tradition to be proscriptive reported less alcohol consumption and higher religious/spiritual profiles.

Individual and contextual factors associated with tobacco, alcohol, and cannabis use among Chilean adolescents: A multilevel study

We studied the association between individual and contextual variables and the use of tobacco, alcohol, or cannabis in the last 30 days preceding the study, considering the hierarchical nature of students nested in schools. We used the 7th Chilean National School Survey of Substance Use (2007) covering 45,273 students (aged 12-21 years old) along with information from 1465 schools provided by the Chilean Ministry of Education. Multilevel univariable and multivariable logistic regression models were performed. We found a significant intra-class correlation within schools for all substances in the study. Common (e.g., availability of pocket money, more time spent with friends, poor parental monitoring, poor school bonding, bullying others, and lower risk perception of substance use) and unique predictors (e.g., school achievement on national tests) were identified. These findings may help in planning and conducting preventive interventions to reduce substance use.

Harmful drinking after job loss: a stronger association during the post-2008 economic crisis?

OBJECTIVES

This study investigated, among the Dutch working population, whether job loss during the post-2008 economic crisis is associated with harmful drinking and whether this association is stronger than before the crisis.

METHODS

Repeated cross-sectional data from the Dutch Health Interview Survey 2004-2013 were used to define episodic drinking (≥6 glasses on 1 day ≥1/week) and chronic drinking (≥14 glasses/week for women and ≥21 for men). These data were linked to longitudinal data from tax registries, to measure the experience and duration of job loss during a 5-year working history.

RESULTS

Before the crisis, job loss experience and duration were not associated with harmful drinking. During the crisis, job loss for more than 6 months was associated with episodic drinking [OR 1.40 (95% CI 1.01; 1.94)], while current job loss was associated with chronic drinking [OR 1.43 (95% CI 1.03; 1.98)]. These associations were most clear in men and different between the pre-crisis and crisis period (p interaction = 0.023 and 0.035, respectively).

CONCLUSIONS

The results suggest that economic crises strengthen the potential impact of job loss on harmful drinking, predominately among men.

Nutrition and dementia care: developing an evidence-based model for nutritional care in nursing homes

Background

There is a growing volume of research to offer improvements in nutritional care for people with dementia living in nursing homes. Whilst a number of interventions have been identified to support food and drink intake, there has been no systematic research to understand the factors for improving nutritional care from the perspectives of all those delivering care in nursing homes. The aim of this study was to develop a research informed model for understanding the complex nutritional problems associated with eating and drinking for people with dementia.

Methods

We conducted nine focus groups and five semi-structured interviews with those involved or who have a level of responsibility for providing food and drink and nutritional care in nursing homes (nurses, care workers, catering assistants, dietitians, speech and language therapists) and family carers. The resulting conceptual model was developed by eliciting care-related processes, thus supporting credibility from the perspective of the end-users.

Results

The seven identified domain areas were person-centred nutritional care (the overarching theme); availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care and provision of information.

Conclusions

This collaboratively developed, person-centred model can support the design of new education and training tools and be readily translated into existing programmes. Further research is needed to evaluate whether these evidence-informed approaches have been implemented successfully and adopted into practice and policy contexts and can demonstrate effectiveness for people living with dementia.

Deletion of Rictor in catecholaminergic neurons alters locomotor activity and ingestive behavior

While the etiology of depression is not fully understood, increasing evidence from animal models suggests a role for the ventral tegmental area (VTA) in pathogenesis. In this paper, we investigate the potential role of VTA mechanistic target of rapamycin 2 (TORC2) signaling in mediating susceptibility to chronic social defeat stress (CSDS), a well-established mouse model of depression. Utilizing genetic and viral knockout of Rictor (rapamycin-insensitive companion of target of rapamycin), a requisite component of TORC2, we demonstrate that decreasing Rictor-dependent TORC2 signaling in catecholaminergic neurons, or within the VTA specifically, does not alter susceptibility to CSDS. Opiate abuse and mood disorders are often comorbid, and previous data demonstrate a role for VTA TORC2 in mediating opiate reward. Thus, we also investigated its potential role in mediating changes in opiate reward following CSDS. Catecholaminergic deletion of Rictor increases water, sucrose, and morphine intake but not preference in a two-bottle choice assay in stress-naïve mice, and these effects are maintained after stress. VTA-specific knockout of Rictor increases water and sucrose intake after physical CSDS, but does not alter consummatory behavior in the absence of stress. These findings suggest a novel role for TORC2 in mediating stress-induced changes in consummatory behaviors that may contribute to some aspects of mood disorders.

Sex differences in the behavioral sequelae of chronic ethanol exposure

Rates of alcohol use disorders (AUDs) differ between men and women, and there is also marked variation between sexes in the effects of acute and chronic alcohol. In parallel to observations in humans, prior studies in rodents have described male/female differences across a range of ethanol-related behaviors, including ethanol drinking. Nonetheless, there remain gaps in our knowledge of the role of sex in moderating the effects of ethanol, particularly in models of chronic ethanol exposure. The goal of the current study was to assess various behavioral sequelae of exposing female C57BL/6J mice to chronic intermittent ethanol (CIE) via ethanol vapors. Following four weeks of CIE exposure, adult male and female mice were compared for ethanol drinking in a two-bottle paradigm, for sensitivity to acute ethanol intoxication (via loss of righting reflex [LORR]) and for anxiety-like behaviors in the novelty-suppressed feeding and marble burying assays. Next, adult and adolescent females were tested on two different two-bottle drinking preparations (fixed or escalating ethanol concentration) after CIE. Results showed that males and females exhibited significantly blunted ethanol-induced LORR following CIE, whereas only males showed increased anxiety-like behavior after CIE. Increased ethanol drinking after CIE was also specific to males, but high baseline drinking in females may have occluded detection of a CIE-induced effect. The failure to observe elevated drinking in females in response to CIE was also seen in females exposed to CIE during adolescence, regardless of whether a fixed or escalating ethanol-concentration two-bottle procedure was employed. Collectively, these data add to the literature on sex differences in ethanol-related behaviors and provide a foundation for future studies examining how the neural consequences of CIE might differ between males and females.

Genetic correlation between alcohol preference and conditioned fear: Exploring a functional relationship

Post-traumatic stress disorder (PTSD) and alcohol-use disorders have a high rate of co-occurrence, possibly because they are regulated by common genes. In support of this idea, mice selectively bred for high (HAP) alcohol preference show greater fear potentiated startle (FPS), a model for fear-related disorders such as PTSD, compared to mice selectively bred for low (LAP) alcohol preference. This positive genetic correlation between alcohol preference and FPS behavior suggests that the two traits may be functionally related. This study examined the effects of fear conditioning on alcohol consumption and the effects of alcohol consumption on the expression of FPS in male and female HAP2 and LAP2 mice. In experiment 1, alcohol consumption (g/kg) under continuous-access conditions was monitored daily for 4 weeks following a single fear-conditioning or control treatment (foot shock and no shock). FPS was assessed three times (once at the end of the 4-week alcohol access period, once at 24 h after removal of alcohol, and once at 6-8 days after removal of alcohol), followed by two more weeks of alcohol access. Results showed no change in alcohol consumption, but alcohol-consuming, fear-conditioned, HAP2 males showed increased FPS at 24 h during the alcohol abstinence period compared to control groups. In experiment 2, alcohol consumption under limited-access conditions was monitored daily for 4 weeks. Fear-conditioning or control treatments occurred four times during the first 12 days and FPS testing occurred four times during the second 12 days of the 4-week alcohol consumption period. Results showed that fear conditioning increased alcohol intake in both HAP2 and LAP2 mice immediately following the first conditioning session. Fear-conditioned HAP2 but not LAP2 mice showed greater alcohol intake compared to control groups on drinking days that occurred between fear conditioning and FPS test sessions. FPS did not change as a function of alcohol consumption in either line. These results in mice help shed light on how a genetic propensity toward high alcohol consumption may be related to the risk for developing PTSD and co-morbid alcohol-use disorders in humans.

Clinical assessments and care interventions to promote oral hydration amongst older patients: a narrative systematic review

BACKGROUND

Older patients in hospital may be unable to maintain hydration by drinking, leading to intravenous fluid replacement, complications and a longer length of stay. We undertook a systematic review to describe clinical assessment tools which identify patients at risk of insufficient oral fluid intake and the impact of simple interventions to promote drinking, in hospital and care home settings.

METHOD

MEDLINE, CINAHL, and EMBASE databases and two internet search engines (Google and Google Scholar) were examined. Articles were included when the main focus was use of a hydration/dehydration risk assessment in an adult population with/without a care intervention to promote oral hydration in hospitals or care homes. Reviews which used findings to develop new assessments were also included. Single case reports, laboratory results only, single technology assessments or non-oral fluid replacement in patients who were already dehydrated were excluded. Interventions where nutritional intake was the primary focus with a hydration component were also excluded. Identified articles were screened for relevance and quality before a narrative synthesis. No statistical analysis was planned.

RESULTS

From 3973 citations, 23 articles were included. Rather than prevention of poor oral intake, most focused upon identification of patients already in negative fluid balance using information from the history, patient inspection and urinalysis. Nine formal hydration assessments were identified, five of which had an accompanying intervention/ care protocol, and there were no RCT or large observational studies. Interventions to provide extra opportunities to drink such as prompts, preference elicitation and routine beverage carts appeared to support hydration maintenance, further research is required. Despite a lack of knowledge of fluid requirements and dehydration risk factors amongst staff, there was no strong evidence that increasing awareness alone would be beneficial for patients.

CONCLUSION

Despite descriptions of features associated with dehydration, there is insufficient evidence to recommend a specific clinical assessment which could identify older persons at risk of poor oral fluid intake; however there is evidence to support simple care interventions which promote drinking particularly for individuals with cognitive impairment.

TRIAL REGISTRATION

PROSPERO 2014:CRD42014015178.

Urgency traits moderate daily relations between affect and drinking to intoxication among young adults

BACKGROUND

Young adults with higher trait urgency (i.e., a tendency to act rashly in response to heightened affect) may be especially vulnerable to heavy drinking. The current study examined 1) the influence of urgency on daily relations between affect and drinking to intoxication, and 2) whether urgency influenced the effectiveness of naltrexone (vs. placebo) for reducing alcohol use.

METHODS

This study is a secondary analysis of data from 126 (n=40 female) heavy drinking young adults, ages 18-25, enrolled in a double-blind, 8-week clinical trial comparing brief motivational intervention and either naltrexone or placebo. Multilevel models examined whether trait urgency moderated daily relations between positive and negative affect and drinking to intoxication, measured by an estimated blood-alcohol concentration (eBAC) at or above the legal limit (≥0.08g%). Person-level interactions examined whether naltrexone was more effective than placebo at reducing the odds of eBAC≥0.08g% for individuals with higher vs. lower trait urgency.

RESULTS

On days of greater within-person positive or negative affect, young adults with higher urgency were more likely to drink to intoxication than those with lower urgency. Naltrexone reduced the odds of drinking to intoxication significantly more than placebo, independent of positive or negative urgency.

CONCLUSIONS

Although naltrexone treatment reduced drinking overall, young adults with higher trait urgency were still at increased risk for hazardous drinking following times of strong positive or negative mood. Targeted interventions are needed to reduce the risk of heavy drinking among young adults with high trait urgency.

Association between breath alcohol concentration and waterpipe lounge patrons' carbon monoxide exposure: A field investigation

BACKGROUND AND AIMS

Concurrent alcohol use and waterpipe (WP) smoking is common among young adults. WP smokers are more than twice as likely to use alcohol as non-users and frequently consume alcohol immediately before and during a WP smoking session. It is unclear what impact alcohol has on WP smoking patterns and resultant exposure to tobacco-related toxicants. The current research aimed to understand the association between alcohol consumption and WP smoke exposure among WP lounge patrons.

METHODS

Seventy-one lounge patrons (66.2% male; M_age=27.03, SD=5.32) completed pre- and post-WP session self-report measures and biomarkers of smoking (expired carbon monoxide; eCO) and alcohol consumption (breath alcohol concentration; BrAC) upon entering and exiting the WP lounge.

RESULTS

After controlling for number of bowls and charcoals smoked, greater consumption of alcohol was associated with greater smoke exposure among WP lounge patrons (p<0.05), such that a 0.1 unit increase in BrAC was associated with an eCO increase of 19.44ppm. This relationship was mediated by time spent in the WP lounge.

CONCLUSIONS

Concurrent alcohol use resulted in greater eCO, likley due to participants spending a greater amount of time in the WP lounge and experiencing longer sustained exposure to secondhand smoke. These findings illustrate a need for further research on the impact of alcohol consumption on WP smoking to assess the potential need for regulation of these products in WP lounges.

Baseline health status and quality of life after alcohol treatment for women with alcohol dependence

BACKGROUND

Research suggests that women with alcohol use disorders (AUDs) experience more severe medical and social consequences from alcohol use compared to men, but little is known about health improvements following alcohol treatment.

METHODS

This study sought to characterize the pre-treatment health status of 138 alcohol dependent women enrolled in 12 sessions of female-specific group or individual outpatient treatment and examine the degree to which alcohol treatment might promote positive quality of life changes. Quality of life was assessed using the World Health Organization Quality of Life measure at baseline and 3months later at the end of treatment.

RESULTS

The most common health problems at baseline were: smoking cigarettes (34.1%), hypertension (31.2%), obesity (27.5%), arthritis (21.0%), high cholesterol (17.4%), heart problems (8.7%), and a history of cancer (7.2%). Significant improvements across physical, t(117)=4.67, p<0.001, d=0.42; psychological, t(117)=7.31, p<0.001, d=0.62; social, t(117)=3.18, p=0.002, d=0.28; and environmental, t(117)=2.39, p=0.018, d=0.17; quality of life domains were seen after treatment. Percent days abstinent during treatment was positively associated with overall health satisfaction and psychological health at the end of treatment.

CONCLUSIONS

Women presenting for outpatient treatment for alcohol use disorders report many comorbid negative health problems. Thus, it is important for both substance use and health care providers to consider the overlap of alcohol use problems and health domains. Furthermore, female-specific cognitive behavioral treatment for alcohol use disorders positively impacted multiple health domains for women, suggesting a potential transdiagnostic intervention to target co-occurring health and substance use problems.

Sigma Receptors and Alcohol Use Disorders

Although extensive research has focused on understanding the neurobiological mechanisms underlying alcohol addiction, pharmacological treatments for alcohol use disorders are very limited and not always effective. This constraint has encouraged the search for novel pharmacological targets for alcoholism therapy. Sigma receptors were shown to mediate some of the properties of cocaine and amphetamine, which was attributed to the direct binding of psychostimulants to these receptors. More recently, the role of sigma receptors in the rewarding and reinforcing effects of alcohol was also proposed, and it was suggested that their hyperactivity may result in excessive alcohol drinking. This chapter reviews current knowledge on the topic, and suggests that the sigma receptor system may represent a new therapeutic target for the treatment of alcohol use disorders.

Employment Status, Depression, Drinking, and Alcohol Use Disorder in Puerto Rico

BACKGROUND

Our aim was to examine the association between employment status, depression, drinking, binge drinking, and DSM-5 alcohol use disorder in Puerto Rico.

METHODS

Data are from a 2013 to 2014 household random sample of individuals 18 to 64 years of age in San Juan, Puerto Rico.

RESULTS

Bivariate analyses showed that depression was 5 times higher among unemployed males than among those employed full time (21% vs. 4%) and 2 times higher among unemployed females compared to those employed part time or full time (18% vs. 7% and 9%). Employment status was not associated with weekly volume of drinking, but nonparticipation in the workforce was protective against drinking (odds ratio [OR] = 2.17; 95% confidence interval [CI]: 1.03 to 4.57; p < 0.05) and binge drinking (OR = 0.62; 95% CI = 0.39 to 0.97; p < 0.05). This association could be due to the fact that those not in the work force may not be working due to sickness or disability. Male gender was a factor of risk for being a current drinker (OR = 2; 95% CI = 1.53 to 2.6; p < 0.001) and binge drinking (OR = 1.69; 95% CI = 1.29 to 2.2; p < 0.001). Male gender was protective against depression (OR = 0.32; 95% CI = 0.14 to 0.73; p < 0.01), but males employed only part time were almost 5 times more likely than females employed full time to be depressed (OR = 4.66; 95% CI = 1.25 to 17.38; p < 0.05).

CONCLUSIONS

Employment status in Puerto Rico is associated with depression and with current drinking, but not with other alcohol-related outcomes. Perhaps Puerto Rico is a "wet" environment, where drinking is already at a relatively high level that is not affected by employment status. Perhaps the chronic high rate of unemployment in the island has also created familial (e.g., support) and personal level accommodations (e.g., participation in the informal economy) that do not include increased drinking.

Drinking, Alcohol Use Disorder, and Treatment Access and Utilization Among U.S. Racial/Ethnic Groups

Data from approximately 140 articles and reports published since 2000 on drinking, alcohol use disorder (AUD), correlates of drinking and AUD, and treatment needs, access, and utilization were critically examined and summarized. Epidemiological evidence demonstrates alcohol-related disparities across U.S. racial/ethnic groups. American Indians/Alaska Natives generally drink more and are disproportionately affected by alcohol problems, having some of the highest rates for AUD. In contrast, Asian Americans are less affected. Differences across Whites, Blacks, and Hispanics are more nuanced. The diversity in drinking and problem rates that is observed across groups also exists within groups, particularly among Hispanics, Asian Americans, and American Indians/Alaska Natives. Research findings also suggest that acculturation to the United States and nativity affect drinking. Recent studies on ethnic drinking cultures uncover the possible influence that native countries' cultural norms around consumption still have on immigrants' alcohol use. The reasons for racial/ethnic disparities in drinking and AUD are complex and are associated with historically rooted patterns of racial discrimination and persistent socioeconomic disadvantage. This disadvantage is present at both individual and environmental levels. Finally, these data indicate that admission to alcohol treatment is also complex and is dependent on the presence and severity of alcohol problems but also on a variety of other factors. These include individuals' sociodemographic characteristics, the availability of appropriate services, factors that may trigger coercion into treatment by family, friends, employers, and the legal system, and the overall organization of the treatment system. More research is needed to understand facilitators and barriers to treatment to improve access to services and support. Additional directions for future research are discussed.