Adult outcomes of binge drinking in adolescence: findings from a UK national birth cohort

We Need to Delay the Age of Onset of Alcohol Consumption

In recent years, new consumption patterns, such as binge drinking, have increased among young people and have not always been recognized as problematic either by health personnel or by society in general, as they are intensive episodes, interspersed with no consumption periods. Although the prevalence of alcohol use disorders in the adult population continues to be higher in men than in women, these gender differences in relation to alcohol consumption are barely observed in adolescents between 14 and 18. Therefore, we are witnessing a change in the pattern of consumption, from regular to episodic, and an attenuation of gender differences. New patterns of alcohol consumption have not only been associated with an increased risk of alcohol use disorders in adult life, but also with neurocognitive involvement in youth. Understanding the risk and resilience factors of alcoholism or problematic drinking patterns will not only allow us to identify the most vulnerable group, but also to guide prevention programs towards protective factors; the skills that contribute to the natural abandonment of the pattern. Knowing the variables involved in the trajectories of abandonment and dependency would contribute to personalizing the interventions and increasing their efficacy and success—a lower relapse rate—, reducing the economic and socio-sanitary costs associated with alcohol dependency, as well as improving the health and well-being, family relations, work and social status of alcohol-dependent people.

Self-medication Hypothesis and Family Socialization Theory: Examining Independent and Common Mechanisms Responsible for Binge Drinking

For many, binge drinking behaviors start early and become a persistent pattern of use throughout the lifespan. In an effort to strengthen understanding of etiology, this study considered the mechanisms from the self-medication hypothesis and family socialization theory. The goal was to identify whether emotional distress is a potential shared mechanism that accounts for the development of binge drinking in different developmental periods. This study used the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset to examine binge drinking across time for n = 9,421 participants ranging in age from 11 to 18 (M = 15.39, SD = 1.62) at Wave I and ranging from 24 to 32 (M = 28.09, SD = 1.61) at Wave IV of the study. Using an autoregressive cross-lagged model, I examined how parent-child closeness, depressive symptoms, and binge drinking were related over three developmental periods. In examining cross-sectional and longitudinal relations, depressive symptoms were significantly related to binge drinking more often than parent-child closeness; however, results indicated the self-medication model may primarily account for concurrent drinking behaviors rather than long-term. The family socialization theory was indicated to account for some variability above and beyond the self-medication hypothesis. No indirect association between binge drinking and the parent-child relationship was detected through depressive symptoms, failing to support a shared mechanism between the two theories. The results provide support for a multifaceted assessment process for substance using clients, and support the use of Multisystemic Family Therapy, Multidimensional Family Therapy, and perhaps Attachment-Based Family Therapy.

Neuroimmune and epigenetic involvement in adolescent binge ethanol-induced loss of basal forebrain cholinergic neurons: Restoration with voluntary exercise

Binge drinking and alcohol abuse are common during adolescence and cause lasting pathology. Preclinical rodent studies using the adolescent intermittent ethanol (AIE; 5.0 g/kg, i.g., 2‐day on/2‐day off from postnatal day [P]25 to P55) model of human adolescent binge drinking report decreased basal forebrain cholinergic (ie, ChAT+) neurons that persist into adulthood (ie, P56‐P220). Recent studies link AIE‐induced neuroimmune activation to cholinergic pathology, but the underlying molecular mechanisms contributing to the persistent loss of basal forebrain ChAT+ neurons are unknown. We report here that the AIE‐induced loss of cholinergic neuron markers (ie, ChAT, TrkA, and p75^NTR), cholinergic neuron shrinkage, and increased expression of the neuroimmune marker pNF‐κB p65 are restored by exercise exposure from P56 to P95 after AIE. Our data reveal that persistently reduced expression of cholinergic neuron markers following AIE is because of the loss of the cholinergic neuron phenotype most likely through an epigenetic mechanism involving DNA methylation and histone 3 lysine 9 dimethylation (H3K9me2). Adolescent intermittent ethanol caused a persistent increase in adult H3K9me2 and DNA methylation at promoter regions of Chat and H3K9me2 of Trka, which was restored by wheel running. Exercise also restored the AIE‐induced reversal learning deficits on the Morris water maze. Together, these data suggest that AIE‐induced adult neuroimmune signaling and cognitive deficits are linked to suppression of Chat and Trka gene expression through epigenetic mechanisms that can be restored by exercise. Exercise restoration of the persistent AIE‐induced phenotypic loss of cholinergic neurons via epigenetic modifications is novel mechanism of neuroplasticity.

Binge drinking and frequent or heavy drinking among adolescents: prevalence and associated factors

OBJECTIVE

To analyze the sociodemographic, school, and family factors associated with the patterns of binge drinking and frequent or heavy drinking among adolescents.

METHODS

This was a cross-sectional study, nested in a randomized controlled trial, of 6285 seventh and eighth grade adolescent students from Brazilian public schools. The associations between binge drinking (consumption of five or more doses of alcohol on a single occasion) in the last 12 months and frequent or heavy drinking (alcohol consumption on six or more days) in the last month and the several factors were analyzed through weighted logistic regression.

RESULTS

16.5% of the students reported binge drinking in the year before the interview and 2.2% reported frequent/heavy drinking in the previous month. The factors associated with binge drinking were cigarette smoking (OR=6.7, 95% CI=3.96; 11.23), use of marijuana (OR=2.2, 95% CI=1.17; 4.31), use of inhalant drugs (OR=3.0, 95% CI=1.98; 4.43), exposure to a drunk relative (OR=2.1, 95% C=1.67; 2.53), practice of bullying (OR=1.8, 95% CI=1.47; 2.17), verbal aggression (OR=1.7, 95%CI=1.40; 2.14), and intermediate/low school grades (OR=1.7, 95% CI=1.35; 2.20). The factors associated with frequent/heavy drinking were cigarette smoking (OR=2.5, 95% CI=1.16; 5.22), use of marijuana (OR=3.2, 95% CI=1.32; 7.72), and physical aggression (OR=2.2, 95% CI=1.36; 3.50).

CONCLUSIONS

The analyzed outcomes showed an association between the risk consumption of alcohol in early adolescence and low academic performance, involvement with other drugs, aggressiveness, and witnessing episodes of a family member's drunkenness. Considering the impact on public health of the damages caused by alcohol consumption during adolescence, these factors that showed such association should be considered in the development of preventive interventions.

The health behaviour status of teenage and young adult cancer patients and survivors in the United Kingdom

PURPOSE

The primary aim of this study was to investigate the health behaviour status of teenage and young adult (TYA) cancer patients and survivors; the secondary aim was to determine if TYA cancer patients and survivors health behaviour differs to general population controls.

METHODS

Two hundred sixty-seven young people with cancer (n =83 cancer patients receiving active treatment: n =174 cancer survivors, 57.1% >1 year since treatment completion) and 321 controls completed a health and lifestyle questionnaire which included validated measures of physical activity (PA) (Godin Leisure Time Exercise Questionnaire), diet (Dietary Instrument for Nutrition Education, DINE), smoking status, and alcohol consumption (AUDIT-C).

RESULTS

General population controls and cancer survivors were more likely to meet current (PA) recommendations (p <0.001) than TYA cancer patients undergoing treatment (54.8% vs 52.3% vs 30.1%, respectively). Less than 40% of young people with cancer and controls met fat intake, sugar intake, fibre intake or current fruit and vegetable recommendations. TYA cancer survivors were more likely to report binge drinking than controls (OR=3.26, 95% CI 2.12-5.02, p <0.001). Very few young people with in the study were current smokers. The majority of TYA cancer patients and survivors reported a desire to make positive changes to their health behaviour.

CONCLUSION

Consideration should be given to whether existing health behaviour change interventions which have demonstrated positive effects among the general TYA population could be adapted for young people with cancer.

The relation between ADHD symptoms, perceived stress and binge drinking in college students

Binge drinking is a major public health problem associated with various negative short-term and long-term clinical and social outcomes. If there is evidence to suggest a relationship between ADHD and alcohol use in college students, no study has investigated the role of ADHD symptomatology in binge drinking. Thus, this research was designed to explore the relative contributions of inattention and hyperactivity/impulsivity symptoms to binge drinking in a sample of French college students while controlling for effects of perceived stress. Participants (N = 7011; mean age = 20.9; 74.9% of females) completed self-report surveys assessing ADHD symptoms, perceived stress, sociodemographic characteristics, and binge drinking frequency. Multinomial logistic regression revealed significant associations between higher levels of ADHD symptoms in general, but not perceived stress, and increasing frequency of binge drinking. Moreover, higher levels of inattention and hyperactivity/impulsivity symptoms were independently associated with greater frequency of binge drinking. The association was stronger between high rates of binge drinking and inattention than for hyperactivity/impulsivity. These findings, which remained statistically significant after adjusting for a range of potential confounders (including perceived stress), suggest that the presence of ADHD symptoms may be an important factor related to binge drinking.

Prospective Associations between BOLD Markers of Response Inhibition and the Transition to Frequent Binge Drinking

BACKGROUND

Altered brain activation during response inhibition has been linked to a greater risk for alcohol and other substance use behaviors in late adolescence. However, the ability of neural markers of response inhibition, acquired during adolescence, to temporally predict the transition from less frequent and lower quantity alcohol use to high-risk, frequent (≥ weekly) binge drinking behavior remains unclear.

METHODS

Adolescents (N = 29; 9 females) were selected from a larger ongoing longitudinal study to include those who transitioned to at least weekly binge drinking (≥5/4 alcoholic drinks for males/females per occasion) over a 15-year follow-up period. Prior to the onset of weekly binge drinking (mean age = 18.0), participants underwent a functional MRI including a go/no-go task. Whole-brain activation from the no-go correct rejection versus no-go false alarm contrast was used to predict time to transition to frequent binge drinking.

RESULTS

Less no-go correct rejection versus no-go false alarm activation in a cluster including the precentral gyri, insula, and inferior frontal gyri predicted a more rapid transition into frequent binge drinking (voxel-wise alpha < 0.001, cluster-wise alpha < 0.05, cluster threshold ≥ 18 voxels).

CONCLUSIONS

Results from this study are supported by literature suggesting that frontoinsular involvement is important for successful inhibition and cognitive control. Altered brain activation during response inhibition may thus represent neural antecedents of impulse regulation difficulties related to alcohol consumption. The magnitude of this activation provides temporal information that may be used to inform and optimize timing of interventions aimed at preventing the escalation and transition to problematic drinking for youth who have already begun to engage in drinking behaviors.

Early Signs of Emotional Recognition Deficits in Adolescent High-Binge Drinkers

Background: Emotional dysregulation, measured with face recognition tasks, is prevalent in alcohol use disorders (AUD), constituting a risk factor for alcohol use and relapse. It is not clear however whether emotional dysregulation is a by-product of alcohol consumption, or if it can act as a predisposing factor for AUD. Objective: Our aim was to examine early signs of emotional dysregulation in adolescent drinkers. Method: Twenty-four high-school students and 24 university students completed two tasks. On the first one, participants had to gradually increment the emotional content of different faces until they could perceive an emotional expression (emotion perception threshold task). We also examined the propensity to perceive fearful expressions in an emotion identification task. Participants were semantically primed with emotion words (i.e., "fear"), and they then had to indicate whether a neutral-fearful facial composite matched the prime. Results: Using repeated-measures ANOVAS, in the emotion perception threshold task, "happy" faces were the easiest to detect and "sad" ones the hardest. For high school students there was a differential response pattern depending on binge scores, such that High-binge drinkers found it easier to detect a sad face but harder to detect a happy one compared to Low-binge drinkers. In the facial emotion identification task, Low-binge drinkers observed more fearful expressions compared to High-binge drinkers. Conclusions: Differences in emotional processing in young adolescents depending on drinking habits point towards the relevance of emotional dysregulation as an early sign of AUD. These findings could help develop novel diagnostic and treatment tools for young populations.

Observing Change Over Time in Strength-Based Parenting and Subjective Wellbeing for Pre-teens and Teens

The focus of this study was on adolescent mental health. More specifically, the relationship between strength-based parenting (SBP) and subjective wellbeing (SWB) during adolescence was examined at three time points over 14 months (N = 202, M age = 12.97, SD age = 0.91, 48% female). SBP was positively related to life satisfaction and positive affect at each of the three time points, and was negatively related to negative affect. SBP and SWB both declined significantly over time. When examining the causal relationships between SBP and SWB, two different statistical models were applied: latent growth-curve models (LGM) and random-intercept cross-lagged panel models (RI-CLPM). The LGM revealed a strong positive relationship between changes in SBP and SWB. Specifically, this model showed that SBP at one time point predicted adolescent SWB at future time points. However, when the more stringent statistical test was completed through RI-CLPMs, no cross-lagged paths reached significance. Thus, while parenting is a significant predictor of wellbeing for pre-teens and teens in real time, it is not predictive of wellbeing at future time points. Parents, thus, cannot assume that their current levels of SBP are 'banked' by their children to support future wellbeing. Instead, SBP needs to be an ongoing, contemporary parenting practice. Furthermore, the fact that perceptions of SBP decline in this age bracket suggest that SBP interventions may be helpful in supporting adolescent mental health.

Associations Between Alcohol Policies and Adolescent Alcohol Use: A Pooled Analysis of GSHS and ESPAD Data

Aims

Alcohol-attributable harm remains high worldwide, and alcohol use among adolescents is particularly concerning. The purpose of this study is to determine the effect of national alcohol control policies on adolescent alcohol use in low-, middle- and high-income countries and improve on previous cross-national attempts to estimate the impact of alcohol policy on this population.

Methods

Data on adolescent (n = 277,110) alcohol consumption from 84 countries were pooled from the Global School-based Health Survey and the European School Survey Project on Alcohol and Other Drugs. Alcohol use measures included lifetime alcohol use, current (past 30 days) alcohol use and current (past 30 days) binge drinking. Information on national alcohol control policies was obtained from the World Health Organization’s Global Information System on Alcohol and Health and scored for effectiveness. Main effects were estimated using two-level, random intercept hierarchical linear models, and the models were adjusted for sex and age of the participants, and pattern of drinking score, gross domestic product based on purchasing power parity and study at the country level.

Results

Availability (OR [95% CI] = 0.991 [0.983, 0.999]), marketing (OR [95% CI] = 0.994 [0.988, 1.000]) and pricing (OR [95% CI] = 0.955 [0.918, 0.993]) policies were inversely associated with lifetime drinking status. Pricing policies were also inversely associated with current binge drinking status among current drinkers (OR [95% CI] = 0.939 [0.894, 0.986]). There were no associations between the included alcohol policies and current drinking status.

Conclusions

Strong availability, marketing and pricing policies can significantly and practically impact adolescent alcohol consumption.

Interventions integrating health and academic education in schools to prevent substance misuse and violence: a systematic review

Background

Schools struggle to timetable health education. Interventions integrating academic and health education to reduce substance use and violence offer promise. No current systematic reviews examine such interventions.

Objectives

To review evidence to explore the following questions: (1) what types of interventions integrating health and academic education in schools serving those aged 4–18 years have been evaluated? (2) What theories of change inform these interventions? (3) What factors facilitate or limit the successful implementation and receipt of such interventions, and what are the implications for the delivery of such implementations in the UK? (4) How effective are such interventions in reducing smoking and violence and the use of alcohol and drugs, and at increasing attainment? Does this vary by students’ sociodemographic characteristics? (5) What factors appear to influence the effectiveness of such interventions?

Data sources

In total, 19 databases were searched from 18 November to 22 December 2015, updating searches for outcome evaluations for violence on 28 February 2018 and for substance use on 14 May 2018. References were extracted from included studies and authors contacted.

Review methods

Included studies reported on theories of change, and process or outcome evaluations of interventions that integrated academic and health education to reduce substance use and/or violence. References were screened on the title/abstract and then on the full report. Data extraction and appraisal used Cochrane, Evidence for Policy and Practice Information Centre and other established tools. Theories of change and process data were qualitatively synthesised. Outcome evaluations were synthesised narratively and meta-analytically.

Results

In total, 78,451 unique references were originally identified and 62 reports included. Search updates on 28 February and 14 May 2018 retrieved a further 2355 and 1945 references, respectively, resulting in the inclusion of six additional reports. Thirty-nine reports described theories, 16 reports (15 studies) evaluated process and 41 reports (16 studies) evaluated outcomes. Multicomponent interventions are theorised to erode ‘boundaries’ (strengthen relationships) between academic and health education, teachers and students, behaviour in classrooms and in the wider school, and schools and families. Teachers, pro-social peers and parents are theorised to act as role models and reinforcers of healthy behaviours learnt in lessons. There was clear evidence that interventions are facilitated by supportive senior management and alignment with the schools’ ethos, collaborative and supportive teaching environments, and positive pre-existing student, teacher and parent attitudes towards interventions. The barriers were overburdened teachers who had little time to both learn and implement integrated curricula. The strongest evidence for effectiveness was found for the reduction of substance use in school key stages (KSs) 2 and 3. For example, a meta-analysis for substance use at KS3 reported a mean difference of –0.09 (95% confidence interval –0.17 to –0.01). A meta-analysis for effectiveness in reducing violence victimisation in KS2 found no effect. There was mixed evidence for effects on academic outcomes, with meta-analysis precluded by methodological heterogeneity.

Limitations

Study quality was variable. Integration was sometimes not emphasised in theories of change.

Conclusions

These interventions are undertheorised but involve multiple forms of boundary erosion. There is clear evidence of characteristics affecting implementation. Interventions are likely to have the greatest impact on substance use. These programmes may be effective in reducing substance use but do not appear to reduce violence and findings on educational impacts are mixed.

Future work

Future evaluations should assess interventions with clearer theories of change and examine academic outcomes alongside violence and substance use outcomes.

Study registration

This study is registered as PROSPERO CRD42015026464.

Funding

The National Institute for Health Research Public Health Research programme.

ELSA cohort 2014: association of age of first drink and progression from first drink to drunkenness on alcohol outcomes in Argentinean college freshmen

Background: College freshman are at-risk for hazardous alcohol drinking and for experiencing alcohol-related negative consequences. This is exacerbated in those featuring an early age of first alcohol use or of first drunkenness. It remains unclear which of these milestones is more strongly associated with alcohol outcomes. Objective: We examined, in Argentinean college drinkers (n = 4088; 43% men; racially and ethnically homogeneous), the association of age at drinking onset and progression to drunkenness (drunkenness naïve [Drunk-Naïve]; No-Delay [same age of first alcohol use and first alcohol intoxication]; one year of delay between age of first alcohol use and first alcohol intoxication; ≥2years of delay) on several alcohol outcomes. Methods: A survey measured substance use, age at drinking and drunkenness onset and alcohol-related consequences. Results: Alcohol consumption per drinking occasion was significantly greater in men than in women. An early drinking onset (alcohol use before age 13) and lifetime drunkenness independently exacerbated alcohol consumption per drinking occasion and during the last year. In men, Early-Onset was associated with a greater number of alcohol-related consequences when the delay between Early-Onset and the first drunkenness episode was 1 or ≥2 years yet did not significantly alter the number of negative consequences in Drunk-naïve or No-delay drinkers. In women, Early-Onset significantly enhanced the number of negative consequences when the delay was two years, but not when the delay was one-year or in Drunk-naïve or No-delay drinkers. Conclusions: The window between the first contact with alcohol and the first episode of drunkenness is a critical period to reduce alcohol-related problems.

Longitudinal Associations of Binge Drinking with Interpersonal Violence Among Adolescents

Binge drinking may be associated with adolescents' experience of multiple types of interpersonal violence perpetration and victimization, and if so, could be a malleable intervention target to prevent interpersonal violence. The current article explores the between- and within-person associations of binge drinking (i.e., 4/5 or more drinks in a row for girls/boys) with interpersonal violence among adolescents (N = 1322, 50.3% girls/women, 88.9% White/non-Hispanic, 85.9% heterosexual, 18.6% free/reduced lunch, aged 13-19) using a longitudinal design (three waves of data collection across more than a year). Overall, adolescents who engaged in binge drinking at more time points were more likely to perpetrate sexual harassment and stalking, and more likely to be victims of stalking and dating violence. At time points when adolescents had engaged in binge drinking in the past month, they were more likely to perpetrate dating violence, less likely to perpetrate stalking, and more likely to be sexual harassment victims. Addressing binge drinking in prevention programs may reduce some forms of interpersonal violence.

Does binge drinking between the age of 18 and 25 years predict alcohol dependence in adulthood? A retrospective case-control study in France

OBJECTIVE

A retrospective case-control study was conducted to evaluate whether frequent binge drinking between the age of 18 and 25 years was a risk factor for alcohol dependence in adulthood.

SETTING

The Department of Addictive Medicine and the Clinical Investigation Center of a university hospital in France.

PARTICIPANTS

Cases were alcohol-dependent patients between 25 and 45 years and diagnosed by a psychiatrist. Consecutive patients referred to the Department of Addictive Medicine of a university hospital between 1 January 2017 and 31 December 2017 for alcohol dependence were included in the study. Controls were non-alcohol-dependent adults, defined according to an Alcohol Use Disorders Identification Test score of less than 8, and were matched on age and sex with cases. Data on sociodemographics, behaviour and alcohol consumption were retrospectively collected for three life periods: before the age of 18 years; between the age of 18 and 25 years; and between the age of 25 and 45 years. Frequency of binge drinking between 18 and 25 years was categorised as frequent if more than twice a month, occasional if once a month and never if no binge drinking.

RESULTS

166 adults between 25 and 45 years were included: 83 were alcohol-dependent and 83 were non-alcohol-dependent. The mean age was 34.6 years (SD: 5.1). Frequent binge drinking between 18 and 25 years occurred in 75.9% of cases and 41.0% of controls (p<0.0001). After multivariate analysis, frequent binge drinking between 18 and 25 years was a risk factor for alcohol dependence between 25 and 45 years: adjusted OR=2.83, 95% CI 1.10 to 7.25.

CONCLUSIONS

Frequent binge drinking between 18 and 25 years appears to be a risk factor for alcohol dependence in adulthood. Prevention measures for binge drinking during preadulthood, especially frequent binge drinking, should be implemented to prevent acute consequences as injury and death and long-term consequences as alcohol dependence.

TRIAL REGISTRATION NUMBER

NCT03204214; Results.

Brief alcohol intervention for risky drinking in young people aged 14–15 years in secondary schools: the SIPS JR-HIGH RCT

Background

Adverse effects from young people’s alcohol consumption manifest in a range of physical and psychosocial factors, including neurological issues, cognitive impairment and risk-taking behaviours. The SIPS JR-HIGH pilot trial showed alcohol screening and brief intervention (ASBI) to be acceptable to young people and schools in the north-east of England.

Objectives

To conduct a two-arm, individually randomised controlled trial to evaluate the effectiveness and cost-effectiveness of ASBI for risky drinking in young people aged 14–15 years in the school setting, to monitor the fidelity of ASBI and to explore the barriers to, and facilitators of, implementation with staff, young people and parents.

Design

A baseline survey with a 12-month follow-up. Interviews with 30 school staff, 21 learning mentors and nine teachers, and 33 young people and two parents.

Setting

Thirty state schools in four areas of England: north-east, north-west, Kent and London.

Participants

Year 10 school pupils who consented to the study (aged 14–15 years, recruited between November 2015 and June 2016), school-based staff and parents of the young people who took part in the study.

Interventions

Young people who screened positively on a single alcohol screening question and consented were randomised to the intervention or control arm (blinded). The intervention was a 30-minute one-to-one structured brief intervention with a trained learning mentor and an alcohol leaflet. The control group received a healthy lifestyle leaflet (no alcohol information).

Main outcome measures

The primary outcome measure was total alcohol consumed in the last 28 days. Secondary outcomes related to risky drinking, general psychological health, sexual risk-taking, energy drink consumption, age of first smoking, quality of life, quality-adjusted life-years, service utilisation and demographic information.

Results

A total of 4523 young people completed the baseline survey, with 1064 screening positively (24%) and 443 being eligible to take part in the trial. Of those 443, 233 (53%) were randomised to the control arm and 210 were randomised to the intervention arm. Of the 443, 374 (84%) were successfully followed up at 12 months (intervention, n = 178; control, n = 196). The results were that the intervention showed no evidence of benefit for any alcohol-related measure when compared with the control arm. At 12 months we found a reduction from 61.9% to 43.3% using the Alcohol Use Disorders Identification Test cut-off point of 8 and cut-off point of 4 (69.0% to 60.7%). These results were not significant. A cost-effectiveness analysis showed that the average net cost saving of the brief intervention was £2865 (95% confidence interval –£11,272 to £2707) per year compared with usual practice, with the intervention showing a 76% probability of being cost saving compared with usual practice. The interview findings showed that school was an acceptable setting to carry out ASBI among staff and young people.

Limitations

Recruitment of parents to take part in interviews was poor. Only 18 ASBI sessions were recorded, making it difficult to assess internal validity.

Conclusions

Although the intervention was ineffective in reducing risky drinking in young people aged 14–15 years, it was well received by the young people and school staff who participated.

Future work

Uniform reporting of the outcomes used for ASBI would generate more robust conclusions on the effectiveness of ASBI in the future. Pilot feasibility studies should include more than one geographical area. Future work on involving parents is needed.

Trial registration

Current Controlled Trials ISRCTN45691494.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 9. See the NIHR Journals Library website for further project information.

Behavioral and Cerebral Impairments Associated with Binge Drinking in Youth: A Critical Review

Binge drinking is a widespread alcohol consumption pattern in youth that is linked to important behavioral and cerebral impairments, in both the short and the long term. From a critical review of the current literature on this topic, we conclude that binge drinkers display executive impairments, cerebral modifications, and problems with emotion-related processes. Five key empirical and theoretical topics are discussed to pave the way for future research in the field: (1) the specificity of the brain modifications observed in binge drinkers that may index a compensatory mechanism or result from multiple withdrawals; (2) the nature of the relationship between binge drinking and impairments, suggesting reciprocal influences between excessive alcohol consumption and executive deficits; (3) the possible recovery of brain and cognitive functioning after the cessation of binge drinking; (4) the validity of the continuum hypothesis, suggesting links between binge drinking and severe alcohol use disorders; and (5) the existing strategies to reduce binge drinking habits or rehabilitate the associated cognitive deficits. Future perspectives are described in relation to the questions raised to identify the crucial variables to be addressed in research and clinical practice.

The lncRNA BDNF-AS is an epigenetic regulator in the human amygdala in early onset alcohol use disorders

Adolescent alcohol drinking is known to contribute to the development and severity of alcohol use disorders (AUDs) later in adulthood. Recent studies have shown that long non-coding RNAs (lncRNAs) are critical for brain development and synaptic plasticity. One such lncRNA is natural occurring brain-derived neurotrophic factor antisense (BDNF-AS) that has been shown to regulate BDNF expression. The role of BDNF-AS lncRNA in the molecular mechanisms of AUD is unknown. Here, we evaluated the expression and functional role of BDNF-AS in postmortem amygdala of either early onset or late onset alcoholics (individuals who began drinking before or after 21 years of age, respectively) and age-matched control subjects. BDNF-AS expression is increased in early onset but not in late onset AUD amygdala and appears to be regulated epitranscriptomically via decreased N6-methyladenosine on BDNF-AS. Upregulation of BDNF-AS is associated with a significant decrease in BDNF expression and increased recruitment of EZH2, which deposits repressive H3K27 trimethylation (H3K27me3) at regulatory regions in the BDNF gene in the early onset AUD group. Drinking during adolescence also contributed to significant decreases in activity-regulated cytoskeleton-associated protein (ARC) expression which also appeared to be mediated by increased EZH2 deposition of repressive H3K27me3 at the ARC synaptic activity response element. These results suggest an important role for BDNF-AS in the regulation of synaptic plasticity via epigenetic reprogramming in the amygdala of AUD subjects who began drinking during adolescence.

Effectiveness of a web-based screening and brief intervention with weekly text-message-initiated individualised prompts for reducing risky alcohol use among teenagers: study protocol of a randomised controlled trial within the ProHEAD consortium

BACKGROUND

Early and excessive alcohol use is a significant threat to healthy development. Evidence supports the effectiveness of electronic alcohol interventions for young drinkers. However, effects are typically small and studies targeting under 18-year-olds are scarce. This trial is the first to evaluate the effectiveness of a single-session, brief, motivational, web-based intervention (ProWISE) plus weekly text-message-initiated individualised prompts (TIPs) in reducing alcohol consumption and alcohol-related harm among children and adolescents aged ≥ 12 years. TIPs are designed to decrease risky alcohol use by reaching youth in the contexts of their everyday lives and by providing individualised feedback on drinking intentions, actual drinking and succession in achieving personal goals for low-risk drinking or abstinence.

METHODS/DESIGN

The trial is part of the multicentre consortium ProHEAD testing e-interventions for mental health problems in children and adolescents. Participants in grades 6-13 aged ≥ 12 years will be recruited in schools which participate in ProHEAD (target N = 15,000). Main criterion for inclusion in the ProWISE-TIP trial is a positive screening for at-risk alcohol use in the CRAFFT-d questionnaire (target n = 1076). In a multicentre, four-arm, randomised controlled design the following groups will be compared: (A) web-based intervention plus TIPs for 12 weeks; (B) web-based intervention plus text-message-initiated assessment of alcohol consumption for 12 weeks; (C) web-based intervention only; and (D) alcohol-related psychoeducation. TIPs will be delivered shortly before and after high-risk situations for excessive alcohol use and will be tailored to age, gender, drinking motives and alcohol consumption. Study participants will be followed up at three, six and nine months in the ProWISE-TIP trial and at one and two years in the ProHEAD consortium. Primary outcome is alcohol use in the past 30 days at nine months after enrolment. Secondary outcomes are alcohol-related problems, co-occurring substance use, health service utilisation, mental health problems and quality of life.

DISCUSSION

Trial results will generate important evidence on how to enhance effectiveness of single-session, web-based alcohol interventions for youth. The ProWISE-TIP intervention, if effective, can be used as a stand-alone alcohol intervention or as an add-on to school-based or community-based alcohol prevention programs.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00014606 Registered on 20 April 2018.

The impact of social assistance programs on population health: a systematic review of research in high-income countries

Background

Socioeconomic disadvantage is a fundamental cause of morbidity and mortality. One of the most important ways that governments buffer the adverse consequences of socioeconomic disadvantage is through the provision of social assistance. We conducted a systematic review of research examining the health impact of social assistance programs in high-income countries.

Methods

We systematically searched Embase, Medline, ProQuest, Scopus, and Web of Science from inception to December 2017 for peer-reviewed studies published in English-language journals. We identified empirical patterns through a qualitative synthesis of the evidence. We also evaluated the empirical rigour of the selected literature.

Results

Seventeen studies met our inclusion criteria. Thirteen descriptive studies rated as weak (n = 7), moderate (n = 4), and strong (n = 2) found that social assistance is associated with adverse health outcomes and that social assistance recipients exhibit worse health outcomes relative to non-recipients. Four experimental and quasi-experimental studies, all rated as strong (n = 4), found that efforts to limit the receipt of social assistance or reduce its generosity (also known as welfare reform) were associated with adverse health trends.

Conclusions

Evidence from the existing literature suggests that social assistance programs in high-income countries are failing to maintain the health of socioeconomically disadvantaged populations. These findings may in part reflect the influence of residual confounding due to unobserved characteristics that distinguish recipients from non-recipients. They may also indicate that the scope and generosity of existing programs are insufficient to offset the negative health consequences of severe socioeconomic disadvantage.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6337-1) contains supplementary material, which is available to authorized users.

Reconsidering the Relationship between Age at Migration and Health Behaviors among US Immigrants: The Modifying Role of Continued Cross-border Ties

Age-at-migration is commonly utilized as a proxy measure for assimilation. We re-consider this approach by examining the role of continued connection with places of origin on alcohol use. Cross-border connections may diminish the association between earlier age-at-migration and alcohol use by providing an alternative channel of influence for behavioral norms. Alternatively, a stress and coping perspective on cross border ties suggests potentially countervailing impacts of these connections on alcohol use. We use data from the 2002/2003 National Latino and Asian American Study (NLAAS) (n=1641/1630 Asian and Latino origin respondents, respectively). We first estimate the association between age-at-migration (child/adolescent versus adult migrant) and any past-year alcohol use. We subsequently test the interaction between age-at-migration and two measures of cross-border contact. All models are stratified by region of origin and gender. For Latin American-origin women, cross-border ties are associated with increased risk for alcohol use among those who migrated early in life. In contrast, Asian-origin men and women who migrated as adults and have contact with family and friends abroad have the lowest predicted probabilities of past-year alcohol use. The results among Asians support the idea that cross-border ties can be alternative influences on health behavior outcomes, particularly for adult migrants. Overall, we find qualified support for both transnational and assimilationist perspectives on alcohol use behaviors among US immigrants -- as well as the interaction between these two frameworks. The joint influences of cross-border ties and age-at-migration were observed primarily for immigrant women, and not always in expected directions. We nevertheless urge future research to consider both US and country-of-origin influences on a wider range of health and health behavior outcomes for immigrants, as well as the potential intersection between US and cross-border connections.

Predicting Alcohol Misuse Among Australian 19-Year-Olds from Adolescent Drinking Trajectories

BACKGROUND

Alcohol use in adolescence predicts future alcohol misuse. However, the extent to which different patterns of adolescent use present risk remains unclear.

OBJECTIVES

This study investigated how adolescent trajectories of alcohol consumption during the school years predict alcohol misuse at age 19 years.

METHODS

Data were drawn from 707 students from Victoria, Australia, longitudinally followed for 7 years. Five alcohol use trajectories were identified based on the frequency of alcohol use from Grade 6 (age 12 years) to Grade 11 (age 17 years). At age 19 years, participants completed measures indicating Heavy Episodic Drinking (HED), dependency - Alcohol Use Disorders Identification Test (AUDIT) and social harms.

RESULTS

At 19 years of age, 64% of participants reported HED, 42% high AUDIT scores (8+), and 23% social harms. Participants belonging to a steep escalator trajectory during adolescence had twice the odds at 19 years of age of high AUDIT scores and social harms, and three times greater odds of HED than participants whose alcohol use slowly increased. Stable moderate consumption was also associated with an increased risk of HED compared to slowly increasing use. Abstinence predicted a reduced likelihood of all forms of misuse at 19 years of age compared to slowly increased alcohol use.

CONCLUSIONS

Trajectories of drinking frequency during adolescence predict alcohol misuse at age 19 years. Although rapid increasing use presents the greatest risk, even slowly increasing drinking predicts increased risk compared to abstinence. The findings indicate that alcohol policies should recommend nonuse and reduced frequency of use during adolescence.

Intermittent voluntary ethanol consumption combined with ethanol vapor exposure during adolescence increases drinking and alters other behaviors in adulthood in female and male rats

Epidemiological studies suggest that binge drinking is prevalent among adolescents, and may result in neurobehavioral consequences. Animal models provide the experimental control to investigate the consequences of "binge" alcohol exposure during this neurodevelopmental epoch. The current study used an animal model that combined an intermittent pattern of alcohol vapor exposure with voluntary drinking of 20% unsweetened alcohol in adolescent male and female Wistar rats (postnatal day [PD] 22-62), in order to test for potential differences in behavioral changes, ethanol drinking, and hypocretin/orexin (Hcrt/OX) signaling associated with exposure status. Two weeks after discontinuation of the alcohol vapor exposure and drinking during adolescence, rats were tested in adulthood for anxiety-like behaviors using a modified open-field conflict task, pre-pulse facilitation of startle response, light/dark box, and marble burying test. Adolescent alcohol exposure led to overall decreased startle response and increased behavioral arousal in the light/dark chamber during adulthood. Additionally, male rats demonstrated more disinhibited behavior during the conflict task compared to females, and female rats exhibited more rearing behavior during the light/dark test. Rats were also given a 2-bottle choice test that resulted in adolescent alcohol-exposed rats drinking significantly more alcohol in adulthood. Further, female rats also consumed more alcohol in adulthood compared to males. Estrous cycle phase did not account for any of the sex differences observed in the behavioral measures. Histological results indicated that adolescent alcohol did not alter Hcrt/OX-1 or Hcrt/OX-2 receptor mRNA expression levels in adult rats compared to control adults. However, female rats expressed a higher level of Hcrt/OX-1 and Hcrt/OX-2 receptor mRNA in the frontal cortex compared to males. These data suggest that our current model of intermittent ethanol exposure in adolescence can modestly affect both behavior and future consumption of alcohol and that Hcrt/OX receptor signaling differs between males and females.

Widening health inequalities between the employed and the unemployed: A decomposition of trends in Canada (2000-2014)

Recent developments in the social epidemiological literature indicate that health inequalities between the employed and the unemployed are widening in many advanced capitalist countries. At present, we know relatively little about why these inequalities are worsening. Drawing on nationally-representative data from the largest health survey in Canada, we explored this question by analyzing changes in self-rated health inequalities between employed and unemployed Canadians from 2000 to 2014. Using a regression-based method that decomposes a given inequality into its component sources, we investigated the extent to which risk factors that account for unemployment-related health inequalities at a single point in time can also explain the extent and direction of change in these unemployment-related health inequalities over time. Our results indicate that relative and absolute health inequalities between employed and unemployed Canadians widened over the study period. Between 2000 and 2014, the prevalence of poor self-rated health among unemployed Canadians increased from 10.8% to 14.6%, while rates among employed Canadians were stable at around 6%. Our findings suggest that the demographic, socioeconomic, and proximal risk factors that are routinely used to explain unemployment-related health inequalities may not be as powerful for explaining how and why these inequalities change over time. In the case of unemployment-related health inequalities in Canada, these risk factors explain neither the increasing prevalence of poor self-rated health among the unemployed nor the growing gap between the unemployed and their employed counterparts. We provide several possible explanations for these puzzling findings. We conclude by suggesting that widening health inequalities may be driven by macrosocial trends (e.g. widening income inequality and declining social safety nets) which have changed the meaning and context of unemployment, as well as its associated risk factors, in ways that are not easy to capture using routinely available survey data.

Government social assistance programmes are failing to protect the health of low-income populations: evidence from the USA and Canada (2003–2014)

Background

Social policies that improve the availability and distribution of key socioeconomic resources such as income, wealth and employment are believed to present the most promising avenue for reducing health inequalities. The present study aims to estimate the effect of social assistance recipiency on the health of low-income earners in the USA and Canada.

Methods

Drawing on nationally representative survey data (National Health Interview Survey and the Canadian Community Health Survey), we employed propensity score matching to match recipients of social assistance to comparable sets of non-recipient ‘controls’. Using a variety of matching algorithms, we estimated the treatment effect of social assistance recipiency on self-rated health, chronic conditions, hypertension, obesity, smoking, binge drinking and physical inactivity.

Results

After accounting for underlying differences in the demographic and socioeconomic characteristics of recipients and non-recipients, we found that social assistance recipiency was associated with worse health status or, at best, the absence of a clear health advantage. This finding was consistent across several different matching strategies and a diverse range of health outcomes.

Conclusions

From a public health perspective, our findings suggest that interventions are warranted to improve the scope and generosity of existing social assistance programmes. This may include reversing welfare reforms implemented over the past several decades, increasing benefit levels and untethering benefit recipiency from stringent work conditionalities.

Effects of the social norms intervention The GOOD Life on norm perceptions, binge drinking and alcohol-related harms: A cluster-randomised controlled trial

The study aimed to investigate if the school-based social norms intervention The GOOD Life was effective in reducing misperceptions, heavy alcohol use and alcohol-related harms among Danish pupils aged 13–17 years.

In total 38 schools were included in a cluster-randomised controlled trial and allocated to either intervention (n = 641) or control group (n = 714) during 2015/2016. Both groups completed an online survey before the intervention and 3 months after baseline. The GOOD Life intervention provided normative feedback tailored for each school-grade using three communication channels: classroom sessions, posters and web application. Outcome measures were overestimation of peers' lifetime binge drinking, binge drinking (5 or more drinks on one occasion) and alcohol-related harms. Intervention effects at follow-up were examined using multilevel logistic regression models.

Pupils in the intervention group were less likely to overestimate peers' lifetime binge drinking compared to those in the control group (OR: 0.52, 95%CI: 0.33–0.83) and were less likely to report two or more alcohol-related harms (OR: 0.59, 95%CI: 0.37–0.93). Overall, no significant effect of the intervention was found on binge drinking. However, among pupils stating it would be ok, if they drank more (n = 296), a preventive effect was found on binge drinking four or more times during the last 30 days (OR: 0.37, 95%CI: 0.15–0.95). Additionally, the intervention effect on overestimation was higher among pupils who reported binge drinking at baseline.

Receiving the intervention had a positive effect on norm perceptions and alcohol-related harms. We also found that the intervention effect differed by baseline status of alcohol use.

Episodic and Binge Gambling: An Exploration and Preliminary Quantitative Study

The DSM-5 includes provisions for episodic forms of gambling disorder, with such changes aligned with earlier accounts of potential binge gambling behaviours. However, there is little research that indicates the utility of these classifications of episodic or binge gambling, and this study considered their characteristics in a clinical sample. It involved administration of a new binge gambling screening tool, along with routine measures, to n = 214 patients entering a specialist treatment clinic for gambling problems. Results indicated that episodic gambling was common in this clinical context, with 28 and 32% of patients reporting gambling episodes that were (a) regular and alternating, and (b) irregular and intermittent, respectively. These patterns were distinguished by factors including associations with covariates that indicated differences from continuous gamblers. For example, the irregular episodic gamblers, but not the regular pattern, demonstrated lower levels of problem gambling severity and comorbidity. Rates of potential binge gambling, which was defined in terms of additional criteria, were around 4% and numbers were insufficient for comparable analyses. The findings support inclusion of episodic forms of gambling disorder in the DSM-5, but highlight the need for improved recognition and research on heterogeneous forms of episodic gambling.

Neural correlates of correct and failed response inhibition in heavy versus light social drinkers: an fMRI study during a go/no-go task by healthy participants

The ability to suppress responses that are inappropriate, as well as the mechanisms monitoring the accuracy of actions in order to compensate for errors, is central to human behavior. Neural alterations that prevent stopping an inaccurate response, combined with a decreased ability of error monitoring, are considered to be prominent features of alcohol abuse. Moreover, (i) alterations of these processes have been reported in heavy social drinkers (i.e. young healthy individuals who do not yet exhibit a state of alcohol dependence); and (ii) through longitudinal studies, these alterations have been shown to underlie subsequent disinhibition that may lead to future alcohol use disorders. In the present functional magnetic resonance imaging study, using a contextual Go/No-Go task, we investigated whether different neural networks subtended correct inhibitions and monitoring mechanisms of failed inhibitory trials in light versus heavy social drinkers. We show that, although successful inhibition did not lead to significant changes, neural networks involved in error monitoring are different in light versus heavy drinkers. Thus, while light drinkers exhibited activations in their right inferior frontal, right middle cingulate and left superior temporal areas; heavy drinkers exhibited activations in their right cerebellum, left caudate nucleus, left superior occipital region, and left amygdala. These data are functionally interpreted as reflecting a "visually-driven emotional strategy" vs. an "executive-based" neural response to errors in heavy and light drinkers, respectively. Such a difference is interpreted as a key-factor that may subtend the transition from a controlled social heavy consumption to a state of clinical alcohol dependence.

A Co-Twin Control Study of the Relationship Between Adolescent Drinking and Adult Outcomes

OBJECTIVE

The effect of drinking during adolescence on adult functioning is a public health concern. A variety of mechanisms have been proposed where drinking in adolescence has an adverse impact on later outcomes; unfortunately, few studies have included methodologies that account for confounding influences that might link adolescent drinking with subsequent problems. To address this limitation, the current study used a co-twin control design, which uses members of twin pairs that differ from each other on their adolescent drinking.

METHOD

We used a prospective longitudinal sample drawn from the Minnesota Twin Family Study, consisting of 2,764 twins (1,434 female) assessed at regular follow-ups from age 17 to age 29. Adolescent drinking was defined by measures of early initiation of use and a measure of overall consumption at age 17. Adult outcomes included indicators of substance use, antisocial behavior, personality, socioeconomic status, and social functioning.

RESULTS

The co-twin control analyses suggested that many of the associations between adolescent drinking and later outcomes were largely influenced by genetic confounding. However, for the measure of adolescent alcohol consumption, results were consistent with a small causal impact of drinking on multiple domains of adult functioning. This pattern was less consistently observed for the measures of early initiation.

CONCLUSIONS

These results provide empirical justification for policies designed to alleviate long-term consequences associated with adolescent drinking by reducing the level of alcohol consumption in adolescence. In contrast, the evidence did not suggest that delaying drinking would have a broad impact on later-life adjustment.

Does integrated academic and health education prevent substance use? Systematic review and meta-analyses

BACKGROUND

Prevention of substance (alcohol, tobacco, illegal/legal drug) use in adolescents is a public health priority. As the scope for school-based health education is constrained in school timetables, interventions integrating academic and health education have gained traction in the UK and elsewhere, though evidence for their effectiveness remains unclear. We sought to synthesize the effectiveness of interventions integrating academic and health education for the prevention of substance use.

METHODS

We searched 19 databases between November and December 2015, among other methods. We included randomized trials of interventions integrating academic and health education targeting school students aged 4-18 and reporting substance use outcomes. We excluded interventions for specific health-related subpopulations (e.g., children with behavioural difficulties). Data were extracted independently in duplicate. Outcomes were synthesized by school key stage (KS) using multilevel meta-analyses, for substance use, overall and by type.

RESULTS

We identified 7 trials reporting substance use. Interventions reduced substance use generally in years 7-9 (KS3) based on 5 evaluations (d = -0.09, 95% CI [-0.17, -0.01], I²  = 35%), as well as in years 10-11 (KS4) based on 3 evaluations (-0.06, [-0.09, -0.02]; I²  = 0%). Interventions were broadly effective for reducing specific alcohol, tobacco, and drug use in both KS groups.

CONCLUSIONS

Evidence quality was highly variable. Findings for years 3-6 and 12-13 could not be meta-analysed, and we could not assess publication bias. Interventions appear to have a small but significant effect reducing substance use. Specific methods of integrating academic and health education remain poorly understood.

A Co-Twin Control Study of the Relationship Between Adolescent Drinking and Adult Outcomes

OBJECTIVE

The effect of drinking during adolescence on adult functioning is a public health concern. A variety of mechanisms have been proposed where drinking in adolescence has an adverse impact on later outcomes; unfortunately, few studies have included methodologies that account for confounding influences that might link adolescent drinking with subsequent problems. To address this limitation, the current study used a co-twin control design, which uses members of twin pairs that differ from each other on their adolescent drinking.

METHOD

We used a prospective longitudinal sample drawn from the Minnesota Twin Family Study, consisting of 2,764 twins (1,434 female) assessed at regular follow-ups from age 17 to age 29. Adolescent drinking was defined by measures of early initiation of use and a measure of overall consumption at age 17. Adult outcomes included indicators of substance use, antisocial behavior, personality, socioeconomic status, and social functioning.

RESULTS

The co-twin control analyses suggested that many of the associations between adolescent drinking and later outcomes were largely influenced by genetic confounding. However, for the measure of adolescent alcohol consumption, results were consistent with a small causal impact of drinking on multiple domains of adult functioning. This pattern was less consistently observed for the measures of early initiation.

CONCLUSIONS

These results provide empirical justification for policies designed to alleviate long-term consequences associated with adolescent drinking by reducing the level of alcohol consumption in adolescence. In contrast, the evidence did not suggest that delaying drinking would have a broad impact on later-life adjustment.

[Prediction of binge drinking in young adults: a cohort study over nine years]

Prediction of binge drinking in young adults: a cohort study over nine years Abstract.

OBJECTIVE

Which person characteristics and environmental factors predict binge drinking at age 21?

METHOD

A longitudinal observational study with a nine-year follow-up. A total of 5,176 adolescents from the German states Schleswig-Holstein and Saxony-Anhalt were surveyed in 2006 with paper-pencil questionnaires (mean age 12.6 years, SD = 0.6). A follow-up assessment was conducted in the year 2015. Baseline predictors were age, gender, school type, school performance, parenting style, early experience with alcohol, alcohol use of parents, alcohol use of friends, and sensation seeking. Primary outcome in 2015 was binge drinking at least once a month (six or more alcoholic drinks during one drinking occasion).

RESULTS

A subsample of 1,087 (20.9 %) of the former students could be surveyed nine years after baseline (mean age 21.6 years, SD = 0.8). One out of four (25.4 %) reported binge drinking at least once in a month. A multiple regression model revealed three significant predictors of binge drinking: male gender, early experience with alcohol and frequency of parental alcohol use at baseline.

CONCLUSIONS

Perceived frequency of parental alcohol use might be an important risk factor for children's alcohol use in early adulthood. Parents need to reflect their role as alcohol-specific socialization agents.

Examining the relationships between life satisfaction and alcohol, tobacco and marijuana use among school-aged children

Background

There are many known risk factors associated with youth substance use. Nonetheless, the impact of life satisfaction (LS) on the use of alcohol, tobacco and marijuana by adolescents still remains largely unknown.

Methods

The present analysis utilized data from the Health Behavior in School-Aged Children 2009–10 US study. Multilevel logistic regression models were used to assess the relationship between LS and individual substance use. Multilevel multinomial regression models examined the relationship with total number of substances used.

Results

After controlling for numerous variables associated with substance use, individuals reporting low LS were significantly more likely to ever use tobacco (OR = 1.34, 95% CI = [1.01, 1.78]), alcohol (OR = 1.45, 95% CI = [1.10, 1.92]) and marijuana (OR = 1.98, 95% CI = [1.39, 2.82]). Additionally, students with low LS were significantly more likely to use two substances (OR = 1.90, 95% CI = [1.15, 3.14]) and three substances concurrently (OR = 2.00, 95% CI = [1.27, 3.16]).

Conclusions

The present study identified strong associations between LS and individual, as well as concurrent, substance use among adolescents. Interventions aiming to reduce adolescent substance use may benefit from incorporating components to improve LS.

The dual-process model in young adults with a consistent binge drinking trajectory into adulthood

BACKGROUND

Binge Drinking (BD) generally declines once students have left university. However, many individuals continue to partake in BD into adulthood, constituting a scarcely investigated high-risk group towards whom interventions should be prioritized. Following the dual-process model, we examined the relationship between BD and both the reflective system (executive functions) and the affective system (alcohol bias) in young adults with a consistent BD trajectory. We considered impulsivity as a moderator in the relationship between BD and alcohol bias.

METHODS

A cohort of 63 (31♀) young adults were followed for eleven years (18-29 years old). In the last assessment, participants, with high and low drinking trajectories underwent neuropsychological assessment of executive functions (working memory [SOPT], cognitive flexibility [TMT -Verbal Fluency], inhibition [Stroop]) and alcohol bias (Addiction Stroop). The Barratt Impulsivity Scale measured impulsivity. Generalized linear mixed models and regression-based moderation models were applied.

RESULTS

BD was associated with weak inhibitory control, poor working memory and greater alcohol bias moderated by non-planning impulsivity. At moderate levels of non-planning impulsivity, BD was associated with greater alcohol bias. This association was not found at high levels of impulsivity. These deficits were related to loss of control over drinking and severity of alcohol use.

CONCLUSIONS

The imbalance between poor cognitive control and greater alcohol bias may contribute to the persistence of BD into adulthood. The findings highlight the complexities of the dual-process model, with intervention implications.

Binge drinking and associated factors among school students: a cross-sectional study in Zhejiang Province, China

OBJECTIVE

To investigate the prevalence and correlating factors of binge drinking among middle and high school students in Zhejiang Province, China.

METHODS

We performed a cross-sectional study using data from a school-based survey. A total of 23 543 (response rate=97.5%) eligible adolescents from 442 different schools (including middle schools, academic high schools and vocational high schools) were asked to fill in an anonymous self-administered behaviour questionnaire between April and May 2017. Multivariable logistic regression models were used to examine the associations of sociodemographic and behavioural factors with binge drinking.

RESULTS

The mean (SD) age of participants was 15.6 (1.7) years and 51.3% were boys. The proportions of students from middle schools, academic high schools and vocational high schools were 51.9%, 27.5% and 20.6%, respectively. In total, 22.8% (95% CI 21.6 to 23.9) of students reported drinking alcohol in the past 30 days and 9.2% (95% CI 8.5 to 10.0) of students reported binge drinking (defined as drinking four or more alcoholic drinks in 1-2 hours period among girls and five or more alcoholic drinks among boys) during the past month. The prevalence of binge drinking was highest among vocational high school students (17.9% vs 6.3% and 7.7% among middle school and academic high school students, respectively). Older age, studying at high school, poor academic performance, higher levels of physical activity, excessive screen-time, loneliness, insomnia, previous suicide attempt, cigarette smoking, fighting, being bullied and sexual experience were found to be positively associated with adolescent binge drinking.

CONCLUSIONS

Binge drinking is common among middle and high school students in Zhejiang, China. Efforts to prevent binge drinking may need to address a cluster of sociodemographic and behavioural factors. Our findings provide information to enable healthcare providers to identify students at high-risk of binge drinking and to inform planning of intervention measures for at-risk students.

Trends in alcohol use among young people according to the pattern of consumption on starting university: A 9-year follow-up study

AIM

To identify differences in Risky Consumption (RC) and Binge drinking (BD) trends in students who already followed these patterns of alcohol consumption on starting university and those who did not, and also to try to understand what leads students to engage in these types of behaviour at university.

MATERIAL AND METHODS

Cohort study among university students in Spain (n = 1382). BD and RC were measured with the Alcohol Use Disorders Identification Test at ages 18, 20, 22, 24 and 27 years. Multilevel logistic regression for repeated measures was used to calculate the adjusted Odds Ratios (ORs).

RESULTS

The prevalence rates of RC and BD were lower throughout the study in students who did not follow these patterns of consumption at age 18. For RC and BD, the differences at age 27 years, expressed as percentage points (pp), were respectively 24 pp and 15 pp in women and 29 pp and 25 pp in men. Early age of onset of alcohol use increased the risk of engaging in RC and BD patterns at university, for men (OR = 2.91 & 2.80) and women (OR = 8.14 & 5.53). The same was observed in students living away from the parental home for BD (OR = 3.43 for men & 1.77 for women). Only women were influenced by having positive expectancies for engaging in RC (OR = 1.82) and BD (OR = 1.96).

CONCLUSIONS

The prevalence rates of both RC and BD at age 27 years were much higher among university students who already followed these patterns of consumption at age 18 years, with the differences being proportionally higher among women. Focusing on the age of onset of alcohol consumption and hindering access to alcohol by minors should be priority objectives aimed at preventing students from engaging in these patterns of alcohol consumption at university.

Alcohol Misuse and Injury Outcomes in Young People Aged 10-24

PURPOSE

The burden of alcohol-attributable disease is a global problem. Young people often present to emergency health-care services with alcohol intoxication but little is known about how best to intervene at that point to improve future health outcomes. This study aimed to assess whether young people with an alcohol-specific hospital admission are at increased risk of injury following discharge.

METHODS

A cohort study was conducted using a general population of 10- to 24-year-olds identified using primary care medical records with linked hospital admission records between 1998 and 2013. Exposed individuals had an alcohol-specific admission. Unexposed individuals did not and were frequency matched by age (±5 years) and general practice (ratio 10:1). Incidence rates of injury-related hospital admission post discharge were calculated, and hazard ratios (HR) were estimated by Cox regression.

RESULTS

The cohort comprised 11,042 exposed and 110,656 unexposed individuals with 4,944 injury-related admissions during follow-up (2,092 in exposed). Injury rates were six times higher in those with a prior alcohol admission (73.92 per 1,000 person-years, 95% confidence interval (CI) 70.82-77.16 vs. 12.36, 11.91-12.81). The risk of an injury admission was highest in the month following an alcohol-specific admission (adjusted HR = 15.62, 95% CI 14.08-17.34), and remained higher compared to those with no previous alcohol-specific admission at 1 year (HR 5.28 (95% CI 4.97-5.60)) and throughout follow-up.

CONCLUSIONS

Young people with an alcohol-specific admission are at increased risk of subsequent injury requiring hospitalization, especially immediately post discharge, indicating a need for prompt intervention as soon as alcohol misuse behaviors are identified.

Alcohol intake among adolescent students and association with social capital and socioeconomic status

The aim was to evaluate the prevalence of alcohol consumption, binge drinking and their association with social capital and socioeconomic factors among Brazilian adolescents students. A cross-sectional study was carried out with a randomly selected representative sample of 936 adolescents aged 15 to 19 years. Information on alcohol consumption, social capital and socioeconomic status was collected using the Alcohol Use Disorders Identification Test, the Integrated Questionnaire for the Measurement of Social Capital and Social Vulnerability Index, respectively. The prevalence of alcohol consumption was 50.3% and binge drinking 36% the last year. Adolescents who reported believing that people in their community could help solve a collective problem (with the water supply) and those classified as having high social vulnerability had lower likelihood of binge drinking (PR = 0.776 [95%CI:0.620 to 0.971] and PR = 0.660 [95%CI:0.542 to 0.803], respectively). The prevalence of alcohol consumption and binge drinking the last year is high among participants. Those with higher socioeconomic status as well as lower perceptions of community capital social are more likely to display binge-drinking behavior.

The Arf6 activator Efa6/PSD3 confers regional specificity and modulates ethanol consumption in Drosophila and humans

Ubiquitously expressed genes have been implicated in a variety of specific behaviors, including responses to ethanol. However, the mechanisms that confer this behavioral specificity have remained elusive. Previously, we showed that the ubiquitously expressed small GTPase Arf6 is required for normal ethanol-induced sedation in adult Drosophila. Here, we show that this behavioral response also requires Efa6, one of (at least) three Drosophila Arf6 guanine exchange factors. Ethanol-naive Arf6 and Efa6 mutants were sensitive to ethanol-induced sedation and lacked rapid tolerance upon re-exposure to ethanol, when compared with wild-type flies. In contrast to wild-type flies, both Arf6 and Efa6 mutants preferred alcohol-containing food without prior ethanol experience. An analysis of the human ortholog of Arf6 and orthologs of Efa6 (PSD1-4) revealed that the minor G allele of single nucleotide polymorphism (SNP) rs13265422 in PSD3, as well as a haplotype containing rs13265422, was associated with an increased frequency of drinking and binge drinking episodes in adolescents. The same haplotype was also associated with increased alcohol dependence in an independent European cohort. Unlike the ubiquitously expressed human Arf6 GTPase, PSD3 localization is restricted to the brain, particularly the prefrontal cortex (PFC). Functional magnetic resonance imaging revealed that the same PSD3 haplotype was also associated with a differential functional magnetic resonance imaging signal in the PFC during a Go/No-Go task, which engages PFC-mediated executive control. Our translational analysis, therefore, suggests that PSD3 confers regional specificity to ubiquitous Arf6 in the PFC to modulate human alcohol-drinking behaviors.

DNA methylation from birth to late adolescence and development of multiple-risk behaviours

BACKGROUND

Risk behaviours in adolescence are linked to poor educational attainment and health and other outcomes in young adulthood. We explored whether there are molecular mechanisms associated with the development, or the result, of multiple risk behaviours (MRBs).

METHODS

MRBs (antisocial behaviour and delinquency, traffic-related risk behaviour, risky sexual behaviour, lack of exercise) and their sumscore were characterized based on self-reported questions at age 7 and 17 within the ARIES subsample of the ALSPAC birth cohort, and were linked to DNA methylation at over 485,000 CpG sites at ages 0,7 and 17. Associations were determined for participants with complete data (n = 227-575).

RESULTS

There was weak evidence of associations between cumulative MRBs and methylation at cg01783492 and cg16720578 at age 17. DNA methylation at age 17 was associated with risky sexual behaviour (cg22883332), lack of exercise (cg03152353, cg20056908, cg20571116) and substance use (cg02188400, cg13906377). No associations between DNA methylation and individual risk behaviours at age 7 were observed. DNA methylation at age 7 might predispose for traffic-related risk behaviour (cg24683561) and substance use (cg08761410) at age 17.

LIMITATIONS

Main limitations are absence of information on directly measured blood cell type proportions and tissue specificity, and a modest sample size.

CONCLUSIONS

Cumulative MRB in late adolescence was associated with effects on DNA methylation. More specifically, risky sexual behaviour and sedentary behaviour are associated with changes in DNA methylation, while DNA methylation in childhood may predict later traffic-related risky behaviour. For substance use effects in both temporal directions were observed.

Use of alcohol, tobacco and illicit drugs among ethnic Norwegian and ethnic minority adolescents in Hordaland county, Norway: the youth@hordaland-survey

OBJECTIVE

To describe potential differences in unhealthy behaviours among ethnic Norwegian adolescents and minority adolescents from countries within the European Union, European Economic Area or US (EU/EEA countries) and adolescents from non-EU/EEA countries. Specifically, we aimed to investigate ethnic differences in use of alcohol, tobacco and illicit drugs, and potential confounding due to socio-demographic characteristics.

DESIGN

Cross-sectional population-based study of adolescents aged 16-19 (N = 10,122), with self-reported ethnicity as grouping variable, and self-reported use of alcohol, tobacco and illicit drugs as dependent variables.

RESULTS

We found that minority adolescents from EU/EEA and non-EU/EEA countries differed from ethnic Norwegian adolescents on important indicators of unhealthy behaviours. Compared to Norwegian adolescents, adolescents from EU/EEA were more likely to report having tried to smoke, to be a daily smoker and to ever having tried an illicit drug (adjusted odds ratio (OR) ranging from 2.01 to 3.74). They were, however, less likely to have tried snus (a form of smokeless tobacco; adjusted OR 0.64; confidence interval (CI) 95% 0.43-0.97) and to report daily snus use (adjusted OR 0.31; CI95% 0.15-0.67). There were no differences in having tried alcohol. Non-EU/EEA adolescents were less likely to have ever tried alcohol (OR 0.24; CI95% 0.18-0.31), snus (OR 0.47; CI95% 0.34-0.65) and to smoke (0.68; CI95% 0.52-0.91), and less likely to report daily snus use (OR 0.36; CI95% 0.21-0.62) compared to Norwegian adolescents. There were no differences with regard to having tried illicit drugs and reporting being a daily smoker. All differences observed were robust to adjustment for age, gender and family socio-economic status.

CONCLUSION

The presents study identified important differences in unhealthy behaviours across different ethnic groups in Norway. The differences in the prevalence of unhealthy behaviours among ethnic minorities are still relevant in a public health perspective, and potential mechanisms should be investigated further.

Risk of alcohol dependence: prevalence, related problems and socioeconomic factors

The present study evaluated the possible alcohol dependence and related problems among adolescents and determined possible associations with socioeconomic factors and gender. A cross-sectional study was conducted with a representative sample of 936 adolescents aged 15 to 19 years enrolled at public and private schools in the city of Belo Horizonte, Brazil. Data related to alcohol consumption and associated problems were collected using the Alcohol Use Disorder Identification Test (AUDIT). The Social Vulnerability Index (SVI), mother's schooling and type of school were used to assess socioeconomic factors. Statistical analysis involved the chi-square test (p < 0.05) and Poisson regression. The prevalence of possible dependence was 16.4%, 52.1% reported concern of a family member regarding the adolescent's alcohol consumption. Female adolescents were less likely to exhibit possible dependence in comparison to males. Participants with living in a low vulnerability area were more likely to consume alcohol in comparison to those living in underprivileged areas. The results of the present study demonstrate that possible dependence was significantly associated with the male gender and low social vulnerability.

A randomised controlled pilot trial evaluating feasibility and acceptability of a computer-based tool to identify and reduce harmful and hazardous drinking among adolescents with alcohol-related presentations in Canadian pediatric emergency departments

OBJECTIVE

This study piloted procedures and obtained data on intervention acceptability to determine the feasibility of a definitive randomised controlled trial (RCT) of the effectiveness of a computer-based brief intervention in the emergency department (ED).

DESIGN

Two-arm, multi-site, pilot RCT.

SETTING AND PARTICIPANTS

Adolescents aged 12-17 years presenting to three Canadian pediatric EDs from July 2010 to January 2013 for an alcohol-related complaint.

INTERVENTIONS

Standard medical care plus computer-based screening and personalised assessment feedback (experimental group) or standard care plus computer-based sham (control group). ED and research staff, and adolescents were blinded to allocation.

OUTCOMES

Main: change in alcohol consumption from baseline to 1- and 3 months post-intervention. Secondary: recruitment and retention rates, intervention acceptability and feasibility, perception of group allocation among ED and research staff, and change in health and social services utilisation.

RESULTS

Of the 340 adolescents screened, 117 adolescents were eligible and 44 participated in the study (37.6% recruitment rate). Adolescents allocated to the intervention found it easy, quick and informative, but were divided on the credibility of the feedback provided (agreed it was credible: 44.4%, disagreed: 16.7%, unsure: 16.7%, no response: 22.2%). We found no evidence of a statistically significant relationship between which interventions adolescents were allocated to and which interventions staff thought they received. Alcohol consumption, and health and social services data were largely incomplete due to modest study retention rates of 47.7% and 40.9% at 1- and 3 months post-intervention, respectively.

CONCLUSIONS

A computer-based intervention was acceptable to adolescents and delivery was feasible in the ED in terms of time to use and ease of use. However, adjustments are needed to the intervention to improve its credibility. A definitive RCT will be feasible if protocol adjustments are made to improve recruitment and retention rates; and increase the number of study sites and research staff.

TRIAL REGISTRATION

clinicaltrials.gov NCT01146665.

Correlates of alcohol consumption on heavy drinking occasions of young risky drinkers: event versus personal characteristics

AIMS

Risky single-occasion drinking (RSOD) by young people is a serious public health issue, yet little is known about the specific circumstances of risky drinking occasions. This study examined the independent effects of event- and individual-specific variables on RSOD.

DESIGN

Longitudinal cohort study measuring self-reported RSOD and event- and individual-specific variables across two drinking occasions approximately 1 year apart.

SETTING

Metropolitan Melbourne, Australia.

PARTICIPANTS

A sample of 710 young risky drinkers aged between 18 and 25 years and defined as engaging in risky drinking practices (males: consumed alcohol in excess of 10 Australian Standard Drinks (ASD: 10 g ethanol) in a single occasion in the previous year; females: consumed alcohol in excess of seven ASD for females in a single occasion in the previous year).

MEASUREMENTS

Random digit-dial telephone landline survey of the most recent heavy drinking occasion and socio-demographic variables. The primary outcome was the log of the total drinks consumed in the most recent heavy drinking occasion. Event-specific (e.g. number of drinking locations) and time-varying (e.g. weekly income) and time-invariant (e.g. sex) individual-specific variables were examined as correlates of total drinks consumed.

FINDINGS

Changes in event-specific characteristics including the length of the drinking occasion (Likelihood Ratio χ² (2) = 24.4, P < 0.001), the number of drinking locations (Wald χ²₍₁₎  = 7.6, P = 0.006) and the number of different drink types (Wald χ²₍₁₎  = 13.6, P < 0.001) were associated with increases in total drinks consumed, after adjustment for time-invariant and time-variant individual-specific variables such as gender, income level and weekly consumption. Few other effects were noted.

CONCLUSIONS

Event-specific characteristics are important predictors of the number of drinks consumed during risky single occasion drinking (RSOD) and illustrate the importance of event contexts when considering interventions targeting RSOD. The total number of drinks consumed in a RSOD session appears to rise independently with the duration of the drinking event, the number of drinking locations and the number of different types of beverage consumed.