When does attrition lead to biased estimates of alcohol consumption? Bias analysis for loss to follow-up in 30 longitudinal cohorts

Reasons for alcohol use from 1976 to 2020 in the United States among individuals aged 18 to 30: Historical changes and mediation of cohort effects in binge drinking

BACKGROUND

Alcohol use is declining among US adolescents/early young adults and increasing among other adults, with increases in adult binge drinking more concentrated in females than males. Reasons for drinking are historically patterned by age and sex, and if historically variant, could suggest that changes over time could in part explain age- and sex-differential cohort effects.

METHODS

We analyzed longitudinal Monitoring the Future data for individuals born from 1958 to 1990. These individuals were aged 29/30 from 1987 to 2020, and first surveyed at age 18 from 1976 to 2008 (N = 14,190). Five reasons for drinking were analyzed (social, enhancement, avoid problems, relax, boredom). Drinking for social reasons and to relax were most prevalent. Total effects of birth cohort predicting past-2-week binge drinking were estimated with polynomial regression models by age; indirect effects through mediators were estimated.

RESULTS

Drinking reasons exhibited dynamic time trends across birth cohort and sex. Notable increases were observed in social reasons: among women aged 29/30, social reasons increased from 53% to 87% from 1987 to 2020. Social reasons to drink had prominent positive indirect effects at adult ages (age 23/24 and above among men; age 19 and above among women), indicating that binge drinking would have increased less were it not for the increase in social reasons for drinking. Social reasons also mediated adult male/female differences, indicating that part of the reason sex differences are diminishing is the more rapid increases in social reasons for drinking among women. Indirect effects were also observed for drinking to relax and for boredom, and limited indirect effects were observed for enhancement and to avoid problems.

CONCLUSION

Changing endorsement of drinking reasons, especially social reasons, among US adult drinkers mediate cohort effects in binge drinking in the US adult population and explain in part why binge drinking is converging by sex.

Smartphone-delivered approach bias modification for reducing harmful drinking amongst middle-older age adults: Secondary analyses of a single-arm pilot study

INTRODUCTION

Novel, scalable, low-cost interventions are needed to reduce harmful drinking amongst middle-older adults. Approach bias modification (ApBM) is a promising form of cognitive training for preventing/reducing alcohol use that can be delivered via smartphone. This study explored the acceptability and preliminary effectiveness of smartphone delivered and personalised ApBM amongst Australians ≥55 years, an age cohort at risk of alcohol-related harms.

METHODS

Secondary analyses in a middle-older adult subsample (≥55 years, n = 289) of an open-label pilot study using a retrospective, repeated measures design. We explored acceptability (adherence, user mobile acceptability ratings, free-text responses) and preliminary effectiveness (changes in drinking quantity and frequency, craving, dependence and proportion drinking within government-recommended guidelines) of two sessions/week over 4 weeks of evidence-based ApBM training, adapted to include personalisation and smartphone delivery amongst Australians ≥55 years.

RESULTS

Although minor adaptations to training were suggested, the intervention was acceptable amongst survey completers, with 72% training adherence. Relative to baseline, there was a significant increase in the proportion of drinking within recommended single-session and weekly guidelines post-training (from 25% to 41% and 6% to 28%, respectively, p < 0.001), with past-week standard drinks significantly decreasing by 18% (p < 0.001) and significant reductions in drinking days, mean craving and dependence scores (p < 0.001).

DISCUSSION AND CONCLUSIONS

Findings suggest smartphone ApBM is acceptable amongst middle-to-older aged Australians and may support this 'at risk' cohort to remain within government-recommended alcohol consumption guidelines to optimise healthy aging, although, in the context of a single-arm study, preliminary results should be interpreted cautiously.

Cohort effects of women's mid-life binge drinking and alcohol use disorder symptoms in the United States: Impacts of changes in timing of parenthood

BACKGROUND AND AIMS

Alcohol use is increasing among women in mid-life concurrently with societal changes in timing of parenthood and changing cultural norms, which may influence alcohol use. The aim of this study was to determine if age of first parenting was associated with excessive drinking [i.e. past 2-week binge drinking and past 5-year alcohol use disorder (AUD) symptoms] among women during mid-life in the United States and to determine if there were pronounced cohort effects influencing these relationships.

DESIGN

This was a retrospective cohort, longitudinal study.

SETTING, PARTICIPANTS AND MEASUREMENTS

Data were drawn from the Monitoring the Future survey, an annual ongoing survey of high school students' substance use behaviors in the United States. Participants were women who completed the age 35 survey between 1993 and 2019, corresponding to high school senior years 1976-2002 (n = 9988). Past 2-week binge drinking and past 5-year AUD symptoms were self-reported. Age of first parenting was self-reported.

FINDINGS

Binge drinking and AUD symptoms were higher among women in recent than in older cohorts. Women from the 2018-19 cohort had increased odds of binge drinking [odds ratio (OR) = 1.73, 95% confidence interval (CI) = 1.41-2.12] and AUD symptoms (OR = 1.51, CI = 1.27-1.80) relative to women from the 1993-97 cohort. Throughout cohorts, there was an inverse association between transition to parenthood and excessive drinking outcomes (e.g. range for ORs for binge drinking among those without children compared with those who had had children between the ages of 18 and 24: 1.22-1.55). Simultaneously, there was a population shift towards delaying parenting in recent cohorts (i.e. 54% of women in the 1993-97 cohort had children before age 30 compared with 39% in the two recent cohorts), increasing the size of the group at highest risk for excessive drinking.

CONCLUSIONS

In the United States, subgroups of women at highest risk of excessive drinking appear to be expanding, probably supported in part by a trend towards delayed parenting.

Comparative effectiveness of adding delamanid to a multidrug-resistant tuberculosis regimen comprised of three drugs likely to be effective

Clarity about the role of delamanid in longer regimens for multidrug-resistant TB is needed after discordant Phase IIb and Phase III randomized controlled trial results. The Phase IIb trial found that the addition of delamanid to a background regimen hastened culture conversion; the results of the Phase III trial were equivocal. We evaluated the effect of adding delamanid for 24 weeks to three-drug MDR/RR-TB regimens on two- and six-month culture conversion in the endTB observational study. We used pooled logistic regression to estimate the observational analogue of the intention-to-treat effect (aITT) adjusting for baseline confounders and to estimate the observational analogue of the per-protocol effect (aPP) using inverse probability of censoring weighting to control for time-varying confounding. At treatment initiation, 362 patients received three likely effective drugs (delamanid-free) or three likely effective drugs plus delamanid (delamanid-containing). Over 80% of patients received two to three Group A drugs (bedaquiline, linezolid, moxifloxacin/levofloxacin) in their regimen. We found no evidence the addition of delamanid to a three-drug regimen increased two-month (aITT relative risk: 0.90 (95% CI: 0.73-1.11), aPP relative risk: 0.89 (95% CI: 0.66-1.21)) or six-month culture conversion (aITT relative risk: 0.94 (95% CI: 0.84, 1.02), aPP relative risk: 0.93 (95% CI: 0.83, 1.04)). In regimens containing combinations of three likely effective, highly active anti-TB drugs the addition of delamanid had no discernible effect on culture conversion at two or six months. As the standard of care for MDR/RR-TB treatment becomes more potent, it may become increasingly difficult to detect the benefit of adding a single agent to standard of care MDR/RR-TB regimens. Novel approaches like those implemented may help account for background regimens and establish effectiveness of new chemical entities.

An empirical evaluation of alternative approaches to adjusting for attrition when analyzing longitudinal survey data on young adults' substance use trajectories

OBJECTIVES

Longitudinal survey data allow for the estimation of developmental trajectories of substance use from adolescence to young adulthood, but these estimates may be subject to attrition bias. Moreover, there is a lack of consensus regarding the most effective statistical methodology to adjust for sample selection and attrition bias when estimating these trajectories. Our objective is to develop specific recommendations regarding adjustment approaches for attrition in longitudinal surveys in practice.

METHODS

Analyzing data from the national U.S. Monitoring the Future panel study following four cohorts of individuals from modal ages 18 to 29/30, we systematically compare alternative approaches to analyzing longitudinal data with a wide range of substance use outcomes, and examine the sensitivity of inferences regarding substance use prevalence and trajectories as a function of college attendance to the approach used.

RESULTS

Our results show that analyzing all available observations in each wave, while simultaneously accounting for the correlations among repeated observations, sample selection, and attrition, is the most effective approach. The adjustment effects are pronounced in wave-specific descriptive estimates but generally modest in covariate-adjusted trajectory modeling.

CONCLUSIONS

The adjustments can refine the precision, and, to some extent, the implications of our findings regarding young adult substance use trajectories.

Structural sexism and Women's alcohol use in the United States, 1988-2016

BACKGROUND

Women's alcohol consumption and binge drinking have increased concurrent with socio-economic gains and may be related to structural sexism.

METHODS

We examined associations between structural sexism (state-level sex inequality in political/economic status), and alcohol outcomes among women in Monitoring the Future (N = 20,859) from 1988 to 2016 (ages 27-45 in 2016). We controlled for state and individual confounders and tested three mediators: depressive symptoms, restrictive alcohol norms, and college completion.

RESULTS

Increased structural sexism was associated with decreased alcohol consumption frequency (RR: 0.974, 95% CI: 0.971, 0.976) and binge drinking probability (OR: 0.917, 95% CI: 0.909, 0.926). Norms and education but not depressive symptoms partially mediated these relationships.

CONCLUSION

Among women in the midlife in recent years, lower levels of state structural sexism were associated with greater alcohol consumption and binge drinking. These findings suggest that as states become more gender-equal-which confer numerous benefits for women's rights and health-additional resources and messaging may be required to prevent harmful alcohol use among women.

Alcohol use and the COVID-19 pandemic: Historical trends in drinking, contexts, and reasons for use among U.S. adults

Objective

The current study used U.S. national data to examine drinking trends prior to and during the COVID-19 pandemic in 2020, focusing on changes in U.S. young- and middle-adult alcohol prevalence, frequency, and drinking contexts and reasons, and whether they differed by age and college status.

Methods

Data from 2015 to 2020 from 16,987 young adults (ages 19–30) and 23,584 middle adults (ages 35–55) in the national Monitoring the Future study were used to model historical trends and potential 2020 shifts (data collection April 1 to November 30, 2020) in prevalence (30-day, daily, binge drinking) and frequency (30-day, binge drinking). For young adults, data on drinking contexts and negative affect reasons for drinking were examined. Moderation by age and college status was also tested.

Results

2020 was associated with (1) downward deviation in 30-day (young and middle adults) and binge drinking (young adults) prevalence; (2) upward deviation in daily drinking prevalence (middle adults); (3) among drinkers, upward deviation in frequency of 30-day (young and middle adults) and binge drinking (young adults); and (4) changes in drinking contexts and reasons among drinkers. Among college students, in particular, 2020 was associated with a downward deviation from expected historical trends in drinking prevalence. Upward deviations in daily prevalence and both binge and 30-day drinking frequency were stronger at ages 25–30 (vs. 19–24) and 35–45 (vs. 50–55).

Conclusions

Among U.S. young and middle adults, deviations from expected historical trends in population alcohol use that occurred during the pandemic included decreases in alcohol use prevalence, increases in alcohol use frequency, and increases in the use of alcohol to relax/relieve tension and because of boredom. These shifts were likely due, in part, to drinking while alone and at home—which increased during the pandemic.

The destabilization and destandardization of social roles across the adult life course: Considering aggregate social role instability and its variability from a historical-developmental perspective

Existing research focused on social role destabilization (historical increases in role instability) and destandardization (historical increases in variability of role instability) has primarily focused on discrete social roles during discrete periods of development. Building on this work, we applied a macro approach to elucidate the extent to which historical trends toward destabilization and destandardization are occurring at the aggregate among a key set of social roles (union formation, education, residential independence, and employment) and across the whole of adulthood. Applying a historical-developmental approach, we also document how historical trends toward destabilization and destandardization vary by age. We used 3 historical, longitudinal data sets: the Monitoring the Future study (N = 69,464; 55.4% women; 75.5% white), the Panel Study of Income Dynamics (N = 45,001; 51.4% women; 54.3% white), and The Health and Retirement Study (N = 30,913; 53.6% women; 75.6% white) that collectively cover the entire adult life course and over a century of U.S. birth cohorts. We found that aggregate destabilization and destandardization have occurred across the entirety of adulthood, although trends appear more pronounced at either end of the adult life course and the specific roles driving both trends vary across the adult life course. Findings were robust for educational attainment, and destabilization and destandardization were more pronounced among women. Findings highlight the importance of considering social role changes at the aggregate and singularly, and the need to evaluate social role changes in any 1 period of adulthood in conjunction with those occurring in other periods of adulthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Exploring the role of social capital, self-efficacy and social contagion in shaping lifestyle and mental health among students representing the future healthcare workforce in Palestine: social cohort study protocol

INTRODUCTION

Non-communicable diseases (NCDs) and depression form an unhealthy mix. The project focuses on potentially effective psychosocial factors shaping health-related habits and mental health. The study is conducted among health domain students. Understanding what shapes their health will determine their quality of care. The study is implemented at An-Najah National University in Palestine. This zone of continuous conflict psychological stress is high and mental health problems are stigmatised.

METHODS AND ANALYSIS

Students who are enrolled in second and third year will be invited to fill in a baseline and two follow-up online questionnaires. The questionnaires will assess: health behaviours and outcomes (health-related habits, obesity and mental health), main predictors (social capital, social network, self-efficacy), confounders (general and sociodemographic characteristics) and effect modifiers (sense of coherence (SOC) and family SOC). Friendships within participating students will be identified by allowing students to name their friends from a pull-down menu of all students. Descriptive statistics and scores will describe participant's characteristics. The relationship between health behaviour, outcomes and main predictors will be examined by regression and structural equation models. Clustering of health behaviours and outcomes will be assessed by permutation tests. Their spread within the network of friends will be investigated by longitudinal generalised estimating equations.

DISCUSSION

The study will identify the prevalence of NCD-related health habits and mental health aspects in the future healthcare workforce in Palestine. It will be the first study to address the role of psychosocial factors for the targeted students. It has the potential to identify targets for promoting physical and mental health among these future professionals.

ETHICS AND DISSEMINATION

Ethical approval was obtained from Ethikkommission Nordwest- und Zentralschweiz (EKNZ) in Switzerland and the Institutional Review Board Committee (IRBC) in Palestine. Participation in the study is voluntary and requires informed consent. The data management methodology ensures the confidentiality of the data. The outcomes of the study will be published as scientific papers. In addition, it will be presented in stakeholder conferences and to students at An-Najah National University.

Cohort effects on gender differences in alcohol use in the United States: How much is explained by changing attitudes towards women and gendered roles?

Gender differences in binge drinking have converged in recent cohorts, due in part to faster decreases in consumption among boys in adolescence, and faster increases in consumption among women in young to middle adulthood. Changes in education and occupation explain a portion, but not all, of these differences; the present study examines how attitudes about gender, religion and family additionally explain cohort effects in binge drinking by sex. Data were drawn from the Monitoring the Future panel studies, including >54,000 participants who were high school seniors from 1976 through 2006, followed to age 29/30 from 1988 through 2016. The main effect relationship between cohort and binge drinking was assessed, and 28 items on gender, religion and family were evaluated to determine if mediation criteria were met; mediation models assessed direct and indirect effects. Results indicated that gender, religion and family attitudes and beliefs among US adults across the 20 th and 21 st centuries have shifted dramatically but not monotonically. US adolescents and adults have largely become less religious; some attitudes on women and family have become less conservative and some more. Among men, views on marriage showed the largest mediation effects; agreeing with the statement 'one partner is too restrictive' mediated 3.35% of the cohort effect (95% C.I. 2.42, 4.31) and 'couples should live together before they are married' mediated 1.6% of the cohort effect (95% C.I. -2.37, -0.8). Among women, declines in religious service attendance mediated 2.0% of cohort effects in binge drinking (95% C.I. -3.03, -1.09), as well as similar family attitudes as men. In conclusion, changes in social roles, as well as some gender, and religious views, partially mediate cohort effects on binge drinking for men and women. The dynamic changes in how adolescents and adults view family and gender are important components of alcohol epidemiology.

When does attrition lead to biased estimates of alcohol consumption? Bias analysis for loss to follow-up in 30 longitudinal cohorts

OBJECTIVES

Survey nonresponse has increased across decades, making the amount of attrition a focus in generating inferences from longitudinal data. Use of inverse probability weights [IPWs] and other statistical approaches are common, but residual bias remains a threat. Quantitative bias analysis for nonrandom attrition as an adjunct to IPW may yield more robust inference.

METHODS

Data were drawn from the Monitoring the Future panel studies [twelfth grade, base-year: 1976-2005; age 29/30 follow-up: 1987-2017, N = 73,298]. We then applied IPW imputation in increasing percentages, assuming varying risk differences [RDs] among nonresponders. Measurements included past-two-week binge drinking at base-year and every follow-up. Demographic and other correlates of binge drinking contributed to IPW estimation.

RESULTS

Attrition increased: 31.14%, base-year 1976; 61.33%, base-year 2005. The magnitude of bias depended not on attrition rate but on prevalence of binge drinking and RD among nonrespondents. The probable range of binge drinking among nonresponders was 12-45%. In every scenario, base-year and follow-up binge drinking were associated. The likely range of true RDs was 0.14 [95% CI: 0.11-0.17] to 0.28 [95% CI: 0.25-0.31].

CONCLUSIONS

When attrition is present, the amount of attrition alone is insufficient to understand contribution to effect estimates. We recommend including bias analysis in longitudinal analyses.