Depression and alcohol misuse among older adults: exploring mechanisms and policy impacts using agent-based modelling

Investigating the impacts of alcohol outlet zoning policy on alcohol consumption and access to non-alcoholic services: A spatial agent-based simulation

Debates continue over the effectiveness of limiting alcohol outlet density in reducing alcohol consumption, and its broader impacts on access to non-alcoholic services in low-income urban communities remain underexplored. This study addresses this gap by investigating the impacts of alcohol outlet zoning policies on alcohol consumption and walkable access to non-alcoholic services in low-income urban communities with different baseline densities of liquor and grocery stores. We developed a spatial agent-based model of Baltimore City neighborhoods, simulating the closure of non-conforming liquor stores following the city's zoning code rewrite. The model was calibrated using national survey data and empirical research on alcohol consumption and walkable access to alcohol, food, lottery, and ATM outlets by subgroups. We observed non-linear relationships and differences by gender and employment status in the effects of liquor store closures on heavy drinking, with policies showing limited effectiveness in neighborhoods with high baseline liquor store density. While the policies had minimal impact on access to food and ATMs due to high prevalence of grocery stores, they reduced access to lottery services. Our modeling approach serves as a valuable decision-making tool for policymakers to explore hypothetical scenarios, identify tipping points of policy impacts, and provide actionable insights into the complex interactions between zoning policies and neighborhood dynamics concerning alcohol consumption and access to essential goods and services.

Addictive behaviors in older adults: The role of psychopathological symptoms, health, purpose in life, and loneliness

BACKGROUND AND OBJETIVES

This study explored addictive behaviors, including both substance use and behavioral addictions. Specifically, we examined the predictive role of psychopathological symptoms, health, loneliness, and purpose in life in addictive behaviors, as well as analyzing gender differences in the variables studied.

METHOD

The sample comprises 100 individuals over 60 (Mage=69.1; SD=6.7; 52% men). Multiple linear regression analyses were conducted to examine predictors of addictive behaviors, and t-tests to analyze gender differences.

RESULTS

Psychopathological symptoms were identified as a risk factor for problematic alcohol and substance use (β between -.392 and .877). Additionally, psychopathological symptoms (β between .314 and .432) and mental health were both significant predictors of compulsive buying (β=-.579). Women exhibited higher scores in psychopathological symptoms (p≤.015), while men showed higher levels of physical and mental health (p≤.022).

CONCLUSION

Understanding the risk factors associated with addictive behaviors in older adults is crucial to increasing public awareness of these problems and to improving early detection and effective management of addictions in this demographic group.

College Student Alcohol Use: Understanding the Role of Alcohol Expectancies, Social Anxiety, Social Connectedness, and Need to Belong

ObjectiveCollege students consume more alcohol and engage in binge drinking more frequently than their non-college attending peers, and prevalence of alcohol-related consequences (e.g., drinking and driving; taking avoidable risks) has not decreased proportionally with decreases in consumption. Social anxiety and alcohol expectancies, or beliefs about the effects of alcohol, have been found to be significantly related to alcohol use and account for significant variance in alcohol use and related consequences. Few studies, however, have examined how other social variables such as need to belong and social connectedness may fit into existing models of increased and risky alcohol use. Methods: Students at a large state university (n = 1,278) completed an online survey measuring alcohol expectancies, need to belong, social anxiety, and social connectedness. Mean age of participants was 19.65 years, and 59.5% self-identified as female, 39.8% male, and 0.7% identified as transgender. Structural equation modeling supported hypothesized relationships between need to belong, social anxiety, social connectedness, alcohol expectancies, and alcohol use, a mean centered variable that included binge drinking, drinking frequency, and amount of consumption. Results: Positive alcohol expectancies related to tension reduction, sociability, and sexuality, were positively related to drinking, such that increased alcohol expectancies were associated with increased drinking. Alcohol expectancies mediated the relationship between need to belong and increased alcohol use, as well as social connectedness and increased alcohol use. Similarly, social anxiety also mediated these relationships. No direct relationships were found between need to belong or social connectedness and alcohol use, suggesting previous research exploring these relationships may have excluded control variables (e.g., biological sex, race/ethnicity) that better explain the impact of need to belong and social connectedness on alcohol use. Conclusion: Prevention and intervention efforts might be more effective in reducing alcohol use if social factors are more broadly targeted.

Applying a complex systems perspective to alcohol consumption and the prevention of alcohol-related harms in the 21st century: a scoping review

BACKGROUND AND AIMS

A complex systems perspective has been advocated to explore multi-faceted factors influencing public health issues, including alcohol consumption and associated harms. This scoping review aimed to identify studies that applied a complex systems perspective to alcohol consumption and the prevention of alcohol-related harms in order to summarize their characteristics and identify evidence gaps.

METHODS

Studies published between January 2000 and September 2020 in English were located by searching for terms synonymous with 'complex systems' and 'alcohol' in the Scopus, MEDLINE, Web of Science and Embase databases, and through handsearching and reference screening of included studies. Data were extracted on each study's aim, country, population, alcohol topic, system levels, funding, theory, methods, data sources, time-frames, system modifications and type of findings produced.

RESULTS

Eighty-seven individual studies and three systematic reviews were identified, the majority of which were conducted in the United States or Australia in the general population, university students or adolescents. Studies explored types and patterns of consumption behaviour and the local environments in which alcohol is consumed. Most studies focused on individual and local interactions and influences, with fewer examples exploring the relationships between these and regional, national and international subsystems. The body of literature is methodologically diverse and includes theory-led approaches, dynamic simulation models and social network analyses. The systematic reviews focused on primary network studies.

CONCLUSIONS

The use of a complex systems perspective has provided a variety of ways of conceptualizing and analyzing alcohol use and harm prevention efforts, but its focus ultimately has remained on predominantly individual- and/or local-level systems. A complex systems perspective represents an opportunity to address this gap by also considering the vertical dimensions that constrain, shape and influence alcohol consumption and related harms, but the literature to date has not fully captured this potential.

Ältere, einsame Männer mit Alkoholabhängigkeit: Systematische Literaturrecherche zum aktuellen Stand der alters- und geschlechtsspezifischen Interventionen

Der Kenntnisstand zu Prävalenzen und Krankheitsverläufen älterer, einsamer Männer, die an Alkoholstörungen leiden, ist immer noch sehr gering und damit auch das Hilfeangebot. Die vorliegende systematische Literaturrecherche identifiziert die Risikofaktoren dieser Zielgruppe, den aktuellen Wissensstand über Alkoholkonsum bei älteren, einsamen Männern sowie den aktuellen Interventionsstand. Hierfür wurden nach einem umfangreichen Suchlauf 43 einschlägige Literaturquellen zum Thema Alkohol im Alter, Einsamkeit und Interventionen einbezogen. Eindeutiges Ergebnis ist, dass es wenige alters- oder geschlechtsspezifische Suchthilfeprogramme für Männer insgesamt gibt und keines, welches sich spezifisch auf ältere und einsame Männer ausrichtet. Einsamkeit wird in den Studien zwar hin und wieder als Problem bei Suchtkranken beschrieben, aber nicht explizit untersucht. Es wurde daher ein innovatives Interventionskonzept, das auf diese Gruppe zugeschnitten ist, entwickelt. Das Programm „Viktor“ bezieht sich auf diese Problematik und bietet ein spezifisches Angebot für Männer ab 55 Jahren mit einer Alkohol- und Einsamkeitsproblematik an.

Alcohol and public mental health for older people: 20 years of UK policy change

Purpose

The purpose of this paper is to detail developments in UK alcohol policy for older people over the past 20 years, based on evidence for a growing public health problem with alcohol misuse in older people.

Design/methodology/approach

A literature search was carried out using health and social care databases, including grey literature.

Findings

There has been considerable progress in areas such as screening and brief intervention, low-risk drinking and service provision for integrated care in older people with dual diagnosis.

Research limitations/implications

There remains a dearth of research and policy for older people with alcohol misuse and dual diagnosis prior to 2011. Although there remains limited empirical evidence for public health interventions to improve health outcomes from alcohol-related harm, improvements in population health from implementation of recent policy changes and intervention programmes remains to be seen.

Practical implications

This review has implications for best practice in the provision of integrated care to reduce harm and improve health and social outcomes in older people with alcohol misuse and dual diagnosis.

Originality/value

This review draws together a large area of research and policy on alcohol misuse in older people that has the potential to improve public mental health for older people who are at risk of alcohol-related harm.

Evaluating the Impact of Improving Access on Consumption of Fruits and Vegetables in a Rural Community in Texas: A Modeling Study

Purpose: Most residents in rural regions of the United States consume fewer amounts of fruits and vegetables (FVs) compared with their urban counterparts. Difficulties in access to FVs often contribute to different consumption patterns in rural regions, aside from a lack of education or motivation for eating healthy foods. This article uses simulation methods to estimate the relationship between increasing food access and FV consumption levels in a targeted rural community. Methods: An agent-based model previously developed to predict individual dietary behaviors was used. We adapted it to a rural community in west Texas following a two-step process. First, we validated the model with observed data. Second, we simulated the impact of increasing access on FV consumption. We estimated model parameters from the 2010 census and other sources. Results: We found that decreasing the driving distance to FV outlets would increase FV consumption in the community. For example, a one-mile decrease in driving distance to the nearest FV store could lead to an 8.9% increase in FV consumption; a five-mile decrease in driving distance could lead to a 25% increase in FV consumption in the community. We found that the highest marginal increase in FV consumption was when the driving distance decreased from 3.5 miles to 3 miles. Conclusions: Analysis to inform policy alternatives is a challenge in rural settings due to lack of data. This study highlights the potential of simulation modeling to inform and analyze policy alternatives in settings with scarce data. The findings from modeling can be used to evaluate alternative policies in addressing chronic diseases through dietary interventions in rural regions.