Associations between binge drinking frequency and tobacco use among young adults

Factors related to increased alcohol misuse by students compared to non-students during the first Covid-19 lockdown in France: the Confins study

BACKGROUND

The closure of bars and lockdowns related to the Covid-19 pandemic changed alcohol use levels in France during the spring of 2020. We wondered whether this sudden cessation of social interactions impacted students more than non-students and what factors specific to students would explain the increase in alcohol misuse. The aims of this study were to compare self-reported changes in alcohol misuse (alcohol intake and binge-drinking frequency) during the first Covid-19 lockdown from March 17 to May 10, 2020, between French students and non-students and describe factors associated with this alcohol misuse in each subgroup.

METHODS

Data collected in the Confins study from April 8 to May 10, 2020, were used in cross-sectional analyses stratified by student status. Multiple logistic regression was performed to estimate the association between self-reported increase in alcohol intake or binge-drinking frequency (at least six drinks of alcohol on one occasion) and demographic, socioeconomic, and clinical factors, as well as conditions associated with the Covid-19 pandemic. The population-attributable fraction was then used to estimate the contribution of identified risk factors to increased alcohol misuse in students and non-students.

RESULTS

Among both students and non-students, a self-reported decrease or no change in alcohol intake or binge-drinking was more common than an increase. However, the risk factors explaining an increase in alcohol intake differed among students (≥ 25 years old, not working or studying in the health field, and having suicidal ideation during the last 7 days) and non-students (having a medical diagnosis of mental disorders). The risk factors explaining an increase in binge-drinking frequency were similar in the two subgroups (being a tobacco smoker before lockdown and not practicing any physical activity during the last 7 days), except suicidal thoughts, which was a risk factor for alcohol misuse specific to students.

CONCLUSIONS

These results highlight the vulnerability of certain French students to alcohol misuse and the necessity of combining both mental health and substance use-related screening in the student population.

Temporal associations linking alcohol and cannabis use to cigarette smoking in young adults engaged in a tobacco cessation and relapse monitoring study

Young adulthood remains a developmental period in which cigarette smoking initiation and progression to dependence and regular use is common. Moreover, co-use of alcohol and/or cannabis with tobacco is common in this age group and may have detrimental effects on tobacco use rates and cessation outcomes. Although young adults are interested in quitting smoking, achieving abstinence remains difficult, even with evidence-based treatment strategies. Understanding proximal associations between other substance use (e.g., alcohol and cannabis) and smoking may have important treatment implications. This exploratory analysis investigated the role of alcohol and/or cannabis use in contributing to smoking events on the same day or next day among young adults engaged in a smoking cessation and relapse monitoring study. We used ecological momentary assessment (EMA) data from 43 young adults (ages 18-25; 932 observations) who smoked cigarettes daily and agreed to participate in a 5-week study that included a 2-day smoking quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence (incentives were provided only during the 2-day quit attempt). We tested multilevel time-series models of daily associations between alcohol use, cannabis use, and smoking. Consistent with hypotheses, days on which participants were more likely to drink alcohol predicted increased likelihood of smoking the next day (OR = 2.27, p =.003). This effect was significant after controlling for both the one-day lagged effect of smoking (i.e., autoregression) and the concurrent (i.e., same day) effects of drinking and cannabis use. Although there was a positive concurrent effect of cannabis use on smoking (OR = 12.86, p =.003), the one-day lagged effect of cannabis use and the concurrent effect of drinking was not significant, contrary to hypotheses. Results indicate that alcohol use presents a potential threat to successful smoking cessation that extends to the following day. This suggests a risk-window in which treatment could be supplemented with just-in-time interventions and extending the focus on co-use to include this lagged impact on cessation outcomes.

Associations of daily alcohol, cannabis, combustible tobacco, and e-cigarette use with same-day co-use and poly-use of the other substances

BACKGROUND

Young adults frequently use alcohol, cannabis, and tobacco together. Given the increased prevalence of e-cigarette use and recreational cannabis use, we investigated daily patterns of alcohol, cannabis, and tobacco use and distinguished combustible tobacco from e-cigarettes.

METHODS

Young adult college students (N=341) reporting past-month alcohol and cannabis use "at the same time so that their effects overlapped" completed two 28-day bursts of repeated daily surveys. Exposures were day- and person-level use of each substance. Outcomes were (1) same-day co-use of each remaining substance or (2) poly-use of the other substances.

RESULTS

Daily use of alcohol, cannabis, combustible cigarettes, and e-cigarettes increased the odds of same-day co-use of the other substances (except combustible tobacco with e-cigarettes) and each poly-use outcome. The influence of person-level substance use on daily substance use was less consistent. Only e-cigarette use increased the odds of daily alcohol use. Use of either tobacco product but not alcohol increased the odds of daily cannabis use. Person-level alcohol and cannabis use increased the odds of daily use of either tobacco product but use of one tobacco product was not associated with daily use of the other product.

CONCLUSIONS

These findings increase our understanding of emerging daily patterns of alcohol, cannabis, and tobacco co-use, and the impact of different tobacco products. Future work is needed to extend this research into non-college samples and people who use tobacco but do not use alcohol and cannabis simultaneously, and examine daily chronologies of multiple substances that could serve as dynamic markers of risk.

A Bayesian mixed effects support vector machine for learning and predicting daily substance use disorder patterns

Background: Substance use disorder (SUD) is a heterogeneous disorder. Adapting machine learning algorithms to allow for the parsing of intrapersonal and interpersonal heterogeneity in meaningful ways may accelerate the discovery and implementation of clinically actionable interventions in SUD research.Objectives: Inspired by a study of heavy drinkers that collected daily drinking and substance use (ABQ DrinQ), we develop tools to estimate subject-specific risk trajectories of heavy drinking; estimate and perform inference on patient characteristics and time-varying covariates; and present results in easy-to-use Jupyter notebooks. Methods: We recast support vector machines (SVMs) into a Bayesian model extended to handle mixed effects. We then apply these methods to ABQ DrinQ to model alcohol use patterns. ABQ DrinQ consists of 190 heavy drinkers (44% female) with 109,580 daily observations. Results: We identified male gender (point estimate; 95% credible interval: -0.25;-0.29,-0.21), older age (-0.03;-0.03,-0.03), and time varying usage of nicotine (1.68;1.62,1.73), cannabis (0.05;0.03,0.07), and other drugs (1.16;1.01,1.35) as statistically significant factors of heavy drinking behavior. By adopting random effects to capture the subject-specific longitudinal trajectories, the algorithm outperforms traditional SVM (classifies 84% of heavy drinking days correctly versus 73%). Conclusions: We developed a mixed effects variant of SVM and compare it to the traditional formulation, with an eye toward elucidating the importance of incorporating random effects to account for underlying heterogeneity in SUD data. These tools and examples are packaged into a repository for researchers to explore. Understanding patterns and risk of substance use could be used for developing individualized interventions.

Correlates of U.S. Young adults’ awareness of alcohol use as a behavioral risk factor for cancer

Although alcohol increases the risk of cancer, awareness of alcohol-related cancer risks is low. Alcohol use is prevalent among young adults, and understanding factors associated with awareness and perceptions of alcohol-related cancer risks in this group is critical for cancer prevention efforts. We examined the demographic, tobacco, and alcohol related correlates of young adults’ awareness and perceptions of alcohol as a behavioral risk factor for cancer. We completed a secondary analysis of data collected in February 2020 in the U.S. from 1,328 young adults (ages 18–30) who completed a cross-sectional online survey. Participants reported (1) awareness of alcohol as a risk factor for cancer and (2) perceived risks of serious disease such as cancer. We analyzed demographic characteristics, alcohol use, and tobacco use associated with these outcome variables using multivariable regression. Overall, 18.5% of participants believed that alcohol does not increase cancer risk. Perceived cancer risk associated with alcohol use was moderate (M 3.2, SD 1.6, 1–7 scale). In multivariable analysis, awareness of risk was significantly higher among those with higher socioeconomic status. Perceived risk was significantly greater among those with higher socioeconomic status, higher alcohol consumption, and a history of tobacco use. These findings indicate research is warranted to better understand awareness of alcohol as a behavioral risk factor for cancer and associated beliefs in subgroups of young adults to help guide the development of interventions to raise awareness of the risks of cancer associated with alcohol use.

Factors associated with binge drinking-Findings from 2019 Kansas behavioral risk factor surveillance system

Background: In the U.S., excessive drinking accounts for one in 10 deaths among adults aged 20-64 years old. Binge drinking is a common form of excessive alcohol consumption that contributes to this chilling statistic. Binge drinking is defined as women consuming four or more drinks or men consuming five or more drinks within a 2-h time span. Examining existing data on risk factors for binge drinking can inform strategies to prevent this deadly practice. Methods: The 2019 Kansas Behavioral Risk Factor Surveillance System (BRFSS) dataset consists of data collected from 11,368 non-institutionalized adults aged 18 years and older with landline or cell phones. The dependent variable in this study was binge drinking status. The independent variables included several sociodemographic variables and risk factors. Data were analyzed using descriptive statistics, bivariate analysis, single logistic regression, and multivariable logistic regression. Results: In the population, 1,447 (17.4%) were reported to be binge drinkers. Significant factors associated with binge drinking in the final model included sex (aOR = 0.53 (0.45-0.63)), age (18-24 years old aOR = 8.77 (6.02-12.79); 25-34 years old aOR = 7.10 (5.35-9.42); 35-44 years old aOR = 6.23 (4.73-8.19); 45-54 years old aOR = 3.87 (2.92-5.14); and 55-64 years old aOR = 2.58 (1.96-3.38)), income ($15,000-$24,999 aOR = 1.00 (0.63-1.58); $25,000-$34,999 aOR = 1.61 (1.04-2.50); $35,000-$49,999 aOR = 1.69 (1.13-2.55); ≥$50,000 aOR = 1.97 (1.34-2.89)), smokeless tobacco use (aOR = 2.09 (1.55-2.82)), and smoking/e-cigarette use (Cigarette user only aOR = 2.11 (1.69-2.65); E-cigarette user only aOR = 2.67 (1.62-3.17); dual cigarette and e-cigarette user = 3.43 (2.21-5.33)). Conclusion: Developing interventions that take into account elevated risk for binge drinking amongst demographic characteristics (i.e., age, sex, income) and lifestyle factors (i.e., smokeless tobacco use, and smoking/e-cigarette use) is crucial to lowering morbidity and mortality related to this form of excessive alcohol consumption.

Is E-cigarette Use Associated With Persistence or Discontinuation of Combustible Cigarettes? A 24-Month Longitudinal Investigation in Young Adult Binge Drinkers

INTRODUCTION

It remains unclear whether electronic cigarette (e-cigarette) use promotes persistent combustible tobacco use or smoking discontinuation over time. Alcohol use is associated with a greater risk of adverse health effects of tobacco, and higher likelihood of e-cigarette use, making drinkers a high-priority subpopulation.

AIMS AND METHODS

This study examined longitudinal patterns of combustible tobacco and e-cigarette use over 24 months in young adult binge drinkers. A pooled dataset of 1002 (58.5% female; M age = 22.14) binge drinkers from the United States (60%) and Canada (40%) was used. The primary outcomes were past month combustible tobacco and e-cigarette use. Nicotine dependence was measured using the Fagerström Test of Cigarette Dependence. Alcohol severity was measured using the Young Adult Alcohol Consequences Questionnaire. Latent transition analysis (LTA) was used to identify patterns of cigarette smoking and e-cigarette use over 24 months.

RESULTS

The LTA yielded a four-class solution: (1) e-cigarettes-only users (prevalence over time: 7.75%-10.10%), (2) dual-product users (2.61%-9.89%), (3) combustible-only smokers (8.12%-20.70%), and (4) nonusers (61.66%-80.06%). Dual-product users predominantly transitioned to complete abstinence or exclusively e-cigarette use. In combustible-only smokers, the most common transition was to abstinence, followed by persistence of combustible-only status. At 24 months, 63% of e-cigarettes-only users transitioned to abstinence, with 37% continuing e-cigarettes-only use and 0% transitioning to dual or combustible cigarette use.

CONCLUSIONS

Dual-product use in young adult binge drinkers was associated with discontinuation of combustible tobacco over time, and e-cigarette-only use was not associated with subsequent combustible tobacco use.

IMPLICATIONS

These findings suggest that concurrent or exclusive e-cigarette use is not a risk factor for the persistence or development of combustible tobacco use in this subpopulation, with dual-product use reflecting a transitional pattern away from combustible use, toward discontinuation.

The association between current smoking and binge drinking among adults: A systematic review and meta-analysis of cross-sectional studies

BACKGROUND

The substantial increasing trend of binge drinking is a global alarm. Our aim was to undertake a systematic review and meta-analysis of cross-sectional studies to explore the association of current smoking with binge drinking among adults.

METHODS

We systematically searched Web of Knowledge; PubMed; Scopus; Embase and Ovid (MEDLINE, EMBASE, PsycARTICLES, PsycINFO, PsycEXTRA, and PsycTests) (from inception to 27 May 2020) databases to identify cross-sectional studies of the association between current smoking and binge drinking. Study screening, data extraction, and methodological quality assessment were all carried out by two independent authors. Adjusted odds ratio (AOR) was pooled with 95% confidence intervals (CI) using random effects model in the meta-analysis, followed by the investigation of the heterogeneity via Q-test and I ² statistic. We assessed publication bias using a funnel plot, the Egger's, and Begg's tests.

RESULTS

We identified 3,171 studies and included nine cross-sectional studies with 64,516 participants. A significant association was found between current smoking and binge drinking among both genders (AOR = 2.97; 95% CI = 1.98 to 4.45; I ² = 90.5%). Subgroup analysis showed that this association among women, men, Caucasians, and Asians/Africans were (AOR = 3.68; 95% CI = 1.03 to 13.18; I ² = 98.9%), (AOR = 2.53; 95% CI = 1.87 to 3.42; I ² = 73.1%), (AOR = 1.36; 95% CI: 1.01-1.83, I ² = 47.4%), and (AOR = 3.93; 95% CI: 2.99-5.17, I ² = 61.3%), respectively. There was no evidence of publication bias.

CONCLUSION

Current smoking is associated with binge drinking and can be used for identifying and screening binge drinkers. Moreover, this association is stronger among men, and Asians/Africans. This meta-analysis estimation was limited to English-language studies, and the full text of about 3.5% of reports for retrieval was not found, then generalization of the results should be done with caution.

An Association of Adverse Childhood Experiences with Binge Drinking in Adulthood: Findings from a Population-Based Study

Background: Adverse childhood experiences (ACEs) are a major public health issue linked to negative health outcomes. Yet, few recent studies drawing on national data have examined the association between ACEs and binge drinking. Objective: The objective of this study was to examine the association between ACEs and binge drinking among adults in the United States and whether this association is dependent on sex. Methods: Data for this study were obtained from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 41,322 adults aged 18-64 years (50.7% male) from 17 states was analyzed using binary logistic regression. The outcome variable was binge drinking, and the main explanatory variable was ACEs. Results: Of the 41,322 respondents, 21.3% engaged in binge drinking. About 30% of the respondents had no ACEs and 23.9% had four or more ACEs. In the multivariable logistic regression, we observed that sex moderated the association between ACEs and binge drinking. Odds were 1.36 times higher for females who experienced two ACEs (aOR = 1.36 p < .05, 95% CI = 1.04-1.77) and 1.58 times higher for females who experienced three ACEs (aOR = 1.58 p < .01, 95% CI = 1.17-2.12) to engage in binge drinking. Other factors associated with binge drinking include younger age, non-Hispanic White, higher income level, higher education, not being married, being overweight, and history of cigarette smoking. Conclusion: The findings of this study underscore the importance of developing sex-appropriate screening and intervention strategies to support individuals exposed to ACEs and potentially mitigate negative health outcomes later in life.

Students in Danger: Binge Drinking Behaviour and Associated Factors in Hungary

Introduction

Among young adults, high rates of binge drinking were observed in certain European countries. Binge drinking is associated with several health problems (unplanned pregnancy, HIV infections, problems with memory, and injuries). The aim of this questionnaire-based study was to measure the frequency of binge drinking and its association with sociodemographic, familial, lifestyle factors and school performance among secondary and university students (n=2449) in Csongrád County, Hungary.

Methods

In this cross-sectional study the students’ sociodemographic data, parents’ educational and economic level, and students’ academic performance and self-reported use of tobacco, drugs, and alcohol were collected by a questionnaire. Descriptive statistics and multivariable binary logistic regression analyses were applied using SPSS 24.0 software.

Results

Altogether 2449 Hungarian secondary school students and university students participated in the study. Nearly one-third of the students were classified as binge drinkers, significantly more male university students. Tobacco or illicit drug use resulted in higher odds of being a binge drinker in both subgroups. Poor school performance and binge drinking were significantly correlated especially among secondary school students.

Conclusions

Targeting alcohol, tobacco, and illicit drug use together, including education, parent interventions, and public health policies, are crucial in the prevention of possible serious consequences.

Cigarette use and binge drinking among Korean adolescents: examining the moderating role of multicultural status

Cigarette is usually used conjointly with alcohol however its impact may vary with how much alcohol is being consumed. Besides the general use of alcohol, this study specifically focused on identifying the association between cigarette use and binge drinking of Korean adolescents. Furthermore, it aims to testify whether the multicultural status plays a moderating role in this relationship, and to discover other problem behavior theory constructs that may be associated with binge drinking of the Korean adolescents. Using the nationally representative data from the 2018 Korea Youth Health Risk Survey, 60,040 students were selected to perform chi-square, t-test, and hierarchical multiple regression. There was a strong association between cigarette use and binge drinking, and multicultural status had the moderating effect in this relationship. More specifically, adolescents from the multicultural families had higher levels of cigarette use and binge drinking than the non-multicultural adolescents. Besides these main findings, covariates such as suicidal ideation, sexual intercourse, e-cigarette use, and harmful experiences from the alcohol use of others were found to be the additional significant factors of Korean adolescents' binge drinking. Based on these findings, author suggests for the combined interventions for alcohol and tobacco, and raise awareness on the possible health disparities that could occur between multicultural families and non-multicultural families in South Korea.

Why should we ask binge drinkers if they smoke cannabis? Additive effect of alcohol and cannabis use on college students' neuropsychological performance

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This study focused on combined binge drinking and cannabis use in college students.

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Cannabis use and binge drinking had an additive effect on cognition.

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This consumption pattern contributed to memory and executive impairments.

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Binge drinkers had a heterogeneous cognitive profile regardless of cannabis use.

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Cannabis use should be assessed in binge drinkers to adapt prevention strategies.

Introduction

Binge drinking (BD) and cannabis use are prevalent in European adolescents and students. BD has been shown to have a negative impact on neuropsychological functioning, but little is known about the additive effect when it is combined with cannabis consumption. We therefore investigated the neuropsychological profiles of students who engage in combined BD and cannabis use, in order to explore the potentially harmful additive effects of cannabis use and BD on cognition.

Material and methods

A sample of college students (N = 298) completed questionnaires on alcohol and cannabis use, and were screened for neuropsychological impairments using the Brief Evaluation of Alcohol-Related Neuropsychological Impairments (BEARNI). First, after dividing students into three groups according to their alcohol and cannabis use (i.e., light drinkers, binge drinkers, and binge drinkers consuming cannabis), we ran a linear mixed model based on the BEARNI z scores to test the performances of the three groups. Information yielded by the mixed model was supplemented by individual analyses. Second, to explore the heterogeneity of binge drinkers’ profiles, we ran a cluster analysis to characterize the alcohol users at higher risk of more severe neuropsychological impairment.

Results

Overall, poorer neuropsychological performances were observed among binge drinkers compared with light drinkers, whether they used cannabis or not. However, flexibility, episodic memory and working memory were particularly affected among binge drinkers who used cannabis.

Conclusions

Results emphasize the importance of asking binge drinkers if they smoke cannabis, in order to adapt care and prevention strategies to their consumption and neuropsychological profile.

Bar Atmospherics and Smoking: A Qualitative Analysis of New Zealand Young Adult Smokers

INTRODUCTION

Smoking among young adults is often associated with social contexts and alcohol use. Although many countries, including New Zealand, have prohibited smoking inside licensed premises, outdoor areas have enabled smoking and alcohol co-use to persist. We examined whether and how outdoor bar areas facilitate and normalize young adult smoking and explored potential policy implications.

METHODS

We conducted in-depth interviews with 22 young adults who had recently smoked in a New Zealand bar or nightclub and investigated how physical design attributes (atmospherics) influenced experiences of smoking in outside bar settings. We used qualitative description to identify recurring accounts of the outdoor bar environment and thematic analysis to explore how participants experienced the bar in relation to smoking.

RESULTS

Participants valued outdoor smoking areas that were comfortable and relaxing, and saw attributes such as seating, tables, heating, protection from inclement weather, and minimal crowding, as important. We identified four themes; these explained how participants used smoking to gain respite and make social connections, showed how bar settings enabled them to manage smoking's stigma, and identified potential policy measures that would decouple smoking and alcohol co-use.

CONCLUSIONS

Evidence bar environments facilitate and normalize smoking among young adults questions whether smokefree policies should be expanded to include all bar areas. Introducing more comprehensive smokefree outdoor policies could reduce the influence of design attributes that foster smoking while also reframing smoking as outside normal social practice.

IMPLICATIONS

Bar environments contain many stimuli that cue and reinforce smoking and integrate smoking into social experiences. Expanding smokefree bar settings to include outdoor areas would reduce exposure to these stimuli, decrease opportunities for casual smoking, help maintain young people's smokefree status, and support longer-term goals of sustained reductions in smoking prevalence.

Tobacco/nicotine and marijuana co-use motives in young adults: Associations with substance use behaviors one year later

Co-administration of tobacco/nicotine and marijuana (e.g., using both products on the same occasion by mixing them in the same delivery device) is a risky, yet common, form of co-use among young adults. Understanding motivations for co-administration co-use, and how these are associated with subsequent use and related problems, is needed to inform policy, prevention, and intervention efforts. We conducted a latent class analysis on 342 young adults with past-year co-administration of tobacco/nicotine and marijuana to determine how emergent classes of 16 co-use motives were associated with use and co-administration co-use of tobacco/nicotine and marijuana one year later. Four classes emerged: (1) a high all class that reported high endorsement of all motives, (2) a high coping class that reported high endorsement of co-use due to coping with stress and bad moods, (3) a high social/physiological reinforcement class that reported low endorsement of coping but high probability of social and relaxation motives and motives to even out effects of each substance, and (4) a low all class that reported low endorsement of all motives. The high all and high coping classes reported greater frequency and quantity of single substance use and co-administration. The high coping class reported more marijuana consequences than the low all class. The high all and high coping classes reported younger age of initiation of each individual substance and co-administration. Considering co-use motives may be useful in identifying those at highest risk for future use and consequences and tailoring interventions to the distinct needs of co-use subgroups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perceived reward from using cigarettes with alcohol or cannabis and concurrent use: A smartphone-based daily diary study

INTRODUCTION

Smoking cigarettes under the influence of alcohol or cannabis is associated with perceived pleasure. However, it is unclear whether these changes in perceived reward impact the extent of concurrent use of cigarettes with alcohol or cannabis. The current study investigated if self-reported changes in perceived reward from concurrent use of cigarettes with alcohol or cannabis are related to the extent of concurrent use in real-world contexts using a smartphone-based Ecological Momentary Assessment (EMA) study.

METHODS

The sample included 126 diverse young adult smokers in the San Francisco Bay Area who reported current alcohol or cannabis use at baseline (M = 22.8 years, 50.8% male, 40.5% sexual minority, 39.7% Non-Hispanic White). Participants completed an online baseline survey and 30 days of smartphone-based daily EMA surveys of cigarette, alcohol, and cannabis use. The baseline assessed self-reported changes in perceived pleasure of smoking cigarettes while using alcohol or cannabis separately. EMA surveys included detailed questions about concurrent use (i.e., the extent of smoking while using another substance) covering the previous day. A total of 2,600 daily assessments were analyzed using mixed models.

RESULTS

Higher perceived pleasure from smoking cigarettes while drinking alcohol or using cannabis at baseline were both associated with a greater extent of concurrent use of cigarettes with alcohol (b = 0.140; SE = 0.066; t = 2.1; p = .035) and cannabis (b = 0.136; SE = 0.058; t = 2.4; p = .019) on a given day.

CONCLUSIONS

Results suggest that perceived reward from concurrently using cigarettes with alcohol or cannabis is associated with the extent of concurrent use. Findings can inform tailored smoking cessation interventions.

A Facebook intervention to address cigarette smoking and heavy episodic drinking: A pilot randomized controlled trial

BACKGROUND

Co-occurrence of tobacco use and heavy episodic drinking (HED; 5+ drinks for men and 4+ drinks for women per occasion) is common among young adults; both warrant attention and intervention. In a two-group randomized pilot trial, we investigated whether a Facebook-based smoking cessation intervention addressing both alcohol and tobacco use would increase smoking abstinence and reduce HED compared to a similar intervention addressing only tobacco.

METHODS

Participants were 179 young adults (age 18-25; 49.7% male; 80.4% non-Hispanic white) recruited from Facebook and Instagram who reported smoking 4+ days/week and past-month HED. The Smoking Tobacco and Drinking (STAND) intervention (N = 84) and the Tobacco Status Project (TSP), a tobacco-only intervention (N = 95), both included daily Facebook posts for 90 days and weekly live counseling sessions in private "secret" groups. We verified self-reported 7-day smoking abstinence via remote salivary cotinine tests at 3, 6, and 12 months (with retention at 83%, 66%, and 84%, respectively). Participants self-reported alcohol use.

RESULTS

At baseline, the participants averaged 10.4 cigarettes per day (SD = 6.9) and 8.9 HED occasions in the past month (SD = 8.1), with 27.4% in a preparation stage of change for quitting smoking cigarettes. Participants reported significant improvements in cigarette smoking and alcohol use outcomes over time, with no significant differences by condition. At 12 months, intent-to-treat smoking abstinence rates were 3.5% in STAND vs. 0% in TSP (biochemically verified) and 29.4% in STAND vs. 25.5% in TSP (self-reported). Compared to TSP, participants rated the STAND intervention more favorably for supporting health and providing useful information.

CONCLUSIONS

Adding an alcohol treatment component to a tobacco cessation social media intervention was acceptable and engaging but did not result in significant differences by treatment condition in smoking or alcohol use outcomes. Participants in both conditions reported smoking and drinking less over time, suggesting covariation in behavioral changes.

Correlates of Alcohol Consumption Among a Socially-Disadvantaged Population in Poland

Alcohol consumption at a level exceeding existing recommendations is one of the leading risk factors for death and disability worldwide. The aim of the study was to identify correlates of alcohol drinking among a socially-disadvantaged population in Poland. The cross-sectional study covered 1644 adult social assistance beneficiaries from the Piotrkowski district (rural area in central Poland). A detailed questionnaire filled in during a face-to-face interview allowed for the collection of socio-demographic, lifestyle-related (including alcohol consumption) and health status data. About 42% of the participants, including 67% of the men and 30% of the women, exceeded the recommended level of alcohol consumption. In the adjusted model, the men tended not to follow recommendations for alcohol consumption more frequently than the women (OR = 4.5, p < 0.001). The higher odds of not following alcohol-related recommendations were also observed for the subjects declaring having a permanent or temporary job compared to the unemployed participants (OR = 1.2, p = 0.04). A lower healthy lifestyle index (indicating an unhealthy lifestyle related to a diet, body mass index (BMI), physical activity, and tobacco smoking) was associated with not following recommendations for alcohol consumption (OR = 1.1, p = 0.04). Our study indicates that being men, having a permanent or a temporary job, and coexistence of other unfavorable lifestyle-related factors are important correlates of not following recommendations for alcohol consumption among the beneficiaries of government welfare assistance.

Patterns of tobacco and alcohol misuse among presumptive TB Patients in Myanmar: prevalence and sociodemographic associations

This study aimed to assess the prevalence and patterns of tobacco and alcohol use and the associations with socio-demographic variables among presumptive TB patients. A cross-sectional study was conducted among 397 presumptive TB patients in a tertiary hospital in Myanmar. Global Adult Tobacco Survey (GATS) questionnaire and AUDIT-C were used to measure daily tobacco use (single, any or dual use of smoked and smokeless tobacco) and harmful alcohol use, respectively. Multiple and multinomial logistic regression were used to examine the associations with socio-demographic factors. The prevalence of daily use of dual tobacco and any tobacco was 28.2% and 65.7%, respectively. Harmful alcohol use was also high (44.8%). While single use of daily tobacco and harmful alcohol was 28.2% and 7.3%, respectively, concurrent tobacco and alcohol use was 37.5%. While being male and having low education were associated with tobacco use, concurrent tobacco and harmful alcohol use were associated with male gender, low education, and occupation with the government or a company. Due to the high prevalence of tobacco and alcohol misuse, identifying those at risk of tobacco and alcohol misuse and providing integrated care services in a health facility should be considered as a joint activity in national TB and tobacco control programmes.

Individual and Contextual Factors Associated With Hazardous Drinking in Spain: Evidence From a National Population-Based Study

BACKGROUND

Heavy drinking (HD) and binge drinking (BD) exhibit marked differences in their relationships with contextual-level factors imbedded in geographical areas of residence. The objective is to identify sociodemographic factors, both at the individual and at the contextual level, associated with these 2 main hazardous consumption patterns.

METHODS

Cross-sectional study using data from the 2011 to 2012 National Health Survey in Spain. The sample included 21,007 individuals ≥15 years of age. HD was defined as an alcohol intake of ≥40 g/d in men and ≥24 g/d in women. BD was defined as the consumption in the previous month of ≥6 alcoholic drinks (men) or ≥5 drinks (women) within 4 to 6 hours. Individual-level variables included sociodemographic factors, urban/rural residence, smoking, and perceived social support. Contextual-level variables covered percentage of population with no schooling, unemployment rate, and hospitality industry-related economic activity, all at the census tract level. We analyzed data using multilevel logistic regression and calculated areas under the curve (AUC).

RESULTS

Being male, smoking, high-income, and low perceived social support were associated with both hazardous drinking patterns. Younger individuals were at higher risk for BD but at lower risk for HD. BD was more common among rural than urban dwellers (odds ratios [OR] = 1.35; 95% CI: 1.05 to 1.72), whereas HD was less likely in participants residing in areas with high unemployment rates (OR = 0.62; 95% CI: 0.41 to 0.93). HD was more likely in census tracts with higher levels of hospitality industry activity (OR = 1.74; 95% CI: 1.20 to 2.54). The AUC increased substantially for both HD and BD when the census tract variable was entered in the respective models (reaching 89.5 and 93.3%, respectively).

CONCLUSIONS

Except for age, both drinking patterns have similar associations with individual-level variables but disparate links to contextual-level indicators. In both cases, accounting for area of residence substantially increased the ability to discriminate between high-risk drinkers from nonhazardous alcohol consumers.

Differential patterns of alcohol and nicotine intake: Combined alcohol and nicotine binge consumption behaviors in mice

Late adolescence and young adulthood, corresponding to the high school and college years, are vulnerable periods for increased alcohol and nicotine use. The dramatic increase in the prevalence of electronic cigarette use is particularly concerning in these age groups. Late adolescents and young adults are more likely to engage in cycles of binge drug consumption, and alcohol and nicotine are frequently used together. However, there are few data examining the combination of alcohol and nicotine in binge models in animal models. In this study, our objectives were to determine how voluntary nicotine consumption beginning in late adolescence influenced subsequent binge alcohol consumption in young adulthood, how a combination of alcohol and nicotine binge consumption differed from alcohol-only binge consumption, and whether nicotine would be consumed when presented in a binge procedure. Male C57BL/6J mice voluntarily consumed unsweetened alcohol and nicotine in continuous-access bottle-choice procedures in combination with cycles of drinking-in-the-dark. Our results show that experience with voluntary nicotine consumption in late adolescence did not affect subsequent binge alcohol consumption in early adulthood. However, mice that consumed nicotine in adolescence showed an initial decrease in alcohol preference, and consequently increase in nicotine preference, on the first session of combined ethanol and nicotine binge consumption in adulthood compared with mice that drank only water during late adolescence. Lastly, we found that mice readily consumed unsweetened nicotine when presented in a binge procedure, and the level of consumption exceeded the nicotine consumption observed in the combination alcohol and nicotine binge. Our data show that expansion of the patterns of alcohol and nicotine co-consumption in a mouse models is possible, which will enable us to dissect relevant molecular targets underlying these consumption patterns and better inform drug development efforts.

Substance use among Latino international and domestic college students

While the United States hosts the greatest number of international students in the world, Latino international students remain understudied, especially in regards to substance use. The present study tests differences between Latino international and Latino domestic undergraduates in how they use alcohol, cigarette, and illicit drugs. Participants (N = 786 students, 386 international and 400 domestic, 65% female, mean age = 21.2 years) were a subsample of Latino students surveyed in the 2009 American College Health Association's revised National College Health Assessment (ACHA-NCHA II). Results indicate that Latino international students reported more alcohol use than Latino domestic students, but had similar use of cigarettes and illicit drugs. Among international students, gender, participation in Greek life, cigarette use, marijuana use, and year in school were associated with alcohol use. Similarly, gender, cigarette use, and marijuana use were significantly related to international students' binge drinking. Prevention and research implications are discussed.

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.

Naltrexone and alcohol effects on craving for cigarettes in heavy drinking smokers

Naltrexone has been extensively studied for the treatment of alcohol use disorder. However, less is known about the effects of naltrexone on smoking outcomes in the context of alcohol use among East Asian individuals who have been suggested to differ in response to alcohol and to naltrexone. The present study is a secondary analysis that used a double-blind placebo-controlled design (n = 31) to examine the (a) effects of alcohol on basal craving for cigarettes, (b) effects of naltrexone on cigarette craving and alcohol craving during alcohol administration, and (c) relationship between craving for alcohol and cigarettes. Heavy drinking smokers of East Asian descent completed two counterbalanced intravenous alcohol administration sessions, one after taking naltrexone (50 mg) for five days and one after taking a placebo for five days. Self-reported subjective craving for cigarettes and for alcohol was recorded during each experimental session. Craving for cigarettes and alcohol increased significantly throughout the intravenous alcohol administration. A significant breath alcohol concentration (BrAC) × Medication interaction revealed that naltrexone blunted cigarette craving during alcohol administration, compared to placebo. Naltrexone significantly reduced craving for alcohol during alcohol administration in this group of heavy drinking smokers. Alcohol craving significantly predicted cigarette craving, however this effect did not vary across rising alcohol administration or by medication. These findings demonstrate that naltrexone reduces the urge to smoke and to drink during alcohol administration. Clinical studies are needed to further ascertain whether naltrexone may be of benefit to this distinct subgroup of heavy drinking smokers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Development of a social media-based intervention targeting tobacco use and heavy episodic drinking in young adults

Background

Tobacco use and heavy episodic drinking (HED) commonly co-occur in young adults. We developed and tested usability of the Smoking Tobacco and Drinking (STAND) intervention for young adults delivered on Facebook.

Methods

To inform the intervention, focus groups were held with 25 young adults age 18 to 25 (12% female; Mean age = 20.4) who smoked cigarettes and reported at least one HED episode in the past month. Facebook intervention posts (N = 180) were tailored to readiness to quit smoking, and tested in two private Facebook behavioral change groups (Ready, Not Ready) with N = 29 young adults (10% female; Mean age = 20.8). Participants flagged posts in need of change, and we assessed engagement (comment frequency).

Results

Focus groups revealed preference for changing one substance at a time and greater receptivity to quitting smoking than reducing drinking. Mean comments per post were 5.3 (SD = 1.1) in Ready groups and 11.7 (SD = 5.1) in Not Ready groups; 94/180 (52.2%) posts were flagged for change. The level of engagement and the flagging of posts for change did not differ by group or by whether the post targeted tobacco, alcohol, or both substances combined (all p > .10). Overall, STAND was rated as easy to understand, providing sound advice, worthy of recommendation, and helpful (all agreement 100% among Ready; 50–70% among Not Ready).

Conclusions

The current findings informed development of a social media-based intervention targeting tobacco and alcohol use in young adults. Although there was greater interest in making changes in smoking than drinking behavior, receptivity and acceptability of the Facebook post messages in the STAND intervention was high overall. The intervention is being further refined for evaluation in a larger trial.

Trial registrationName of the registry Smoking Tobacco and Drinking Study (STAND); Trial registration number NCT03163303; Date of registration 5/23/17; URL of trial registry recordhttps://clinicaltrials.gov/ct2/show/NCT03163303.

Electronic supplementary material

The online version of this article (10.1186/s13722-019-0141-9) contains supplementary material, which is available to authorized users.

The Effectiveness of Internet- and Field-Based Methods to Recruit Young Adults Who Use Prescription Opioids Nonmedically

BACKGROUND

Nonmedical prescription opioid (NMPO) use is a problem among young adults, yet young NMPO users are a diverse population that has been challenging to engage in overdose prevention and harm reduction programs.

OBJECTIVES

This study compared the effectiveness and characteristics of persons recruited through two different sampling strategies to inform research and intervention efforts with young adult NMPO users.

METHODS

We analyzed data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS), which enrolled persons aged 18 to 29 who reported past 30-day NMPO use. We compared the characteristics of two samples recruited simultaneously between February 2015 and February 2016. One sample was recruited using field-based strategies (e.g., respondent-driven sampling, transit ads), and a second from internet sources (e.g., online classifieds).

RESULTS

Among 198 eligible participants, the median age was 25 (IQR: 22, 27), 130 (65.7%) were male, 123 (63.1%) were white, and 150 (78.1%) resided in urban areas. A total of 79 (39.9%) were recruited using field-based strategies and 119 (60.1%) were recruited from internet sources. Internet-recruited persons were younger (median = 24 [IQR: 21, 27] vs. 26 [IQR: 23, 28] years) and more likely to reside in rural areas (16.2% vs. 5.3%), although this finding was marginally significant. Field-recruited participants were more likely to have been homeless (36.7% vs. 17.7%), have been incarcerated (39.7% vs. 21.8%), and engage in daily NMPO use (34.6% vs. 14.5%).

CONCLUSIONS

Multipronged outreach methods are needed to engage the full spectrum of young adult NMPO users in prevention and harm reduction efforts.

Binge Drinking among adolescents is related to the development of Alcohol Use Disorders: results from a Cross-Sectional Study

Binge drinking (BD) is a common pattern of alcohol consumption among adolescents. At present few data are available on the possible relationship between BD and alcohol use disorders (AUD) in adolescents. The aim of this study was to assess the prevalence of BD and relationship between BD behavior and AUD among adolescents. A total of 2704 students attending 10 purposively selected high schools from three Italian provinces were surveyed. Questionnaires regarding socio-demographic data, pattern and amount of alcohol intake, smoking habits, use of illicit drugs, and physical activity were administered. AUD and affective disorders were also evaluated. Alcohol intake was reported by 2126 participants; 1278 reported at least one episode BD in the last year and 715 in the last month. A diagnosis of AUD was made in 165 adolescents. The prevalence of AUD was higher in adolescents that reported BD behavior than in those that did not report BD (11.6% vs 0.9%, respectively; p < 0.0001). Logistic regression showed a positive relationship between a diagnosis of AUD and BD behavior (OR 9.6; 95% CI 4.7–22·9; p < 0.0001). In conclusion alcohol consumption with the pattern of BD among adolescents is highly related to development of AUD.

Are Metabolic Signatures Mediating the Relationship between Lifestyle Factors and Hepatocellular Carcinoma Risk? Results from a Nested Case-Control Study in EPIC

Background: The "meeting-in-the-middle" (MITM) is a principle to identify exposure biomarkers that are also predictors of disease. The MITM statistical framework was applied in a nested case-control study of hepatocellular carcinoma (HCC) within European Prospective Investigation into Cancer and Nutrition (EPIC), where healthy lifestyle index (HLI) variables were related to targeted serum metabolites.Methods: Lifestyle and targeted metabolomic data were available from 147 incident HCC cases and 147 matched controls. Partial least squares analysis related 7 lifestyle variables from a modified HLI to a set of 132 serum-measured metabolites and a liver function score. Mediation analysis evaluated whether metabolic profiles mediated the relationship between each lifestyle exposure and HCC risk.Results: Exposure-related metabolic signatures were identified. Particularly, the body mass index (BMI)-associated metabolic component was positively related to glutamic acid, tyrosine, PC aaC38:3, and liver function score and negatively to lysoPC aC17:0 and aC18:2. The lifetime alcohol-specific signature had negative loadings on sphingomyelins (SM C16:1, C18:1, SM(OH) C14:1, C16:1 and C22:2). Both exposures were associated with increased HCC with total effects (TE) = 1.23 (95% confidence interval = 0.93-1.62) and 1.40 (1.14-1.72), respectively, for BMI and alcohol consumption. Both metabolic signatures mediated the association between BMI and lifetime alcohol consumption and HCC with natural indirect effects, respectively, equal to 1.56 (1.24-1.96) and 1.09 (1.03-1.15), accounting for a proportion mediated of 100% and 24%.Conclusions: In a refined MITM framework, relevant metabolic signatures were identified as mediators in the relationship between lifestyle exposures and HCC risk.Impact: The understanding of the biological basis for the relationship between modifiable exposures and cancer would pave avenues for clinical and public health interventions on metabolic mediators. Cancer Epidemiol Biomarkers Prev; 27(5); 531-40. ©2018 AACR.

Contingency management for college student smokers: The role of drinking as a moderator and mediator of smoking abstinence during treatment

INTRODUCTION

Contingency management (CM) is effective for promoting smoking abstinence; however, moderators and mediators of CM treatment efficacy in young adult populations are under-explored. We leveraged fine-grained data from a large randomized controlled trial: 1) to determine whether early attainment of sustained abstinence mediated the effect of treatment on abstinence; 2) to test whether heavy drinking moderated the effect of treatment on abstinence; and 3) to test a serial mediation model of the effects of drinking during early treatment on sustained smoking abstinence.

METHODS

College student smokers (N=110) were randomized to receive either CM treatment or noncontingent reinforcement (NR) over a 21-day treatment period. All participants received $5 for providing twice-daily breath carbon monoxide (CO) samples. In CM, additional money was provided for samples that indicated smoking reduction (Initial Phase; first 7days), and for samples ≤5ppm (Abstinence Phase; following 14days).

RESULTS

CM treatment led to greater sustained abstinence relative to NR. Longer sustained abstinence in the Initial Phase partially mediated the effect of treatment on sustained abstinence in the Abstinence Phase. Heavier pretreatment drinkers had shorter periods of sustained abstinence in the Abstinence Phase; this effect was greater in CM. A serial mediation model determined that increased drinking during the Initial Phase led to decreased sustained abstinence, which then led to decreased sustained abstinence in the Abstinence Phase.

CONCLUSIONS

These data provide a greater understanding of how heavy drinking and early sustained abstinence may affect success during treatment in young adults undergoing contingency management treatment for smoking.

Alcohol-flavoured tobacco products

BACKGROUND

In 2009, the Food and Drug Administration (FDA) banned characterising flavours in cigarettes (except for menthol) due to their appeal to teen starter smokers. In August 2016, the agency deemed all tobacco products to be under its authority and a more comprehensive flavour ban is under consideration.

OBJECTIVES

To determine the scope and scale of alcohol-flavoured tobacco products among cigars & cigarillos, hookahs and electronic cigarettes (e-cigarettes).

METHODS

Alcohol-flavoured tobacco products were identified by online search of tobacco purveyors' product lines and via Google search cross-referencing the various tobacco product types versus a list of alcoholic beverage flavours (eg, wine, beer, appletini, margarita).

RESULTS

48 types of alcohol-flavoured tobacco products marketed by 409 tobacco brands were identified. Alcohol flavours included mixed drinks (n=25), spirits (11), liqueurs (7) and wine/beer (5). Sweet and fruity tropical mixed drink flavours were marketed by the most brands: piña colada (96), mojito (66) and margarita (50). Wine flavours were common with 104 brands. Among the tobacco product categories, brands offering alcohol-flavoured e-cigarettes (280) were most numerous, but alcohol-flavoured products were also marketed by cigars & cigarillos (88) and hookah brands (41). Brands by major tobacco companies (eg, Philip Morris, Imperial Tobacco) were well represented among alcohol-flavoured cigars & cigarillos with five companies offering a total of 17 brands.

CONCLUSIONS

The widespread availability of alcohol-flavoured tobacco products illustrates the need to regulate characterising flavours on all tobacco products.

Young adults report increased pleasure from smoking cigarettes when drinking alcohol but not when using marijuana

BACKGROUND

Among young adults, cigarette smoking is strongly associated with alcohol and marijuana use. The present study compared self-reported co-use of cigarettes and alcohol versus cigarettes and marijuana among young adults using cross-sectional survey data.

METHODS

Participants were young adult cigarette smokers (age 18 to 25) who also reported past month alcohol or marijuana use enrolled in a randomized trial testing a smoking cessation intervention on Facebook. Participants self-reported extent of cigarette smoking under the influence of alcohol or marijuana and differences in perceived pleasure from cigarette smoking when drinking alcohol compared to using marijuana.

RESULTS

Among cigarette smokers who drank alcohol and used marijuana in the past month (n=200), a similar percentage of cigarettes were smoked under the influence of alcohol (42.4%±31.2%) and marijuana (43.1% ±30.0%). Among alcohol + marijuana users, perceived pleasure from smoking cigarettes was significantly greater when drinking alcohol versus when using marijuana (t₍₁₉₉₎=7.05, p<0.001). There was, on average, an increase in perceived pleasure from smoking cigarettes when drinking alcohol, though perceived pleasure did not differ by binge drinking frequency. In contrast, there was on average no change in perceived pleasure from smoking cigarettes when using marijuana. Results from the cigarette smokers who used alcohol + marijuana were similar to cigarette smokers who only used alcohol (n=158) or only used marijuana (n=54).

CONCLUSION

Findings highlight greater perceived reward from smoking cigarettes when drinking alcohol compared to when using marijuana, informing smoking cessation interventions that target users of multiple substances.