A latent class analysis of underage problem drinking: evidence from a community sample of 16-20 year olds

Latent class analysis of perceived stigma among older adults receiving medications for opioid use disorder

RATIONALE

Public stigma surrounds individuals who use medication for their recovery from a substance use disorder. However, we know little about subgroups of individuals with varying levels of perceived stigma and how these levels may be associated with physical and mental health-related quality of life (HRQOL) and social support.

METHODS

We used latent class analysis to define subgroups of people aged 50-72 years of age (N = 104) who were enrolled in eight medication for opioid use disorder (MOUD) programs to explore subgroupings and correlates of group membership.

RESULTS

We found evidence for three distinct classes of individuals and named the classes 1) the high stigma class, 2) the embarrassed class, and 3) the low stigma class. We found that people in the high-stigma class reported more rejection, more abstinence-based support group involvement, and reduced mental HRQOL.

CONCLUSIONS

Results suggest reducing stigma among people on MOUD may help to boost mental HRQOL and improve social support receipt. The results are consistent with iatrogenic effects of AA/NA support groups such that these treatment modalities may increase stigma due to their focus on abstinence-only treatment for substance use disorders.

Patterns of COVID-19 related lifestyle disruptions and their associations with mental health outcomes among youth and young adults

The COVID-19 pandemic is a socionatural disaster that has disrupted the lives of individuals, families, and communities. Youth and young adults (YYA) were uniquely vulnerable to the proximal mental health effects of the pandemic; however, few studies have examined the long-term mental health effects of the pandemic. In the present study, we sought to (a) identity distinctive profiles of COVID-related lifestyle disruptions experienced by YYA, (b) investigate sociodemographic characteristics correlates of profile membership, and (c) examine the extent to which profile membership was prospectively associated with changes in depressive and anxiety symptoms. Hypothesis were tested using latent profile analysis with data from 1055 YYA collected across two time-points, 6-months apart. Results produced a three-class model: low- (11%), moderate- (61%), and high-levels of (28%) disruption. Members of the high levels of disruption group were more likely to identify as Black or Latinx American, bisexual/pansexual, or as transgender or gender diverse in comparison to the low levels of disruption group. Inclusion in the high levels of disruption group was associated with increases in depressive and anxiety symptoms from T1 to T2. YYA from multiple marginalize communities (i. e. those who identified as both racial/ethnic and sexual/gender minorities) experienced the greatest levels of lifestyle disruption related to COVID-19. Consequently, disruptive effects of the COVID-19 pandemic prospectively eroded their mental health. YYA are in urgent need of developmentally appropriate resources to effectively recovery from the pandemic.

An examination of the associations between depressive symptoms, perceived parental discipline, alcohol use, and drinking-related consequences during the first year of college: A moderated mediation model

Background

Depression is prevalent among adolescents and young adults and is associated with experiencing increased negative alcohol-related consequences; thus, it is imperative to identify malleable protective factors for alcohol risks in young adults experiencing elevated depressive symptoms. The current study longitudinally explored the effects of perceived parental alcohol-related discipline on the relationship between depressive symptoms, alcohol use, and negative drinking consequences during the transition into college.

Methods

Incoming college students (N = 272, 63.2% female) completed web-based surveys before (July, T1) and after (October, T2) the transition into college and reported depressive symptoms, perceived alcohol-related discipline, alcohol use, and consequences of drinking experienced in the past 30 days.

Results

The moderated mediation model revealed that at above average perceptions of alcohol-related discipline, depressive symptoms were negatively associated with alcohol use, which in turn was associated with experiencing fewer negative consequences of drinking.

Limitations

The current study did not measure a diagnosis of major depressive disorder, and therefore our results may differ among clinical populations. In addition, we did not measure other parenting constructs shown to protect students with elevated levels of depressive symptoms from experiencing consequences (i.e., monitoring).

Conclusions

The present findings suggest perceptions of parental alcohol-related discipline measured here (e.g., having a privilege taken away, being scolded or grounded) can be protective against alcohol risks among college students experiencing above average depressive symptoms. Parent-based alcohol interventions administered prior to matriculation should encourage parents of depressed students to clearly communicate consequences for drinking to their child.

Co-occurrence subgroups of child sexual abuse, health risk behaviors and their associations among secondary school students in China

BACKGROUND

Little is known on the co-occurrence and heterogeneity of child sexual abuse (CSA) or health risk behavior (HRB) prevalence nor the associations among the victims.

OBJECTIVES

To detect the prevalence and subgroups of adolescents reporting CSAs or HRBs, and to examine the association between the subgroups.

METHODS

Participants were secondary school students in a national survey in China (N = 8746). Self-reported CSA and HRB experiences were collected through a computer assisted questionnaire. Prevalence and confidence intervals were calculated. Multigroup latent class analysis (LCA) was used to examine latent subgroups of CSA and HRB. Dual latent class regression analysis was used to examine the association between CSA and HRB classes.

RESULTS

A total of 8746 students participated in our study. The prevalence of having ever experienced any of the reported seven CSA items was 12.9%. The preferred LCA model consisted of a three-class CSA latent variable, i.e. "Low CSAs"(95.7% of the total respondents), "Verbal or exhibitionism CSAs"(3.3%), and "high multiple CSAs" (1.1%); and a three-class HRB latent variable, i.e. "Low HRBs"(70.5%), "externalizing HRBs" (20.7%), and "internalizing HRBs" (8.7%). Students in the "Verbal or exhibitionism CSAs" or "high multiple CSAs" classes had higher probabilities of being in "externalizing HRBs" or "internalizing HRBs" classes. The probabilities were higher in "high multiple CSAs" class(male externalizing OR 4.05, 95%CI 1.71-9.57; internalizing OR 11.77, 95%CI 4.76-29.13; female externalizing OR 4.97, 95%CI 1.99-12.44; internalizing OR 9.87, 95%CI 3.71-26.25) than those in "Verbal or exhibitionism CSA"(male externalizing OR 2.51, 95%CI 1.50-4.20; internalizing OR 3.08, 95%CI 1.48-6.40; female externalizing OR 2.53, 95%CI 1.63-3.95; internalizing OR 6.05, 95%CI 3.73-9.80).

CONCLUSIONS

Prevalence of CSA items varies. Non-contact CSAs are the most common forms of child sexual abuse among Chinese school students. There are different latent class co-occurrence patterns of CSA items or HRB items among the respondents. CSA experiences are in association with HRB experiences and the associations between latent classes are dose-responded. Multi-victimization has more significantly negative effects. The results could help identify high-risk subgroups and promote more nuanced interventions addressing adverse experiences and risk behaviors among at-risk adolescents.

Profiles of patients with cocaine and alcohol use disorder based on cognitive domains and their relationship with relapse

BACKGROUND

Relapse in drug use constitutes a research topic on addiction that is relevant for understanding both the addictive process and its clinical implications. The objective of this study was to explore if it is possible to identify patient profiles according to their performance on cognitive tasks whilst examining the relationship between such profiles and relapse.

METHODS

The sample consisted of 222 patients with dependence on cocaine and / or alcohol, of which 86 % were men. Cognitive domains related to salience, decision- making, and emotional processing were measured.

RESULTS

Latent class analysis revealed three patient profiles that differ in terms of performance on cognitive tasks. Two of these profiles are clearly differentiated in terms of their execution of the impulsive decision-making task. The third patient profile, unlike the latter two, is composed of patients with severe alterations in the three domains evaluated. Analysis revealed that patients in Profile 3 are those with the highest rates of relapse in cocaine (Profile 1 = 40.3 %; Profile 2 = 35.6 %; Profile 3 = 69.2 %; Chi2 = 9.169; p < .05) and cocaine and alcohol use (Profile 1 = 55.1 %; Profile 2 = 54.1 %; Profile 3 = 80 %; Chi2 = 6.698; p < .05).

CONCLUSIONS

The results support the postulates of the I-RISA model. From a clinical perspective, these findings highlight the need for a comprehensive evaluation of the cognitive domains involved in addiction.

Self-medicating low mood with alcohol use: Examining the role of frequency of alcohol use, quantity consumed and context of drinking

OBJECTIVE

The concept of self-medication refers to the use of substances to help cope with periods of psychological distress. This study sought to examine the typical drinking patterns of adults who self-report using alcohol to self-medicate low mood using data from a large, nationally representative US household survey.

MATERIALS AND METHODS

Data was from the Wave I (2001-2002) National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The sample consisted of individuals who met the depression criteria, who indicated that they had drank alcohol to improve their mood when they felt down for at least two weeks, and consumed alcohol in the last 12 months (n = 5900). Alcohol use related to the last 12 months (frequency, quantity, and drinking context).

RESULTS

A multiple group Latent Class Analysis was conducted to identified clinically relevant homogeneous groups of drinkers who self-report use of alcohol to self-medicate compared to those who do not. Two latent classes emerged for each of the two self-medicating groups, which were named based on their probabilities, as 'seldom drinkers' and 'hazardous drinkers' in the self-medication group, and as 'normal drinkers' and 'very seldom drinkers' in the non-self-medication group.

CONCLUSIONS

The findings of this paper indicate that the behaviour of self-medication may be a factor in why people may be more hazardous drinkers, and that these individuals are drinking to relieve their mood, more likely than someone who does not use alcohol for this purpose. The findings also provide clinical insight, as the behaviour of self-medication could be used as a target for intervention.

Alcohol-Related Risky Behavior Patterns and Their Association With Alcohol Use and Perceived Alcohol Stigma in Moshi, Tanzania

OBJECTIVE

The Kilimanjaro region has one of the highest rates of reported alcohol use per capita in Tanzania. Alcohol-related risky behaviors pose substantial threats to the health and well-being of alcohol users and the people around them. This study seeks to understand how alcohol-related risky behaviors co-occur with other risky behaviors.

METHOD

Latent class analysis (LCA) was applied to examine alcohol-related risky behaviors. The optimal number of latent classes was confirmed by using model fit indices. Negative binomial models were used to test latent classes and their association with harmful and hazardous drinking and perceived alcohol stigma. With the model defined, we explored each class's drinking patterns and risky behavior patterns.

RESULTS

A total of 622 (60% male) of 841 participants were included in these analyses because they drank alcohol at least once in their lifetime. Three classes of risky behavior patterns were identified: Class 1, "Limited risk behaviors" (59.7%); Class 2, "Primarily foolish behaviors" (25.6%); and Class 3, "Pervasive risk behaviors" (13.1%). Class 3 had the most alcohol use quantity and frequency. No association between classes and alcohol stigma was found. Compared with males, females are less likely to be classified in Class 2 and 3.

CONCLUSIONS

Three different classes of risky behaviors became apparent and were distinguished by gender, age, and personal alcohol use. Our findings suggest a potential role for personalized interventions based on latent classes specifically to reduce risk behaviors.

Alcohol-Related Risky Behavior Patterns and Their Association With Alcohol Use and Perceived Alcohol Stigma in Moshi, Tanzania

OBJECTIVE

The Kilimanjaro region has one of the highest rates of reported alcohol use per capita in Tanzania. Alcohol-related risky behaviors pose substantial threats to the health and well-being of alcohol users and the people around them. This study seeks to understand how alcohol-related risky behaviors co-occur with other risky behaviors.

METHOD

Latent class analysis (LCA) was applied to examine alcohol-related risky behaviors. The optimal number of latent classes was confirmed by using model fit indices. Negative binomial models were used to test latent classes and their association with harmful and hazardous drinking and perceived alcohol stigma. With the model defined, we explored each class's drinking patterns and risky behavior patterns.

RESULTS

A total of 622 (60% male) of 841 participants were included in these analyses because they drank alcohol at least once in their lifetime. Three classes of risky behavior patterns were identified: Class 1, "Limited risk behaviors" (59.7%); Class 2, "Primarily foolish behaviors" (25.6%); and Class 3, "Pervasive risk behaviors" (13.1%). Class 3 had the most alcohol use quantity and frequency. No association between classes and alcohol stigma was found. Compared with males, females are less likely to be classified in Class 2 and 3.

CONCLUSIONS

Three different classes of risky behaviors became apparent and were distinguished by gender, age, and personal alcohol use. Our findings suggest a potential role for personalized interventions based on latent classes specifically to reduce risk behaviors.

A Latent Class Analysis of HIV Risk Factors Among Men and Women with Opioid Use Disorder in Pre-trial Detention

Adults entering pre-trial detention who inject drugs are at high risk for acquiring HIV/AIDS. In the current study, we examined pre-incarceration HIV risk behaviors among 114 people with opioid use disorder who inject drugs. Participants were recruited from the Baltimore City Detention Center as part of a randomized controlled trial of pre-release methadone treatment. Using latent class analysis, we found three separate latent classes, which we identified as the sex exchange class (14.2%), drug equipment sharing class (36.8%) and lower risk class (49.0%). Women in the sex exchange class (n = 16) reported having multiple male partners and selling sex for money or drugs; however, this group also reported more consistent condom use and less frequent injection drug and equipment sharing than participants in the drug equipment sharing class. Our findings highlight distinct profiles of jail detainees with OUD based on their risks for HIV, and could inform more targeted interventions for each group.Clinical Trials Registration: Clinicaltrials.gov NCT02334215.

[Patterns of Drinking Behaviors and Predictors of Class Membership among Adolescents in the Republic of Korea: A Latent Class Analysis]

PURPOSE

Despite the high drinking rates and the complexity of drinking behaviors in adolescents, insufficient attention has been paid to their drinking patterns. Therefore, we aimed to identify patterns of adolescent drinking behaviors and factors predicting the distinct subgroups of adolescent drinking behaviors.

METHODS

We analyzed nationally representative secondary data obtained in 2017. Our final sample included 24,417 Korean adolescents who had consumed at least one glass of alcohol in their lifetime. To investigate patterns of drinking behaviors, we conducted a latent class analysis using nine alcohol-related characteristics, including alcohol consumption levels, solitary drinking, timing of drinking initiation, and negative consequences of drinking. Furthermore, we investigated differences in demographics, mental health status, and characteristics of substance use across the latent classes identified in our study. To do so, we used the PROC LCA with COVARIATES statement in the SAS software.

RESULTS

We identified three latent classes of drinking behaviors: current non-drinkers (CND), binge drinkers (BD), and problem drinkers (PD). Compared to the CND class, both BD and PD classes were strongly associated with higher academic year, lower academic performance, higher levels of stress, suicidal ideation, lifetime conventional or electronic cigarette use, and lifetime use of other drugs.

CONCLUSION

Health professionals should develop and implement intervention strategies targeting individual subgroups of drinking behaviors to obtain better outcomes. In particular, health professionals should consider different characteristics across subgroups of adolescent drinking behaviors when developing the interventions, such as poor mental health status and other substance use among binge and problem drinkers.

Sleep-related functional impairment as a moderator of risky drinking and subsequent negative drinking consequences in college students

OBJECTIVE

Poor sleep quality and insufficient total sleep time have been shown to modify the relationship between college drinking and negative drinking consequences. This study aimed to examine whether prospective associations between risky drinking and negative drinking consequences similarly differ by sleep-related functional impairment, which is novel to the literature.

METHOD

Data were obtained from a 2-month prospective study of 157 college drinkers (mean age = 19 years [SD = 1.11], 30% male, 76% White). Online questionnaires were administered at both Time 1 (T1) and Time 2 (T2) to measure sleep-related functional impairment (assessed by Insomnia Diurnal Impact Scale; Ruiz, Guilera, & Gomez-Benito, 2011) and drinking behaviors and negative drinking consequences (assessed retrospectively over the past 2 months).

RESULTS

Prospective negative binomial regression analyses demonstrated that associations of both maximum drinks and binge drinking frequency at T1 with negative drinking consequences at T2 differed by T1 sleep-related functional impairment after controlling for covariates (sex, negative mood, total sleep time, insomnia symptoms, morning preference, and negative drinking consequences at T1). Students reporting lower sleep-related functional impairment experienced high levels of negative drinking consequences only at high levels of risky drinking, whereas students reporting higher sleep-related functional impairment experienced consistently high levels of negative drinking consequences regardless of their risky drinking levels.

CONCLUSION

Findings indicate that sleep-related functional impairment may exacerbate negative drinking consequences of risky drinking. Thus, sleep-related functional impairment helps to explain individual differences in the association between risky drinking and negative drinking consequences in college students.

Typology of cannabis use among adults: A latent class approach to risk and protective factors

BACKGROUND

Cannabis is among the most widely used substances worldwide. The United States has seen an increase in the number of adult daily cannabis users and in the number of adults diagnosed with cannabis use disorder. However, little work has examined patterns of use or unique subgroups of adult cannabis users, which may be useful in developing targeted treatment interventions for problematic cannabis users. Therefore, the current study used latent profile analysis to identify whether cannabis users can be categorized across distinct subgroups of adult users.

METHOD

The sample included 374 current cannabis using adults (64.2% Male; M_age = 32.6). Cannabis use frequency, quantity, and related problems were used to differentiate subgroups. Further, age, race, emotion dysregulation, affect, anxiety sensitivity, other substance use, and motives for cannabis use were examined as class correlates.

RESULTS

Results supported five unique classes of cannabis users, generally ranging from light, infrequent users with few problems to heavy, frequent users with more problems. Additionally, race, negative affectivity, anxiety sensitivity, emotion regulation, cannabis use motives, and alcohol use emerged as unique predictors of class membership. The current findings substantiate past work for heterogeneous latent classes that underlie the larger cannabis using population, however, this study provides novel evidence for subgroups of adult users.

CONCLUSION

The identification of different classes of cannabis users may inform future treatment interventions, and ultimately, lead to the development of personalized treatments for each class based on correlates of group membership.

Identifying heterogeneous health profiles of primary care utilizers and their differential healthcare utilization and mortality - a retrospective cohort study

BACKGROUND

Heterogeneity of population health needs and the resultant difficulty in health care resources planning are challenges faced by primary care systems globally. To address this challenge in population health management, it is critical to have a better understanding of primary care utilizers' heterogeneous health profiles. We aimed to segment a population of primary care utilizers into classes with unique disease patterns, and to report the 1 year follow up healthcare utilizations and all-cause mortality across the classes.

METHODS

Using de-identified administrative data, we included all adult Singapore citizens or permanent residents who utilized Singapore Health Services (SingHealth) primary care services in 2012. Latent class analysis was used to identify patient subgroups having unique disease patterns in the population. The models were assessed by Bayesian Information Criterion and clinical interpretability. We compared healthcare utilizations in 2013 and one-year all-cause mortality across classes and performed regression analysis to assess predictive ability of class membership on healthcare utilizations and mortality.

RESULTS

We included 100,747 patients in total. The best model (k = 6) revealed the following classes of patients: Class 1 "Relatively healthy" (n = 58,213), Class 2 "Stable metabolic disease" (n = 26,309), Class 3 "Metabolic disease with vascular complications" (n = 2964), Class 4 "High respiratory disease burden" (n = 1104), Class 5 "High metabolic disease without complication" (n = 11,122), and Class 6 "Metabolic disease with multi-organ complication" (n = 1035). The six derived classes had different disease patterns in 2012 and 1 year follow up healthcare utilizations and mortality in 2013. "Metabolic disease with multiple organ complications" class had the highest healthcare utilization (e.g. incidence rate ratio = 19.68 for hospital admissions) and highest one-year all-cause mortality (hazard ratio = 27.97).

CONCLUSIONS

Primary care utilizers are heterogeneous and can be segmented by latent class analysis into classes with unique disease patterns, healthcare utilizations and all-cause mortality. This information is critical to population level health resource planning and population health policy formulation.

Fatores sociodemográficos e comportamentos de risco associados ao consumo do álcool: um recorte do Erica

RESUMO O uso de álcool impacta a morbimortalidade na adolescência. Assim, este estudo objetivou identificar a relação entre álcool, variáveis sociodemográficas e comportamentos de risco entre adolescentes do município de Belo Horizonte. Realizaram-se análise descritiva e testes de associação e regressão logística a partir dos dados do Estudo de Riscos Cardiovasculares na Adolescência (Erica). Foi encontrado um consumo de álcool por 22,1% dos adolescentes. Os resultados da análise multivariada revelaram que não usar o Anticoncepcional Oral (ACO) na última relação aumentou 3,5 vezes as chances de o adolescente fazer uso de bebida alcoólica (OR: 3,5 IC95% 2,49-4,91). Fumar aumentou 7,25 vezes as chances de o adolescente fazer uso de bebida alcóolica (OR: 7,25 IC95% 3,7-14,22). Adolescentes do sexo masculino possuem 1,47 vezes mais chances de consumir bebidas alcoólicas que as meninas (OR: 1,47 IC95% 1,14-1,89). O avançar da idade aumenta 1,36 vezes a chance de o adolescente fazer uso de álcool (OR:1,36 IC95% 22-1,51). Apresentar maior valor de proxy de riqueza aumentou 1,04 vezes a chance de o adolescente consumir bebida alcoólica (OR: 1,04 IC95% 1,01-1,07). Assim, conclui-se que as ações em saúde voltadas para a prevenção do consumo do álcool entre adolescentes devem contemplar as diferenças entre as classes sociais, o gênero e a idade, bem como a prevenção do tabagismo e a promoção da saúde sexual e reprodutiva.

Profiles of Physical Fitness Risk Behaviours in School Adolescents from the ASSO Project: A Latent Class Analysis

The aim of the present investigation was to describe profiles of adolescents’ fitness level, identify latent classes of fitness-related risk behaviours, and describe their sociodemographic and environmental predictors. In total, 883 adolescents (16.4 ± 1.4 years; 167.3 ± 10.4 cm; 62.8 ± 13.5 kg; 62.2% males) were assessed for personal and lifestyle information and for physical fitness components. Eleven possible fitness determinants and seven predictors were included. Latent class analysis (LCA) was used to determine fitness-related risk behaviours. Logistic regressions predicted class membership and assessed associations with fitness levels and fitness components. Five latent classes were recognised: 1—virtuous, 30.7% of respondents; 2—low physical activity/sport, 18.8%; 3—incorrect alcohol/food habits, 25.8%; 4—health risk/overweight, 15.9%; 5—malaise/diseases, 8.8%. Sex, age, parents’ overweightness/obesity and education, and school type predicted most classes significantly. Compared to class 1, class 2 had higher odds of having all poor fitness components except upper body maximal strength; class 4 had higher risk of low muscular endurance; and class 5 was likely to have lower maximal strength, muscular endurance, and speed/agility. Educating adolescents to reach a sufficient practice of PA/sport could help decreasing the risk of low health-related fitness more than discouraging them from using alcohol, addressing proper food behaviours and habits, and helping them understand their psychophysical malaise symptoms.

Male-female differences in the onset of heavy drinking episode soon after first full drink in contemporary United States: From early adolescence to young adulthood

BACKGROUND

Globally, there is a male excess in the occurrence of heavy drinking once alcoholic beverages are consumed and some new evidence that this 'gender gap' might be null among underage drinkers. Here, we estimate age-specific male-female differences in heavy drinking episode (HDE) incidence across the first eight calendar-quarters after first full drink.

METHODS

Study population is non-institutionalized civilians in the United States (2006-2014). Standardized audio computer-assisted self-interviews were used to assess the date of first full drink and the date of first HDE (i.e., 5+ drinks on one occasion) among ∼33,000 12-to-21-year-old newly incident drinkers (all with 1st full drink and HDE evaluated within 24 months of drinking onset). Time-to-HDE survival analyses are used to estimate age-specific male-female ratios in the hazard of HDE onset.

RESULTS

We found that among early adolescent new drinkers (drinking onset at age 11-14), the newly incident drinking females progress to HDE more quickly than males (HR = 1.3, 95% CI = 1.1, 1.6). In contrast, male excess risk is observed when drinking starts at or after age 15 years. For underage drinkers, age-specific hazard ratios (HR) depend upon age at first full drink.

CONCLUSIONS

Based on recent survey data from the US, this study's survival analyses support early adolescent female excess in the onset of HDE. When drinking starts at or after age 15 years, a male excess becomes apparent within two years since first full drink. Future studies may probe any sex-specific mechanisms toward the rapid onset of HDE at different age groups.

Correlates of Patterns of Health Values of African Americans Living With HIV/AIDS: Implications for Advance Care Planning and HIV Palliative Care

CONTEXT

Advance care planning rates remain low, especially among people who are HIV positive, disadvantaged, and African American. Although advance care planning can be a sensitive topic for clinicians and patients to discuss, health values clarification can be an important initial step.

OBJECTIVES

The purpose of the study was to explore health values of African Americans living with HIV/AIDS and to examine correlates of these values.

METHODS

Data were from the first 325 participants in the AFFIRM Care study, which enrolled adults living with HIV/AIDS in Baltimore, Maryland, who had histories of illicit drug use. Respondents were asked whether (yes/no) they thought any of six health states would be worse than death: severe unremitting pain, total dependency on others, irreversible coma, being on mechanical ventilation, nursing home residence, and severe dementia. Latent class analysis was used to group individuals by their pattern of responses, interpretable as preference for aggressive (life-sustaining) or nonaggressive (palliative) end-of-life care. Latent class regression analysis was used to examine associations between class membership and background, health status, and social variables.

RESULTS

We found statistical support for a three-class latent class analysis model: 1) the nonaggressive treatment class, comprising 43% of cases, in which members perceived that every state was worse than death; 2) the aggressive treatment class, comprising 33% of cases, in which members perceived that none of the states was worse than death; and 3) the mixed class (24% of cases), in which members perceived that only four of the six states were worse than death.

CONCLUSION

Three-quarters of participant response patterns had clear preferences for treatment decisions. Further research is needed to ensure inclusion of end-of-life scenarios relevant to this population.

Polysubstance use profiles among electronic dance music party attendees in New York City and their relation to use of new psychoactive substances

BACKGROUND

Electronic Dance Music (EDM) party attendees are often polysubstance users and are at high risk for use of new psychoactive substances (NPS). We sought to identify patterns of use of common illegal drugs among EDM party attendees, sociodemographic correlates, and use of NPS as a function of patterns of use of more common drugs to inform prevention and harm reduction.

METHOD

Using time-space-sampling, 1045 individuals aged 18-40 were surveyed entering EDM parties in New York City. We queried past-year use of common illegal drugs and 98 NPS. We conducted latent class analysis to identify polysubstance use profiles of use of eight common drugs (i.e., ecstasy, ketamine, LSD, mushrooms, powder cocaine, marijuana, amphetamine, benzodiazepines). Relationships between drug classification membership and sociodemographics and use of drugs within six NPS categories were examined.

RESULTS

We identified four profiles of use of common drugs: non-polysubstance use (61.1%), extensive polysubstance use (19.2%), moderate polysubstance use/stimulants (12.8%), and moderate polysubstance use/psychedelics (6.7%). Those in the moderate/psychedelic group were at higher odds of using NPS with psychedelic-type effects (2C, tryptamines, and other "new" psychedelics; Ps<0.05). Extensive polysubstance users were at increased odds of reporting use of 2C drugs, synthetic cathinones ("bath salts"), tryptamines, other new (non-phenethylamine) psychedelics, new dissociatives, and synthetic cannabinoids (Ps<0.05).

CONCLUSION

NPS preference is linked to the profile of use of common drugs among individuals in the EDM scene. Most participants were identified as non-polysubstance users, but findings may help inform preventive and harm reduction interventions among those at risk in this scene.

Drinking to Cope: a Latent Class Analysis of Coping Motives for Alcohol Use in a Large Cohort of Adolescents

Alcohol consumption during adolescence is widespread, although there is considerable variation in patterns of use. The aim of this study was to identify patterns of coping-motivated alcohol use in a UK birth cohort and examine individual and family characteristics associated with the resulting drinker profiles. At age 17, participants (n = 3957; 56 % female) reported their alcohol and drug use, internalising symptoms and use of alcohol to cope with a range of emotions. Socio-demographic data were collected via maternal report. Latent class analysis identified drinker subtypes based on the coping motives reported. Association between these profiles and socio-demographic characteristics and internalising disorders was examined. The vast majority (92 %) of adolescents reported alcohol consumption in the past year, and 26 % of those drank weekly or more often. Four distinct motive profiles were identified. These profiles were associated with different socio-demographic characteristics: adolescents from higher socio-economic backgrounds drank primarily for increased confidence, whereas adolescents from low socio-economic backgrounds were more likely to drink to cope with low mood. Adolescents with an anxiety or depressive disorder were six times more likely to fall within the high-risk subtype, characterised by a generalised pattern of drinking to cope with emotions across the board. Coping motives for drinking vary with individual and family factors. Adolescents from low versus high socio-economic backgrounds were characterised by distinct drinking profiles; thus, prevention messages may need to be tailored accordingly. Internalising disorders were strongly associated with a high-risk profile of coping-motivated drinking.

The role of perceived injunctive alcohol norms in adolescent drinking behavior

Peers have a major influence on youth during adolescence, and perceptions about peer alcohol use (perceived norms) are often associated with personal drinking behavior among youth. Most of the research on perceived norms among adolescents focuses on perceived descriptive norms only, or perceptions about peers' behavior, and correcting these perceptions are a major focus of many prevention programs with adolescents. In contrast, perceived injunctive norms, which are personal perceptions about peers' attitudes regarding the acceptability of behaviors, have been minimally examined in the adolescent drinking literature. Yet correcting perceptions about these perceived peer attitudes may be an important component to include in prevention programs with youth. Using a sample of 2493 high school-aged youth (mean age=17.3), we assessed drinking behavior (past year use; past month frequency, quantity, and peak drinks), drinking consequences, and perceived descriptive and injunctive norms to examine the relationships of perceived injunctive and descriptive norms on adolescent drinking behavior. Findings indicated that although perceived descriptive norms were associated with some drinking outcomes (past year use; past month frequency; past month quantity; peak drinks), perceived injunctive norms were associated with all drinking outcomes, including outcomes of consequences, even after controlling for perceived descriptive norms. Findings suggest that consideration of perceived injunctive norms may be important in models of adolescent drinking. Prevention programs that do not include injunctive norms feedback may miss an important opportunity to enhance effectiveness of such prevention programs targeting adolescent alcohol use.

Distinguishing subpopulations of marijuana users with latent profile analysis

BACKGROUND

Although marijuana is the most commonly used illicit drug in the United States, little is known about the effects of typical marijuana use patterns and whether there are distinct subgroups of marijuana users.

METHODS

The present study used latent profile analysis to determine the number of distinct subgroups of marijuana users in a large sample of college students (n=2129 past month marijuana users across 11 universities). We also examined how these distinct groups differ on several putative risk/protective factors (e.g., personality traits, perceptions of marijuana, and motives for using marijuana).

RESULTS

Using the Lo-Mendell-Rubin Likelihood Ratio Test, we identified four latent classes with the largest class consisting of infrequent marijuana users, and three other classes demonstrating increasingly frequent use and more negative consequences with the most severe class being the smallest class. We found the largest between-class differences (i.e., distinctions across classes) to be on identification with being a marijuana user and use of protective behavioral strategies (PBS), such that the heavier user classes showed higher identification with marijuana users and lower use of PBS.

CONCLUSIONS

Our findings demonstrate that college student marijuana users are a heterogeneous group with different profiles of risk/protective factors and that those who use marijuana a few times per month are different from those who are near-daily or daily users. Our findings also serve as a call to action for the field to consider examining identification with being a marijuana user and the use of PBS in future marijuana studies.

Binge drinking and associated factors among adolescents in a city in southeastern Brazil: a longitudinal study

Abstract: The aim of this study was to investigate changes in the frequency of binge drinking and associated factors in the city of Belo Horizonte, Minas Gerais State, Brazil. The sample consisted of 436 adolescents. Data collection involved the Alcohol Use Disorders Identification Test and the Alcohol, Smoking and Substance Involvement Screening Test. Ordinal logistic regression was used in the multivariate analysis. An increase in the frequency of binge drinking was found among adolescents who lived in areas of greater social vulnerability (OR = 1.64; 95%CI: 1.01-2.68), those whose mothers consumed alcoholic beverages (OR = 1.75; 95%CI: 1.05-2.92), those whose fathers consumed alcoholic beverages (OR = 2.02; 95%CI: 1.11-3.68), those with an increased risk of tobacco use (OR = 2.82; 95%CI: 1.07-7.42) and those who attended religious services (OR = 2.10; 95%CI: 1.30-3.38). Knowledge regarding factors associated with a change in the frequency of binge drinking among adolescents can assist in the establishment of public policies directed at health promotion and the prevention of adverse health conditions.

Alcohol consumption among university students: a typology of consumption to aid the tailoring of effective public health policy

OBJECTIVE

Elevated levels of alcohol consumption among university students are well documented. Policymakers have attempted to combat this issue at a university, national and international level. Tailoring public health policy to effectively tackle alcohol use is crucial. Using Q-methodology, the current study aims to develop a typology of alcohol consumption in the Irish university student population.

SETTING

A large Irish university.

PARTICIPANTS

Hundreds of possible statements on types of consumption were generated from a systematic review and a set of one-on-one interviews. These were reduced to 36 statements, 6 statements which define each of the 6 previously defined consumption types. Participants were advised to scan through the 36 statements and fill the statements into a 'forced choice, standardised distribution'. Following this, a 45-90 min interview was conducted with students to illuminate subjectivity surrounding alcohol consumption. Analysis was conducted using PQ Method and NVivo software. Principal component analysis, followed by varimax rotation, was conducted to uncover the final factor information.

RESULTS

In total, 43 students completed the Q-study: 19 men and 24 women. A typology describing 4 distinct groupings of alcohol consumer was uncovered: the guarded drinker, the calculated hedonist, the peer-influenced drinker and the inevitable binger. Factor loadings of each of the consumer groupings were noted for type description.

CONCLUSIONS

This is the first study to propose ideal types of alcohol consumption among a university student population. Further research is required to investigate the degree to which each of these ideal types is subscribed. However, this typology, in addition to informing public policy and strategies, will be a valuable analytic tool in future research.

A latent profile analysis of drinking patterns among nonstudent emerging adults

Research indicates that nonstudent emerging adults, as compared to their college-attending peers, are at higher risk for experiencing alcohol-related problems, including alcohol use disorders. The present study sought to extend the limited research on nonstudent drinking by (1) identifying sub-groups of nonstudent drinkers based on their drinking patterns and (2) determining the extent to which social-cognitive between-person factors related to drinking (i.e., social expectancies, perceived drinking norms, social drinking motivations) distinguish these sub-groups. Participants were 195 (65.1% men) nonstudent emerging adult heavy episodic drinkers recruited from the community. Mean age was 21.88 (SD=2.08) years and 45.4% were unemployed. Latent profile analysis identified two classes based on drinking across 30days. The "moderate drinkers" group (n=143; 73.3%) reported consuming 10-11 drinks weekly and drinking two to three times per week, on average. The "heavy drinkers" class (n=52; 26.7%) reported consuming 42-43 drinks weekly and drinking six to seven days per week. Both groups exhibited a cyclic pattern of drinking whereby weekday drinking was lower, with increases on the weekend; the heavy drinkers class had stronger weekend increases starting earlier. Heavy drinkers reported greater volume, frequency, and problematic drinking behaviors, as compared to the moderate drinkers. The heavy drinkers class also endorsed stronger social motives and perceived their peers to drink more. The present study offered unique insights into nonstudent emerging adult drinking patterns by identifying sub-populations of drinkers based on their past 30-day use. Knowledge gained from this study could aide in tailoring existing alcohol interventions to nonstudents to reduce alcohol-related harms.

Profiles of College Drinkers Defined by Alcohol Behaviors at the Week Level: Replication Across Semesters and Prospective Associations With Hazardous Drinking and Dependence-Related Symptoms

OBJECTIVE

Types of college drinkers have been identified using traditional measures (e.g., 12-month drinking frequency). We used an alternative multidimensional approach based on daily reports of alcohol behaviors to identify college drinker statuses, each with a unique behavioral profile. The current study aimed to (a) identify drinker statuses at the week level across four semesters, (b) examine the predictive utility of drinker status by testing associations with senior-year hazardous drinking and dependence symptoms, and (c) identify concurrent predictors (gender, drinking motivations, hazardous drinking, any dependence symptoms) of senior-year drinker status. We also compared the week-level drinker statuses with drinker statuses identified using traditional measures.

METHOD

A multi-ethnic sample of U.S. college students completed 14-day bursts of daily web surveys across college (91%-96% completed ≥6 daily reports of the sampled week). Analyses focus on nine alcohol-related behaviors (including estimated blood alcohol concentration, pregaming, and drinking games) assessed daily in spring/sophomore year to fall/senior year and drinking motivations, hazardous drinking, and dependence symptoms assessed fall/senior year (n = 569; 56% women).

RESULTS

Four week-level drinker statuses were replicated across semesters: Nondrinker, Light Weekend, Heavy Weekend, and Heavy Frequent. Across semesters, drinker status was associated with senior-year hazardous drinking and any dependence symptoms. Senior-year fun/social motivations were also associated with senior-year drinker status. Differences in behavioral profiles between week-level drinker statuses and those identified using traditional measures were found.

CONCLUSIONS

Replicable week-level drinker statuses were identified, suggesting consistency in possible types of drinking weeks. Drinker statuses were predictive of senior-year hazardous drinking and dependence symptoms.

Substance Use Patterns Among Adolescents in Europe: A Latent Class Analysis

BACKGROUND

Several researchers have investigated substance use patterns using a latent class analysis; however, hardly no studies exist on substance use patterns across countries.

OBJECTIVES

Adolescent substance use patterns, demographic factors, and international differences in the prevalence of substance use patterns were explored.

METHODS

Data from 25 European countries were used to identify patterns of adolescent (12-16 years, 50.6% female) substance use (N = 33,566).

RESULTS

Latent class analysis revealed four substance use classes: nonusers (68%), low-alcohol users (recent use of beer, wine, and alcopops; 16.1%), alcohol users (recent use of alcohol and lifetime use of marijuana; 11.2%), and polysubstance users (recent use of alcohol, marijuana, and other illicit drugs; 4.7%). Results support a general pattern of adolescent substance use across all countries; however, the prevalence rates of use patterns vary for each country.

CONCLUSIONS/IMPORTANCE

The present research provides insight into substance use patterns across Europe by using a large international adolescent sample, multidimensional indicators and a variety of substances. Substance use patterns are helpful when targeting policy and prevention strategies.

Progressive elaboration and cross-validation of a latent class typology of adolescent alcohol involvement in a national sample

OBJECTIVE

Most studies of adolescent drinking focus on single alcohol use behaviors (e.g., high-volume drinking, drunkenness) and ignore the patterning of adolescents' involvement across multiple alcohol behaviors. The present latent class analyses (LCAs) examined a procedure for empirically determining multiple cut points on the alcohol use behaviors in order to establish a typology of adolescent alcohol involvement.

METHOD

LCA was carried out on six alcohol use behavior indicators collected from 6,504 7th through 12th graders who participated in Wave I of the National Longitudinal Study of Adolescent Health (AddHealth). To move beyond dichotomous indicators, a "progressive elaboration" strategy was used, starting with six dichotomous indicators and then evaluating a series of models testing additional cut points on the ordinal indicators at progressively higher points for one indicator at a time. Analyses were performed on one random half-sample, and confirmatory LCAs were performed on the second random half-sample and in the Wave II data.

RESULTS

The final model consisted of four latent classes (never or non-current drinkers, low-intake drinkers, non-problem drinkers, and problem drinkers). Confirmatory LCAs in the second random half-sample from Wave I and in Wave II support this four-class solution. The means on the four latent classes were also generally ordered on an array of measures reflecting psychosocial risk for problem behavior.

CONCLUSIONS

These analyses suggest that there may be four different classes or types of alcohol involvement among adolescents, and, more importantly, they illustrate the utility of the progressive elaboration strategy for moving beyond dichotomous indicators in latent class models.

Alcohol drinking cultures of European adolescents

BACKGROUND

Adolescent alcohol use varies across Europe. Differences in use might be due to variations in social drinking norms. These norms become apparent, e.g. in different proportions of alcohol drinking types per country. This study's purpose is to cluster European countries according to prevalence rates of alcohol drinking habits among adolescents aged 12-16.

METHODS

Based on results of previously done cluster analyses regarding alcohol use patterns in Europe, a second level hierarchical cluster analysis is performed. To do so, the proportions of each drinking pattern per country (non, mild, episodic, frequent and heavy episodic use) across 25 European countries (N = 48 423, M = 13.83 years, 48.5% male) are used as classifying variables.

RESULTS

Three country clusters are extracted that differentiate between eight countries with 'mainly non-using' adolescents, six countries with adolescents who use alcohol in a 'mainly mild but frequent' way and 11 countries that show the 'highest proportions of (heavy) episodic drinking adolescents'.

CONCLUSIONS

When applying and developing intervention strategies, differences in adolescent alcohol drinking cultures (i.e. social drinking norms) within Europe should be focused on. Alcohol policies and prevention programs should take cultural aspects like social drinking norms into account.

Phylogenetic Investigation of a Statewide HIV-1 Epidemic Reveals Ongoing and Active Transmission Networks Among Men Who Have Sex With Men

BACKGROUND

Molecular epidemiological evaluation of HIV-1 transmission networks can elucidate behavioral components of transmission that can be targets for intervention.

METHODS

We combined phylogenetic and statistical approaches using pol sequences from patients diagnosed between 2004 and 2011 at a large HIV center in Rhode Island, following 75% of the state's HIV population. Phylogenetic trees were constructed using maximum likelihood, and putative transmission clusters were evaluated using latent class analyses to determine association of cluster size with underlying demographic/behavioral characteristics. A logistic growth model was used to assess intracluster dynamics over time and predict "active" clusters that were more likely to harbor undiagnosed infections.

RESULTS

Of the 1166 HIV-1 subtype B sequences, 31% were distributed among 114 statistically supported, monophyletic clusters (range: 2-15 sequences/cluster). Sequences from men who have sex with men (MSM) formed 52% of clusters. Latent class analyses demonstrated that sequences from recently diagnosed (2008-2011) MSM with primary HIV infection (PHI) and other sexually transmitted infections (STIs) were more likely to form larger clusters (odds ratio: 1.62-11.25, P < 0.01). MSM in clusters were more likely to have anonymous partners and meet partners at sex clubs and pornographic stores. Four large clusters with 38 sequences (100% male, 89% MSM) had a high probability of harboring undiagnosed infections and included younger MSM with PHI and STIs.

CONCLUSIONS

In this first large-scale molecular epidemiological investigation of HIV-1 transmission in New England, sexual networks among recently diagnosed MSM with PHI and concomitant STIs contributed to the ongoing transmission. Characterization of transmission dynamics revealed actively growing clusters, which may be targets for intervention.

A social network analysis approach to alcohol use and co-occurring addictive behavior in young adults

INTRODUCTION

The current study applied egocentric social network analysis (SNA) to investigate the prevalence of addictive behavior and co-occurring substance use in college students' networks. Specifically, we examined individuals' perceptions of the frequency of network members' co-occurring addictive behavior and investigated whether co-occurring addictive behavior is spread evenly throughout networks or is more localized in clusters. We also examined differences in network composition between individuals with varying levels of alcohol use.

METHOD

The study utilized an egocentric SNA approach in which respondents ("egos") enumerated 30 of their closest friends, family members, co-workers, and significant others ("alters") and the relations among alters listed. Participants were 281 undergraduates at a large university in the Southeastern United States.

RESULTS

Robust associations were observed among the frequencies of gambling, smoking, drinking, and using marijuana by network members. We also found that alters tended to cluster together into two distinct groups: one cluster moderate-to-high on co-occurring addictive behavior and the other low on co-occurring addictive behavior. Lastly, significant differences were present when examining egos' perceptions of alters' substance use between the networks of at-risk, light, and nondrinkers.

CONCLUSIONS

These findings provide empirical evidence of distinct clustering of addictive behavior among young adults and suggest the promise of social network-based interventions for this cohort.

'Klar bleiben': a school-based alcohol prevention programme for German adolescents-study protocol for a cluster randomised controlled trial

INTRODUCTION

There is a noticeable increase in hazardous alcohol use during adolescence, which is significantly associated with adverse consequences. In Germany, up to 30% of adolescents report regular heavy episodic drinking. However, only a few German prevention programmes target adolescents of legal drinking age (16 years and above); thus, this trial aims to develop, implement and evaluate 'Klar bleiben' ('Stay clearheaded'), a school-based prevention programme for grade 10 students.

METHODS AND ANALYSIS

'Klar bleiben' consists of a class commitment to drink responsibly and refrain from hazardous consumption patterns for 9 weeks. The commitment is accompanied by educational lessons on alcohol-related cognitions and consequences. It will be evaluated in a sample of approximately 3000 students (150 classes) from two German federal states (Schleswig-Holstein and Lower Saxony) via a two-armed cluster randomised controlled trial with baseline and postassessment 6 months apart. The intervention group (75 classes) will participate in 'Klar bleiben', whereas the control group (75 classes) will receive education as usual. 'Klar bleiben' addresses classes, individuals, teachers and parents. It is based on a social norms approach and aims to reduce hazardous drinking and drinking-related consequences in adolescents. Secondary outcomes include general drinking behaviour, use of other substances, alcohol-related cognitions and social factors. Covariates include sociodemographic characteristics, environmental and individual (vulnerability) factors.

ETHICS AND DISSEMINATION

'Klar bleiben' provides a multicomponent school-based programme that bridges a gap in alcohol prevention. Similar class-level and social norms-based prevention programmes have already been proven to be successful for other substances among adolescents. Thus, dissemination to other federal states as well as longer term follow-up testing of the robustness of effects is to be anticipated. The study was approved by the Ethics Committee of the German Psychological Society (RH_0620152), and study findings will be disseminated through peer-reviewed publications and conference contributions.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register: DRKS00009424.

Drinking patterns of alcohol intoxicated adolescents in the emergency department: A latent class analysis

INTRODUCTION

The increasing number of children and adolescents in need of emergency medical treatment following acute alcohol intoxication has been a major public health concern in Europe in recent years. However, little is known about drinking habits and associated risks in this population. To our knowledge, this is the first study to examine drinking patterns and associated risks in adolescent emergency department patients following alcohol intoxication. The aim of this study is to establish a classification system for admitted adolescents

METHODS

Latent class analysis was used to identify subgroups of adolescents with distinct patterns of habitual drinking as defined by the quantity of consumed alcohol on a typical drinking occasion, frequency of binge drinking and drunkenness, alcohol-related problems, prior alcohol-related hospitalizations and alcohol-related risk behaviors. Subgroup characteristics were examined with regard to sociodemographics, other substance use and psychosocial problems using analysis of variance (ANOVA) and chi-square tests.

RESULTS

A total of 316 adolescents aged 12-17 treated in 6 urban emergency departments in Germany were analyzed. Five classes of drinking patterns were identified: one class representing low-risk drinking (class 1 "low-risk" (61.2%)), two classes representing risky drinking (class 2 "moderate-risk" (5.7%) and class 3 "frequent drunk" (15.8%)), as well as two classes representing high-risk drinking (class 4 "alcohol-related problems" (11.4%) and class 5 "excessive drinking" (5.1%)). Membership of classes 4 and 5 was associated with the most severe psychosocial problems, especially with regard to aggressive-dissocial behaviors. The CRAFFT-d and brief RAPI screening tools allowed identifying the two risky drinking classes and two high-risk drinking classes.

CONCLUSIONS

Our findings provide the first in-depth analysis of habitual drinking in this study population and may help practitioners to better tailor interventions to patients' needs by using the identified classes as a form of classification system for admitted adolescents.

A Latent Class Analysis of Risk Factors for Acquiring HIV Among Men Who Have Sex with Men: Implications for Implementing Pre-Exposure Prophylaxis Programs

Current Centers for Disease Control and Prevention (CDC) guidelines for prescribing pre-exposure prophylaxis (PrEP) to prevent HIV transmission are broad. In order to better characterize groups who may benefit most from PrEP, we reviewed demographics, behaviors, and clinical outcomes for individuals presenting to a publicly-funded sexually transmitted diseases (STD) clinic in Providence, Rhode Island, from 2012 to 2014. Latent class analysis (LCA) was used to identify subgroups of men who have sex with men (MSM) at highest risk for contracting HIV. A total of 1723 individuals presented for testing (75% male; 31% MSM). MSM were more likely to test HIV positive than heterosexual men or women. Among 538 MSM, we identified four latent classes. Class 1 had the highest rates of incarceration (33%), forced sex (24%), but had no HIV infections. Class 2 had <5 anal sex partners in the previous 12 months, the lowest rates of drug/alcohol use during sex and lower HIV prevalence (3%). Class 3 had the highest prevalence of HIV (7%) and other STDs (16%), > 10 anal sex partners in the previous 12 months (69%), anonymous partners (100%), drug/alcohol use during sex (76%), and prior STDs (40%). Class 4 had similar characteristics and HIV prevalence as Class 2. In this population, MSM who may benefit most from PrEP include those who have >10 sexual partners per year, anonymous partners, drug/alcohol use during sex and prior STDs. LCA is a useful tool for identifying clusters of characteristics that may place individuals at higher risk for HIV infection and who may benefit most from PrEP in clinical practice.

Moral Disengagement, Anticipated Social Outcomes and Adolescents' Alcohol Use: Parallel Latent Growth Curve Analyses

Moral disengagement is a social cognitive process that has been extensively applied to transgressive behaviors, including delinquency, aggression and illicit substance use. However, there has been limited research on moral disengagement as it relates to underage drinking. The current study aimed to examine moral disengagement contextualized to underage drinking and its longitudinal relationship to alcohol use. Moreover, the social context in which adolescent alcohol use typically occurs was also considered, with a specific emphasis on the social sanctions, or social outcomes, that adolescents anticipate receiving from friends for their alcohol use. Adolescents were assessed across three time-points, 8 months apart. The longitudinal sample consisted of 382 (46% female) underage drinkers (12-16 years at T1). Parallel latent growth curve analysis was used to examine the bi-directional influence of initial moral disengagement, anticipated social outcomes, and alcohol use on subsequent growth in moral disengagement, anticipated social outcomes and alcohol use. The interrelation of initial scores and growth curves was also assessed. The findings revealed that, in the binary parallel analyses, initial moral disengagement and anticipated social outcomes both significantly predicted changes in alcohol use across time. Moreover, initial anticipated social outcomes predicted changes in moral disengagement. These findings were not consistently found when all three process analyses were included in a single model. The results emphasize the impact of social context on moral disengagement and suggest that by targeting adolescents' propensity to justify or excuse their drinking, as well as the social outcomes adolescents anticipate for being drunk, it may be possible to reduce their underage drinking.

Adolescent Alcohol Use Patterns From 25 European Countries

This study’s purpose is to describe European adolescents’ alcohol use patterns by grouping adolescents regarding their current alcohol use by cluster analysis (CA). Discriminant and latent profile analyses (LPA) evaluate and validate the solution that will be described further by ANOVAs. From 25 European countries, 57,771 students (49.4% male, 13.87 years) are grouped using hierarchical and k-means clustering. Alcohol use is measured by frequency of drinking occasions during the previous month and number of beverages consumed on the last drinking occasion. CA suggests four drinking patterns: mild (73.6%), episodic (20.0%), frequent (3.8%), and heavy episodic use (2.5%). Discriminant analysis attests a classification reliability of 94%, and confirmatory LPA replicates the cluster solution with a satisfying model fit. Three of the found patterns fulfill criteria for heavy drinking and underline the importance of individualized indicated prevention by promoting responsible use.

Profiles of substance use disorders in patients of therapeutic communities: link to social, medical and psychiatric characteristics

BACKGROUND

Therapeutic community (TC) clients frequently display a pattern of multiple substance use disorders (SUDs) which is associated with poorer treatment outcomes. This study aimed to characterize multiple SUD profiles in patients enrolled in TCs, and examine the association of these profiles with social, medical and psychiatric outcomes.

METHODS

Observational study. We acquired substance use diagnoses and sociodemographic, medical and psychiatric comorbidity data for 4102 patients who had been admitted to six public TCs in Andalusia (Spain) from 2004 to 2012. Latent class analysis was applied to participants' substance use diagnoses, and the resulting classes were associated with social (i.e., education, employment, criminality), medical (i.e., infectious diseases) and psychiatric comorbidity.

RESULTS

We found four differentiated profiles of substance use diagnoses among TC patients: cocaine/opiates (Class 1: 37% of participants); cocaine/opiates/benzodiazepines (Class 2: 25.3%); alcohol (Class 3: 24.7%); and cocaine/cannabis/alcohol (Class 4: 12.9%). Classes 1 and 2 were associated with poorer social and medical characteristics. Class 2 was also associated with greater prevalence of impulsive spectrum mental disorders. Class 3 was associated with greater prevalence of mood and anxiety disorders and cognitive dysfunction, and Class 4 was associated with higher prevalence of psychotic illness.

CONCLUSIONS

Patients admitted to TCs have heterogeneous substance use diagnostic profiles. Profiles involving multiple use of heroin, cocaine, alcohol and benzodiazepines are associated with poorer social and medical function and impulse control disorders. Profiles involving alcohol use and cannabis/cocaine use are associated with cognitive dysfunction and psychotic illness respectively.

Patterns of health risk behaviors among job-seekers: a latent class analysis

OBJECTIVES

To examine the patterning of four behavior-related health risk factors (tobacco smoking, risky alcohol drinking, overweight, and physical inactivity) among job-seekers and to investigate socio-demographic and health-related predictors of patterning.

METHODS

The sample of 3,684 female and 4,221 male job-seekers was proactively recruited at three job agencies in northeastern Germany in 2008/09. Participants provided data on socio-demographics, substance use, body mass index, physical activity and self-rated health. Latent class analyses (LCA) and multinomial logistic regression analyses were applied to identify health risk patterns and possible predictors of patterning, respectively.

RESULTS

Forty-three percent of the female and 58% of the male participants had two or more health risk factors. LCA revealed three similar patterns for women and men: Substance use (tobacco smoking, risky drinking), Non-exercising overweight (physical inactivity, overweight/obesity) and Health-conscious (non-smoking, low-risk drinking, under-/normal weight, physical activity). Age, education, marital status, life-time unemployment and self-rated health were significantly associated with patterning in both genders.

CONCLUSIONS

Our results may help to define target populations for improving health behaviors among job-seekers.

Drinking patterns and victimization among male and female students in Mexico

AIMS

The purpose of this study is to estimate the prevalence of alcohol use and alcohol-related consequences, identify drinking profiles using latent profile analysis (LPA), and investigate associations between profiles and violent victimization among young people in Mexico.

METHODS

LPA identified profiles of drinking behavior in a survey of entering first year university students. Multinomial and logistic regression examined associations between drinking patterns, socio-demographic variables and violent victimization.

RESULTS

The LPA identified five profiles of behaviors and consequences among the 22,224 current, former and never drinkers: Non/Infrequent-No Consequences, Occasional-Few Consequences, Regular-Some Consequences, Heavy-Many Consequences and Excessive-Many Consequences drinkers. The Occasional-Few Consequences profile comprised the largest, and the Excessive-Many Consequences profile the smallest, group of drinkers. Multinomial regression showed males and older students more likely to be Heavy or Excessive-Many Consequences drinkers. Living alone was associated with higher odds, and higher maternal education with lower odds, of being a Non/Infrequent-No Consequences drinker. Heavier drinking profiles were more likely to experience violent victimization adverse consequences. Logistic regression showed male and female Heavy and Excessive-Many Consequences drinkers had the highest odds, and Non/Infrequent drinkers the lowest odds, of experiencing any victimization.

CONCLUSION

Findings suggest changes in male and female drinking behavior and a continuation of the established pattern of infrequent but high consumption among Mexican youths. Both male and female Heavy and Excessive-Many Consequences drinkers were at elevated risk for experiencing victimization. Identifying cultural gender norms about drinking including drinker expectations and drinking context that contribute to these patterns can inform prevention efforts.

Gender and racial/ethnic differences in patterns of adolescent alcohol use and associations with adolescent and adult illicit drug use

OBJECTIVES

The study objective was to use latent class analyses (LCAs) to identify gender- and racial/ethnic-specific groups of adolescent alcohol users and associations between alcohol use group and adolescent and adulthood illicit drug use in a nationally-representative US sample.

METHODS

We used Wave I (1994-1995, adolescence) of the National Longitudinal Study of Adolescent Health to conduct LCAs by gender and race/ethnicity and measure associations between class membership and Wave I and Wave III (2001-2002, young adulthood) drug use. Participants included white (n=9548), African American (n=4005) and Hispanic (n=3184) participants. LCAs were based on quantity and frequency of adolescent alcohol use; physiological and social consequences of use; and peer use.

RESULTS

Males and females were characterized by different alcohol use typologies and consequences. Males in the highest severity class (i.e. drank both heavily and frequently) experienced disproportionate risk of alcohol-related consequences compared with abstainers and other alcohol-using groups. Females who drank heavily when drinking even if only occasionally, experienced high risk of alcohol-related consequences. Substantial proportions of males reported diverse alcohol-related problems, whereas females most commonly reported alcohol-related problems with dating and sexual experiences. Though levels of alcohol use and report of problems associated with use were higher among white versus minority populations, other racial/ethnic differences in patterns of alcohol use were minimal. Classification in any drinking class was a strong risk factor for adolescent and adulthood illicit drug use, with heavy drinkers at greatest risk of drug use.

CONCLUSIONS

Gender-specific adolescent alcohol and substance use prevention programs are warranted.

The validity of a latent class typology of adolescent drinking patterns

Objectives: This study examined the validity of a latent class typology of adolescent drinking based on four alcohol dimensions; frequency of drinking, quantity consumed, frequency of binge drinking and the number of alcohol related problems encountered.

Method: Data used were from the 1970 British Cohort Study 16-year-old follow-up. Partial or complete responses to the selected alcohol measures were provided by 6,516 cohort members. The data were collected via a series of postal questionnaires.

Results: A five class LCA typology was constructed. Around 12% of the sample were classified as ‘hazardous drinkers’ reporting frequent drinking, high levels of alcohol consumed, frequent binge drinking and multiple alcohol related problems. Multinomial logistic regression, with multiple imputation for missing data, was used to assess the covariates of adolescent drinking patterns. Hazardous drinking was associated with being white, being male, having heavy drinking parents (in particular fathers), smoking, illicit drug use, and minor and violent offending behaviour. Non-significant associations were found between drinking patterns and general mental health and attention deficient disorder.

Conclusion: The latent class typology exhibited concurrent validity in terms of its ability to distinguish respondents across a number of alcohol and non-alcohol indicators. Notwithstanding a number of limitations, latent class analysis offers an alternative data reduction method for the construction of drinking typologies that addresses known weaknesses inherent in more tradition classification methods.

Applicability of Type A/B alcohol dependence in the general population

BACKGROUND

This study examined the concurrent and predictive validity of Type A/B alcohol dependence in the general population-a typology developed in clinical populations to gauge severity of dependence.

METHODS

Data were drawn from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The sample included 1,172 alcohol-dependent drinkers at baseline who were reinterviewed three years later. Latent class analysis was used to derive Type A/B classification using variables replicating the original Type A/B typology. Predictive validity of the Type A/B classification was assessed by multivariable linear and logistic regressions.

RESULTS

A two-class solution consistent with Babor's original Type A/B typology adequately fit the data. Type B alcoholics in the general population, compared to Type As, had higher alcohol severity and more co-occurring drug, mental, and physical health problems. In the absence of treatment services utilization, Type B drinkers had two times the odds of being alcohol dependent three years later. Among those who utilized alcohol treatment services, Type B membership was predictive of heavy drinking and drug dependence, but not alcohol dependence, three years later.

CONCLUSIONS

Findings suggest that Type A/B classification is both generalizable to, and valid within, the US general population of alcohol dependent drinkers. Results highlight the value of treatment for mitigating the persistence of dependence among Type B alcoholics in the general population. Screening for markers of vulnerability to Type B dependence could be of clinical value for health care providers to determine appropriate intervention.

Cognitive performance profiles by latent classes of drug use

BACKGROUND AND OBJECTIVES

The relationship between substance use and cognitive deficits is complex and requires innovative methods to enhance understanding. The present study is the first to use LCA to examine associations of drug use patterns with cognitive performance.

METHODS

Cocaine/heroin users (N = 552) completed questionnaires, and cognitive measures. LCA identified classes based on past-month drug use and adjusted for probabilities of group membership when examining cognitive performance. Latent indicators were: alcohol (ALC), cigarettes (CIG), marijuana (MJ), crack smoking (CS), nasal heroin (NH), injection cocaine (IC), injection heroin (IH), and injection speedball (IS). Age and education were included as covariates in model creation.

RESULTS

Bootstrap likelihood ratio test (BLRT) supported a 5-class model. Prevalent indicators (estimated probability of over 50%) for each class are as follows: "Older Nasal Heroin/Crack Smokers" (ONH/CS, n = 166.9): ALC, CIG, NH, CS; "Older, Less Educated Polysubstance" (OLEP, n = 54.8): ALC, CIG, CS, IH, IC, and IS; "Younger Multi-Injectors" (MI, n = 128.7): ALC, CIG, MJ, IH, IC, and IS; "Less Educated Heroin Injectors" (LEHI, n = 87.4): CIG, IH; and "More Educated Nasal Heroin" users (MENH, n = ALC, CIG, NH. In general, all classes performed worse than established norms and older, less educated classes performed worse, with the exception that MENH demonstrated worse cognitive flexibility than YMI.

DISCUSSION AND CONCLUSIONS

This study demonstrated novel applications of a methodology for examining complicated relationships between polysubstance use and cognitive performance.

SCIENTIFIC SIGNIFICANCE

Education and/or nasal heroin use are associated with reduced cognitive flexibility in this sample of inner city drug users.

Predictors of drinking patterns in adolescence: a latent class analysis

BACKGROUND

Uni-dimensional measures of alcohol consumption may be unable to fully capture the complexity of adolescent drinking and experience of alcohol-related harms. Latent class analysis provides an empirical method to understand different adolescent drinking patterns.

METHODS

Latent class analysis was used to create typologies of drinking among the 5018 current drinkers in the national Youth '07 survey. Determinants of drinking patterns were identified using multinomial logistic regression.

RESULTS

Four latent classes were identified, demonstrating an overall increase in risk of alcohol-related outcomes from increasing consumption. One class strongly deviated from this pattern, having moderate consumption patterns but disproportionately high levels of alcohol-related problems. Multinomial logistic regression found that the strongest predictors of belonging to high-risk drinking typologies were having a positive attitude to regular alcohol use, buying own alcohol, peers using alcohol, and obtaining alcohol from friends and/or other adults. Other significant predictors included being male, having a strong connection to friends, having parents with a low level of knowledge of their daily activities and poor connection to school. Class membership also varied by ethnicity.

CONCLUSION

The latent class approach demonstrated variability in alcohol-related harms across groups of students with different drinking patterns. Longitudinal studies are necessary to determine the causes of this variability in order to inform the development of targeted policy and preventative interventions. Legislative controls, such as increasing the legal purchase age and reducing the commercial availability of alcohol, will continue to be important strategies for reducing harm in young people.

Patterns of substance use among Argentinean adolescents and analysis of the effect of age at first alcohol use on substance use behaviors

OBJECTIVE

The present study used an empirically based method to characterize substance use in a sample of Argentinean adolescents and analyzed the association between age at drinking onset and substance use behaviors. Differences in alcohol expectancies and personality traits as a function of different patterns of substance use were also explored.

METHOD

Data were obtained from 583 adolescents aged 13-18years (M=15.01years; SD=1.5years; 59.5% female) from the city of Cordoba, Argentina. Alcohol, tobacco, and drug use and age at first alcohol use were measured. Personality traits, including extroversion, conscientiousness, impulsivity, and aggression, and positive and negative alcohol expectancies were assessed. Latent Class Analysis was applied to examine the structure of five co-occurring substance use behaviors: frequency of alcohol use, quantity of alcohol use, prevalence of drunkenness episodes, tobacco use, and drug use.

RESULTS

Latent Class Analysis revealed five distinct patterns of substance use. The classes differed in substance use behaviors, personality traits, and alcohol expectancies. Adolescents with early drinking onset were more likely to show heavier alcohol use, more drunkenness episodes, and more drug use than adolescents with late drinking onset.

CONCLUSIONS

Latent Class Analysis allowed the detection of groups of adolescents with distinct patterns of substance use. These groups exhibited significantly different personality and alcohol expectancy profiles, likely representing subgroups who are at greater risk for developing alcohol-related problems.

Types of alcohol use experience from childhood through adolescence

PURPOSE

There have been few reports of the development of alcohol involvement from childhood through adolescence. We examined the ages at which children first sipped or tasted alcohol, drank, had three or more drinks in a row, had five or more drinks in a row, were drunk, or had alcohol problems, to describe the types of drinking experience exhibited at each age from 8.5 through 18.0 years. Sipping and three or more drinks per occasion have been understudied to date.

METHODS

We collected 14 waves of longitudinal data from 452 children aged 8 or 10 years, randomly sampled from Allegheny County, Pennsylvania. Ages of initiating each alcohol use behavior were determined, and the data were coded to reflect the child's status on each behavior at each age. We determined types of alcohol use experience using latent class analyses.

RESULTS

From age 8.5 to 12.5 years, there were two latent classes: abstainers and sippers. The percentage of sippers increased to 67% by age 12.5 years. From ages 13.0 to 18.0, we identified three latent classes: abstainers, sippers/light drinkers, and drinkers with drunkenness. At ages 13.5-15.5 years, drinkers in the latter class reported drunkenness with just three to four drinks per occasion. By age 18 years, sippers/light drinkers comprised 55% of the sample and drinkers with drunkenness comprised 38%.

CONCLUSIONS

Childhood experience with alcohol was surprisingly widespread. Sipping or tasting alcohol was common by age 12 years. A quarter of the sample drank before age 15 years. Experience of intoxication increased throughout adolescence, even among those who had ever consumed just three to four drinks on an occasion.