Ways of measuring drinking patterns and the difference they make: experience with graduated frequencies

Quantification of racial and ethnic disparities in alcohol-related problems in light of different methodological approaches

AIM

We applied the Institute of Medicine (IOM) definition of racial and ethnic disparities in healthcare to estimate disparities in alcohol-related problems. This estimation involved adjusting for drinking patterns, gender and age, with observed disparities further explained by socioeconomic status (SES). We compared results of five statistical approaches which use different methods for adjusting covariates.

DESIGN AND SETTING

We conducted analysis of the repeated cross-sectional data from the US National Alcohol Surveys (NAS) from 2000 to 2020, comparing traditional regression, rank-and-replacement, propensity score weighting, G-computation and the double-robust methods.

PARTICIPANTS

39 239 respondents aged 18 + across five NAS surveys oversampling Black and Hispanic/Latino/a populations.

MEASUREMENTS

Our primary analysis examined the dichotomous outcomes of the three alcohol problem measures: occurrence of negative consequences, alcohol dependence (using DSM-IV criteria) and alcohol use disorder (AUD, using DSM-5 criteria). The drinking pattern variables encompassed past year total alcohol volume and measures of heavy drinking, including the number of days consuming 12+, 8-11 and 5-7 drinks.

FINDINGS

After adjusting for age, alcohol volume and heavy drinking days, statistically significantly higher prevalence of DSM-IV dependence and DSM-5 AUD were observed for Black and Hispanic men who drank in the past year compared with White men who drank. For instance, the Black-White difference in AUD prevalence ranged from 3.7% (95% confidence interval = 1.1%, 6.2%) to 4.9% (2.1%, 7.8%)-, while the HispanicWhite difference ranged from 2.3% (0.1%, 4.4%) to 3.4% (1.1%, 5.6%), using different adjustment methods. Further adjusting for SES factors only moderately explained the observed disparities. We found consistent results in the estimation of disparities across all five methods.

CONCLUSIONS

There appear to be racial and ethnic disparities in alcohol-related problems between Black and Hispanic men in the United States relative to White men after alcohol drinking patterns and age are adjusted. The findings also exhibit overall consistency across the five different methods or measurement applied.

A Longitudinal Increase in Serum Gamma-Glutamyl Transferase Levels, but Not in Alanine Aminotransferase Levels, Improves the Prediction of Risk of Impaired Fasting Glucose in Male

BACKGROUND

Impaired fasting glucose (IFG), being a pre-diabetic condition, can increase the risk of overt diabetes; thus early detection and prediction of IFG are important to reduce the incidence of overt diabetes. Some predictive factors, including serum alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT), have been reported in several studies, but none of the studies have investigated the effect of longitudinal changes in individual serum ALT and GGT levels on the risk of IFG.

METHODS

We aimed to investigate the association between changes in the serum ALT and GGT levels and the risk of IFG using a checkup database between 1999 and 2014.

RESULTS

A total of 3,598 males and 3,275 females were enrolled in the study. We performed a follow-up test of serum ALT or GGT in each individual, and classified the cases in which the serum ALT or GGT level was increased or decreased during the follow-up test compared to the baseline. According to the multivariate Cox proportional hazards model, the hazard ratio was 1.76 (95% confidence interval, 1.45-2.12; P < 0.001) in male subjects with an increased serum GGT level compared to male subjects with a decrease in the serum GGT level at follow-up compared to the baseline. However, the relationship between the serum ALT level and incidence of new-onset IFG was not statistically significant in both sexes; and in females, the relationship between the serum GGT level and incidence of new-onset IFG was also not statistically significant.

CONCLUSION

We revealed that a longitudinal increase in serum GGT levels was related to an increased risk of IFG in males. Therefore, monitoring the changes in serum GGT levels is important for predicting new-onset IFG, and it can be used as an early indicator of onset of overt diabetes in males.

Changes in US drinking and alcohol use disorders associated with social, health, and economic impacts of COVID-19

AIMS

The COVID-19 pandemic increased alcohol consumption in the USA as a result of widespread individual changes in drinking patterns. Few studies have utilized longitudinal data allowing the prediction of increased or decreased drinking from COVID-19 economic, social, and health impacts.

METHODS

Data are from 1819 respondents in the 2019-20 National Alcohol Survey and a one-year follow-up in early 2021. Changes in past-year alcohol volume, drinking days, days with 5+ drinks, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alcohol use disorder (AUD) severity were measured as outcomes. Measures of COVID-19 economic, health, and social impacts were assessed for the individual and household. Economic impacts were combined into Self and Household scores. Analyses utilized multinomial logistic regression models to estimate meaningful increases or decreases in outcomes, while generalized estimating equation models estimated overall effects.

RESULTS

Increases in alcohol use and AUD severity were larger and more prevalent than decreases, and differences between sociodemographic groups in the prevalence of meaningful increases and decreases were found. Models of meaningful changes found that higher self-economic impact scores predicted increases in 5+ days and AUD severity. Generalized estimating equation models also found that the self-economic impact score predicted increased AUD severity and additionally that being an essential worker was associated with reductions in alcohol volume and 5+ days.

CONCLUSIONS

Substantial changes in drinking and AUD severity were observed, with increases in these outcomes being more prevalent and larger than decreases. Results highlight the importance of the pandemic's economic impacts in predicting changes in drinking and AUD severity.

Substance use trajectories among urban college students: associations with symptoms of stress, anxiety, and depression before and during COVID-19

This study explored substance use trajectories and associations with mental health among an ethnically/racially diverse college student sample before and during the COVID-19 pandemic. We combined repeated cross-sections and panel data from a total of 3,247 college students assessed with an online survey in 2018, 2019, and in three waves in 2020. We estimated trends in substance use and their relation to mental health over the survey waves using generalized estimating equations (GEE). Our results revealed notable associations between 30-day substance use patterns, time of assessment, and psychological well-being. These findings suggest a complex interplay between access to substances, context of substance use, and mental health. We discuss several initiatives that have been launched in response to the results of this ongoing study. Such initiatives may serve as examples for expanding similar efforts to other commuter colleges to prevent further increases in mental health problems and risky substance use.

Methane gas in breath test is associated with non-alcoholic fatty liver disease

Although the associations between a patient's body mass index (BMI) and metabolic diseases, as well as their breath test results, have been studied, the relationship between breath hydrogen/methane levels and metabolic diseases needs to be further clarified. We aimed to investigate how the composition of exhaled breath gases relates to metabolic disorders, such as diabetes mellitus, dyslipidemia, hypertension, and nonalcoholic fatty liver disease (NAFLD), and their key risk factors. An analysis was performed using the medical records, including the lactulose breath test (LBT) data of patients who visited the Ajou University Medical Center, Suwon, Republic of Korea, between January 2016 and December 2021. The patients were grouped according to four different criteria for LBT hydrogen and methane levels. Of 441 patients, 325 (72.1%) had positive results for methane only (hydrogen < 20 parts per million [ppm] and methane ⩾ 3 ppm). BMIs and NAFLD prevalence were higher in patients with only methane positivity than in patients with hydrogen and methane positivity (hydrogen ⩾ 20 ppm and methane ⩾ 3 ppm). According to a multivariate analysis, the odds ratio of only methane positivity was 2.002 (95% confidence interval [CI]: 1.244-3.221,P= 0.004) for NAFLD. Our results demonstrate that breath methane positivity is related to NAFLD and suggest that increased methane gas on the breath tests has the potential to be an easily measurable biomarker for NAFLD diagnosis.

Long-term trends in beverage-specific drinking in the National Alcohol Surveys: Differences by sex, age, and race and ethnicity

BACKGROUND

Despite substantial declines in underage drinking and binge drinking, alcohol consumption has increased in the past 30 years. This study examined how beverage-specific drinking patterns varied by sex, age, and race and ethnicity from 1979 to 2020.

METHODS

Secondary data analysis was conducted on pooled data from the National Alcohol Survey series from 1979 to 2020 of a sample of U.S. adults ages 18 years or older. Total and beverage-specific volume were calculated from graduated frequency questions on reported beverage type, which included beer, wine, and spirits. Sex-stratified analyses focused on descriptive trends of each alcohol measure over time and by age and race and ethnicity. Time-varying effect models were also conducted to identify subgroups at higher risk for increased consumption over time.

RESULTS

Women's drinking increased, with alcohol volume rising substantially from 2000 to 2020; the largest increase was among women 30 and older. Men's alcohol volume also rose over this period but remained below the levels of 1979 and 1984, with older adults increasing their consumption those 18-29 decreased their drinking. Beverage-specific trends showed some similarities by gender: in 2020, wine volume was at its highest level for both women and men, while spirits volume also was at its highest level for men and in women was tied with the 1979 peak in spirits consumption. Increases were also found among Black men and women and Latina women from 2000 to 2020.

CONCLUSIONS

Given the increases in alcohol volume, particularly among women and older age groups, alcohol policy, interventions, and education should consider ways to reduce harms associated with alcohol use among these groups. Continued monitoring of beverage-specific drinking patterns is needed to track policy-relevant changes.

Age at first drink and its influence on alcohol use behaviours in young adulthood: Evidence from an Australian household-based panel study

BACKGROUND

Public health guidelines recommend delaying the initiation age for alcohol. However, the causal link between age-at-first-drink (AFD) and future alcohol use in young adulthood is uncertain. This study examined the association between AFD and alcohol-related outcomes at age 20 years using an Australian sample.

METHODS

Data were obtained from Waves 1-19 (years 2001-2019) of the Household, Income and Labour Dynamics in Australia Survey on 20-year-olds with responses across ≥3 consecutive waves (n = 2278). The AFD for each respondent (between 15 and 20 years) was analysed relative to Australian legal drinking age (18 years). Inverse probability treatment weighting was used to evaluate associations between AFD and four outcomes at age 20 years: risk of current alcohol use; quantity of weekly alcohol consumption; risk of binge drinking; and frequency of binge drinking. Adjustments were made for confounders (e.g., heavy drinking by parents). Robustness of study findings was evaluated using several diagnostic tests/sensitivity analyses.

RESULTS

Among 20-year-olds, those with an AFD of 15-16 years consumed significantly more alcohol per week compared to an AFD of 18 years. Additionally, 20-year-old drinkers with an AFD of 16 years were significantly more likely to binge drink (though this association was likely confounded). An inverse dose-response relationship was observed between AFD and weekly alcohol consumption at 20 years, where a higher AFD led to lower alcohol consumption.

CONCLUSION

Study findings indicate an association between a higher AFD and consuming less alcohol in young adulthood, which could potentially support the scale-up of prevention programs to delay AFD among Australian adolescents.

Examining the association between psychological distress and alcohol use in Australian adolescents over a period of declining consumption

INTRODUCTION

Youth drinking rates have declined over the past 15 years while self-reported psychological distress has increased, despite a well-recognised positive relationship between the two. The current study aimed to identify changes in the relationship between psychological distress and alcohol use in adolescents from 2007 to 2019.

METHODS

This study used survey responses from 6543 Australians aged 14-19 years who completed the National Drug Strategy Household Survey in 2007, 2010, 2013, 2016 or 2019. Logistic and multivariable linear regressions with interactions (psychological distress × survey wave) predicted any alcohol consumption, short-term risk and average quantity of standard drinks consumed per day.

RESULTS

Psychological distress was a positive predictor of alcohol use and this association remained stable across survey waves as alcohol consumption decreased.

DISCUSSION AND CONCLUSIONS

The relationship between distress and alcohol consumption remained relatively steady, even as youth drinking declined and distress increased. The proportion of drinkers experiencing distress did not increase as consumption rates dropped, suggesting that the decline in youth drinking is occurring independently of the increase in self-reported and diagnosed mental health issues.

Cask wine: Describing drinking patterns associated with Australia's cheapest alcohol

INTRODUCTION

In Australia, cask wine is the cheapest alcoholic beverage available, offering the lowest price per standard drink. Despite this, there is little research on the contextual correlates of cask wine consumption. Therefore, the current study aims to describe how cask wine consumption has changed over the last decade. Then, through comparisons between cask and bottled wine, how prices, typical drinking locations, and patterns of consumption differ between the beverages.

METHODS

Cross-sectional data was drawn from two sources. Four waves of the National Drug Strategy Household Survey were used (2010, 2013, 2016 and 2019) in order to examine consumption trends over time. The International Alcohol Control study (2013) in Australia was additionally used to explore pricing and consumption trends in greater detail.

RESULTS

Cask wine was considerably cheaper than other forms of wine at $0.54 per standard drink (95% confidence interval [CI] 0.45-0.62, p < 0.05). Consumption trends associated with cask wine differed from that of bottled wine, being consumed almost entirely at home and in significantly greater quantity (standard drinks per day 7.8, 95% CI 6.25-9.26, p < 0.05). Among the heaviest drinkers, 13% (95% CI 7.2-18.8, p < 0.05) consumed cask wine as their main drink, compared to 5% (95% CI 3.76-6.24, p < 0.05) consuming bottled wine.

CONCLUSIONS

Cask wine drinkers are disproportionately more likely to consume higher amounts of alcohol, paying less per drink doing so compared to bottled wine drinkers. As all cask wine purchases were under $1.30, a minimum unit price may largely affect cask wine purchases, applying to a far smaller proportion of bottled wine.

Associations between state-level general population alcohol policies and drinking outcomes among women of reproductive age: Results from 1984 to 2020 National Alcohol Surveys

BACKGROUND

Policies specific to alcohol use during pregnancy have not been found to reduce risks related to alcohol use during pregnancy. In contrast, general population alcohol policies are protective for the general population. Here, we assessed whether US state-level general population alcohol policies are related to drinking outcomes among women of reproductive age.

METHODS

We conducted secondary analyses of 1984-2020 National Alcohol Survey data (N = 13,555 women ≤44 years old). State-level policy exposures were government control of liquor retail sales, heavy beer at gas stations, heavy beer at grocery stores, liquor at grocery stores, Sunday off-premise liquor sales, and blood alcohol concentration (BAC) driving limits (no law, 0.10 limit, 0.05-0.08 limit). Outcomes were past 12-month number of drinks, ≥5 drink days, ≥8 drink days, and any DSM-IV alcohol abuse/dependence symptoms. Regressions adjusted for individual and state-level controls, clustering by state, and included fixed effects for survey month and year.

RESULTS

Allowing Sunday off-premise liquor sales versus not was related to having 1.20 times as many drinks (95% CI: 1.01, 1.42), 1.41 times as many ≥5 drink days (95% CI: 1.08, 1.85), and 1.91 times as many ≥8 drink days (95% CI: 1.28, 2.83). BAC limits of 0.05-0.08 for driving versus no BAC limit was related to 0.51 times fewer drinks (95% CI: 0.27, 0.96), 0.28 times fewer days with ≥5 drinks (95% CI: 0.10, 0.75), and 0.20 times fewer days with ≥8 drinks (95% CI: 0.08, 0.47).

CONCLUSIONS

US state-level policies prohibiting Sunday off-premise liquor sales and BAC limits of 0.05-0.08 for driving are related to less past 12-month overall and heavy drinking among women 18-44 years old.

A new statistical model for binge drinking pattern classification in college-student populations

Background

Binge drinking (BD) among students is a frequent alcohol consumption pattern that produces adverse consequences. A widely discussed difficulty in the scientific community is defining and characterizing BD patterns. This study aimed to find homogenous drinking groups and then provide a new tool, based on a model that includes several key factors of BD, to assess the severity of BD regardless of the individual's gender.

Methods

Using the learning sample (N1 = 1,271), a K-means clustering algorithm and a partial proportional odds model (PPOM) were used to isolate drinking and behavioral key factors, create homogenous groups of drinkers, and estimate the probability of belonging to these groups. Robustness of our findings were evaluated with Two validations samples (N2 = 2,310, N3 = 120) of French university students (aged 18-25 years) were anonymously investigated via demographic and alcohol consumption questionnaires (AUDIT, AUQ, Alcohol Purchase Task for behavioral economic indices).

Results

The K-means revealed four homogeneous groups, based on drinking profiles: low-risk, hazardous, binge, and high-intensity BD. The PPOM generated the probability of each participant, self-identified as either male or female, to belong to one of these groups. Our results were confirmed in two validation samples, and we observed differences between the 4 drinking groups in terms of consumption consequences and behavioral economic demand indices.

Conclusion

Our model reveals a progressive severity in the drinking pattern and its consequences and may better characterize binge drinking among university student samples. This model provides a new tool for assessing the severity of binge drinking and illustrates that frequency of drinking behavior and particularly drunkenness are central features of a binge drinking model.

High Intensity Drinking (HID) Assessed by Maximum Quantity Consumed Is an Important Pattern Measure Adding Predictive Value in Higher and Lower Income Societies for Modeling Alcohol-Related Problems

Adjusting for demographics and standard drinking measures, High Intensity Drinking (HID), indexed by the maximum quantity consumed in a single day in the past 12 months, may be valuable in predicting alcohol dependence other harms across high and low income societies. The data consisted of 17 surveys of adult (15,460 current drinkers; 71% of total surveyed) in Europe (3), the Americas (8), Africa (2), and Asia/Australia (4). Gender-disaggregated country analyses used Poison regression to investigate whether HID (8-11, 12-23, 24+ drinks) was incrementally influential, beyond log drinking volume and HED (Heavy Episodic Drinking, or 5+ days), in predicting drinking problems, adjusting for age and marital status. In adjusted models predicting AUDIT-5 for men, adding HID improved the overall model fit for 11 of 15 countries. For women, 12 of 14 countries with available data showed an improved fit with HID included. The results for the five Life-Area Harms were similar for men. Considering the results by gender, each country showing improvements in model fit by adding HID had larger values of the average difference between high intensity and usual consumption, implying variations in amounts consumed on any given day. The amount consumed/day often greatly exceeded HED levels. In many societies of varying income levels, as hypothesized, HID provided important added information on drinking patterns for predicting harms, beyond the standard volume and binging indicators.

Does the relationship between alcohol retail environment and alcohol outcomes vary by depressive symptoms? Findings from a U.S. Survey of Black, Hispanic and White drinkers

AIMS

To assess whether associations between alcohol availability and consumption, drinking to drunkenness, and negative drinking consequences vary among individuals with elevated depressive symptoms.

METHODS

10,482 current drinkers in 2005-2015 National Alcohol Surveys (50.0% female; 74.4% White, 8.7% Black, 11.1% Hispanic). Elevated depressive symptoms was defined as having symptoms suggestive of major depressive disorder (above CES-D8/PHQ-2 cut-offs) versus no/sub-threshold symptoms (below cut-offs). Inverse probability of treatment weighted and covariate adjusted Poisson models with robust standard errors estimated associations of ZIP-code bar density and off-premise outlet density (locations/1,000 residents), elevated depressive symptoms, and their interaction with past-year volume consumed, monthly drinking to drunkenness, and negative drinking consequences. Models were then stratified by sex and race and ethnicity.

RESULTS

Overall, 13.7% of respondents had elevated depressive symptoms. Regarding density, the only statistically significant association observed was between off-premise density and volume consumed (rate ratio = 1.3, 95% confidence interval = 1.0, 1.7). Elevated depressive symptoms were associated with higher volume consumed, prevalence of drinking to drunkenness, and prevalence of negative consequences when controlling for off-premise density or bar density. However, there was no evidence of interaction between symptoms and density in the full sample nor among subgroups.

CONCLUSION

This study suggests that, while elevated depressive symptoms do not alter associations between alcohol availability and alcohol use and problems, they remain associated with these outcomes among past-year drinkers in a U.S. general population sample even when accounting for differential availability. Addressing depressive symptoms should be considered along with other policies to reduce population-level drinking and alcohol problems.

Association of short-term changes in drinking after onset of a serious health condition and long-term heavy drinking

BACKGROUND

Literature on changes in drinking following diagnosis of chronic health conditions is limited, especially differential response to specific conditions or across demographic subgroups. Methods Data were analyzed from the 2020 National Alcohol Survey of the U.S. adult population (n = 9968). Predictors of change in drinking following first diagnosis of hypertension, heart disease, diabetes, and cancer, and how the short-term post-disease change in drinking was associated with a change in long-term heavy (5 +) drinking from the decade before diagnosis to the decade following diagnosis were analyzed. Results The majority of respondents reported no change in drinking after diagnosis. Men were more likely than women to reduce drinking after hypertension (OR=1.47) but less likely to quit after heart disease (OR=0.46). Black and Hispanic/Latinx drinkers were more likely than white or other drinkers to reduce (OR=2.68, 2.35, respectively) or quit (OR=2.69, 2.34) after hypertension, and more likely to quit after diabetes (OR=3.44, 2.74) and cancer (OR=5.00, 5.27). Black drinkers were more likely to quit after heart disease (OR=3.26). Heavier drinkers were more likely to reduce or quit drinking than lighter drinkers. For all disease types, those who quit drinking after disease onset were less likely to report heavy drinking in the following decade. Conclusions Just cutting down had little effect on subsequent long-term heavy drinking compared to quitting. These data are important for informing efforts aimed at harm reduction in patients diagnosed with a chronic health condition and suggest specific demographic subgroups.

A Randomized, Double-Blind, Placebo-Controlled Trial to Evaluate the Effects of Multi-Strain Synbiotic in Patients with Functional Diarrhea and High Fecal Calprotectin Levels: A Pilot Study

Synbiotics, including probiotics and prebiotics, are useful for patients with functional bowel disorders. However, which synbiotics are beneficial for patients with which diseases, especially those with functional diarrhea (FDr) with high fecal calprotectin levels, is currently unknown. FDr is an extension of irritable bowel syndrome with diarrhea (IBS-D). Although fewer studies have been conducted on FDr compared to IBS-D, its importance is increasing as its prevalence increases. The aim of this study was to evaluate the effects of a synbiotic containing a mixture of Lactobacillus and Bifidobacterium and its substrate, fructooligosaccharide, on bowel symptoms, fecal calprotectin levels, fecal microbiota, and safety in FDr patients with high fecal calprotectin levels. Forty patients were randomly assigned to either a synbiotic group or a placebo group. A total of 20 subjects in the synbiotic group and 19 subjects in the placebo group completed the study (8 weeks). Changes in FDr symptoms, fecal calprotectin levels, and gut microbiota were assessed during the intervention period. At 4 and 8 weeks, the number of bowel movements tended to increase in the synbiotic group, with a significant increase in the number of formed stools rather than loose stools (p < 0.05). Bowel movement satisfaction was significantly increased in the synbiotic group, but not in the placebo group. Intestinal flora analysis revealed that Lactobacillales at the order level was increased only in the synbiotic group at the end of the intervention. In contrast, at week 8 of the intervention, log-transformed fecal calprotectin levels were significantly decreased in the synbiotic group, although the change was not significantly different from that of the placebo group. These findings suggest that the intake of a multi-strain-containing synbiotic for 8 weeks could improve gut symptoms and the intestinal microenvironment of FDr patients with high fecal calprotectin levels.

Harmful alcohol consumption in elite sports players in Ireland

BACKGROUND

Sportspeople are more prone to binge drink than their peers.

AIMS

We aimed to assess alcohol consumption, harms and behaviours in an elite Irish sporting population (Gaelic footballers and hurlers).

METHODS

An anonymous web-based questionnaire (demographics, alcohol consumption, culture and related harms) was administered to all elite players. The AUDIT-C questionnaire (frequency, quantity of alcohol consumption and frequency of binge drinking) was used to assess for adverse alcohol use. Univariate and multivariate analyses assessed for predictors of adverse alcohol use.

RESULTS

717 players (mean age 24 years) were analysed. The majority of patients were male (75%), unmarried (93%) and had completed university (67%). 96% were current drinkers. Players consumed more alcohol during the off-season (median 20 versus 8 standard drinks in 28 days) compared to the elite season. Amongst current drinkers, 73% exhibit adverse alcohol use, 93% reported binge drinking and 65% an alcohol related harm in the past year. Most players would turn to family (36%) or friends (21%) for help. There were significant associations between monthly bingeing (OR 18.4), smoking (OR 3.3), generally drinking in public (OR 3.2), current gambling (OR 2.3), male gender (OR 2.1), an alcohol harm in the past year (OR 1.9) and adverse alcohol use. In contrast, co-habiting with a partner (OR 0.5) was protective.

CONCLUSIONS

Excess alcohol consumption, alcohol related harms and binge drinking are prevalent in an elite sporting population, particularly during the off-season. Specific strategies are required to reduce alcohol related harms, particularly amongst high-risk groups during the off-season.

Predictors of alcohol screening quality in a US general population sample and subgroups of heavy drinkers

Alcohol screening is one of the most cost-effective clinical preventive services and important for intervening in the development of alcohol problems. We examine predictors of the quality of alcohol screening, approximated by alcohol quantity screening, which is a prerequisite for appropriate counseling, and compare conventional regression approach with Classification and Regression Trees (CART). Data come from the 2020 National Alcohol Survey, a population survey of US adults aged 18 years and over. Analyses focus on those reporting any alcohol screening at all (N = 989). The primary outcome was whether a healthcare profession had ever asked how much they drink, which is necessary to identify heavy drinking. We examined 12 potential predictors of alcohol quantity: gender, age, race and ethnicity, education, marital status, having a usual source of primary care, insurance, and health conditions. Analyses were replicated in heavy episodic drinking (HED) and high intensity drinking (HID) subgroups, both warranting alcohol counseling. Logistic regression results show that having diabetes and not having a college degree predict missed alcohol quantity screening in the sample overall, and younger age predicts missed alcohol quantity screening in the HED/HID subgroups. CART identified Black and Hispanic respondents who had not attended college at high risk of missed screening for heavy drinking in the overall sample, and those with public insurance at high risk of missed screening for heavy drinking in the HED/HID subgroups. The quality of alcohol screening needs improvement in general, and to avoid unintended disparities in alcohol-related health services.

Longitudinal assessment of drinking changes during the pandemic: The 2021 COVID-19 follow-up study to the 2019 to 2020 National Alcohol Survey

Background

Surveys of changes in drinking during the COVID‐19 pandemic have primarily relied on retrospective self‐report. Further, most such surveys have not included detailed measures of alcohol use patterns, such as beverage‐specific consumption, nor measures of alcohol use disorder (AUD) symptoms that would allow a comprehensive understanding of changes in alcohol use.

Methods

Data from 1819 completed interviews from the N14C follow‐up survey to the 2019 to 2020 National Alcohol Survey (N14) were conducted between January 30 and March 28, 2021. Questions on alcohol use from the Graduated Frequency series, beverage‐specific quantity and frequency, and DSM‐5 AUD items were asked in both surveys and used to estimate changes from pre‐pandemic drinking to drinking during the pandemic. Analyses focus on changes in these measures over time and comparisons between key subgroups defined by gender, race/ethnicity, and age.

Results

Key findings include particularly large increases in drinking and AUD for African Americans and women, reduced drinking and heavy drinking prevalence among men and White respondents, and a concentration of increased drinking and AUD among respondents aged 35 to 49. Increases in alcohol use were found to be driven particularly by increases in drinking frequency and the consumption of spirits.

Conclusions

Results confirm prior findings of overall increases and subgroup‐specific changes, and importantly, provide detailed information on the patterns of change across major socio‐demographic subgroups. Substantial increases in the prevalence of DSM‐5 moderate to severe AUDs are a novel finding that is of particular concern.

Impact of the policy environment on substance use among sexual minority women

Background:

Sexual minority women (SMW) are at greater risk for heavy episodic drinking, frequent marijuana use, and tobacco use than heterosexual women. Because past research has suggested the political and social environment may influence disparities in substance use by sexual orientation, this study examined associations of the U.S. state-level policy environment on substance use by SMW.

Methods:

A total of 732 SMW participants were recruited from two national online panels: a general population panel (n = 333) and a sexual minority-specific panel (n = 399). Past year substance use was defined by number of days of heavy episodic drinking (HED; 4+ drinks in a day), weekly tobacco use (once a week or more vs. less or none), and weekly marijuana use (once a week or more vs. less or none). Comprehensive state policy protection was defined by enactment of five policies protecting rights of sexual minorities. Regression models compared substance use outcomes for SMW living in states with comprehensive policy protections to SMW living in states with fewer or no protections. Models also assessed the impact of state policies related to alcohol (state monopoly on alcohol wholesale or retail sales), tobacco (state enactment of comprehensive smoke-free workplace laws) and marijuana (legalization of purchase, possession, or consumption of marijuana for recreational use).

Results:

Comprehensive policy protections were associated with fewer HED days. Recreational marijuana legalization was associated with higher odds of weekly use.

Conclusions:

Findings underscore the importance of policy protections for sexual minorities in reducing substance use, particularly HED, among SMW.

The who and what of women's drinking: Examining risky drinking and associated socio-demographic factors among women aged 40-65 years in Australia

INTRODUCTION

Recent trends in Australian national survey data show an increase in alcohol use among middle-aged people, amidst declines in alcohol use among other population groups. There is limited research, however, on middle-aged women's alcohol use. This study aimed to examine patterns in alcohol use among Australian women aged 40-65 and the associated sociodemographic and contextual factors.

METHODS

Cross-sectional data from six waves of the National Drug Strategy Household Survey (2001-2019). We estimated the prevalence of long-term risky drinking (>2 Australian standard drinks per day) and risky-single occasion drinking (>5 Australian standard drinks on one occasion) among middle-aged women. Logistic regression models were estimated using 2019 data to examine demographic characteristics and contextual factors associated with alcohol use.

RESULTS

Since 2001, there has been a statistically significant increase in long-term risky drinking and risky-single occasion drinking amongst middle-aged women in Australia. Educational attainment, marital status and employment status were negatively associated with risky drinking, whereas rurality, age and location of use were positively associated with risky drinking. Beverage type was both positively and negatively associated with risky drinking.

DISCUSSION AND CONCLUSIONS

Given the significant increase in alcohol use amongst middle-aged women in Australia, prevention efforts are needed for this group, which may focus in particular on home drinking and the impact of rurality on alcohol use.

Declines in alcohol consumption in Australia: some challenges to the theory of collectivity

BACKGROUND AND AIMS

There is significant debate about whether or not changes in per-capita alcohol consumption occur collectively across the entire distribution of drinking. This study used data from a decade of declining drinking in Australia to test the collectivity of drinking trends.

DESIGN

Repeated cross-sectional surveys (2010, 2013, 2016, 2019), analysed with quantile regression techniques assessing trends in drinking for 20 quantile groups.

SETTING

Australia.

PARTICIPANTS

A general population sample (total n = 85 891; males = 39 182, females = 46 709) aged 14 years and over.

MEASUREMENTS

Past-year volume of alcohol consumed was measured using standard graduated frequency survey questions. Models were stratified by sex and age group.

FINDINGS

Throughout the whole population, alcohol consumption had declined in all percentile groups, with the largest proportional declines evident for light and moderate drinkers [e.g. drinkers in the 25th percentile declined by 32.7%; 95% confidence interval (CI) = -41.6, -22.3% per wave]. Broadly collective declines were also found for younger men and women with significant declines in every percentile group, but older groups showed some evidence of polarization. For example, women aged 45-64 years significantly increased their consumption (2.9% per wave, 95% CI = 0.3-5.5%), while consumption for those in the 25th percentile fell significantly (-16.7%, 95% CI = -27.6, -4.2%).

CONCLUSIONS

The declines in Australian drinking since 2010 have included important deviations from the collectivity predicted by Skog's influential theory of collectivity of drinking, with markedly different patterns evident among different demographic groups.

Digital Assessment Tools Using Animation Features to Quantify Alcohol Consumption: Systematic App Store and Literature Review

Background

Accurate and user-friendly assessment tools for quantifying alcohol consumption are a prerequisite for effective interventions to reduce alcohol-related harm. Digital assessment tools (DATs) that allow the description of consumed alcoholic drinks through animation features may facilitate more accurate reporting than conventional approaches.

Objective

This review aims to identify and characterize freely available DATs in English or Russian that use animation features to support the quantitative assessment of alcohol consumption (alcohol DATs) and determine the extent to which such tools have been scientifically evaluated in terms of feasibility, acceptability, and validity.

Methods

Systematic English and Russian searches were conducted in iOS and Android app stores and via the Google search engine. Information on the background and content of eligible DATs was obtained from app store descriptions, websites, and test completions. A systematic literature review was conducted in Embase, MEDLINE, PsycINFO, and Web of Science to identify English-language studies reporting the feasibility, acceptability, and validity of animation-using alcohol DATs. Where possible, the evaluated DATs were accessed and assessed. Owing to the high heterogeneity of study designs, results were synthesized narratively.

Results

We identified 22 eligible alcohol DATs in English, 3 (14%) of which were also available in Russian. More than 95% (21/22) of tools allowed the choice of a beverage type from a visually displayed selection. In addition, 36% (8/22) of tools enabled the choice of a drinking vessel. Only 9% (2/22) of tools allowed the simulated interactive pouring of a drink. For none of the tools published evaluation studies were identified in the literature review. The systematic literature review identified 5 exploratory studies evaluating the feasibility, acceptability, and validity of 4 animation-using alcohol DATs, 1 (25%) of which was available in the searched app stores. The evaluated tools reached moderate to high scores on user rating scales and showed fair to high convergent validity when compared with established assessment methods.

Conclusions

Animation-using alcohol DATs are available in app stores and on the web. However, they often use nondynamic features and lack scientific background information. Explorative study data suggest that such tools might enable the user-friendly and valid assessment of alcohol consumption and could thus serve as a building block in the reduction of alcohol-attributable health burden worldwide.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42020172825; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172825

Concurrent validity of an estimator of weekly alcohol consumption (EWAC) based on the extended AUDIT

BACKGROUND AND AIMS

The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0-12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption.

DESIGN

Cross-sectional diagnostic study based on a nationally-representative survey.

SETTINGS

Community dwelling households in England.

PARTICIPANTS

A total of 22 404 household residents aged ≥16 years reporting drinking alcohol at least occasionally.

MEASUREMENTS

Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the 'Extended AUDIT') and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units.

FINDINGS

EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was ±11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and ±2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]).

CONCLUSIONS

A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions.

Racial/Ethnic and Gender Differences in Risk of Injury and Life-Course Drinking Patterns: Data from US National Alcohol Surveys

AIMS

To estimate risk of injury associated with frequency of drinking and heavy drinking (5+ drinks on occasion) by gender and race/ethnicity in the US population.

METHODS

Data were from a merged sample of two National Alcohol Surveys (telephone and web-based) (2014-2015 and 2019-2020) on 16,639 respondents, and analyzed using Cox proportional hazards models with age as the timescale in a retrospective cohort design. Life-course drinking was determined by age of onset and questions on any drinking and heavy drinking by decade of life. The outcome measure was having had an injury from a serious accident at a certainage.

RESULTS

Frequent heavy drinking (5+ daily, weekly and monthly) was significantly predictive of injury with hazard ratios (HRs) of 2.40, 1.81 and 1.50, respectively, while frequent light drinking (alcohol at least weekly and 5+ yearly or less) was also significant for women (HR = 1.73). For White respondents, 5+ at least weekly was significant for both men (HR = 1.74) and women (HR = 2.42). Among Hispanic respondents, 5+ at least weekly and 5+ monthly were both significant for men (HR = 2.81 and 2.49, respectively) and women (HR = 2.81 and 3.48, respectively). Among Black women, risk was significant for 5+ monthly (HR = 2.90) and for any alcohol ≥ weekly (HR = 2.72), but neither frequency of any drinking or 5+ was significant for Blackmen.

CONCLUSIONS

Data suggest a greater risk of injury from a serious accident for frequent heavy drinkers among all White and Hispanic respondents, and Black women, but not for Blackmen.

A Randomized, Double-Blind, Placebo-Controlled Trial to Assess the Efficacy and Safety of Lactiplantibacillus plantarum CJLP243 in Patients with Functional Diarrhea and High Fecal Calprotectin Levels

Micro-inflammation in the gut, assessed by fecal calprotectin (FC), is considered a component of the pathogenesis of functional diarrhea (FD). Since probiotics may suppress micro-inflammation in the intestine by competing with harmful bacteria, we hypothesized that they would reduce the ratio of loose stool symptoms and gut inflammation in patients with FD. We conducted a double-blind, placebo-controlled trial to assess the clinical and laboratory effects of Lactobacillus plantarum CJLP243 in FD patients with elevated FC levels for two months. Twenty-four patients diagnosed with FD with elevated FC levels were randomly assigned to either a probiotic group or a placebo group. After 2 months, 10 patients in the probiotic group and 12 patients in the placebo group completed the study, and FD symptoms, FC values, and intestinal flora were re-evaluated in these subjects. The percentage of subjects who had adequate FD relief (decrease in loose stool frequency) in the probiotic group was significantly increased after two months compared with the baseline. In addition, the probiotic group showed a statistically significant decrease in log-transformed FC values compared with the pre-treatment group, whereas the placebo group showed no difference before and after the intervention. Furthermore, the levels of Leuconostoc genus organisms in the gut microbiota composition in the probiotic group increased significantly after the end of the study compared with the baseline values. In this preliminary exploratory research, we found that two months of Lactiplantibacillus plantarum CJLP243 treatment resulted in FD symptom improvement, reduced FC values, and increased Leuconostoc levels, suggesting that the intake of Lactiplantibacillus plantarum was helpful in those patients. These findings need to be validated via further clinical studies.

Role of psychological distress on long-term risky and heavy-episodic drinking patterns in major cities and rural and remote areas

OBJECTIVE

Psychological distress and alcohol consumption are associated but few studies have focused on the association with problematic drinking in semi-urban and rural settings. In this study, we assessed the role of psychological distress on various measures of problematic drinking in urban, semi-urban and rural settings.

DESIGN

Retrospective descriptive study Setting SETTING: National Drug Strategy Household Survey population health survey data PARTICIPANTS: 151,341 Australian residents MAIN OUTCOME MEASURES: Problematic alcohol consumption categorised as either heavy-episodic drinking (defined as drinking 5 or more standard drinks at least once in the last 12 months) or long-term risky drinking (defined as drinking more than 730 standard drinks in the past 12 months) was the outcome variables. Psychological distress was identified from the K10 questionnaire. Participants were grouped into area of residence: urban, semi-urban and rural. Sex differences were also explored.

RESULTS

Poor-to-severe psychological distress was associated with higher odds of both long-term and heavy-episodic drinking. Being male alone increased the risk of both long-term and heavy-episodic drinking in all areas. When stratified by sex, being female and severe levels of psychological distress increased the risk of both long-term risky and heavy-episodic drinking. These risks were greater in non-urban environments.

CONCLUSIONS

Poor mental health outcomes may exacerbate problematic drinking amongst females, especially those living in non-urban environments. Public health campaigns could both target these at-risk groups of females in non-urban settings and also account for the interplay between problematic drinking and mental health.

Drinking and Neighborhood Contexts of Alcohol's Harms from Others

AIMS

Negative consequences of alcohol (or secondhand effects) extend beyond drinkers to affect other people, including both known others (friends, family members, spouses/partners) and strangers. Secondhand effects of alcohol manifest across various social environments, including the places where people drink and the neighborhoods where they live. These neighborhoods are characterized by different levels of alcohol availability and degrees of residential social cohesion. Hence, social environments may confer risk or protect from harms from others' drinking. The current study explores: (a) how drinking venues and neighborhood contexts relate to harms from other people's drinking (both known others and strangers), and (b) whether these associations vary by gender.

METHODS

Using pooled data from the National Alcohol Survey and National Alcohol's Harms to Others Survey (N = 5425), we regressed harms from various drinking others on social environment characteristics (drinking venues, alcohol availability and social cohesion) for the full sample and separately by gender. We used the false discovery rate method to adjust for multiple testing.

RESULTS

Overall, greater neighborhood social cohesion was associated with lower odds of harm from drinking others and, specifically, harm from drinking strangers. The effect of social cohesion was most pronounced for men.

CONCLUSIONS

Social cohesion was the most salient neighborhood factor associated with reduced alcohol-related harms from strangers. Directions for future research and policies to mitigate these harms are discussed.

Harmful alcohol consumption in elite sports players in Ireland

BACKGROUND

Sportspeople are more prone to binge drink than their peers.

AIMS

We aimed to assess alcohol consumption, harms and behaviours in an elite Irish sporting population (Gaelic footballers and hurlers).

METHODS

An anonymous web-based questionnaire (demographics, alcohol consumption, culture and related harms) was administered to all elite players. The AUDIT-C questionnaire (frequency, quantity of alcohol consumption and frequency of binge drinking) was used to assess for adverse alcohol use. Univariate and multivariate analyses assessed for predictors of adverse alcohol use.

RESULTS

717 players (mean age 24 years) were analysed. The majority of patients were male (75%), unmarried (93%) and had completed university (67%). 96% were current drinkers. Players consumed more alcohol during the off-season (median 20 versus 8 standard drinks in 28 days) compared to the elite season. Amongst current drinkers, 73% exhibit adverse alcohol use, 93% reported binge drinking and 65% an alcohol related harm in the past year. Most players would turn to family (36%) or friends (21%) for help. There were significant associations between monthly bingeing (OR 18.4), smoking (OR 3.3), generally drinking in public (OR 3.2), current gambling (OR 2.3), male gender (OR 2.1), an alcohol harm in the past year (OR 1.9) and adverse alcohol use. In contrast, co-habiting with a partner (OR 0.5) was protective.

CONCLUSIONS

Excess alcohol consumption, alcohol related harms and binge drinking are prevalent in an elite sporting population, particularly during the off-season. Specific strategies are required to reduce alcohol related harms, particularly amongst high-risk groups during the off-season.

The Chicago Health and Life Experiences of Women Couples Study: Protocol for a Study of Stress, Hazardous Drinking, and Intimate Partner Aggression Among Sexual Minority Women and Their Partners

BACKGROUND

Large gaps exist in research on alcohol use and intimate partner aggression (IPA) among sexual minority women (SMW; eg, lesbian, bisexual). Dyadic research with SMW and their partners can illuminate how couple-level factors operate in conjunction with individual-level factors to shape well-being in this understudied and vulnerable population. Given the traditionally gendered lens with which women are primarily viewed as victims and men as perpetrators, understanding the dynamics of IPA in same-sex female couples can also advance research and practice related to IPA more generally.

OBJECTIVE

Guided by a recent extension of the minority stress model that includes relational (couple-level) sexual minority stress and the I-cubed theoretical perspective on IPA, we will collect individual and dyadic data to better characterize the links between hazardous drinking and IPA among SMW and their partners. First, this study aims to examine the associations among minority stress, hazardous drinking, and IPA in SMW and their partners. Minority stressors will be assessed as both individual and couple-level constructs, thus further extending the minority stress model. Second, we aim to examine potential mediators and moderators of the associations among minority stress, hazardous drinking, and IPA. Finally, we aim to test models guided by the I-cubed theoretical perspective that includes instigating (eg, relationship conflict), impelling (eg, negative affect and trait anger), and inhibiting (eg, relationship commitment and emotion regulation) or disinhibiting (eg, hazardous drinking) influences on IPA perpetration.

METHODS

This United States National Institutes of Health-funded project will draw from a large and diverse cohort of SMW currently enrolled in the Chicago Health and Life Experiences of Women (CHLEW) study-a 21-year longitudinal study of risk factors and consequences associated with SMW hazardous drinking. SMW currently enrolled in the CHLEW and their partners will be invited to participate in the CHLEW Couples Study. By analyzing dyadic data using actor-partner interdependence models, we will examine how each partner's minority stress, hazardous drinking, and IPA experiences are associated with both her own and her partner's minority stress, hazardous drinking, and IPA perpetration.

RESULTS

Data collection began in February 2021 and will likely continue through 2023. Initial results should be available by mid-2024.

CONCLUSIONS

The CHLEW Couples Study will fill important gaps in knowledge and provide the basis for future research aimed at clarifying the causal pathways linking hazardous drinking and IPA among SMW. This will support the development of culturally appropriate targeted individual and dyadic prevention and intervention strategies.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/28080.

Quantifying risk of injury from usual alcohol consumption: An instrumental variable analysis

BACKGROUND

Numerous studies of roadside accidents among emergency room patients show elevated risk of injury from acute alcohol consumption, i.e., recent drinking precedes the injury event. The observed effects are large and show a dose-response relationship. In contrast, studies quantifying the association between injury risk and chronic consumption, such as past-year average volume, show lower relative risk estimates than those from acute consumption.

METHODS

Combining data from 4 waves of US National Alcohol Surveys (NAS) for years 2000-2015 (N = 29,571, 53% overall cooperation rate), we estimated the risk of any past-year injury from past-year volume using logistic regression. This was contrasted with an instrumental variable (IV) analysis utilizing a 2-stage residual inclusion (2SRI) approach to estimate injury risk from volume, which adjusted for unobserved confounders using state beer and spirits tax rates, zip code-level outlet and bar density, and control state status as instruments.

RESULTS

Based on the combined US population surveys and controlling for sociodemographics, using conventional logistic regression, the odds ratios of injury from an average volume of 1, 2, and 5 drinks per day were 1.12 [95% confidence interval: 1.02, 1.24], 1.10 [1.00, 1.22], and 1.04 [0.88, 1.22], respectively. These compared with 1.67 [1.00, 2.78], 2.38 [0.87, 6.54], and 6.98 [0.57, 85.89] using the IV method. The proportion of injury attributed to alcohol also increased in magnitude, from 6.2% [0.3%, 11.9%] using the conventional approach to 17.9% [8.2%, 27.7%] using the IV method.

CONCLUSIONS

The association between injury and chronic alcohol consumption may be confounded by unobserved factors, resulting in a possible downward bias of the risk estimate.

The Great Recession, behavioral health, and self-rated health: An examination of racial/ethnic differences in the US

The Great Recession has been associated with racial/ethnic disparities in economic loss, alcohol-related problems and mental health in the US. In this study, we examine its effect on overall health, the role of heavy drinking and mental health, and whether these relationships vary by race/ethnicity. Using US National Alcohol Survey data collected from White, African American and Latino individuals between June 2009 and March 2010 (N = 4656), we conducted gender-stratified simultaneous path modeling to test racial/ethnic differences in hypothesized paths from recession-related hardships to overall self-rated health through current depressive symptoms and heavy drinking. Recession impacts were measured using an index of job-related, financial and housing hardships. Models accounted for demographic characteristics and heavy drinking, health conditions and alcohol-related health harms occurring prior to the Great Recession. We found that in men and women of each racial/ethnic group, more accumulated recession hardships were associated with greater depressive symptoms and more frequent heavy drinking, and depressive symptoms were associated with poorer self-rated health. Further, heavy drinking was related to poorer self-rated health in Black men and depressive symptoms in Latino men, and for Black and Latina women, prior heavy drinking was associated with current depressive symptoms. Findings highlight adverse, behavioral and overall health consequences of a severe recession for men and women of diverse racial/ethnic groups, as well as unique risks for Black and Latino men and women. Findings suggest the need for behavioral health interventions alongside multisector strategies to bolster the labor market and social safety net during severe economic downturns.

Support for Alcohol Policies in Marginalized Populations

AIM

Kingdon [(2014) Agendas, Alternatives, and Public Policies. Essex. United Kingdom: Pearson Education Limited] argues that windows of opportunity to pass policies emerge when problems, solutions and policy support co-occur. This study aims to identify a set of alcohol policies with the potential to reduce alcohol-related disparities given high levels of support from marginalized groups, such as racial/ethnic minorities and lower-income groups.

METHODS

This study used data from five US National Alcohol Surveys, which were based on household probability samples of adults in 1995 (n = 4243), 2000 (n = 5736), 2005 (n = 1445), 2010 (n = 4164) and 2015 (n = 4041). We used multiple logistic regression to determine the odds of policy support by racial/ethnic group and income level, considering price, place and marketing policies as well as individual-level interventions.

RESULTS

Overall a majority of Americans supported banning alcohol sales in corner stores (59.4%), banning alcohol advertisements on television (55.5%), and establishing universal health coverage for alcohol treatment (80.0%). Support was particularly high among Blacks, Hispanics/Latinos and lower-income persons. Multivariate models showed that compared with White people, foreign-born Hispanics/Latinos had the most robust levels of support, including raising alcohol taxes (aOR = 2.40, 95% CI: 2.00, 2.88, P < 0.0001), banning alcohol sales in corner stores (aOR = 2.85, 95% CI: 2.22, 3.65, P < 0.0001) and reducing retail sales hours (aOR = 2.91, 95% CI: 2.38, 3.55, P < 0.0001).

CONCLUSION

Of the policies examined, banning alcohol sales at corner stores is most likely to be in a "window of opportunity" for reducing alcohol-related disparities. By simultaneously reducing population-level consumption and harms from others' drinking, place-based policies have the potential to reduce harms experienced by marginalized groups.

Racial/Ethnic Disparities in the Relationship of Alcohol-Related Injury and Perceived Driving Under the Influence from Hours of Exposure to High Blood Alcohol Concentration: Data From Four US National Alcohol Surveys (2000-2015)

AIMS

To analyze racial/ethnic disparities in risk of two alcohol-related events, alcohol-related injury and self-reported perceived driving under the influence (DUI) from hours of exposure to an elevated blood alcohol concentration (BAC).

METHODS

Risk curves for the predicted probability of these two outcomes from the number of hours of exposure to a BAC ≥ 0.08 mg% in the past year were analyzed separately for whites, blacks and Hispanics in a merged sample of respondents from four US National Alcohol Surveys (2000-2015).

RESULTS

Hours of exposure to a BAC ≥ 0.08 showed a stronger association with perceived DUI than with alcohol-related injury for all racial/ethnic groups. Greater risk was found for whites than blacks or Hispanics for outcomes at nearly all BAC exposure levels, and most marked at the highest level of exposure. Risk of both outcomes was significant for whites at all exposure levels, but small for alcohol-related injury. Little association was found for alcohol-related injury for blacks or Hispanics. For perceived DUI, risk for blacks was significantly elevated at lower levels of exposure, while risk for Hispanics was significantly elevated beginning at 30 h of exposure.

CONCLUSIONS

Findings showed racial/ethnic differences in risk of alcohol-related injury and perceived DUI from hours of exposure to elevated BAC. Risk increased at relatively low levels of exposure to a BAC ≥ 0.08, especially for whites, highlighting the importance of preventive efforts to reduce harmful outcomes for moderate drinkers.

Changes in DNA methylation persist over time in males with severe alcohol use disorder-A longitudinal follow-up study

Treatment strategies for alcohol use disorder (AUD) aim for abstinence or harm reduction. While deranged biochemical parameters reverse with alcohol abstinence, whether molecular changes at the epigenetic level reverse is not clearly understood. We investigated whether the reduction from high alcohol use reflects DNA methylation at the gene-specific and global level. In subjects seeking treatment for severe AUD, we assessed gene-specific (aldehyde dehydrogenase [ALDH2]/methylene tetrahydrofolate reductase [MTHFR]) and global (long interspersed elements [LINE-1]) methylation across three-time points (baseline, after detoxification and at an early remission period of 3 months), in peripheral blood leukocytes. We observed that both gene-specific and global DNA methylation did not change over time, irrespective of the drinking status at 3 months (52% abstained from alcohol). Further, we also compared DNA methylation in AUD subjects with healthy controls. At baseline, there was a significantly higher gene-specific DNA methylation (ALDH2: p < .001 and MTHFR: p = .001) and a significant lower global methylation (LINE-1: p = .014) in AUD as compared to controls. Our results suggest that epigenetic changes at the DNA methylation level associated with severe AUD persist for at least 3 months of treatment.

Considering serum alanine aminotransferase and gamma-glutamyltransferase levels together strengthen the prediction of impaired fasting glucose risk: a cross-sectional and longitudinal study

Emerging data suggest that an increase in serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) as biomarkers of oxidative stress are associated with increased risk of impaired fasting glucose (IFG). The present study was an investigation of whether an increase in serum ALT and GGT had a combined effect on increasing IFG risk through cross-sectional and longitudinal studies. In the cross-sectional study, data were analyzed from 9937 subjects without diabetes who underwent health check-ups between 1999 and 2001 (baseline data). In the longitudinal study, 6390 subjects were analyzed who had been rechecked between 2009 and 2014, excluding IFG patients from baseline data. In cross-sectional analysis, adjusted odds ratio (OR) of IFG in the fourth quartile of both ALT and GGT was 1.829 (95% confidence interval [CI] 1.545–2.164) compared with the reference group (1st and 2nd quartiles of ALT and GGT). In longitudinal analysis, IFG probability increased gradually with an increase in the circulating levels of ALT and GGT. Adjusted hazard ratios for developing IFG in the fourth quartile of both ALT and GGT was 1.625 (95% CI 1.263–2.091) compared with the reference group (1st and 2nd quartiles). Increased serum ALT and GGT levels are well associated with IFG after potential confounders are adjusted for, and elevated ALT and GGT at the same time can have a combined effect in predicting the development of IFG.

A Context-Specific Instrument to Record Drinking Behaviour: A Pilot Study on Implications of Identifying the Context of Risky Drinking

A context-specific quantity-frequency (CSQF) questionnaire has been developed to accurately measure alcohol consumption using probing questions on drinking context. The study aimed to describe the drinking context associated with different drinking intensities in a community of southern Thailand using the CSQF. A cross-sectional survey was conducted among adults aged > 15 years in Songkhla Province, Thailand. Among 804 participants, there were 183 current drinkers with 412 drinking events (215 low-, 79 medium-, and 118 high-intensity). More than half of these events occurred in special situations (i.e., holiday, party, and cultural drinking). About half of the drinking events occurred outside the drinker's house and most drinking events occurred among friends. Higher drinking intensity was associated with higher level of education [adjusted odds ratio (aOR) 4.74 for medium- and aOR 5.23 for high-intensity] and with a special drinking situation (aOR 2.46 for medium- and aOR 2.78 for high-intensity).

Distribution of Drinks Consumed by U.S. Adults by Average Daily Alcohol Consumption: A Comparison of 2 Nationwide Surveys

INTRODUCTION

Estimates of alcohol consumption in the Behavioral Risk Factor Surveillance System are generally lower than those in other surveys of U.S. adults. This study compares the estimates of adults' drinking patterns and the distribution of drinks consumed by average daily alcohol consumption from 2 nationwide telephone surveys.

METHODS

The 2014-2015 National Alcohol Survey (n=7,067) and the 2015 Behavioral Risk Factor Surveillance System (n=408,069) were used to assess alcohol consumption among adults (≥18 years), analyzed in 2019. The weighted prevalence of binge-level drinking and the distribution of drinks consumed by average daily alcohol consumption (low, medium, high) were assessed for the previous 12 months using the National Alcohol Survey and the previous 30 days using the Behavioral Risk Factor Surveillance System, stratified by respondents' characteristics.

RESULTS

The prevalence of binge-level drinking in a day was 26.1% for the National Alcohol Survey; the binge drinking prevalence was 17.4% for the Behavioral Risk Factor Surveillance System. The prevalence of high average daily alcohol consumption among current drinkers was 8.2% for the National Alcohol Survey, accounting for 51.0% of total drinks consumed, and 3.3% for the Behavioral Risk Factor Surveillance System, accounting for 27.7% of total drinks consumed.

CONCLUSIONS

National Alcohol Survey yearly prevalence estimates of binge-level drinking in a day and high average daily consumption were consistently greater than Behavioral Risk Factor Surveillance System monthly binge drinking and high average daily consumption prevalence estimates. When planning and evaluating prevention strategies, the impact of different survey designs and methods on estimates of excessive drinking and related harms is important to consider.

Effects of Question Type and Order When Measuring Peak Consumption of Risky Drinking Events

AIMS

There is new interest in measuring alcohol consumption during risky drinking events, but there is little guidance on how to best ask such questions. In this study, we contrast two different types of questions on peak consumption over a single heavy drinking occasion. We used a general question that ask respondents to recall the total amount consumed (total consumption question), and location-specific questions that ask respondents to recall consumption in each drinking location (location-specific peak consumption, LSPC).

METHODS

Heavy drinkers (≥11 Australian Standard Drinks (ASD) per occasion for males, ≥8 for females) from the second wave of a prospective cohort study were recruited via landline random digit dial from Melbourne in 2012. Respondents were randomly assigned to surveys of different question order, and either first received total consumption (n = 127) or LSPC questions (n = 147). T-tests compared peak consumption between categories stratified by sex and consumption tercile.

RESULTS

Mean peak consumption was 12.5 ASD. Irrespective of question order, consumption amounts for total consumption and LSPC questions were not significantly different for both sexes. However, drinkers in the highest tercile asked LSPC questions first provided significantly higher consumption estimates in response to the total consumption question than in response to the LSPC questions.

CONCLUSION

At a population level, LSPC and total consumption questions produce similar estimates of peak consumption for risky drinking events. Except for heavy drinkers, general consumption questions may be sufficient when asking about these drinking events in consumption surveys, without the greater response burden of longer LSPC questions.

Subgroups of adults who drink alcohol at low-risk levels: Diverse drinking patterns and demography

INTRODUCTION

A significant minority of Australians drink within the 2009 national guidelines. Despite encouragement of low-risk drinking as opposed to consumption patterns associated with greater harm, little is known about the drinking patterns of this group. This paper identifies subgroups of low-risk drinkers and their distinguishable characteristics.

METHODS

Data were sourced from the 2016 National Drug Strategy Household Survey, specifically 8492 adults (18+) who consumed 1-730 Australian standard drinks (ASD; 10 g ethanol) in the past year, and never 5+ ASD on a single occasion. Cluster analysis enabled identification of subgroups from drinking variables. Drinking patterns, socio-demographic characteristics, drinking context and alcohol-related perceptions of subgroups were examined.

RESULTS

Three subgroups were identified. Special occasion drinkers (64.6%) drank low to moderate amounts very infrequently. Regular moderates (19.6%) and Regular sippers (15.8%) drank 5-6 days a week on average, with the average number of ASD per day 1.2 and 0.5, respectively. Special occasion drinkers tended to be younger than members of more regular drinking subgroups. Perceptions of regular alcohol use also differed between Special occasion drinkers and members of the other subgroups.

DISCUSSION

Alcohol consumption patterns among low-risk drinkers are not homogeneous. Younger drinkers who consume at low-risk levels are more likely to report infrequent consumption than moderate regular consumption. A better understanding of low-risk drinkers may help increase the prominence and acceptability of this type of drinking, challenge the normativity of heavier drinking norms and help target campaigns as new information emerges on health risks associated with low-level drinking.

Prevalence and sociodemographic factors of risky drinking in Australian older adults

INTRODUCTION AND AIMS

This study describes the prevalence of risky drinking in older adults (aged 60+ years) in Australia and explores the socioeconomic and lifestyle factors associated with this. The negative consequences of drinking behaviours in older adults were also explored.

DESIGN AND METHODS

Cross-sectional design, with data obtained from the Australian 2016 National Drug Strategy Household Survey, yielding a sample size of 7976 participants. Multivariable logistic regression was used to assess the correlates of risky drinking.

RESULTS

Approximately 17% of older Australians reported risky drinking and their most popular drinking location was in the home (93%). Respondents who were male [odds ratio 3.78, 95% confidence interval (3.22, 4.43)], of younger age group (60-69 years) [2.96, (2.25, 3.89)], in a higher socioeconomic status [1.76, (1.41, 2.21)], had no dependents [1.51, (1.10, 2.07)], were unemployed [1.64, (1.10, 2.44)] and were either current or ex-smokers [2.32, (1.90, 2.83) or 3.55, (2.95, 4.29)], were more likely to report risky drinking. Approximately 54% of risky drinkers experienced a negative outcome as a result of their drinking in the last year.

DISCUSSION AND CONCLUSIONS

Risky drinking in older adults is a key public health issue, with a concerning rate of risky drinking and associated negative outcomes seen in the current study. Interventions aimed at older drinkers thus need to focus beyond socio-economically disadvantaged groups, while self-moderation on risky drinking, controlling accessibility to take-away alcohol and increasing the awareness of harms of risky drinking may help to reduce risky drinking among older people.

Gay-Specific and General Stressors Predict Gay Men's Psychological Functioning Over Time

Gay men experience various stressors, including gay-specific stressors such as discrimination and internalized homonegativity as well as general stressors such as occupational and financial strain. While a robust literature has examined how gay-specific stressors are associated with negative mental health outcomes among gay men, less attention has been paid to the association between general stress and gay men's psychological functioning or to how different types of stressors may interact to affect functioning. The current study sought to address this gap by examining the unique and combined associations between gay-specific external stress (discrimination), gay-specific internal stress (rejection sensitivity, internalized homonegativity, sexual identity concealment), and general stressors (e.g., academic difficulties) and negative affect and alcohol use over time. A total of 147 self-identified gay men living in the greater New York City area participated in a baseline assessment and a 7-week diary study. Univariate and multivariate results revealed that gay-specific external stress, gay-specific internal stress, and general stress were each positively and uniquely associated with higher mean levels of and greater fluctuations in negative affect over time, and general stress was positively associated with greater fluctuations in alcohol use over time. Multiplicative analyses indicated that individuals reporting high levels of stress in multiple domains experienced particularly high mean levels of negative affect. These findings highlight the unique contribution of general stress to gay men's functioning over time and underscore the importance of considering multiple forms of stress (i.e., gay-specific and general stress) and their interactions to better understand gay men's psychological functioning.

The Effect of Ursodeoxycholic Acid on Small Intestinal Bacterial Overgrowth in Patients with Functional Dyspepsia: A Pilot Randomized Controlled Trial

Functional dyspepsia (FD) is associated with small intestinal bacterial overgrowth (SIBO). Several animal studies have reported that ursodeoxycholic acid (UDCA) has antibacterial and anti-inflammatory effects in the intestine. We hypothesized that UDCA may be effective against dyspeptic symptoms and SIBO in patients with FD. We conducted this randomized controlled trial to investigate the effects of UDCA in FD patients with SIBO. Twenty-four patients diagnosed with FD and SIBO based on lactulose breath test (LBT) were randomly assigned to either a UDCA treatment group or an untreated group. The treatment group received 100 mg of UDCA three times per day for two months; the untreated group was monitored for two months without intervention. After two months in both groups, we reevaluated LBT and FD symptoms using the Nepean dyspepsia index-K. FD symptoms in the UDCA-treated group were significantly reduced after two months compared with baseline and FD symptom scores between the UDCA-treated and untreated groups showed statistically significant differences after two months. In addition, the total methane gas levels for 90 minutes in LBT were significantly decreased after two months compared with baseline in the UDCA-treated group. In this preliminary exploratory study, we found that two months of UDCA treatment resulted in FD symptom improvement and reduced methane values during 90 minutes on the LBT, suggesting that methane-producing SIBO were associated with symptoms of dyspepsia and that UDCA was helpful in these patients. These findings need to be validated via large-scale controlled and well-designed studies.

Alcohol's Secondhand Harms in the United States: New Data on Prevalence and Risk Factors

OBJECTIVE

This study examined a range of indicators of alcohol's harm to others (AHTO) among U.S. adults and assessed sociodemographic and alcohol-related risk factors for AHTO.

METHOD

The data came from 8,750 adult men and women in two parallel 2015 U.S. national surveys conducted in English and Spanish. Both surveys used computer-assisted telephone interviews and two-stage, stratified, list-assisted, random samples of adults ages 18 and older.

RESULTS

One in five adults experienced at least one of ten 12-month harms because of someone else's drinking. The prevalence of specific harm types and characteristics differed by gender. Women were more likely to report harm due to drinking by a spouse/partner or family member, whereas men were more likely to report harm due to a stranger's drinking. Being female also predicted family/financial harms. Younger age increased risk for all AHTO types, except physical aggression. Being of Black/other ethnicity, being separated/widowed/divorced, and having a college education without a degree each predicted physical aggression harm. The harmed individual's own heavy drinking and having a heavy drinker in the household increased risk for all AHTO types. The risk for physical aggression due to someone else's drinking was particularly elevated for heavy drinking women.

CONCLUSIONS

Secondhand effects of alcohol in the United States are substantial and affected by sociodemographics, the harmed individual's own drinking, and the presence of a heavy drinker in the household. Broad-based and targeted public health measures that consider AHTO risk factors are needed to reduce alcohol's secondhand harms.

Combined effect of serum alanine aminotransferase and gamma-glutamyltransferase on incidence of diabetes mellitus: A longitudinal study

High levels of serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) are associated with increased diabetes risk. In the present study, we investigated the combined effects of ALT and GGT on the development of diabetes in a Korean population. A total of 9405 individuals (4020 women and 5385 men) without diabetes were enrolled in this study. From the baseline health screening to the follow-up examination, the development of diabetes, based on changes in ALT and GGT quartile levels, was analyzed. In addition, we analyzed the quartiles of ALT and GGT together to determine any synergistic effect from the fourth quartile of ALT and GGT on the development of diabetes. The development of diabetes gradually increased with an increase in the circulating levels of ALT and GGT. For the fourth quartile ALT and GGT, the hazard ratios of diabetes compared with the first quartile were 1.892 (95% confidence interval [CI]: 1.26-2.83, P = .002) and 3.526 (95% CI: 2.12-5.85, P < .001) after adjusting for confounders, respectively. Hazard ratios of diabetes after combining both fourth quartiles of ALT and GGT were 3.663 (95% CI: 2.42-5.52, P < .001), as compared with the first and second quartiles. Serum ALT and GGT levels are well associated with diabetes in Koreans after adjusting for confounders, and a combination of ALT and GGT levels can have a synergy in predicting the development of diabetes.

Harmful drinking, tobacco, and marijuana use in the 2000-2015 National Alcohol Surveys: Examining differential trends by sexual identity

BACKGROUND

Population-based surveys document disparities in substance use among sexual minorities compared to heterosexuals, but few studies examine changes over time. This study compared changes in harmful drinking (including alcohol use disorders and high-intensity drinking), tobacco use, marijuana use, and simultaneous marijuana and alcohol co-use between heterosexual and sexual minority adults over a 15-year period. Methods: Gender-stratified logistic regression analyses using 4 waves of cross-sectional data from the National Alcohol Survey (2000, 2005, 2010, and 2015) were conducted to test overall trends over time and differences by sexual identity, as well as the interaction between survey year and sexual identity. Results: Among women, significant effects for sexual identity were present in all models, reflecting greater odds of use among sexual minorities across waves. Among men, significant effects for sexual identity were found for high-intensity drinking (reflecting less use among sexual minorities) as well as marijuana use and marijuana and alcohol co-use (reflecting more use among sexual minorities). For women and men, tobacco use generally decreased and both marijuana use and simultaneous marijuana and alcohol co-use increased during the study period. Although trends were largely driven by heterosexual respondents, only one instance of an interactive effect was found; reports of harmful drinking were generally stable over time among heterosexual women, but higher and more variable over time among sexual minority women. Conclusions: Findings highlight that differences in patterns of substance use by sexual identity persist and underscore the need for screening, prevention, and intervention, particularly for sexual minority women.