Drinking Level Versus Drinking Pattern and Cigarette Smoking Among Older Adults

Prospective cohort of pre- and post-diagnosis alcohol consumption and cigarette smoking on survival outcomes: an Alberta Endometrial Cancer Cohort Study

PURPOSE

To examine the independent and joint relationships between cigarette smoking and alcohol consumption with survival outcomes after endometrial cancer diagnosis.

METHODS

Pre- and post-diagnosis smoking and drinking histories were obtained from endometrial cancer survivors diagnosed between 2002 and 2006 during in-person interviews at-diagnosis and at ~ 3 years post-diagnosis. Participants were followed until death or January 2022. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox proportional hazards regression for associations with disease-free survival (DFS) and overall survival (OS).

RESULTS

During a median 16.9 years of follow-up (IQR = 15.5-18.1 years), 152 of the 540 participants had a DFS event (recurrence: n = 73; deaths: n = 79) and 134 died overall. Most participants in this cohort were current drinkers (pre = 61.3%; post = 64.7%) while few were current cigarette smokers (pre = 12.8%; post = 11.5%). Pre-diagnosis alcohol consumption was not associated with survival, yet post-diagnosis alcohol intake ≥ 2 drinks/week was associated with worse OS compared with lifetime abstention (HR = 2.36, 95%CI = 1.00-5.54) as well as light intake (HR = 3.87, 95% CI = 1.67-8.96). Increased/consistently high alcohol intake patterns were associated with worse OS (HR = 2.91, 95% CI = 1.15-7.37) compared with patterns of decreased/ceased intake patterns after diagnosis. A harmful dose-response relationship per each additional pre-diagnosis smoking pack-year with OS was noted among ever smokers. In this cohort, smoking and alcohol individually were not associated with DFS and combined pre-diagnosis smoking and alcohol intakes were not associated with either outcome.

CONCLUSION

Endometrial cancer survivors with higher alcohol intakes after diagnosis had poorer OS compared with women who had limited exposure. Larger studies powered to investigate the individual and joint impacts of cigarette smoking and alcohol use patterns are warranted to provide additional clarity on these modifiable prognostic factors.

USING MACHINE LEARNING METHODS TO ASSESS THE RISK OF ALCOHOL MISUSE IN OLDER ADULTS

The population of older adults, defined in this study as those 50 years of age or older, continues to increase every year. Substance misuse, particularly alcohol misuse, is often neglected in these individuals. To better identify older adults who might not be properly assessed for alcohol misuse, we have derived a risk assessment tool using patients from the United Kingdom Biobank (UKB), which was validated on patients in the Weill Cornell Medicine (WCM) electronic health record (EHR). The model and tooling created stratifies the risk of alcohol misuse in older adults using 10 features that are commonly found in most EHR systems. We found that the area under the receiver operating curve (AUROC) to correctly predict alcohol misuse in older adults for the UKB and WCM models were 0.84 and 0.78, respectively. We further show that of those who self-identified as having ongoing alcohol misuse in the UKB cohort, only 12.5% of these patients had any alcohol-related F.10 ICD-10 code. Extending this to the WCM cohort, we forecast that 7,838 out of 12,360 older adults with no F.10 ICD-10 code (63.4%) may be missed as having alcohol misuse in the EHR. Overall, this study importantly prioritizes the health of older adults by being able to predict alcohol misuse in an understudied population.

Predictors of alcohol use disorder treatment outcomes over 12 months: Role of concerned others' functioning and Al-Anon participation

BACKGROUND

This study included dyads comprised of adults entering treatment for alcohol use disorder and their Concerned Others (COs) to examine indicators of COs functioning (Al-Anon attendance and involvement, relationship stressors, use of approach coping and stigma) as predictors of patient outcomes (Alcoholics Anonymous (AA) attendance and involvement, abstinence and risk of substance use) over 12 months following adults' entry into AUD treatment.

METHODS

Dyads (n = 279) were assessed when patients entered treatment and at 3-, 6- and 12-month follow-ups. Data were collected through participants' self-report. Lagged generalized linear mixed models were used to examine associations between indicators of COs' functioning at baseline, 3- and 6-month follow-ups and patients' outcomes at 3-, 6- and 12-month follow-ups.

RESULTS

Patients reported less AA attendance and involvement and likelihood of maintaining abstinence from alcohol use over time. Findings from our multivariate analysis showed that any CO involvement in Al-Anon, relative to none, was associated with more patient AA attendance. In contrast, more stigma (e.g., need to hide patient's drinking) reported by COs was associated with lower patient AA participation and involvement, while more CO use of approach coping was associated with less patient risk for alcohol and drug use.

CONCLUSIONS

Findings suggest that COs' functioning can affect longer-term outcomes of adults entering AUD treatment. Treatment programs should increase the availability of help to COs to improve their functioning and patient outcomes.

Al-Anon Intensive Referral to facilitate concerned others' participation in Al-Anon Family Groups: a randomized controlled trial

AIMS

To test the effectiveness of an intervention, Al-Anon Intensive Referral (AIR), to facilitate participation in Al-Anon Family Groups (Al-Anon).

DESIGN, SETTING AND PARTICIPANTS

Multi-site, randomized controlled trial of AIR versus usual care (UC), with follow-up assessments at 3, 6 and 12 months. The 12-month follow-up rate was 74%. Residential alcohol use disorder (AUD) treatment programs in three US locations. Concerned others (COs) of patients in treatment for AUD. COs were mainly women (77%) who were patients' spouses (33%) or parents (25%).

INTERVENTION AND COMPARATOR

AIR (n = 128) consisted of four sessions over 3 months with an Al-Anon coach. UC (n = 151) was the treatment program's offer of educational sessions for COs.

MEASUREMENTS

Primary outcome: COs' self-reports of any Al-Anon attendance (yes or no) at 3 months.

SECONDARY OUTCOMES

number of Al-Anon meetings and the CO-patient relationship (stressors, resources). Potential predictors of outcomes examined in generalized linear mixed models were their baseline value, time, CO-patient relationship type (marital or non-marital), treatment program and condition.

FINDINGS

There was no effect of condition for the primary outcome (28% in AIR, 21% in UC; Bayes factor = 1.86). Relationship stressors at follow-ups were more severe for COs in a marital relationship with the patient than for COs in a non-marital relationship [β = 2.19, 95% confidence interval (CI) = 1.07, 3.32]. For CO-patient relationship resources at follow-ups, the main effect for condition was significant (β = 1.33, 95% CI = 0.04, 2.61). COs assigned to the AIR condition had more resources than COs who were in the UC condition.

CONCLUSIONS

Relative to usual care, Al-Anon Intensive Referral was not associated with increases in participation of concerned others in Al-Anon, but was associated with more resources in the concerned other-patient relationship.

Late-life drinking and smoking in primary care users in Brazil

To estimate the prevalence of at-risk drinking and smoking and associated factors among older adults in primary care in Brazil. A cross-sectional study carried out in seven primary care units with 503 older adults (60+), in a city in the state of Sao Paulo, Brazil. At-risk drinking was defined by AUDIT-C and by consumption of units per week. Poisson regression was used to assess the association between the sociodemographic and health characteristics and smoking and at-risk drinking. The median age of the 503 participants was 69.6 (SD ± 6.7; range:60-93). One third of participants (33.6%) were current drinkers, 16% were at-risk drinkers (AUDIT-C), 4% at-risk drinkers (units per week), and 13% of the sample were regular smokers. The prevalence of at-risk drinking (AUDIT-C) was higher for males (RP: 4.89; 95% CI: 2.52-9.49) and for those with higher levels of education (RP: 1,861.85 95% CI: 1.08-3.14), and lower for those over the age of 70 (RP: 0.50; 95% CI: 0.30-0.84). The prevalence of smoking was higher for those with depressive symptoms (RP: 1.95; 95% CI: 1.03-3.66), and lower for those over age 70 (RP: 0.52; 95% CI: 0.29-0.94). The results point to a set of factors associated with at-risk drinking (being male, younger and having a higher education), and with smoking (being younger and having depressive symptoms). Our findings could help health professionals to identify at-risk drinkers and smokers, as well as support strategies for future interventions by the identification of the groups most vulnerable to these behaviors.

Alcohol consumption among older adults: Findings from the ELSI-Brazil study

OBJECTIVES

This study estimates the national prevalence of drinking patterns (current, heavy, and binge) and the associated factors, among older Brazilians.

DESIGN

Cross-sectional study using survey data from ELSI-Brazil (2015-2016).

SETTING/PARTICIPANTS

A total of 7839 adults aged 50 years or older.

MEASUREMENTS

Respondents were asked about alcohol drinking. Alcohol consumption status was categorized as current drinkers (last month), heavy drinkers (≥7 drinks/week for females and ≥14 drinks/week for males), and binge drinkers (≥4 drinks on one occasion for females and ≥5 drinks on one occasion for males). Covariates included sociodemographic characteristics, tobacco smoking, depression, and number of chronic diseases.

RESULTS

Of the 7839 participants, 29.4% were current drinkers, 5.1% were heavy drinkers, and 10.3% reported binge drinking. In the ≥60 years old age group, the prevalence of current drinking was 23.8%, 3.9% were heavy drinkers, and 6.7% reported binge drinking. All drinking patterns had similar associated factors: being male, being younger, having higher education, tobacco smoking, and falls. In addition, the greater the number of chronic conditions, the lower the prevalence of current drinking and binge drinking.

CONCLUSION

Heavy drinking and binge drinking are often reported by older Brazilians, particularly among males, those with higher education and in the younger age groups. These behaviors can negatively affect the health of older adults. It is, therefore, important to identify the problems related to alcohol consumption among older adults to minimize the risks and harms.

Body Constitution and Unhealthy Lifestyles in a Primary Care Population at High Cardiovascular Risk: New Insights for Health Management

Background

Adherence to lifestyle recommendations remains insufficient in cardiovascular (CV) health management globally. Body constitution, from the perspective of traditional Chinese medicine, is primarily influenced by an individual's internal metabolism and susceptibility to external pathogenic factors. Nevertheless, less is known about whether body constitutions may play a role in the presence of unhealthy lifestyles. We aimed to explore the associations between body constitutions and unhealthy lifestyles among Chinese individuals at high CV risk.

Methods

Computerised data were retrieved from a primary care population-based health record for all 1739 eligible individuals at high CV risk who attended routine check-up in an urbanised, medium-size district in Guangzhou, China. Unhealthy lifestyles were determined in accordance with guideline recommendations. The body constitution was assessed on the basis of physical signs, personality, body symptoms, and the susceptibility to environmental changes, following nationally standard procedure. Binary logistic regression analyses were performed using marginal standardisation method.

Results

The participants ranged in age from 20 to 96 years, with a mean age of 69.55 years. There were slightly more females than males (52.3% vs 47.7%). Current smoking, regular drinking, and physical inactivity were most common. Participants with a body constitution of phlegm-and-dampness type (adjusted odds ratio [aOR]=1.999, 95% confidence interval [CI]=1.003-3.984; p=0.049) tended to be current smokers, and those assessed with special diathesis type (aOR=2.166, 95% CI=1.029-4.559; p=0.042) had a higher likelihood of being regular drinkers. Having a body constitution type of blood stasis (aOR=1.375, 95% CI=1.029-1.838; p=0.031) or qi deficient (aOR=1.711, 95% CI=1.080-2.709; p=0.022) was associated with physical inactivity.

Conclusion

Our findings add to current evidence suggesting that an individual's body constitution is closely related to the presence of unhealthy lifestyles. This offers new insights for health management through body constitution-based strategies to target those at high CV risk who need tailor-made attention in lifestyle modifications during routine primary care.

The role of depression course on life functioning and coping outcomes from baseline through 23-year follow-up

BACKGROUND

Although studies have examined how depressed patients' baseline characteristics predict depression course, still needed are studies of how depression course is associated with modifiable long-term outcomes.

AIMS

This study examined six outcomes of three groups representing distinct depression courses (low baseline severity, rapid decline; moderate baseline severity, rapid decline; and high baseline severity, slow decline): medical functioning, coping patterns, family functioning, social functioning, employment, and work functioning.

METHOD

Adults with depression at baseline (N = 382; 56% women) were followed for 23 years on self-reported outcomes (79% response rate). Data from the baseline assessment and follow-ups (1, 4, 10, and 23 years) were used in a longitudinal analysis to examine associations between depression course and outcomes.

RESULTS

All depression course groups declined on medical and social functioning and employment over follow-up. The high- and moderate-severity depression course groups reported poorer coping patterns than the low-severity group. The high-severity depression course group reported poorer family functioning than the moderate-severity group, and had the poorest work functioning outcome, followed by the moderate-severity and then the low-severity groups.

CONCLUSIONS

Patients with a high- or moderate-severity depression course may benefit from treatment that manages coping patterns and improves family and work functioning.

Functioning of adults in alcohol use disorder treatment: Role of concerned others

OBJECTIVE

This study examined patients in treatment for alcohol use disorders ("Patients") and their "concerned others" (COs-family and friends): (1) Did Patients' functioning differ according to COs' study participation? Among Patients with participating COs, (2) did Patients and COs agree on Patients' functioning, and (3) was Patients' functioning associated with COs' functioning and quality of CO-Patient relationships?

METHOD

Four-hundred and two Patients (mean age = 44, majority white men) and 277 COs (mean age = 52, majority white women) completed validated assessments.

RESULTS

(1) Unexpectedly, Patients who did not identify a CO for potential study participation had more protective factors against future substance use and more readiness to participate in Alcoholics Anonymous (AA) than patients who did identify a CO. (2) Patients had higher scores than COs did when rating the Patient's protective factors, viewed the Patient-CO relationship as having more resources and fewer stressors than COs did, and reported fewer incidents of violence toward the CO than the CO did. (3) Patients had higher risk factors scores when their COs binge drank, and the Patient-CO relationship had more stressors and violence. Patients had higher protective factors scores when COs had greater readiness for Al-Anon participation, and Patients had attended more AA meetings, reported more resources in their relationship with their CO, and used more negotiation tactics when in conflict with their CO.

CONCLUSIONS

Findings suggest that interventions to improve Patients' functioning should be broadened beyond COs who are spouses or partners, decrease COs' binge drinking, facilitate 12-step participation, decrease relationship stressors and conflict, and increase relationship resources.

Functioning of Concerned Others When Adults Enter Treatment for an Alcohol Use Disorder

BACKGROUND

Poor functioning among Concerned Others (COs; family and friends of an individual with an alcohol or other substance use disorder) is a significant public health problem. The purpose of this study was to inform interventions for COs by examining potential correlates of 3 aspects of functioning: quality of life, mental health, and knowledge of how to handle problems related to their drinker.

METHODS

This study collected data from 277 COs when their friend or family member (their "drinker") was entering treatment for an alcohol use disorder. Potential correlates were the drinker's substance use severity, the CO-drinker relationship and communication, and COs' coping and perceived stigma related to involvement with their drinker.

RESULTS

In a summary analysis, only stressors in the CO-drinker relationship (the drinker's criticism, disagreement, anger, and demands) were consistently associated with poorer functioning as indicated by COs' poorer quality of life and mental health. In contrast, only COs' use of approach coping was associated with COs' knowing how to handle problems related to the drinker.

CONCLUSIONS

Because reducing both relationship stressors and the link between stressors and poor functioning can be achieved through CO and drinker education and intervention, these findings inform how to effectively support COs' goals for better functioning.