Alcohol consumption trajectories over the Australian life course

Drinking motives and alcohol sensitivity mediate multidimensional genetic influences on alcohol use behaviors

BACKGROUND

Genetic influences account for a substantial proportion of individual differences in alcohol use behaviors (AUBs). However, multiple distinct sets of genes are linked to different AUBs via uncertain causal links. Here, we explore whether intermediate neurobiological traits mediate the relationship between polygenic scores (PGSs) and multiple AUBs, with the aim to better understand processes captured by different genetic profiles.

METHODS

We derived four alcohol-related PGSs in participants from Spit for Science, a longitudinal study of college students in the United States (n = 4549). Using linear regression, we tested the relationship between PGSs and 22 potential mediators, including personality, alcohol expectancies, drinking motives, and alcohol sensitivity. Nominally significant effects were carried forward to a multiple mediation model to estimate direct and indirect effects on four measured AUBs (frequency, quantity, alcohol use disorder symptoms [AUDsx], and maximum drinks in 24 h).

RESULTS

In univariable regression, PGSs indexing genetic effects on drinks per week (DPW) and problematic alcohol use (PAU) predicted higher levels of impulsivity and drinking motives as well as lower alcohol sensitivity. BeerPref PGSs (indexing a variable pattern of alcohol problems and preference for beer) predicted higher negative urgency and lower alcohol sensitivity. Mediational models indicated direct and indirect effects of DPW PGSs on multiple AUBs via social/enhancement drinking motives and alcohol sensitivity, indirect effects of PAU PGSs on AUDsx, and indirect effects of BeerPref PGS on drinking frequency and AUDsx via the joint effect of mediators including alcohol sensitivity.

CONCLUSIONS

These findings provide evidence that the genetic influences on AUBs are associated with and partially mediated by intermediate neurobiological and cognitive factors, which may be more amenable to intervention. Greater focus on drinking motives and alcohol sensitivity is warranted in genetic research, as well as attention to the heterogeneous pathways linking genes to alcohol use outcomes.

Trajectories of genetic risk across dimensions of alcohol use behaviors

Background

Alcohol use behaviors (AUBs) manifest in a variety of normative and problematic ways across the life course, all of which are heritable. Twin studies show that genetic influences on AUBs change across development, but this is usually not considered in research identifying and investigating the genes linked to AUBs.

Aims

Understanding the dynamics of how genes shape AUBs could point to critical periods in which interventions may be most effective and provide insight into the mechanisms behind AUB-related genes. In this project, we investigate how genetic associations with AUBs unfold across development using longitudinal modelling of polygenic scores (PGSs).

Design

Using results from genome-wide association studies (GWASs), we created PGSs to index individual-level genetic risk for multiple AUB-related dimensions: Consumption, Problems, a variable pattern of drinking associated with a preference for beer (BeerPref), and externalizing behavior (EXT). We created latent growth curve models and tested PGSs as predictors of latent growth factors (intercept, slope, quadratic) underlying trajectories of AUBs.

Setting

PGSs were derived in six longitudinal epidemiological cohorts from the US, UK, and Finland.

Participants

Participant data were obtained from AddHealth, ALSPAC, COGA, FinnTwin12, the older Finnish Twin Cohort, and Spit for Science (total N = 19,194). These cohorts included individuals aged 14 to 67, with repeated measures collected over a span of 4 to 36 years.

Measurements

Primary measures included monthly frequency of typical alcohol consumption (CON) and heavy episodic drinking (HED).

Findings

Results indicated that higher PGSs for all AUBs are robustly associated with higher mean levels of CON and/or HED (B = 0.064-0.333, p < 3.09E-04). However, these same genetic indices were largely not associated with drinking trajectories across cohorts. In the meta-analysis, only PGSs for chronic alcohol Problems consistently predicted a steeper slope (increasing trajectory) of CON across time (B = 0.470, p = 4.20E-06).

Conclusions

The results indicate that genetic associations with AUBs not only differ between behaviors, but also across developmental time points and across cohorts. Genetic studies that take such heterogeneity into account are needed to better represent the underlying etiology of AUBs. Individual-level genetic profiles may be useful to point to personalized intervention timelines, particularly for individuals with high alcohol Problems genetic risk scores.

Alcohol consumption trajectories over the life course and all-cause and disease-specific mortality: the Melbourne Collaborative Cohort Study

BACKGROUND

Published studies rarely assess associations between trajectories of drinking and mortality.

METHODS

We aimed to assess associations between long-term sex-specific drinking trajectories and all-cause and disease-specific mortality for 39 588 participants (23 527 women; 16 061 men) enrolled in the Melbourne Collaborative Cohort Study in 1990-94 aged 40-69 years. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause, cardiovascular disease- and cancer-specific mortality in relation to group-based alcohol intake trajectories.

RESULTS

There were 7664 deaths (1117 cardiovascular; 2251 cancer) in women over 595 456 person-years, and 7132 deaths (1283 cardiovascular; 2340 cancer) in men over 377 314 person-years. We identified three distinct group-based alcohol intake trajectories for women: 'lifetime abstention', 'stable light', and 'increasing moderate'; and six for men: 'lifetime abstention', 'stable light', 'stable moderate', 'increasing heavy', 'early decreasing heavy', and 'late decreasing heavy'. We observed 9%-12% lower all-cause mortality, driven by associations with cardiovascular disease-specific deaths, for 'stable light' (women: HR 0.91; 95% CI 0.87-0.96; men: HR 0.88; 95% CI 0.82-0.94) and 'stable moderate' (HR 0.88; 95% CI 0.81-0.96) drinking, compared with 'lifetime abstention'. In contrast, all-cause mortality was 18%-21% higher for 'early decreasing heavy' (HR 1.18; 95% CI 1.05-1.32) and 'late decreasing heavy' (HR 1.21; 95% CI 1.04-1.40) drinking, and cancer-specific mortality 19%-37% higher for 'increasing moderate' (HR 1.19; 95% CI 1.00-1.43), 'early decreasing heavy' (HR 1.34; 95% CI 1.10-1.64), and 'late decreasing heavy' (HR 1.37; 95% CI 1.06-1.77) drinking.

CONCLUSIONS

Our findings highlight the importance of avoiding higher levels of alcohol intake during the life course to reduce all-cause and cancer-specific mortality.

Have declines in the prevalence of young adult drinking in English-speaking high-income countries followed declines in youth drinking? A systematic review

Background

Alcohol use in early adulthood is a significant public health concern. The prevalence of adolescent alcohol consumption has been declining in high-income English-speaking countries since the early 2000s. This review aims to examine whether this trend continues in young adulthood.

Methods

We systematically searched Medline, PsycInfo and CINAHL and the grey literature. Eligible records reported the prevalence of alcohol consumption amongst 18-25-year-olds over a minimum three-year time frame in the United States (US), Canada, the United Kingdom, the Republic of Ireland, Australia and New Zealand. Results were described using narrative synthesis. Quality assessment was undertaken using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies.

Results and conclusion

Thirty-two records from 22 different surveys were included. The prevalence of consumption amongst young adults fell in Australia, Ireland, and the United Kingdom and was stable in New Zealand and Canada. In the US, there was evidence of a decline in the prevalence of drinking among under-21s, but results for adults over the minimum purchase age were mixed. The prevalence of alcohol consumption in young adults appears to be broadly declining. This could lead to reduced rates of alcohol-related harms in the future. Further high-quality multinational surveys may help to confirm this trend.

Drinking motives and alcohol sensitivity mediate multi-dimensional genetic influences on alcohol use behaviors

Background

Genetic influences account for a substantial proportion of individual differences in alcohol use behaviors (AUBs). However, multiple distinct sets of genes are linked to different AUBs, which may explain their dramatic variability in risk factors and manifestations. In this study, we explore whether intermediate neurobiological traits and alcohol-related cognitions mediate the relationship between polygenic scores (PGS) and multiple AUBs, with the aim to better understand processes captured by different genetic profiles.

Methods

Using results from prior genome-wide association studies, we derived PGS for 6 AUBs in participants from Spit for Science, a longitudinal study of college students in the U.S. (n=4,549). Self-report measures included personality traits, alcohol expectancies, drinking motivations, and alcohol sensitivity measures as well as drinking frequency, drinking quantity, alcohol use disorder (AUD) symptoms, and maximum drinks in 24 hours. Using linear regression and multiple mediation models, we investigated the direct and indirect effects of PGS on AUBs.

Results

In univariable regression results, PGSs indexing broad AUB dimensions such as drinks per week (DPW) and AUD predicted higher levels of sensation-seeking and multiple drinking motives, while BeerPref PGSs (indexing a variable pattern of alcohol problems associated with a preference for beer) predicted higher negative urgency and lower alcohol sensitivity. Mediational models indicated strong direct and indirect effects of DPW PGSs on multiple AUBs via social/enhancement drinking motives and alcohol sensitivity, indirect effects of AUD PGSs on AUD symptoms via coping motives, and indirect effects of BeerPref PGS on all AUBs via the joint effect of mediators including alcohol sensitivity.

Conclusions

These findings provide initial evidence that the genetic influences on different AUBs are associated with and partially mediated by intermediate neurobiological and cognitive factors, which may be more amenable to intervention. Greater focus on drinking motives and alcohol sensitivity is warranted in genetic research, as well as attention to the heterogeneous pathways linking genes to alcohol use outcomes.

Gendered pleasures, risks and policies: Using a logic of candidacy to explore paradoxical roles of alcohol as a good/poor health behaviour for Australian women early during the pandemic

Drinking alcohol facilitates pleasure for women while also elevating disease risk. Symbolic expectations of what alcohol 'does in' life per lay insight (relax, identity-work, connect) sit in tension with scientific realities about what alcohol 'does to' women's bodies (elevate chronic disease risks such as breast cancer). Policy must work amidst - and despite - these paradoxes to reduce harm(s) to women by attending to the gendered and emergent configurations of both realities. This paper applies a logic of candidacy to explore women's alcohol consumption and pleasure through candidacies of wellness in addition to risk through candidacies of disease (e.g. breast cancer). Using qualitative data collected via 56 interviews with Australian women (n = 48) during early pandemic countermeasures, we explore how risk perceptions attached to alcohol (like breast cancer) co-exist with use-values of alcohol in daily life and elucidate alcohol's paradoxical role in women's heuristics of good/poor health behaviours. Women were aged 25-64 years, experienced varying life circumstances (per a multidimensional measure of social class including economic, social and cultural capital) and living conditions (i.e. partnered/single, un/employed, children/no children). We collated coding structures from data within both projects; used deductive inferences to understand alcohol's paradoxical role in candidacies of wellness and disease; abductively explored women's prioritisation of co-existing candidacies during the pandemic; and retroductively theorised prioritisations per evolving pandemic-inflected constructions of alcohol-related gendered risk/s and pleasure/s. Our analysis illuminates the ways alcohol was configured as a pleasure and form of wellness in relation to stress, productivity and respectability. It also demonstrates how gender was relationally enacted amidst the priorities, discourses and materialities enfolding women's lives during the pandemic. We consider the impact of policy regulation of aggressive alcohol marketing and banal availability of alcohol in pandemic environments and outline gender-responsive, multi-level policy options to reduce alcohol harms to women.

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.

Smartphone-delivered approach bias modification for reducing harmful drinking amongst middle-older age adults: Secondary analyses of a single-arm pilot study

INTRODUCTION

Novel, scalable, low-cost interventions are needed to reduce harmful drinking amongst middle-older adults. Approach bias modification (ApBM) is a promising form of cognitive training for preventing/reducing alcohol use that can be delivered via smartphone. This study explored the acceptability and preliminary effectiveness of smartphone delivered and personalised ApBM amongst Australians ≥55 years, an age cohort at risk of alcohol-related harms.

METHODS

Secondary analyses in a middle-older adult subsample (≥55 years, n = 289) of an open-label pilot study using a retrospective, repeated measures design. We explored acceptability (adherence, user mobile acceptability ratings, free-text responses) and preliminary effectiveness (changes in drinking quantity and frequency, craving, dependence and proportion drinking within government-recommended guidelines) of two sessions/week over 4 weeks of evidence-based ApBM training, adapted to include personalisation and smartphone delivery amongst Australians ≥55 years.

RESULTS

Although minor adaptations to training were suggested, the intervention was acceptable amongst survey completers, with 72% training adherence. Relative to baseline, there was a significant increase in the proportion of drinking within recommended single-session and weekly guidelines post-training (from 25% to 41% and 6% to 28%, respectively, p < 0.001), with past-week standard drinks significantly decreasing by 18% (p < 0.001) and significant reductions in drinking days, mean craving and dependence scores (p < 0.001).

DISCUSSION AND CONCLUSIONS

Findings suggest smartphone ApBM is acceptable amongst middle-to-older aged Australians and may support this 'at risk' cohort to remain within government-recommended alcohol consumption guidelines to optimise healthy aging, although, in the context of a single-arm study, preliminary results should be interpreted cautiously.

Associations between alcohol use disorder polygenic score and remission in participants from high-risk families and the Indiana Biobank

BACKGROUND

In the United States, ~50% of individuals who meet criteria for alcohol use disorder (AUD) during their lifetimes do not remit. We previously reported that a polygenic score for AUD (PGSAUD ) was positively associated with AUD severity as measured by DSM-5 lifetime criterion count, and AUD severity was negatively associated with remission. Thus, we hypothesized that PGSAUD would be negatively associated with remission.

METHODS

Individuals of European (EA) and African ancestry (AA) from the Collaborative Study on the Genetics of Alcoholism (COGA) who met lifetime criteria for AUD, and two EA cohorts ascertained for studies of liver diseases and substance use disorders from the Indiana Biobank were included. In COGA, 12-month remission was defined as any period of ≥12 consecutive months without meeting AUD criteria except craving and was further categorized as abstinent and non-abstinent. In the Indiana Biobank, remission was defined based on ICD codes and could not be further distinguished as abstinent or non-abstinent. Sex and age were included as covariates. COGA analyses included additional adjustment for AUD severity, family history of remission, and AUD treatment history.

RESULTS

In COGA EA, PGSAUD was negatively associated with 12-month and non-abstinent remission (p ≤ 0.013, βs between -0.15 and -0.10) after adjusting for all covariates. In contrast to the COGA findings, PGSAUD was positively associated with remission (p = 0.004, β = 0.28) in the Indiana Biobank liver diseases cohort but not in the Indiana Biobank substance use disorder cohort (p = 0.17, β = 0.15).

CONCLUSIONS

PGSAUD was negatively associated with 12-month and non-abstinent remission in COGA EA, independent of behavioral measures of AUD severity and family history of remission. The discrepant results in COGA and the Indiana Biobank could reflect different ascertainment strategies: the Indiana Biobank participants were older and had higher rates of liver disease, suggesting that these individuals remitted due to alcohol-related health conditions that manifested in later life.

Trends in alcohol-related liver disease mortality in Australia: An age-period-cohort perspective

BACKGROUND AND AIMS

There have been few systematic attempts to examine how alcohol-related mortality has changed in Australia, and no studies that have explored cohort effects in alcohol-related mortality. This study uses more than 50 years of data to measure age, period and cohort trends in alcohol-related liver disease (ALD) mortality.

DESIGN, SETTING AND CASES

This was a retrospective age-period-cohort analysis of total Australian ALD mortality data from 1968 to 2020 in Australia. There was a total of 35 822 deaths-27 208 men (76%) and 8614 women (24%).

MEASUREMENTS

Deaths from ALD were grouped into 5-year age groups and periods (e.g. deaths for 20-24-year-olds between 1968 and 1972 were combined).

FINDINGS

ALD mortality peaked in the late 1970s and early 1980s for both men and women. In age-period-cohort models, mortality was highest for cohorts born 1915-30. For example, men born between 1923 and 1927 had a relative risk of 1.58 [95% confidence interval (CI) = 1.52, 1.64] compared with men born between 1948 and 1952. For women, there was an increase in risk for cohorts born in the 1960s [e.g. the 1963-67 cohort had a relative risk (RR) of 1.16 (95% CI = 1.07, 1.25) compared with women born in 1948-52]. For men, there was a broad decline in mortality over time [e.g. in 2020, the RR was 0.87 (95% CI = 0.82, 0.92) compared with the reference year of 2000]. For women, mortality declined until 2000 and has been stable since.

CONCLUSIONS

Alcohol-related liver disease mortality has declined across the Australian population since the 1970s and 1980s partly due to cohort-specific shifts as the highest-risk birth cohorts age. For women, this decline had stalled by the year 2000, and cohorts of women born during the 1960s were at higher risk than earlier cohorts, suggesting the need for thoughtful interventions as this population enters its highest-risk years for ALD mortality.

The role of alcohol in the lives of midlife women living on the Northern Beaches of Sydney, Australia

Background

In Australia, midlife women are experiencing increasing levels of risky drinking behaviours and alcohol-related harms. This is despite the general population trend of decreasing alcohol consumption overall. In light of these diverging trends, this research explores the role of alcohol in the lives of midlife women from their own perspective.

Methods

Six semi-structured focus groups were conducted with 47 women aged 35-59 years of age. Residents from the Northern Beaches of Sydney, Australia were recruited, as this group of women appear to be experiencing heightened alcohol-related harms, with an alcohol-related hospitalisation rate 40 % higher than the NSW state average in 2017-18.

Results

Midlife women described the practical utility of drinking as a habit to relieve stress and escape trauma, as well as an effective method for creating and strengthening social connections within the parenthood life stage. Participants also described the act of moderation as a potent trigger for peer pressure and discussed the individual's tendency to prioritise the short term relieving effects of drinking, despite awareness of the long term health risks.

Conclusion

Findings around the pro-social role of alcohol as a woman and a parent should be explicitly considered when designing 'swap it' population health messages. Furthermore, the marked social penalty of moderation and tendency to discount long term health risks should also be factored into health promotion messages which seek to utilise moderation as a strategy to reduce alcohol-related harm for midlife women.

'A recipe for cultural disaster!'- a case study of Woolworths Group's proposal to build an alcohol megastore in Darwin, Northern Territory

BACKGROUND

The health and wellbeing impacts of commercial activity on Indigenous populations is an emerging field of research. The alcohol industry is a key driver of health and social harms within Australia. In 2016 Woolworths, the largest food and beverage retailer in Australia, proposed to build a Dan Murphy's alcohol megastore in Darwin, near three 'dry' Aboriginal communities. This study examines the tactics used by Woolworths to advance the Dan Murphy's proposal and understand how civil society action can overcome powerful commercial interests to protect Aboriginal and Torres Strait Islander health and wellbeing.

METHODS

Data from 11 interviews with Aboriginal and non-Aboriginal informants were combined with data extracted from media articles and government, non-government and industry documents. Thematic analysis was informed by an adapted corporate health impact assessment framework.

RESULTS

Woolworths employed several strategies including lobbying, political pressure, litigation, and divisive public rhetoric, while ignoring the evidence suggesting the store would increase alcohol-related harm. The advocacy campaign against the proposal highlighted the importance of Aboriginal and non-Aboriginal groups working together to counter commercial interests and the need to champion Aboriginal leadership. Advocacy strategies included elevating the voices of community Elders in the media and corporate activism via Woolworths' investors.

CONCLUSIONS

The strategies used by the coalition of Aboriginal and non-Aboriginal groups may be useful in future advocacy campaigns to safeguard Aboriginal and Torres Strait Islander health and wellbeing from commercial interests.

Through the wine glass: How biographical midlife transitions and women's affective interpretations interact with alcohol consumption

BACKGROUND

Women during midlife are consuming larger quantities of alcohol than any other age group of women and any other generation of midlife women previously. This is concerning given alcohol related-health risks coalesce with age-related health risks for women, in particular, breast cancer.

METHODS

In-depth interviews with 50 Australian midlife women (aged 45-64) from different social classes explored women's personal accounts of midlife transitions and their descriptions of the role of alcohol in navigating these life experiences; both daily occurrences as well as significant moments in the life course.

RESULTS

Our findings point to the complex, confusing and co-existing biographical transitions women experience during midlife (generational, embodied/physiological and material changes) that sharpen a role for alcohol in women's lives and are nuanced by social class (volumes of social, economic and cultural capital). We pay close attention to women's affective interpretations of these transitions and ways alcohol is used to feel robust in navigating daily life or easing their prospective futures. Critically, for women living with limited access to capital, and who could not 'measure up' to social ideals by comparison with the achievements and trajectories of other midlife women, alcohol reconciled their disappointment. Our exploration shows how the social class conditions that shape how women make sense of their transitions through midlife might be differently shaped to enable different options forreducing drinking.

CONCLUSIONS

Policy must address the social and emotional concerns women experience through midlife transitions that give alcohol a worthwhile place in their lives. A first step might be responding to the absence of community and leisure spaces for midlife women especially those that do not integrate alcohol, with benefits including addressing loneliness, isolation and feeling invisible, and enabling positive constructions of midlife identities. Structural barriers to participation and feelings of worth must be removed for women who lack social, cultural and economic resources.