Stress, social support and problem drinking among women in poverty

The impact of pseudoephedrine regulation at Australian pharmacies through Project Stop: A narrative review

ISSUES

Project Stop, a real-time monitoring program for pseudoephedrine-containing medicines, was initiated in 2005 by the Pharmacy Guild of Australia in collaboration with police in the state of Queensland. The program implemented an online database to record pseudoephedrine purchases (and attempted purchases) to prevent large-scale diversion to methamphetamine production.

APPROACH

This narrative review aims to understand the overall impact of Project Stop, what evidence exists for this kind of intervention in Australia, and what lessons can be learned from its introduction. Systematic database searches were conducted in Embase, PubMed, Web of Science and Google Scholar, with 20 relevant sources selected for inclusion.

KEY FINDINGS

Project Stop successfully prevented some pseudoephedrine from being diverted from pharmacies to methamphetamine production. The intervention has been most effective in jurisdictions that made the program mandatory. Project Stop was also associated with a temporary decline in clandestine laboratory seizures in Queensland, changes in methamphetamine production methods and reduced voluntary treatment admissions for methamphetamine use. Implementation was not associated with an appreciable effect on secondary indicators, such as methamphetamine production and harmful use.

IMPLICATIONS

Future applications of a Project Stop model must ensure ongoing impact evaluation, assessment of its effect on individual's drug-related behaviour and combine it with policies that address drug use as a health issue.

CONCLUSION

Project Stop has been narrowly successful in terms of reducing pseudoephedrine diversion and demonstrates the potential for third-party policing practices directed at the consumer level, in collaboration with healthcare practitioners, rather than only regulating precursor wholesalers.

Rural-urban differences in distress, quality of life, and social support among Canadian young adult cancer survivors: A Young Adults with Cancer in Their Prime (YACPRIME) study

PURPOSE

Geographic location plays a significant role in the health and wellbeing of those with cancer. This project explored the impact of rurality and social support on distress and quality of life in young adults (YAs) with cancer in Canada.

METHODS

The current research analyzed data from the Young Adults with Cancer in Their Prime (YACPRIME) study. Participants completed measures of emotional distress (10-item Kessler Psychological Distress Scale), quality of life (12-item Short-form Health Survey), and social support (Medical Outcomes Study-Social Support Survey). Rural and urban-dwelling survivors were compared using MANOVAs. Bivariate analyses were conducted to explore associations between distress and social support.

FINDINGS

Of the sample (N = 379), 26% identified their location as rural. Rural YA cancer survivors reported higher distress and worse physical health-related quality of life (HRQOL) than survivors from urban areas but similar levels of mental-health-related quality of life. Social support appeared to have a marginally greater effect on psychosocial outcomes for urban participants. All types of social support were associated with lower levels of distress. However, different types of social support were associated more strongly with distress depending on a participant's geography.

CONCLUSIONS

Rural-dwelling YA cancer survivors experience significantly more distress and poorer physical HRQOL than urban-dwelling survivors. Different needs and preferences for social support may influence the psychological health of rural cancer survivors. Additional research is needed to determine how best to understand and address distress in rural YAs with cancer.

Are Cisgender Women and Transgender and Nonbinary People Drinking More During the COVID-19 Pandemic? It Depends

PURPOSE

This narrative review of research conducted during the first 2 years of the COVID-19 pandemic examines whether alcohol use among cisgender women and transgender and nonbinary people increased during the pandemic. The overarching goal of the review is to inform intervention and prevention efforts to halt the narrowing of gender-related differences in alcohol use.

SEARCH METHODS

Eight databases (PubMed, APA PsycInfo, CINAHL, Embase, Scopus, Gender Studies Database, GenderWatch, and Web of Science) were searched for peer-reviewed literature, published between March 2020 and July 2022, that reported gender differences or findings specific to women, transgender or nonbinary people, and alcohol use during the pandemic. The search focused on studies conducted in the United States and excluded qualitative research.

SEARCH RESULTS

A total 4,132 records were identified, including 400 duplicates. Of the remaining 3,732 unique records for consideration in the review, 51 were ultimately included. Overall, most studies found increases in alcohol use as well as gender differences in alcohol use, with cisgender women experiencing the most serious consequences. The findings for transgender and nonbinary people were equivocal due to the dearth of research and because many studies aggregated across gender.

DISCUSSION AND CONCLUSIONS

Alcohol use by cisgender women seems to have increased during the pandemic; however, sizable limitations need to be considered, particularly the low number of studies on alcohol use during the pandemic that analyzed gender differences. This is of concern as gender differences in alcohol use had been narrowing before the pandemic; and this review suggests the gap has narrowed even further. Cisgender women and transgender and nonbinary people have experienced sizable stressors during the pandemic; thus, understanding the health and health behavior impacts of these stressors is critical to preventing the worsening of problematic alcohol use.

Stressors and Maladaptive Coping Mechanisms Associated with Elevated Perinatal Depressive Symptoms and Suicidality Among Women Living with HIV in Uganda

BACKGROUND

Perinatal depression is highly prevalent among women living with HIV and contributes to nonadherence to the PMTCT (prevention of mother-to-child transmission) care continuum. We examined correlates of elevated depressive symptoms and suicidality in this population.

METHOD

Baseline data from 391 Ugandan women enrolled in a cluster randomized controlled trial of a depression care intervention were analyzed. Adult women with confirmed sero-positive HIV status were eligible if their gestation period was ≤ 32 weeks, and they had a Patient Health Questionnaire (PHQ-9) score ≥ 5. Correlates of elevated depressive symptoms (PHQ-9 > 9) and moderate-to-severe suicidal ideation (more than half of the days in the prior 2 weeks) were assessed using bivariate and multivariate logistic regression models, controlling for clustering within study sites by using a random effects specification (with study site as the random effect), as well as age and education.

RESULTS

The mean PHQ-9 score was 12.7 (SD = 5.1); 267 (68.3%) participants had elevated depressive symptoms, and 51 (13.0%) reported moderate-to-severe suicidality. In multiple logistic regression analysis, perceived provider stigma of childbearing [OR (95% CI) = 1.81 (1.16, 2.84)], greater use of negative problem-solving [OR (95% CI) = 1.09 (1.04, 1.15)], and lower general social support [OR (95% CI) = 0.50 (0.30, 0.82)] were correlated with elevated depression symptoms, while moderate-to-severe suicidal ideation was correlated with greater experience of physical interpersonal violence (IPV) and greater use of negative problem-solving.

CONCLUSIONS

Programs aimed at improving provider support for the childbearing needs of persons living with HIV, supporting women who are experiencing IPV, and helping women to develop effective problem-solving skills and social supports may reduce symptoms of perinatal depression and help optimize PMTCT care outcomes.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03892915 (registered March 21, 2019).

Protection of gender health and fight against gender violence during the COVID-19 pandemic: the experience of our street clinic in a disadvantaged suburb of Rome Metropolitan City

OBJECT

In this study, we evaluated health, social inequalities and risk to gender violence of women living in a disadvantaged degraded suburb of Rome Metropolitan City, during COVID-19 pandemic.

METHODS

The study included 779 women referring to primary care services of Medicina Solidale Institute for gynecological/breast examinations (209), medical and support aid for the children (383) and COVID-19 test execution (187).

RESULTS

The data show that most women (68%) were unemployed or had an irregular job. The request of support varied depending on the ethnicity: while healthcare support was requested mostly by African female community, the COVID-19 test, mandatory for public transportation and work, was a need of the east-european community. Both these communities referred to Medical Solidale primary care service for the healthcare and food/clothing support for their children. It is interesting to note that the requests from the Italian women community was elevated in terms of personal healthcare, support for the children and COVID-19 test execution. The access to the national health system (NHS) resulted a complex administrative procedure despite the original social-ethnic communities. The vast majority of women lacked awareness of their crucial role for supporting the family entity, while inadequacy was commonly reported.

CONCLUSIONS

This study confirms a critical condition for women living in disadvantaged neighborhoods, whose vulnerability is further worsened by the limited access to primary care assistance with serious consequences for health and quality of life. Prevention and treatment, especially for the most vulnerable subjects, should be a priority for the public health system.

Investigating the relationship between alcohol consumption and subjective poverty in Russia

The Russian government has long struggled with the problem of excessive alcohol consumption. We examined the relationship between alcohol consumption and subjective poverty in Russia using the special survey of the Levada Analytical Center conducted in 2017. Subjective poverty represents an individual's perception of personal well-being when an individual's income is lower than the required not to feel poor. We found that the status of being subjectively poor was associated with the increased probability of consuming vodka for women and the probability of consuming beer for men. Results inform decision-makers about the importance of subjective poverty issues for understanding alcohol consumption.

Profiles of social disadvantage and their associations with alcohol use disorder criteria among Asian Americans and Pacific Islanders

BACKGROUND

The relationship between social disadvantage and alcohol use disorder (AUD) among Asian American and Pacific Islander (AAPI) people is poorly understood. The study explores the patterns of social disadvantage and their associations with the AUD criteria in this population.

METHODS

This study used data from the National Epidemiologic Survey of Alcohol and Related Conditions-III on AAPI people's (N = 1801) social disadvantage, adverse childhood experiences (ACEs), racial discrimination, and AUD. A three-step latent class analysis (LCA) using the Bolck, Croon, and Hagenaars (BCH) method was conducted to examine the heterogeneity within response patterns to items that describe social disadvantage among AAPI people. In addition, the relationship between classes and the AUD criteria was examined.

RESULTS

Three classes were identified: Class 1, labeled "High Adversity" (8.2%); Class 2, labeled "High Discrimination" (9.7%); and Class 3, labeled "Low Disadvantage" (82.2%). Results from the analyses of a multiple regression model suggest that Class 1 (High Adversity; B = 1.049, SE = 0.27, p < 0.001) is more susceptible to AUD compared to Class 3 (Low Disadvantage).

CONCLUSIONS

The average number of AUD criteria among AAPI people who had experienced high levels of adversity was 2.2. Latent class models demonstrate how social disadvantage is distributed across classes and illustrate its associations with the AUD criteria. Tailored interventions for AAPI people are required. Further studies are also necessary to more effectively understand social disadvantage in AAPI populations.

Psychological Distress, Obsessive Compulsive Thoughts about Drinking, and Alcohol Consumption in Young Adult Drinkers

Psychological distress is an important predictor of heavy drinking, especially among lower-income drinkers. The mechanisms underlying this effect have not been well characterized. One possibility is that distressed individuals are more vulnerable to obsessive and compulsive thoughts about drinking. We hypothesized that: 1) distress would predict obsessive and compulsive thoughts about alcohol, which in turn would predict drinking, and 2) effects would be particularly pronounced among lower-income drinkers. Young adults (n=105) were recruited from an urban university and completed the Brief Symptoms Index (BSI), the Obsessive-Compulsive Drinking Scale (OCDS), and a 90-day timeline follow-back (TLFB) drinking interview. Consistent with the hypotheses, drinkers with higher levels of distress (BSI) exhibited higher levels of obsessive and compulsive drinking-related thoughts, which in turn were related to drinking over the past ninety days (p's <.0001). Path analyses revealed that the BSI had a significant indirect effect on drinking outcomes through increased OCDS. Furthermore, conditional process analyses revealed that effects were particularly pronounced among drinkers with lower household incomes. Findings highlight the importance of psychological distress as a predictor of obsessive and compulsive thoughts about alcohol, as well as drinking behavior, and underscore the critical need to address psychological functioning among lower-income drinkers in particular.

The Moderating Role of Social Support in the Relationship between Poor Mental Health and Excessive Alcohol Consumption: A Gender-Specific Analysis

Background: Social support can potentially attenuate the positive relationship between poor mental health and excessive drinking. The present study tried to understand: (1) whether there is a gender-specific relationship between poor mental health and excessive drinking; and (2) if and how social support moderates the relationship between poor mental health and excessive drinking. Methods: We analyzed the data from 2016 Behavioral Risk Factor Surveillance System (BRFSS; N = 33,705). Weighted data were stratified by gender and controlled for demographic variables. We assessed poor mental health and social support as correlates of heavy and binge drinking, followed by analyzing the moderation effect of social support X poor mental health interaction terms. Results: Poor mental health is linked with excessive drinking across genders. The interaction analysis shows that social support moderates the effect of ever having a poor mental health day in men's heavy drinking, but the interaction term is not significant in all other excessive drinking models, suggesting that social support may not buffer the negative impact of poor mental health on problem drinking, particularly among women. Conclusion: Individuals with greater mental health challenges are more likely to drink hazardously, regardless of gender. Those who have low level of social support and poor mental health, particularly men, are at risk for heavy drinking. Given the majority of the interaction results is not significant, the study provides limited support for the buffering role of social support between poor mental health and problem drinking.

Differential Effects of Multiple Dimensions of Poverty on Child Behavioral Problems: Results from the A-CHILD Study

The differential effects of low income and material deprivation—in particular, deprivation related to child educational needs—have not been well examined. This study aimed to examine the effects of low income and life-related and child-related deprivation on child behavioral problems. This study used data from first-grade students who participated in the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in 2015, 2017, and 2019 (N = 12,367) in Japan. Material deprivation was divided into life-related deprivation (i.e., lack of items for a living) and child-related deprivation (i.e., lack of children’s books, etc.), and low income was assessed via annual household income. We assessed child behavioral problems and prosocial behavior using the Strengths and Difficulties Questionnaire. One in ten children belonged to low-income families, 15.4% of children experienced life-related deprivation, and 5.4% of children experienced child-related deprivation. While life- and child-related deprivation had significant adverse effects on behavioral problems, they had no association with prosocial behavior. The effects of low income were mediated by parental psychological distress (45.0% of the total effect) and the number of consulting sources (20.8%) on behavioral problems. The effects of life-related and child-related deprivation were mediated by parental psychological distress (29.2–35.0%) and the number of consulting sources (6.4–6.9%) on behavioral problems. Life-related and child-related deprivation, but not low income, are important for child mental health.

Social support networks of users of crack cocaine and the role of a Brazilian health program for people living on the street: A qualitative study

This cross-sectional qualitative study analyzed characteristics of social support for users of crack cocaine and the role of "Consultório na Rua" (CR), or "Office in the Street," a Brazilian program for people living on the street. Data were collected using 1) ethnographic field observations during the delivery of services from this program, 2) in-depth interviews with 17 users of crack cocaine, and 3) a focus group with professionals from CR. To analyze data, we used content analysis and analytical categories based on Social Network Analysis (SNA) theoretical statements. Results showed that family, peers, community members, and professionals from CR were the main social support providers. Participants mentioned receiving material, informational, and emotional support from CR members. It was observed that CR had a welcoming and inclusive approach, but CR team members identified challenges related to stigma directed toward people who use substances and live on the street. CR assumed a central role in the health and social assistance of users of crack cocaine living on the street, providing an important link to healthcare and social services. However, initiatives related to motivation to receive mental health services, treatment, or social reintegration were not observed in conjunction with this program.

Community Health Behaviors and Geographic Variation in Early-Onset Colorectal Cancer Survival Among Women

INTRODUCTION:

Despite overall reductions in colorectal cancer (CRC) morbidity and mortality, survival disparities by sex persist among young patients (age <50 years). Our study sought to quantify variance in early-onset CRC survival accounted for by individual/community-level characteristics among a population-based cohort of US women.

METHODS:

Geographic hot spots—counties with high early-onset CRC mortality rates among women—were derived using 3 geospatial autocorrelation approaches with Centers for Disease Control and Prevention national mortality data. We identified women (age: 15–49 years) diagnosed with CRC from 1999 to 2016 in the National Institutes of Health/National Cancer Institute's Surveillance, Epidemiology, and End Results program. Patterns of community health behaviors by hot spot classification were assessed by Spearman correlation (ρ). Generalized R² values were used to evaluate variance in survival attributed to individual/community-level features.

RESULTS:

Approximately 1 in every 16 contiguous US counties identified as hot spots (191 of 3,108), and 52.9% of hot spot counties (n = 101) were located in the South. Among 28,790 women with early-onset CRC, 13.7% of cases (n = 3,954) resided in hot spot counties. Physical inactivity and fertility were community health behaviors that modestly correlated with hot spot residence among women with early-onset CRC (ρ = 0.21 and ρ = −0.23, respectively; P < 0.01). Together, individual/community-level features accounted for distinct variance patterns in early-onset CRC survival among women (hot spot counties: 33.8%; non–hot spot counties: 34.1%).

DISCUSSION:

Individual/community-level features accounted for approximately one-third of variation in early-onset CRC survival among women and differed between hot spot vs non–hot spot counties. Understanding the impact of community health behaviors—particularly in regions with high early-onset CRC mortality rates—is critical for tailoring strategies to reduce early-onset CRC disparities.

The associations between polygenic risk, sensation seeking, social support, and alcohol use in adulthood

Genetic predispositions play an important role in alcohol use. Understanding the psychosocial mechanisms through which genetic risk unfolds to influence alcohol use outcomes is critical for identifying modifiable targets and developing prevention and intervention efforts. In this study, we examined the role of sensation seeking and social support from family and friends in linking genetic risk to alcohol use. We also examined the role of social support in moderating the associations between genetic risk and sensation seeking and alcohol use. Data were drawn from a sample of 2,836 European American adults from the Collaborative Study on the Genetics of Alcoholism (46% male, mean age = 35.65, standard deviation [SD] = 10.78). Results from path analysis indicated that genome-wide polygenic scores for alcohol consumption (alc-GPS) were associated with higher sensation seeking, which in turn was associated with higher levels of alcohol use. alc-GPS was also associated with higher alcohol use indirectly via lower levels of family support. In addition, high friend support attenuated the association between alc-GPS and sensation seeking and alcohol use. The pattern of associations was similar for males and females, with some differences in the associations between social support and alcohol use observed across age. Our findings highlight the important role of intermediate phenotypes and gene-environment interplay in the pathways of risk from genetic predispositions to complex alcohol use outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Health and Social Inequalities in Women Living in Disadvantaged Conditions: A Focus on Gynecologic and Obstetric Health and Intimate Partner Violence

Purpose: Gynecologic and obstetric health and intimate partner violence are particularly influenced by social determinants of health, such as poverty, low education, and poor nutritional status, and by ethnic and racial factors. In this study, we evaluated health and social inequalities of women living in disadvantaged neighborhoods in the city of Rome, Italy.

Methods: The study included 128 women living in socioeconomically disadvantaged neighborhoods. For each woman, a medical record was compiled and a gynecologic examination with screening for cervical cancer was performed. Family network, risk factors for gender-based violence, and psychological abuse were also evaluated.

Results: The largest part of the sample, although had adequate schooling, was unemployed or had a low-status job; this was at the basis of intimate partner violence in about one-third of our sample. Nearly 35% of our sample was composed of pregnant women; about half of them were not assisted by the public health system for routine obstetric examinations. Common findings at gynecologic examination for nonpregnant women were infections (n=18, 19.9%), pregnancy planning (n=13, 13.7%), menopause management (n=12, 12.6%), ovarian fibromas (n=6, 6.3%), and post-partum assistance (n=3, 3.2%). Screening for cervical cancer was executed in 62 women; 9 (14.5%) had low- or high-grade squamous intraepithelial lesion or cervical carcinoma.

Conclusions: Health and social inequalities are frequent in women living in disadvantaged conditions, with serious consequences for health and quality of life of women and of their children. Prevention and treatment, especially for the most vulnerable subjects, should be a priority for the public health system.

Prevalence of heavy episodic drinking and associated factors among adults residing in Arba Minch health and demographic surveillance site: a cross sectional study

BACKGROUND

Alcohol consumption is associated with different types of illnesses; particularly heavy episodic drinking is one of the risk factors for the disease burden of alcohol intake. The aim of the study was to assess the prevalence of heavy episodic drinking and associated factors in Arba Minch Health and Demographic Surveillance Site (HDSS).

METHODS

A community-based cross-sectional study was conducted in 2017 among adult residents of Arba Minch HDSS. Using Arba Minch HDSS database, 3368 individuals were selected by simple random sampling techniques. From WHO STEPS instruments, step one was applied for this study. Variables with a p-value of less than 0.10 for bivariate analysis entered into a multivariable logistic regression model to outline the independent predictors of the heavy episodic drinking. To assess the presence of an association between dependent and independent variables, a p-value of less than 0.05 was considered.

RESULTS

The prevalence of heavy episodic drinking was 13.7% (95% CI: 12.6-14.9). The study has shown that heavy episodic drinking was significantly associated with occupation (daily laborer [AOR = 0.49; 95% C.I: 0.29-0.85] and housewives [AOR = 0.63; 95% C.I: 0.45-0.88] compared with farmers), wealth index (2nd quintiles [AOR =0.55; 95% C.I: 0.41-0.74) and 3rd quintiles [AOR = 0.66; 95% C.I: 0.46-0.93] compared with 1st quintiles), and climatic zone (midland [AOR = 1.80;95% CI: 1.11-2.93), highland [AOR = 1.95;95% CI: 1.19-3.18] compared with lowland). In addition, tobacco use [AOR = 4.28;95% CI: 3.38-5.43], and khat use [AOR = 4.75; 95% CI: 2.66-8.50) were also associated with heavy episodic drinking among the study participants.

CONCLUSIONS

More than one in ten adults reported heavy episodic drinking in the study area. Intervention programs that aim to prevent heavy episodic drinking should be designed appropriately for individuals from lower wealth status, and for highlander.

Substance Use Profiles Among Gang-Involved Youth: Social Ecology Implications for Service Approaches

Substance use is a frequently cited health risk behavior in the youth gang literature, yet little is known about how substance use patterns vary among gang-involved youth or the social ecological factors that contribute to potential variation. Developing relevant and effective service approaches will require an understanding of this variation and the malleable factors that are likely to promote or inhibit particular patterns of use. Using latent class analysis, we identified four substance use classes within a school-based sample of gang-involved youth (n = 2,770): Non-Users (38%), Past Users (15%), Casual Users (27%), and Frequent Multi-Users (21%). These classes were distinguished by substance type, frequency of use, and source of access. Demographic and substance use-specific ecological factors across the family, peer, school, and neighborhood contexts were found to significantly differentiate these classes. Specifically, acceptance of use by parents, friends, and neighbors, along with a lack of family rules and high accessibility in the neighborhood, significantly differentiated use patterns. Findings highlight the need for service approaches that are responsive to the unique needs of individuals and their environments. Implications for practice are discussed, including the potential utility of applying a harm reduction service framework to address youth gang substance use.

Social Determinants of Placental Health and Future Disease Risks for Babies

Birthweight is a well-known predictor of adult-onset chronic disease. The placenta plays a necessary role in regulating fetal growth and determining birth size. Maternal stressors that affect placental function and prenatal growth include maternal overnutrition and undernutrition, toxic social stress, and exposure to toxic chemicals. These stressors lead to increased vulnerability to disease within any population. This vulnerability arises from placental and fetal exposure to stressors during fetal life. The biological drivers linking various social determinants of health to compromised placental function and fetal development have been little studied.

A high burden of adverse life events and poor coping mechanisms experienced by urban-dwelling black South Africans

Aim

In view of the current context of poverty and socio-economic inequalities and the high and rising burdens of HIV infection and non-communicable diseases in South Africa, this study aims to describe the distribution of adverse life events (ALEs) by age and gender, and examine the socio-demographic characteristics, psychosocial coping mechanisms, risky lifestyle behaviours and family burden of HIV-related ill-health associated with ALEs in 25-74-year-old black residents of Cape Town.

Materials and methods

In a random cross-sectional sample, 12 ALEs, tobacco and alcohol use, sense of coherence (SOC), locus of control (LOC) and impact of HIV in the family were determined by administered questionnaires. Data analyses included descriptive statistics adjusted for the realised sample. Multivariable linear regression models assessed the independent associations of increasing number of ALEs.

Results

Among 1099 participants, mean lifetime score of ALE categories examined was 6.1 ±2.1 (range 0–12) with men reporting significantly higher number of events compared with women (p<0.001). The most frequent ALE was the death of a loved one (88.5%) followed by a major financial crisis (81.2%) with no trend across gender or age group. In the multivariable linear regression model, increasing ALEs were significantly associated with male gender, unemployment, having spent >50% of life in urban areas, >7 years of education, problematic alcohol use and poorer psychosocial coping mechanisms defined by low SOC and LOC. All four variables pertaining to HIV-related burden of ill-health in the family were significantly associated with increasing ALEs.

Conclusions

Considering that lower SOC and LOC and problem drinking were significantly linked to ALEs, policymakers need to formulate strategies that improve coping mechanisms and promote problem-solving behaviours, target the high burden of alcohol misuse and address unemployment.

Alcohol-Related Disparities Among Women: Evidence and Potential Explanations

Although research on alcohol-related disparities among women is a highly understudied area, evidence shows that racial/ethnic minority women, sexual minority women, and women of low socioeconomic status (based on education, income, or residence in disadvantaged neighborhoods) are more likely to experience alcohol-related problems. These problems include alcohol use disorder, particularly after young adulthood, and certain alcohol-related health, morbidity, and mortality outcomes. In some cases, disparities may reflect differences in alcohol consumption, but in other cases such disparities appear to occur despite similar and possibly lower levels of consumption among the affected groups. To understand alcohol-related disparities among women, several factors should be considered. These include age; the duration of heavy drinking over the life course; the widening disparity in cumulative socioeconomic disadvantage and health in middle adulthood; social status; sociocultural context; genetic factors that affect alcohol metabolism; and access to and quality of alcohol treatment services and health care. To inform the development of interventions that might mitigate disparities among women, research is needed to identify the factors and mechanisms that contribute most to a group's elevated risk for a given alcohol-related problem.

Microecological Relationships Between Area Income, Off-Premise Alcohol Outlet Density, Drinking Patterns, and Alcohol Use Disorders: The East Bay Neighborhoods Study

BACKGROUND

Distinguishing the impacts of neighborhood income and off-premise alcohol outlet density on alcohol use has proven difficult, particularly given the conflation of these measures across neighborhood areas. We explicitly test for differential effects related to individual and area income and outlet densities on alcohol use and alcohol use disorders (AUDs) by implementing a stratified microecological sample.

METHODS

The East Bay Neighborhoods Study included a survey of 984 residents of 72 microenvironments within a geographically contiguous 6-city area in California and Systematic social observations of each site. The sites included 18 areas in each of 4 strata (high/low median household income and off-premise outlet density). We assessed 4 outcomes: 28-day drinking frequency, average quantity of alcohol consumed per drinking occasion, 28-day drinking volume, and Alcohol Use Disorders Identification Test (AUDIT) score. We used zero-inflated negative binomial regression with standard errors adjusted for site clusters to relate drinking measures to individual-level age, race/ethnicity, gender, marital status, education, and income, and neighborhood indicators of site strata, physical disorder, and physical decay. An interaction term was tested representing site-level by individual-level income.

RESULTS

Living in a high-income site, regardless of off-premise alcohol outlet density, was associated with more frequent drinking and higher alcohol dependence/problems. Both individual-level income and site-level income were related to greater frequencies of use, but lower income drinkers in high-income areas drank more than comparable drinkers in low-income areas. Study participants living in high-density off-premise alcohol outlet sites drank less frequently but did not differ in terms of either AUDIT scores or heavy drinking from participants living in low-density sites.

CONCLUSIONS

Using a stratified microecological sampling design, we were able to directly assess statistical associations of off-premise outlet density and neighborhood median household income with patterns of drinking and AUDs. Caution should be used interpreting prior study findings linking off-premise outlet densities to drinking.

Cancer-Related Debt and Mental-Health-Related Quality of Life among Rural Cancer Survivors: Do Family/Friend Informal Caregiver Networks Moderate the Relationship?

Social connectedness generally buffers the effects of stressors on quality of life. Is this the case for cancer-related debt among rural cancer survivors? Drawing on a sample of 135 rural cancer survivors, we leverage family/friend informal caregiver network data to determine if informal cancer caregivers buffer or exacerbate the effect of cancer-related debt on mental-health-related quality of life (MHQOL). Using data from the Illinois Rural Cancer Assessment, a survey of cancer survivors in rural Illinois, we estimate the association between cancer-related debt and MHQOL and whether informal caregiver network size and characteristics moderate this association. Over a quarter of survivors (27%) reported cancer-related debt, and those who did reported worse MHQOL. However, this association only held for survivors who had an informal caregiver network. These findings supplement what is already known about the role of social connectedness in cancer survivors' health outcomes. We offer possible explanations for these findings.

The Downward Spiral: Socioeconomic Causes and Consequences of Alcohol Dependence among Men in Late Young Adulthood, and Relations to Racial/Ethnic Disparities

BACKGROUND

While young adults are generally at highest risk for alcohol problems, not all age out of problem drinking. Evidence suggests that Blacks and Latinos age out more slowly than Whites, particularly among men. Targeting men, we investigated whether differences in lifecourse SES might explain racial/ethnic disparities in alcohol dependence in late young adulthood, along with how experiencing alcohol dependence at that life stage relates to subsequent SES.

METHODS

We used longitudinal, national data to (i) describe racial/ethnic disparities in late young adult alcohol dependence criteria (LYADC), (ii) examine whether income trajectory in early young adulthood contributes to these racial/ethnic disparities, and (iii) test whether LYADC reciprocally predicts income trajectory in early midlife. Data were from the 1979 National Longitudinal Survey of Youth (N = 3,993), which measured LYADC in 1994 (mean age = 33). Income trajectory classes were derived for early young adulthood (mean ages = 21 to 31) and, separately, early midlife (mean ages = 35 to 45). Analyses included negative binomial regressions and multinomial regressions.

RESULTS

Both Black and US-born Latino men reported more LYADC than White men. Further, membership in the persistently low and slow increase (vs. stable middle) early young adult income trajectory classes was associated with more LYADC. Multivariate analyses suggested that Black-White disparities in LYADC were explained by early young adult income trajectories, whereas Latino-White disparities in the same were explained by both early young adult income trajectories and early education. In controlled models, more LYADC predicted a higher likelihood of membership in the persistently low (vs. stable middle) income trajectory class in early midlife.

CONCLUSIONS

This study found that poorer SES in early adulthood contributes to alcohol dependence, which reciprocally contributes to poorer SES in early midlife. This cycle appears particularly likely to affect Black and US-born Latino men. Results underline the need to address socioeconomic factors in addressing racial/ethnic disparities in alcohol problems.

Subjective Social Status and Financial Hardship: Associations of Alternative Indicators of Socioeconomic Status with Problem Drinking in Asian Americans and Latinos

Background: Prior research shows inconsistent associations between socioeconomic status (SES) and alcohol outcomes, particularly for immigrant populations. Conventional markers of SES may not fully capture how social position affects health in these groups. Objective: We examine: (1) the associations of two alternative indicators, subjective social status (SSS) and financial hardship, with problem drinking outcomes, heavy episodic drinking (HED) and alcohol use disorder (AUD), for Asian Americans and Latinos; and (2) moderation of these relationships by educational level and nativity status. Methods: Multiple logistic regression modeling was performed using nationally-representative Asian American (n = 2,095) and Latino samples (n = 2,554) from the National Latino and Asian American Study. Age, gender, nativity, individual-level SES (income and education), unfair treatment, racial discrimination, and social support were adjusted. Results: Financial hardship was independently associated with AUD in both Asians and Latinos. Lower SSS was associated with increased AUD risk among individuals with college degrees or with US nativity in both populations. The association between financial hardship and HED was positive for US-born Latinos and foreign-born Asians, and negative for foreign-born Latinos. Conclusions: SSS and financial hardship are indicators of SES that may have particular relevance for immigrant health, independently of education and income, with SSS particularly meaningful for AUD in the more conventionally advantaged subgroups. There may be underlying processes affecting Asian and other Latino subgroups with similar socioeconomic and nativity profiles and exposing them to common risk/protective factors of AUD.

The causal web of foetal alcohol spectrum disorders: a review and causal diagram

Foetal alcohol spectrum disorders (FASDs) are a leading cause of developmental disability. Prenatal alcohol use is the sole necessary cause of FASD, but it is not always sufficient. Multiple factors influence a child's susceptibility to FASD following prenatal alcohol exposure. Much of the FASD risk factor literature has been limited to discussions of association, rather than causation. While knowledge of predictor variables is important for identifying who is most at risk of FASD and for targeting interventions, causal knowledge is important for identifying effective mechanisms for prevention and intervention programmes. We conducted a systematic search and narrative synthesis of the evidence and used this to create a causal diagram (directed acyclic graph; DAG) to describe the causal pathways to FASD. Our results show that the aetiology of FASD is multifaceted and complex. FASD risk is determined by a range of lifestyle, sociodemographic, maternal, social, gestational, and genetic factors. The causal diagram that we present in this review provides a comprehensive summary of causal risk factors for FASD and can be used as a tool to inform data collection and statistical modelling strategies to minimise bias in future studies of FASD.

Social and public health implications of the legalisation of recreational cannabis: A literature review

BACKGROUND

After many years of legal struggles for the legalisation of recreational use of cannabis, the Constitutional Court of South Africa ruled in favour of the applicants in September 2018. Although the ruling issued caution regarding the social challenges accompanying this legalisation, it did not address how the country would deal with the societal consequences of this ruling.

AIM

The aim of this article was to discuss the social and public health implications of the legalisation of recreational cannabis on South Africa.

METHODS

Literature review on the social, health and legal impacts of legalisation of cannabis, considering experiences of other countries that have legalised cannabis.

RESULTS

The legalisation brings a range of significant negative consequences, which include an expected increase in the number of users and the subsequent undesirable effects on the physical, mental and social health of communities.

CONCLUSION

In terms of financial, infrastructural and human resources, South Africa cannot afford the consequences of the legalisation of recreational cannabis. Poor communities, children and the youth will carry the brunt of the scourge of cannabis use.

The Social Support Buffering Effect in the Relationship Between Perceived Stress and Alcohol Use Among Brazilian Women

This cross-sectional study interviewed Brazilian women regularly attending primary care to investigate whether the relationship between social support and alcohol use is direct or is mediated by stress, in order to support the development of recommendations related to health prevention and mental health promotion actions. The results suggest that social support affects the outcome alcohol use in the women studied by buffering the effect of stress. Based on these results, recommendations are made for amplifying the social support network that prevents stress-induced alcohol use.

Longitudinal Stress-Buffering Effects of Social Integration for Late-Life Functional Health

Stress can negatively affect multiple aspects of health, including functional health, among older adults, who are likely to face unique, age-related stressful experiences. Previous research has addressed the protective effects of social relations (i.e., social ties, social participation, and social integration) for physical and mental health outcomes, yet few studies have examined functional health. This study aimed to investigate the longitudinal stress-buffering effects of social integration on late-life functional health. Using three-wave data from 399 older adults (aged older than 60 years), two-level hierarchical linear modeling analysis was conducted and the results indicated that in addition to its main effect on functional (activity of daily living) limitations, social integration moderated the negative effect of stress on the longitudinal trajectory of functional limitations. The findings suggest important directions of future research to identify the mechanisms of such buffering effects over time and develop effective interventions to enhance late-life functional health while promoting social integration.

Beneficial effects of motivational interviewing case management: A latent class analysis of recovery capital among sober living residents with criminal justice involvement

BACKGROUND

This secondary analysis uses data from a recent clinical trial conducted with probationers and parolees with substance use disorders (N = 330) residing in Sober Living Houses (SLHs). The treatment condition received Motivational Interviewing Case Management (MICM), while controls received usual care SLH residency. Both conditions improved on multiple domains, though residents randomized to MICM improved significantly more than usual care controls on criminal justice outcomes. Because MICM is designed to help ex-offenders attain more recovery capital (RC) in multiple domains, we hypothesized MICM participants that already possessed higher RC would show significantly greater improvement at follow-up than usual SLH residents with higher RC. Moreover, MICM and usual SLH residents with low RC would show no differences at 1-year follow-up.

METHODS

A latent class analysis (LCA) grouped participants into two patterns of RC: those with low RC and those with high RC. These classes were interacted with study condition to predict change on six Addiction Severity Indices (ASI) at follow-up.

RESULTS

MICM was more effective for the higher RC class, with greater improvement in drug, legal, and psychiatric outcomes for those who attended at least three MICM sessions. MICM was no more beneficial than usual care for those in a low RC class.

CONCLUSIONS

SLH operators should consider implementation of MICM for residents with more RC resources. Those with fewer recovery resources, such as a history of psychiatric problems or physical/sexual abuse, would benefit from a more intensive intervention to assist them with improving the amount and quality of their RC.

Brief Exposure to Pictures Depicting Poor Environments Leads to Increased Consumption of Beer in Adult Social Drinkers

Previous studies have suggested a trait-like association between neighborhood deprivation and alcohol consumption. However, it is not known whether temporarily manipulating poverty and affluence states by exposure to stimuli signifying resource-scarcity or resource-wealth would influence alcohol-seeking behavior. Here, we aimed to investigate whether implicit exposure to affluence and poverty-related pictures would influence beer consumption. Participants in a "poverty" group viewed pictures depicting impoverished environments, and participants in an "affluence" group viewed images of wealthy environments. After priming, participants were provided with nonalcoholic beer (which they were told was alcohol-containing beer) and orange juice under the guise of a bogus taste test, to measure their alcohol-seeking behavior. Results showed that priming participants with a resource-scarce environment led to an increase in beer consumption (as a percentage of total fluid consumed), compared to priming with a resource-rich environment. The same pattern of results was obtained in both a Western European sample (Experiment 1) and a West Indian sample (Experiment 2). In Experiment 2, we also tested whether risk-taking behavior, measured by the Balloon Analogue Risk Task, was influenced by the environmental priming; no differences between groups were observed. These results provide the first experimental evidence that manipulation of poverty-affluence state, by brief exposure to pictures of impoverished or wealthy neighborhoods, can influence alcohol-seeking behavior in adult social drinkers.

Broken (windows) theory: A meta-analysis of the evidence for the pathways from neighborhood disorder to resident health outcomes and behaviors

The criminological "broken windows" theory (BWT) has inspired public health researchers to test the impact of neighborhood disorder on an array of resident health behaviors and outcomes. This paper identifies and meta-analyzes the evidence for three mechanisms (pathways) by which neighborhood disorder is argued to impact health, accounting for methodological inconsistencies across studies. A search identified 198 studies (152 with sufficient data for meta-analysis) testing any of the three pathways or downstream, general health outcomes. The meta-analysis found that perceived disorder was consistently associated with mental health outcomes, as well as substance abuse, and measures of overall health. This supported the psychosocial model of disadvantage, in which stressful contexts impact mental health and related sequelae. There was no consistent evidence for disorder's impact on physical health or risky behavior. Further examination revealed that support for BWT-related hypotheses has been overstated owing to data censoring and the failure to consistently include critical covariates, like socioeconomic status and collective efficacy. Even where there is evidence that BWT impacts outcomes, it is driven by studies that measured disorder as the perceptions of the focal individual, potentially conflating pessimism about the neighborhood with mental health.

The Role of Social Support in Motivating Reductions in Alcohol Use: A Test of Three Models of Social Support in Alcohol-Impaired Drivers

BACKGROUND

Social support has been linked to many therapeutic benefits (e.g., treatment retention, reduced posttreatment relapse) for individuals with alcohol use disorder. However, the positive impacts of social support have not been well understood in the context of alcohol-impaired driving. This article examines the role of social support in motivating those with histories of driving while intoxicated (DWI) arrest to reduce alcohol use by testing 3 major models of social support: the Main-Effects model, the Buffering model, and the Optimal Matching model.

METHODS

One hundred and nineteen participants with histories of DWI arrest were recruited from a correctional treatment facility (n = 59) and the local community (n = 60). Participants completed interviews to assess alcohol consumption, psychiatric/physical conditions, and psychosocial factors associated with drinking behavior (e.g., social support, alcohol-related problems, and motivation to change). Hierarchical regression analyses were conducted to test the 3 models. Additionally, the relative magnitude of the effects of general and recovery-specific social support was compared based on the approach of statistical inference of confidence intervals.

RESULTS

Overall social support was positively associated with some motivation to change (i.e., importance of change, confidence in change) among alcohol-impaired drivers, supporting the Main-Effects model. However, the impact of overall social support on motivation to change was not moderated by alcohol-related problems of individuals arrested for DWI, which did not confirm the Buffering model. Last, recovery-specific social support, rather than general social support, contributed to increasing motivation to reduce alcohol use, which supported the Optimal Matching model.

CONCLUSIONS

These findings highlight the benefits of social support (i.e., increased motivation to change alcohol use) for alcohol-impaired drivers. Regardless of the severity of alcohol-related problems of alcohol-impaired drivers, social support had direct positive impacts on motivation to change. In particular, the results underscore that social support can be more effective when it is matched to the recovery effort of individuals, which is consistent with the Optimal Matching model.

Protective Factors as an Explanation for the "Paradox" of Black-White Differences in Heavy Drinking

BACKGROUND

African Americans are generally known to have lower heavy drinking prevalence than Whites despite often greater individual and community risk factors. While it is supposed that their protective resources explain this "paradox," studies have not explicitly examined this.

OBJECTIVE

Assess the contribution of protective resources to Black-White differences in heavy drinking, and (secondarily) whether protective resources operate by reducing heavy drinking and/or increasing abstinence.

METHODS

Using data from the 2009-2010 U.S. National Alcohol Survey (N = 3,133 Whites and 1,040 Blacks ages 18+), we applied propensity score (PS) weighting to estimate racial differences in heavy drinking and abstinence under hypothetical conditions in which Whites are similar to Blacks in: (1) age and marital status; (2) socioeconomic position and unfair treatment; (3) neighborhood socioeconomic conditions and alcohol outlet density; and (4) protective resources (proscriptive religiosity, area-level religiosity, "drier" network drinking norms and patterns, and family social support).

RESULTS

The Black-White gap in male and female drinkers' baseline heavy drinking increased after weighting adjustments for demographics. In women, this gap was reduced after weighting on disadvantage and eliminated after adjusting for protective resources. In men, adjustment for disadvantage increased the racial gap, and protective resources reduced it. Protective resources had a stronger effect on Black-White differences in men's abstinence than heavy drinking, but similar effects on these outcomes in women.

CONCLUSION

Protective resources help explain Black-White differences in men's and particularly women's heavy drinking. Future research is needed to elucidate mechanisms of action and additional factors underlying racial differences in men's heavy drinking.

Substance use disorder and associated factors among prisoners in a correctional institution in Jimma, Southwest Ethiopia: a cross-sectional study

BACKGROUND

Substance use disorder is an important public health problem and one of the major causes of disability worldwide. Substance use and criminal behavior are closely related and there is a significant association between substance misuse and crime, but little is known about substance use disorder among prisoners, in particular in low-income countries. Therefore, we investigated substance use disorder and associated factors in inmates of a correctional institution in Jimma, Southwest Ethiopia.

METHODS

We used a cross-sectional study design to collect data from 336 prisoners from June 5 to July 5, 2017. Study participants were selected from the total of 1460 prisoners eligible for the study by a systematic random sampling technique, i.e., one participant was randomly selected from every four consecutive admissions in the registration book. Alcohol use disorder, nicotine dependence, khat abuse, cannabis use disorder, psychopathy, adverse traumatic life events, and social support were assessed. Data were entered into EpiData version 3.1 and analyzed in bivariate and multivariable logistic regression models with the Statistical Package for Social Science version 21. Variables with a P value < 0.05 in the final fitting model were declared to be associated with the outcome variable.

RESULTS

The overall prevalence of substance use disorder was 55.9%. The prevalence of khat abuse was 41.9%; alcohol use disorder, 36.2%; nicotine dependence, 19.8%; and cannabis use disorder, 3.6%. Poor social support, living in urban areas, psychopathy, and a family history of substance use were positively associated with substance use disorder.

CONCLUSIONS

Substance use disorder is prevalent among prisoners. The increased morbidity and unpleasant psychosocial consequences associated with substance use disorder, together with our finding that 66.3% of prisoners with substance use disorder were interested in obtaining treatment, suggest a need to establish prison-based treatment in this correctional institution in Jimma.

Toxic Stress and Vulnerable Mothers: A Multilevel Framework of Stressors and Strengths

Toxic stress is associated with poor health outcomes that extend across the life span. Although caregivers can protect their children from toxic stress through supportive caregiving, this can be challenging for vulnerable mothers living in socioeconomically disadvantaged environments. We aim to advance the science of toxic stress prevention by exploring the stressors and strengths experienced by vulnerable mothers through application of a theoretical framework, Bronfenbrenner's bioecological model. Following Arksey and O'Malley's five-stage scoping study framework, 179 articles were included. Key information was abstracted and each article was reviewed for relevance to the bioecological model. Results revealed that the sources of stress and strength are multilayered, transactional, and have a complex influence on caregiving in families at risk of toxic stress. Future research should include empirical investigations of the complex relationships among these stressors and strengths, and the development of preventive interventions to support vulnerable families at risk of toxic stress.

Review: Environmental influences on alcohol use: Informing research on the joint effects of genes and the environment in diverse U.S. populations

BACKGROUND AND OBJECTIVES

This review aimed to inform the current state of alcohol research on the joint effects of genes and the environment conducted in U.S. racial/ethnic minority populations, focusing on African Americans, Latinos/Hispanics, Asians, and American Indians.

METHODS

A key-word and author-based search was conducted and supplemented with direct contact to researchers in this area to ensure a comprehensive inclusion of published, peer-reviewed studies. These studies were considered in terms of the racial/ethnic population groups, phenotypes, genetic variants, and environmental influences covered. Research findings from alcohol epidemiologic studies were highlighted to introduce some potential environmental variables for future studies of gene and environment (G-E) relationships.

RESULTS

Twenty-six (N = 26) studies were reviewed. They predominantly involved African American and Asian samples and had a very limited focus on Latinos/Hispanics and American Indians. There was a wide range of alcohol-related phenotypes examined, and studies almost exclusively used a candidate gene approach. Environmental influences focused on the most proximate social network relationships with family and peers. There was far less examination of community- and societal-level environmental influences on drinking. Epidemiologic studies informing the selection of potential environmental factors at these higher order levels suggest inclusion of indicators of drinking norms, alcohol availability, socioeconomic disadvantage, and unfair treatment.

CONCLUSIONS

The review of current literature identified a critical gap in the study of environments: There is the need to study exposures at community and societal levels.

SCIENTIFIC SIGNIFICANCE

These initial studies provide an important foundation for evolving the dialogue and generating other investigations of G-E relationships in diverse racial/ethnic groups. (Am J Addict 2017;26:446-460).

Predictors of and reasons for attempts to reduce alcohol intake: A population survey of adults in England

OBJECTIVE

This study aimed to assess the predictors among high-risk drinkers in England of attempts to reduce alcohol consumption, the reasons given for these attempts and the association between the various reasons and alcohol consumption.

METHOD

Data came from 2,800 high-risk drinkers taking part in the Alcohol Toolkit Study (ATS) between March 2014 and November 2016 who were attempting to reduce their alcohol consumption. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and were asked questions regarding their socio-demographic characteristics, attempts to cut down and reasons for doing so.

RESULTS

Those cutting down were significantly older (OR 1.01, p<0.001), were more likely to be female (OR 1.32, p<0.05), had higher AUDIT-C scores (OR 1.12, p<0. 001), were less likely to be of white ethnicity (OR 0.64, p<0. 001), and were more likely to reside in the South of England (OR 1.34, p<0. 001). They were also more likely to be of higher occupationally-based social-grades (p<0. 001). The main reported reasons for reducing consumption were: fitness (22.5%), weight loss (20.4%), future health (20.4%), advice from a health-care professional (7.9%) and cost (7.6%). Those reporting the followings reasons for cutting down had higher AUDIT-C scores than those who did not report these reasons: a concern about further health problems (β 0.20, p<0.05), advice from a doctor/health worker (β 0.38, p<0.05), that drinking was too expensive (β 0.42, p<0.01) and detoxification (β 0.42, p<0.01). Lower AUDIT-C scores were noted among those who reported that they knew someone who was cutting down (β -0.67, p<0.05), that there was no reason (β -0.36, p<0.05), or they didn't know why they were cutting down (β -0.25, p<0.05).

CONCLUSIONS

Around a fifth of high-risk drinkers in England report trying to reduce their drinking, particularly older, high-socioeconomic female drinkers from the south of England. Attempts to cut down appear to be driven by a desire to improve health, advice from others and cutting down on the cost of drinking.

Racial/ethnic differences in 30-year trajectories of heavy drinking in a nationally representative U.S. sample

BACKGROUND

Racial/ethnic minorities bear a disproportionate burden of alcohol-related problems in the U.S. It is unknown whether this reflects harmful patterns of lifecourse heavy drinking. Prior research shows little support for the latter but has been limited to young samples. We examine racial/ethnic differences in heavy drinking trajectories from ages 21 to 51.

METHODS

Data on heavy drinking (6+ drinks/occasion) are from the 1979 National Longitudinal Survey of Youth (N=9468), collected between 1982 and 2012. Sex-stratified, generalized estimating equations (GEE) were used to model heavy drinking frequency trajectories as a function of age with a cubic curve, and interactions of race with age terms were tested to assess racial/ethnic differences. Models adjusted for time-varying socioeconomic status and marital and parenting status; predictors of trajectories were examined in race- and sex-specific models.

RESULTS

White men and women had similarly steep declines in heavy drinking frequency throughout the 20s, contrasting with slower declines (and lower peaks) in Black and Hispanic men and women. During the 30s there was a Hispanic-White crossover in men's heavy drinking curves, and a Black-White female crossover among lifetime heavy drinkers; by age 51, racial/ethnic group trajectories converged in both sexes. Greater education was protective for all groups.

CONCLUSION

Observed racial/ethnic crossovers in heavy drinking frequency following young adulthood might contribute to disparities in alcohol-related problems in middle adulthood, and suggest a need for targeted interventions during this period. Additionally, interventions that increase educational attainment may constitute an important strategy for reducing heavy drinking in all groups.

Do causes of stress differ in their association with problem drinking by sex in Korean adolescents?

BACKGROUND

Previous studies have focused mainly on whether stress causes present drinking or excessive drinking. However, few studies have been conducted on the relationship between stress and problem drinking in adolescents. The objective of this study was to examine the stress level and the cause of stress related to problem drinking behavior according to sex among Korean youth.

METHOD

Data for this study were pooled from cross-sectional data collected annually from 2007 through 2012 from the Korea Youth Risk Behavior Web-based Survey. A representative sample of 442,113 students from 800 randomly selected middle and high schools in Korea were included. Multiple logistic regression models were used in the analysis.

RESULTS

Both male and female students with extremely high stress were more likely to engage in problem drinking than were students with no stress (odds ratios [OR], 1.73 in males and 1.41 in females). The major causes of stress in male students that were associated with problem drinking were conflict with a teacher, trouble with parents, and peer relationships (ORs, 2.47, 1.72, and 1.71, respectively), whereas there are no statistically significant association between causes of stress and problem drinking among female students. Considering stress level, Male students with extremely high stress level were associated with problem drinking regardless of causes of stress, while Female students who felt extremely high levels of stress were more likely to engage in problem drinking due to stress from a conflict with parents, peer relationships, appearance, and financial difficulty (ORs, 1.53, 1.53, 1.46, and 1.47, respectively).

CONCLUSION

Adolescents who engage in problem drinking may be affected by different causes of stress according to sex. Thus, appropriate approaches that reflect sex differences will be helpful to alleviate problem drinking in adolescents and educational authorities need to arrange more effective education program for drinking given positive associations between drinking education and problem drinking.

Vulnerabilidades clínicas e sociais em usuários de crack de acordo com a situação de moradia: um estudo multicêntrico de seis capitais brasileiras

Resumo: O estudo teve como objetivo avaliar a gravidade do uso de substâncias psicoativas, situações de violência, saúde física e emocional de usuários de crack que buscam atendimento em Centros de Atenção Psicossocial para Álcool e Drogas (CAPSad), em relação ao status de moradia. Trata-se de um estudo multicêntrico em seis capitais brasileiras, com 564 usuários de crack categorizados em dois grupos: (1) usuários que estiveram em situação de rua (n = 266) e (2) nunca estiveram em situação de rua (n = 298). Para avaliar a gravidade do uso de substâncias e as características dos indivíduos utilizou-se o Addiction Severity Index, 6ª versão (ASI-6). Os usuários do grupo 1 demonstraram piores indicadores em relação às subescalas álcool, problemas médicos, psiquiátricos, trabalho e suporte familiar, além de maior envolvimento com problemas legais, violência, abuso sexual, risco de suicídio e problemas de saúde como HIV/AIDS, hepatite e tuberculose, além de possuírem menos renda para pagar necessidades básicas. Após análises multivariadas ajustadas para possíveis confundidores, não possuir renda suficiente para pagar necessidades básicas, apresentar sintomas depressivos e ter sido preso por roubo permaneceram significativos. Este trabalho avaliou de forma mais abrangente a gravidade do uso de drogas e a situação de moradia de usuários de crack. Abordagens desenvolvidas nos dispositivos de tratamento extra-hospitalares devem ser projetadas e adequadas de acordo com perfis e demandas específicos dos usuários, em especial aqueles em situação de rua.

Local spatial clustering in youths' use of tobacco, alcohol, and marijuana in Boston

BACKGROUND

Understanding geographic variation in youth drug use is important for both identifying etiologic factors and planning prevention interventions. However, little research has examined spatial clustering of drug use among youths by using rigorous statistical methods.

OBJECTIVES

The purpose of this study was to examine spatial clustering of youth use of tobacco, alcohol, and marijuana.

METHODS

Responses on tobacco, alcohol, and marijuana use from 1,292 high school students ages 13-19 who provided complete residential addresses were drawn from the 2008 Boston Youth Survey Geospatial Dataset. Response options on past month use included "none," "1-2," "3-9," and "10 or more." The response rate for each substance was approximately 94%. Spatial clustering of youth drug use was assessed using the spatial Bernoulli model in the SatScan™ software package.

RESULTS

Approximately 12%, 36%, and 18% of youth reported any past-month use of tobacco, alcohol, and/or marijuana, respectively. Two clusters of elevated past tobacco use among Boston youths were generated, one of which was statistically significant. This cluster, located in the South Boston neighborhood, had a relative risk of 5.37 with a p-value of 0.00014. There was no significant localized spatial clustering in youth past alcohol or marijuana use in either the unadjusted or adjusted models.

CONCLUSION

Significant spatial clustering in youth tobacco use was found. Finding a significant cluster in the South Boston neighborhood provides reason for further investigation into neighborhood characteristics that may shape adolescents' substance use behaviors. This type of research can be used to evaluate the underlying reasons behind spatial clustering of youth substance and to target local drug abuse prevention interventions and use.

Neighborhood Context and Binge Drinking by Race and Ethnicity in New York City

BACKGROUND

Neighborhood context is associated with binge drinking and has significant health, societal, and economic costs. Both binge drinking and neighborhood context vary by race and ethnicity. We examined the relations between neighborhood characteristics--neighborhood norms that are accepting of drunkenness, collective efficacy, and physical disorder--and binge drinking, with a focus on examining race and ethnic-specific relationships.

METHODS

Respondent data were collected through 2005 random digit-dial-telephone survey for a representative sample of New York City residents; neighborhood data were based on the 2005 New York City Housing and Vacancy Survey. Participants were 1,415 past-year drinkers; Whites (n = 877), Blacks (n = 292), and Hispanics (n = 246). Generalized estimating equations were used to estimate population average models.

RESULTS

For the overall sample, neighborhood norms that were more accepting of drunkenness were associated with greater binge drinking (odds ratio [OR] = 1.22; 95% confidence interval [CI] = 1.09, 1.37); collective efficacy and physical disorder were not significant. However, when examining this by race/ethnicity, greater collective efficacy (OR = 0.75; 95% CI = 0.62, 0.91) and greater physical disorder (OR = 0.76; 95% CI = 0.62, 0.93) were associated with less binge drinking for Whites only. Neighborhood norms that were more accepting of drunkenness were associated with binge drinking among Whites (OR = 1.20; 95% CI = 1.05, 1.38) and, while not significant (perhaps due to power), the associations were similar for Hispanics (OR = 1.18; 95% CI = 0.83, 1.68) and slightly lower for Blacks (OR = 1.11; 95% CI = 0.67, 1.84).

CONCLUSIONS

Overall, results suggest that neighborhood characteristics and binge drinking are shaped, in part, by factors that vary across race/ethnicity. Thus, disaggregating data by race/ethnicity is important in understanding binge drinking behaviors.

Gender Differences in the Life Concerns of Persons Seeking Alcohol Detoxification

BACKGROUND

This study explored the life concerns of persons seeking alcohol detoxification, a group with multiple life and psychosocial challenges. Gender may be an important contributor to the particular life concerns of persons with alcohol use disorders.

METHODS

Using a 32-item, previously-validated life concerns survey that captures ten conceptual domains, we interviewed persons entering inpatient alcohol detoxification asking them to rate their level of concern about health and welfare items.

RESULTS

Participants (n=189) were 27% female, with a mean age of 43.5 years. Overall, concern about alcohol problems was perceived as the most serious, followed by mental health, cigarette smoking, financial, and relationship problems. Men were significantly more concerned than women about six of the ten domains including money, drug use, transmissible diseases, and physical illness.

CONCLUSIONS

Recognition of the daily worries of persons seeking inpatient alcohol detoxification persons could allow providers to better tailor their services to the context of their patients' lives. Focusing on pressing life concerns such as mental health, financial, relationship problems, and other drug use may influence detoxification services and aftercare treatment choices.

Bibliometric analysis of medicine-related publications on poverty (2005-2015)

BACKGROUND

Poverty is a global problem. The war against poverty requires not only financial support, but also poverty-related research to pinpoint areas of high need of intervention. In line with international efforts to fight poverty and negative consequences, we carried out this study to give a bibliometric overview of medicine-related literature on poverty. Such a s study is an indicator of the extent of interaction of various international key players on the war against poverty-related health problems.

METHODS

Scopus was used to achieve the objective of this study. The time span set for this study was 2005-2015. Poverty-related articles under the subject area "Medicine" were used to give bibliometric indicators such as annual growth of publications, international collaboration, highly cited articles, active countries, institutions, journals, and authors.

RESULTS

The total number of retrieved articles was 1583. The Hirsh-index of retrieved articles was 56. A modest and fluctuating increase was seen over the study period. Visualization map of retrieved articles showed that "HIV", infectious diseases, mental health, India, and Africa were most commonly encountered terms. No significant dominance of any particular author or journal was observed in retrieved articles. The United States of America had the largest share in the number of published articles. The World Health Organization and Centers for Disease Prevention and Control were among top active institutions/organizations. International collaboration was observed in less than one third of publications. Top cited articles focused on three poverty-related health issues, mainly, infectious diseases, malnutrition, and child development/psychology. Most of top articles were published in high impact journals.

CONCLUSIONS

Data indicated that articles on poverty were published in high influential medical journals indicative of the importance of poverty as a global health problem. However, the number publications and the extent of international collaborations was lower than expected given the huge burden of poverty-related health problems.

Disentangling contributions of bar attendance, drinking, and other factors to elevated acute alcohol problems on the U.S.-Mexico border

BACKGROUND

Levels of drinking are unusually elevated among young adults on the U.S.-Mexico border, and this elevation can be largely explained by young border residents' unusually high frequency of bar attendance. However, this explanation complicates interpretation of high alcohol problem rates that have also been observed in this group. Because bar environments can lower the threshold for many types of problems, the extent to which elevated alcohol problems among young border residents can be attributed to drinking per se-versus this common drinking context-is not clear.

METHODS

Data were collected from multistage cluster samples of adult Mexican Americans on and off the U.S.-Mexico border (current drinker N = 1,351). After developing structural models of acute alcohol problems, estimates were subjected to path decompositions to disentangle the common and distinct contributions of drinking and bar attendance to problem disparities on and off the border. Additionally, models were estimated under varying degrees of adjustment to gauge the sensitivity of the results to sociodemographic, social-cognitive, and environmental sources of confounding.

RESULTS

Consistent with previous findings for both drinking and other problem measures, acute alcohol problems were particularly elevated among young adults on the border. This elevation was entirely explained by a single common pathway involving bar attendance frequency and drinking. Bar attendance did not predict acute alcohol problems independently of drinking, and its effect was not moderated by border proximity or age. The common indirect effect and its component effects (of border youth on bar attendance, of bar attendance on drinking, and of drinking on problems) were surprisingly robust to adjustment for confounding in all parts of the model (e.g., fully adjusted indirect effect: b = 0.11, SE = 0.04, p < 0.01).

CONCLUSIONS

Bar attendance and associated increases in drinking play a key, unique role in the high levels of acute alcohol problems among the border's young adult population that cannot be entirely explained by sociodemographic or social-cognitive characteristics of young border residents, by contextual effects of bars on problems, or by broader neighborhood factors. Bar attendance in particular may represent an early modifiable risk factor that can be targeted to reduce alcohol problem disparities in the region.

Perceptions of One's Neighborhood and Mammogram Use among a Sample of Low-Income Women at Risk for Human Immunodeficiency Virus and Sexually Transmitted Infections

BACKGROUND

Neighborhood disorder, signs of physical and social disorganization, has been related to a range of poor mental and physical health outcomes. Although individual factors have been widely associated with getting a mammogram, little is known about the impact of the neighborhood environment on a woman's decision to get a mammogram.

METHODS

In a sample of women at risk for human immunodeficiency virus and sexually transmitted infections, we explored the role of perceptions of one's neighborhood on getting a mammogram. The study included two samples: women 40 to 49 years (n = 233) and women 50 years and older (n = 83). Data were collected from May 2006 through June 2008.

RESULTS

Women age 50 years and older who lived in a neighborhood with disorder were 72% less likely to get a mammogram compared with women who lived in neighborhoods without disorder. There was no relationship for women age 40 to 49 years.

CONCLUSIONS

Interventions are needed to increase awareness and encourage women living in neighborhoods with disorder to get a mammogram. In addition to interventions to increase mammography, programs are needed to decrease neighborhood disorder. Increasing neighborhood cohesion, social control, and empowerment could integrate health promotion programs to both reduce disorder and increase health behaviors.

Alcohol consumption and hazardous drinking in western Kenya--a household survey in a health and demographic surveillance site

BACKGROUND

Alcohol use and hazardous drinking have been studied in school children and in urban areas of Kenya, but there has been no adult survey of these issues in a rural household population.

METHODS

This study reports the prevalence of alcohol consumption and hazardous drinking in a household survey of a demographic surveillance site in rural Kenya. Information collected included demographic characteristics, socio-economic factors, recent life events and perceived social support. Alcohol consumption was assessed by questions about quantity and frequency. The Alcohol Use Disorders Identification Test (AUDIT) measured hazardous alcohol use. The Clinical Interview Schedule- Revised assessed common mental disorder, and the Psychosis Screening Questionnaire indicated the presence of psychotic symptoms.

RESULTS

The study found that lifetime and current alcohol consumption were 10.8% and 9.2% respectively. Current alcohol consumption was significantly higher in men (OR 0.4, p < 0.001 for women) and in the self-employed (OR 1.8, p = 0.013), after adjustment for factors significant at the bivariate level. Hazardous drinking was significantly higher in men (OR 0.3, p < 0.001 for women), people living in larger households (OR 1.8, p = 0.021), people who were single (OR 1.7, p = 0.093), and in those who are self-employed (OR 1.8, p = 0.036), after adjustment for factors significant at the bivariate level.

CONCLUSION

This study suggests that alcohol consumption and hazardous drinking in the general population in a poor rural area in Nyanza Province is still relatively low. This represents an important public health educational opportunity to keep such rates low before increasing income and employment opportunities enable higher access to alcohol and other substances, and before the higher consumption found by studies on urban youth, especially neighbouring Kisumu town, spreads to the rural areas.

Examining impulsivity as a moderator of the relationship between body shame and bulimic symptoms in Black and White young women

Impulsivity has been linked to bulimic symptomatology in a number of studies; however, few have examined this relationship among Black women. We investigated the correlations between impulsivity and bulimic symptoms, and tested impulsivity as a moderator of the body shame/bulimic symptoms relationship among a sample of female undergraduates (N=276; 97 Blacks, 179 Whites). These participants provided data on body shame, impulsivity, and bulimic symptoms (EDE-Q binge eating frequency, BULIT-R, EDI-Bulimia). Among Blacks, impulsivity was significantly positively associated with all bulimic symptoms measures; among Whites, impulsivity was only positively correlated with binge eating frequency. Furthermore, among Blacks, the combination of high body shame and high impulsivity was associated with the highest levels of bulimic symptoms; these findings were not observed among Whites. This study highlights the importance of impulsivity and body shame in identifying bulimic symptomatology among Black women.