Measuring alcohol consumption: a comparison of the retrospective diary and the quantity-frequency methods in a college drinking survey

Accurately Estimating Alcohol Consumption: A Comparison of Self-Administrated and Interview Methods

Background: There have been two methods of gaining retrospective self-report estimates of alcohol consumption, quantity frequency (QF) and retrospective diary (RD), offering distinct advantages and disadvantages. The typical and atypical drinking diary (TADD) was developed to benefit from each method's advantages. Objectives: To compare estimates obtained from the TADD with corresponding estimates obtained from a QF measure (Khavari alcohol test; KAT) and an RD measure, the timeline follow-back (TLFB). It was hypothesized that the TADD's alcohol consumption estimates would correlate strongly with those obtained from the TLFB; and the strength of the TADD-TLFB correlation would be significantly stronger than the KAT-TLFB correlation. Method: One hundred and sixty-eight (168) undergraduates (73% female) estimated their alcohol consumption for the preceding 12 weeks using all three measures. Results: The TADD (r = 0.83, p < .001) and the KAT (r = 0.066, p < .001) produced estimates of total alcohol consumption that correlated very strongly and strongly, respectively, with the TLFB. Notably, the TADD-TLFB correlation was significantly stronger than the KAT-TLFB correlation (Z = 5.10, p < .001). Moreover, the TADD's estimates of number of drinking days (r = 0.70, p < .001) and heavy drinking episodes per week (0.77, p < .001) correlated strongly with corresponding estimates from the TLFB. The TADD and KAT provided higher estimates of alcohol consumption than the TLFB. Conclusion: Clinicians and researchers should consider using the TADD to estimate alcohol consumption in time-limited situations.

Item Responses in Quantity-Frequency Questionnaires: Implications for Data Generalizability

Alcohol consumption is an important predictor of a variety of negative outcomes. There is an extensive literature that examines the differences in the estimated level of alcohol consumption between types of assessments (e.g., quantity-frequency [QF] questionnaires, daily diaries). However, it is typically assumed that all QF-based measures are nearly identical in their assessment of the volume of alcohol consumption in a population. Using timeline follow-back data and constructing common QF consumption measures, we examined differences among survey instruments to assess alcohol consumption and heavy drinking. Using three data sets, including clinical to community samples, we demonstrate how scale-specific item characteristics (i.e., number of response options and ranges of consumption assessed by each option) can substantially affect the estimated mean level of consumption and estimated prevalence of binge drinking. Our analyses suggest that problems can be mitigated by employing more resolved measures of quantity and frequency in consumption questionnaires.

Measuring Alcohol Consumption

This article is an overview of different approaches to measuring alcohol consumption: self-reports and objective measures such as blood alcohol concentration (BAC) and aggregate level measures. These approaches are evaluated as regards their ability to capture quantity, frequency, volume and variability of drinking. This review focuses on self-report measures and on the current knowledge of undercoverage error when compared with sales data. In the comparative evaluation of measures, two analytical aims are examined: a) description and testing of differences across groups for which ordinal information is sufficient and b) establishment of cutoff points and risk relationships for which unbiased interval scale level is required. First, minimal differences were found between self-report measures when the recall period was sufficiently long enough. Second, prospective diaries appear to be stronger measures than retrospective recalls. However, prospective diaries commonly cover only short reporting periods and should be combined with simple retrospective measures to capture rare and infrequent drinking episodes. In regard to undercoverage, the discrepancy cannot be fully explained by non-response or concealment of consumption by drinkers. It is argued that undercoverage of sales data may be more related to sample frame defects–-e.g., the non-inclusion of particular subpopulations such as the homeless or institutionalized.

Evaluation of the psychometric properties of self-reported measures of alcohol consumption: a COSMIN systematic review

PURPOSE

To review studies about the reliability and validity of self-reported alcohol consumption measures among adults, an area which needs updating to reflect current research.

METHODS

Databases (PUBMED (1966-present), MEDLINE (1946-present), EMBASE (1947-present), Cumulative Index of Nursing and Allied Health Literature (CINAHL) (1937-present), PsycINFO (1887-present) and Social Science Citation Index (1976-present)) were searched systematically for studies from inception to 11th August 2017. Pairs of independent reviewers screened study titles, abstracts and full texts with high agreement and a third author resolved disagreements. A comprehensive quality assessment was conducted of the reported psychometric properties of measures of alcohol consumption using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) to derive ratings of poor, fair, good or excellent for each checklist item relating to each psychometric property.

RESULTS

Twenty-eight studies met inclusion criteria and, collectively, they investigated twenty-one short-term recall measures, fourteen quantity-frequency measures and eleven graduated-frequency measures. All measures demonstrated adequate/good test-retest reliability and convergent validity. Quantity-frequency measures demonstrated adequate/good criterion validity; graduated-frequency and short-term recall measures demonstrated adequate/good divergent validity. Quantity-frequency measures and short-term recall measures demonstrated adequate/good hypothesis validity; short-term recall measures demonstrated adequate construct validity. Methodological quality varied within and between studies.

CONCLUSIONS

It was difficult to discern conclusively which measure was the most reliable and valid given that no study assessed all psychometric properties and the included studies varied in the psychometric properties that they selected to assess. However, when the results from the range of studies were considered and summed, they tended to indicate that the quantity-frequency measure compared to the other two measures performed best in psychometric terms and, therefore, it is likely to produce the most reliable and valid assessment of alcohol consumption in population surveys.

Feasibility and Utility of Experience Sampling to Assess Alcohol Consumption Among Older Adults

In the literature on alcohol use and aging, drinking has often been conceptualized as a means of coping with negative feelings, such as stress, yet much of the literature on older adults and drinking has utilized cross-sectional or other data ill-suited for exploring dynamic processes. Experience sampling methods have the ability to measure and analyze dynamic processes in real time, such as relations between alcohol use and mood states. Nonetheless, these approaches are intensive and may burden respondents. Therefore, this study evaluated the feasibility, acceptability, and validity of a modified daily diary to measure alcohol use and explored alternate methods of collecting diary data. Findings suggest that a modified diary was acceptable and not burdensome. Respondents were reluctant to consider technology (e.g., cellphone)-based means of data collection. Measures of alcohol use showed little within-person variation suggesting that for those who drink at all, drinking is a daily habit.

Comparing numbers of drinks: college students' reports from retrospective summary, followback, and prospective daily diary measures

OBJECTIVE

Retrospective summary, followback (retrospective diaries), and prospective daily diary measures of alcohol use among college students were compared across 29 days.

METHOD

Participants were college students (n = 176; 60.2% female). Similarities in the three web-based reporting methods and both between-persons (i.e., gender, past drinking behavior, fraternity/sorority affiliation, average drinking behavior during the study period) and within-person (i.e., daily number of drinks, weekend days, Halloween, and week of study) predictors of concordance between reports of followback and prospective diaries were analyzed.

RESULTS

On prospective diaries, students reported a greater number of maximum drinks (compared with followback only) and a greater number of heavy drinking days in the past 2 weeks (compared with both followback and retrospective summary measures). In followback compared with prospective diaries, students tended to provide inflated accounts of their drinking behavior when reporting about occasions with greater typical drinking (i.e., weekends, Halloween) and deflated accounts of their drinking on their own heavier drinking days, especially if they were affiliated with a fraternity/sorority. Women and students who drank more on average across study days tended to provide deflated estimates of their day-to-day drinking in followback compared with prospective diary.

CONCLUSIONS

Understanding the concordance and discordance in self-reported alcohol use is an important area for continued research efforts.

Assessing current alcohol use with the FORM 90 in a student sample

OBJECTIVES

Alcohol use disorders are one of the most common problems among males. A calendar-based instrument for assessing alcohol use, the FORM 90, has been developed and its validity has been tested in clinical samples as an alternative to prospective assessment. Our goal was to examine its validity in a (non-clinical) student sample with and without alcohol-related disorders.

METHOD

Using the CIDI we interviewed 120 male students and identified individuals with alcohol abuse, alcohol dependency or no substance-related disorder. We compared these groups on a global and a calendar-based measure - the FORM 90 - to see whether both lead to comparable results. CIDI and FORM 90 were completed by independent interviewers.

RESULTS

Overall a global and calendar-based assessment showed comparable results, but differed in the estimated number of days of alcohol consumption. More importantly, looking at the average amount of alcohol consumed at each drinking occasion, the FORM 90 revealed a highly stable alcohol consumption pattern for individuals with alcohol dependence, but a significantly less stable pattern for abusers and individuals without a lifetime-history of alcohol-related problems.

CONCLUSION

Even in a non-clinical sample, using the FORM 90 can identify differences in drinking patterns in individuals with abuse and dependency who have never been treated for these conditions. This study supports the validity of the FORM 90 and suggests that this instrument might allow the examination of specific associations between drinking pattern and its correlates in such populations.

Alcohol use among older hospital patients: findings from an Australian study

Data on alcohol use were obtained from structured interviews with hospital patients aged 65 and over. The cross-sectional sample (sex by age by region) was drawn from three hospitals in New South Wales, Australia. Multivariate statistics and chi-square tests of proportion were used to analyse the data. Significant main effects were found for sex and age. The majority (65%) of the sample had consumed alcohol in the past year. Males were more likely than females to be current drinkers and also had a higher mean weekly alcohol intake than females. There was a significant fall in alcohol consumption with age. More males (25%) than females (6%) were found to be hazardous/harmful users of alcohol, and those in the 65-74-year age group had a higher incidence of problem alcohol use (20.8%) than those aged 75-84 (9.8%) and over 85 (4.9%). The results suggest a comparatively high incidence of problem alcohol use among older hospital patients and indicate the need for consumer education.

A night to remember: a harm-reduction birthday card intervention reduces high-risk drinking during 21st birthday celebrations

OBJECTIVE

In collaboration with Residence Life, the Heads UP research team developed a 21st birthday card program to help reduce the risky drinking often associated with these celebrations.

PARTICIPANTS

81 students (28 males, 53 females) completed a post-21st birthday survey. Of these, 74 reported drinking during their 21st birthday and were included in the analyses.

METHODS

During the 2005-2006 school year, the authors assigned students celebrating 21st birthdays to either receive an alcohol risk-reduction birthday card or to a no-card condition. The students completed a survey after their birthday.

RESULTS

Students who received the card consumed fewer drinks and reached lower blood alcohol content (BAC) levels on their birthday than did students who did not receive it. Female students who received the card consumed 40% fewer drinks and reached nearly 50% lower BAC levels than women who did not receive it.

CONCLUSION

This program is easily replicated, inexpensive, and may be used by universities to reduce risk related to celebratory alcohol consumption.

The differential impact of relational health on alcohol consumption and consequences in first year college women

The Relational Health Indices (RHI) is a relatively new measure that assesses the strength of relationships. It has been found that relational health has a protective factor for women, such that it enhances positive experiences and limits negative ones. The current study is the first to use the RHI to examine the effect of relational health on alcohol consumption and alcohol consequences. First year college women were given questionnaires assessing relational health, drinking motives, and alcohol use in their first few months at a mid-sized, private university. Due to the social nature of college settings, it was predicted that relational health would moderate the relationship between motives and alcohol consumption. Further, due to the protective factor of relational health, it was predicted that relational health would attenuate the relationship between drinking and negative consequences. These hypotheses were supported. Relational health, moderated the relationship between both social and coping drinking motives and drinking, such that women with strong relational health towards their peers and community who also had high social and coping motives, drank more than those with weaker relationships. Paradoxically, relational health also moderated the relationship between drinking and consequences such that heavy drinking women with strong relational health experienced fewer negative consequences than women with weaker relational health. Results indicate that although relational health is associated with an increase in alcohol consumption, it may also serve as a protective factor for alcohol-related negative consequences. Future research and interventions may seek to de-link the relational health-drinking connection in the college student environment.

A campus-based motivational enhancement group intervention reduces problematic drinking in freshmen male college students

The current study employs an adaptation to Motivational Interviewing (AMI) group intervention with freshmen male undergraduates. The program follows suggestions of the National Institute on Alcohol Abuse and Alcoholism for effective interventions with problematic college student drinking, and combines several empirically validated strategies to prevent drinking problems throughout college. All participants reduced drinking and alcohol-related problems; heavier drinkers and those experiencing the most alcohol-related problems reduced drinking most. Additionally, freshmen who completed the intervention were less likely than their non-intervention freshmen male peers to commit alcohol-related violations of campus policies. In addition to the reductions in problematic drinking, the group AMI has advantages over individual formats because larger numbers of students can benefit with comparable expenditures of time and effort.

Classifying risky-drinking college students: another look at the two-week drinker-type categorization

OBJECTIVE

The present study examined the effectiveness of the 2-week period currently used in the categorization of heavy episodic drinking among college students. Two-week drinker-type labels included the following: nonbinge drinker, binge drinker, and frequent binge drinker.

METHOD

Three samples of college student drinkers (104 volunteers, 283 adjudicated students, and 238 freshmen male students) completed the 3-month Timeline Followback assessment of drinking. Drinking behavior during the last 2 weeks of the month before the study was compared with drinking behavior during the first 2 weeks of the same month to compare behavior and resulting labels during both 2- week periods.

RESULTS

Inconsistencies existed in drinker-type labels during the first 2 weeks of the month and the last 2 weeks of the month for all three samples. Between 40% and 50% of participants in the three samples were classified as a different drinker type across the month. Nonbinge drinkers experienced a wide range of alcohol-related problems, and much variation existed among the frequent-binge-drinker label.

CONCLUSIONS

The results suggest that the current definition needs to be modified to accurately identify risky-drinking college students. Expanding the assessment window past 2 weeks of behavior, as well as developing different classification schemes, might categorize risky drinkers more accurately.

Drinking game participation among college students: gender and ethnic implications

Participation in drinking games by college students has recently sparked research attention. While previous research indicates that women play drinking games at lower frequencies than men, the current study reveals that college women may be playing games at rates similar to college men. In a sample of 105 coed college students, participants completed a 3-month Timeline Followback recording every drinking event and quantity consumed. They then were prompted to identify which drinking events involved drinking games and how much alcohol was consumed during game playing. Both men and women engaged in drinking games at similar rates and consumed more drinks on game playing days than on non-game drinking days. However, drinking game participation was related to alcohol-related consequences in women only. Further, while Caucasian participants played drinking games more often than non-Caucasian participants, an association between game participation and alcohol-related consequences emerged in non-Caucasian participants.

Alcohol use in families: a 15-year prospective follow-up study

AIMS

To study the prevalence of adolescents' problematic alcohol use and its parental predictors: drinking habits and socio-demographic factors.

DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS

Questionnaires were sent regularly to the same Finnish families (n = 1132) from the onset of pregnancy (in 1986-87) to the child's age of 15 years (in 2001-02) (n = 1028). There was a total of three follow-up points.

FINDINGS

At 15 years of age, 83% of girls and 79% of boys had used alcohol; 18% of boys and 14% of girls had been drunk more than once a month. The child's permanent separation from at least one biological parent was the strongest socio-demographic predictor of adolescents drinking. Fathers' present heavy drinking and parental early drinking were the best predictors of their children's problematic alcohol use at the age of 15.

CONCLUSIONS

Knowledge of fathers' alcohol use and its time of onset may be used to determine children who are at added risk of problematic alcohol use later in life. Special guidance, support and treatment can be targeted to these families.

Using diaries to collect data in resource-poor settings: questions on design and implementation

Diaries, as a tool for data collection, have been around for some time. Lessons shared to date come from disparate settings and there remains a degree of ambiguity regarding the value of diaries, particularly in resource-poor settings where populations are often illiterate and highly mobile. We recently designed a pictorial diary for the collection of data on household consumption and expenditure in Tanzania and The Gambia. A random sample of 361 diary keepers in The Gambia and 308 in Tanzania maintained diaries for a period of 12 months. The aim of this paper is to share some of the lessons learnt in developing and applying this instrument. It is structured around a series of questions about diaries that we found relatively few answers to when we first embarked on this study. These questions include: how should a diary be designed? How long should a diary be maintained? When should entries be recorded? Who should keep the diary? The motive behind this paper is simple: to provide future researchers who are contemplating using diaries in resource-poor settings with some practical information that may guide them through this process.

SPREADING OUT OR CONCENTRATING WEEKLY CONSUMPTION: ALCOHOL PROBLEMS AND OTHER CONSEQUENCES WITHIN A UK POPULATION SAMPLE

AIMS

To consider the consequences, within a UK population sample, of consuming a given amount of alcohol weekly in one or two sessions as against spreading it out over several sessions.

METHODS

A new analysis of data from the UK components of the GENACIS survey of adults aged > or =18, was carried out.

RESULTS

At low levels of weekly alcohol consumption those subjects whose usual drinking frequency was several times per week ('spreaders'), if anything, reported more alcohol problems than those who consumed alcohol only once or twice per week ('bingers'). As weekly consumption increased above approximately 11 units per week 'bingers' began to experience more problems than 'spreaders'. At the highest levels of consumption 'bingers' reported more positive experiences from drinking than did 'spreaders'. Subjects >54 years showed lower levels of weekly alcohol consumption than other subjects, and relationships between problems, drinking level, and drinking pattern were less in evidence. Females drank less alcohol and experienced fewer alcohol-related problems than did their male counterparts. However, at high-consumption levels, female 'bingers' experienced fewer problems than male 'bingers'.

CONCLUSIONS

For most but not all the variables studied, both drinking level and drinking pattern are important determinants of problems experienced. Binge drinking for people who drink more than approximately 11 units per week is an obvious target for harm minimization.

Predicting Alcohol Patterns in First-Year College Students Through Motivational Systems and Reasons for Drinking

In the present study, a typological approach was used to identify patterns of alcohol use in a sample of 533 college freshmen students (<21 years old; 342 women; 191 men), on the basis of quantity and frequency of consumption, and alcohol-related problems. Personality (sensitivity to reward, SR; sensitivity to punishment, SP) and reasons for drinking were examined as correlates of drinking patterns through a mediational model. Analyses were done separately by gender. Latent profile analyses suggested 5 drinking patterns for both genders, including 3 problematic groups. SR was only associated with the problematic drinking patterns, and enhancement, coping, and social reasons for drinking mediated this relationship. These findings demonstrate the utility of latent profile analysis for identifying a drinking typology and for integrating personality and drinking motives to distinguish drinking patterns.

Community-based alcohol counselling: a randomized clinical trial

AIMS

To examine the effectiveness of a brief intervention (BI) and cognitive behaviour therapy (CBT) for alcohol abuse.

DESIGN

A randomized trial with clients randomized within counsellors.

SETTING

Community-based drug and alcohol counselling in Australia.

PARTICIPANTS

Of all new clients attending counselling. 869 (82%) completed a computerized assessment at their first consultation. Four hundred and twenty-one (48%) were defined as eligible, of whom 295 (70%) consented and were allocated randomly to an intervention. Of these, 13 3 (45%) were followed-up at 6 months post-test.

INTERVENTIONS

BI comprised the elements identified by the acronym FRAMES:feedback, responsibility, advice, menu, empathy, self-efficacy. Face-to-face counselling time was not to exceed 90 minutes. CBT comprised six consecutive weekly sessions: introduction: cravings and urges; managing crises; saying 'no' and solving problems: emergencies and lapses: and maintenance. Total face-to-face counselling time was 270 minutes (six 45-minute sessions).

MEASUREMENTS

Treatment outcomes are measured in terms of counsellor compliance, client satisfaction, weekly and binge consumption, alcohol-related problems, the AUDIT questionnaire and cost-effectiveness.

FINDINGS

When analysed on an intention-to-treat basis and for those followed-up. treatment outcomes between BI and CBT were not statistically significantly different at pre- or post-test, whether considered as continuous or categorical variables. BI was statistically significantly more cost-effective than CBT and there was no difference between them in clients' reported levels of satisfaction.

CONCLUSION

For low-dependence alcohol abuse in community settings, BI may be the treatment of choice.

The relation between intake patterns and substance abuse in a student sample

The purpose of the present study was to identify intake patterns related to substance abuse in a sample of Mexican students. Self-report questionnaires were administered to 897 students in a technical high school. A sample of 300 alcohol and drug users was selected for the present analysis. The sample consisted of 90% alcohol users, 60% male, their mean age being 18.67 (+/-2.25) years old, and mean education being 10.44 (+/-0.67) years. Over 60% met the DSM IV criteria for substance abuse, and almost half of the sample has experienced at least one adverse consequence due to substance use. More than half of the alcohol users drink five or more drinks per drinking occasion. Both substance abusers and males reported more adverse consequences, more frequent, and higher levels of consumption than nonabusers and females, respectively. Results from the logistic regression indicated that four factorial scales derived from the Inventory of Drug-Taking Situations (IDTS) [Annis, A., & Martin, G. (1985). Inventory of Drug-Taking Situations. Toronto: Addiction Research Foundation.] were appropriate predictors of substance abuse. The scales Temptation and Boredom, Family Conflict, Good Mood and Testing Control, and Physical Discomfort and Conflict at School were related to substance abuse, correctly classifying 75% of substance abusers. Information about intake situations associated to substance abuse can be useful in the planning of school-based prevention campaigns.

Estimated alcohol consumption in the 1995 National Health Survey: some methodological issues

OBJECTIVE

This paper critically examines the methodology used to ascertain alcohol consumption in the 1995 Australian Bureau of Statistics National Health Survey (NHS).

METHOD

The 1995 NHS was the second in a series of regular, five-yearly population surveys designed to obtain national benchmark information on a range of health-related issues and enable the monitoring of trends over time. The first survey was conducted in 1989-90. In the 1995 NHS, respondents were asked about the quantity of each of seven types of alcohol consumed on up to three days of the week before the interview day. In the 1989-90 NHS, however, respondents were asked about alcohol consumption on each of the seven days before the interview. This paper uses Unit Record Data from the 1989-90 National Health Survey to investigate the methodology used in 1995.

RESULTS

It is shown that the estimates of alcohol consumption obtained using the 1995 methodology are highly dependent on the day of the week on which the interviews were conducted.

CONCLUSION

It is recommended that the 1995 methodology not be used in future NHS surveys. The 1989-90 methodology of seven-day retrospective diaries would seem a better choice for future National Health Surveys.

Measuring problem drinking in first time offenders. Development and validation of the College Alcohol Problem Scale (CAPS)

Research on college drinking continues to justify serious concerns for the psychological, social, and physical well-being of young persons who abuse alcohol. However, despite considerable interest and research in this regard, there are few valid, reliable and clinically useful brief screening instruments available to measure youthful drinking problems. The current study of 315 college students cited their first time for breaking university drinking rules describes the development and validation of the College Alcohol Problem Scale (CAPS) for measuring different psychosocial dimensions of problem drinking in college students. Two related but distinct factors emerged defining Socio-Emotional and Community Problems. These two factors explained almost two thirds of the variance, and showed very good internal reliabilities. MANOVA analysis demonstrated concurrent validity for the CAPS with both a measure of heavy drinking derived from the QFI and a modified version of the MAST. Implications for using the CAPS for identifying potential drinking problems in young persons are emphasized.

Measuring excessive alcohol use in college drinking contexts: the Drinking Context Scale

Research on youthful drinking has shown that the greatest risks associated with alcohol abuse are related to contextual factors that may potentiate heavy drinking as well as increase risks for adverse consequences. These contextual factors include interacting psychological, interpersonal, and environmental dimensions of alcohol use. However, despite considerable college drinking research to identify these factors, few formal instruments have been produced for measuring excessive drinking in multidimensional contexts. The current study of 197 college students who were cited their first time for breaking university drinking rules focuses on the development and validation of a scale for measuring the likelihood of excessive drinking across an array of psychological, interpersonal and situational contexts resulting in the 23-item Drinking Context Scale (DCS). Three distinct factors emerged defining Convivial drinking, Private Intimate drinking, and drinking as a form of Negative Coping. These three factors explained 61.5% of the variance after principal components analysis and varimax rotation, showed excellent internal reliabilities, and were moderately intercorrelated. MANOVA analysis demonstrated concurrent validity with the Quality Frequency Index (QFI) and a modified version of the Michigan Alcoholism Screening Test (MAST). Implications for further research with the DCS are suggested.

Alcohol-induced bone disease: impact of ethanol on osteoblast proliferation

The habitual consumption of even moderate quantities of alcohol (1 to 2 drinks/day) is clearly linked with reduced bone mass (osteopenia). Biochemical and histological evaluation of patients with alcoholic bone disease reveal a marked impairment in bone formation in the face of relatively normal bone resorption. Experiments using well-defined osteoblastic model systems indicate that the observed reductions in bone formation result from a direct, antiproliferative effect of ethanol on the osteoblast itself. As bone remodeling and mineralization are dependent on osteoblasts, it follows that the deleterious effect of alcohol on these cells would result in slowed bone formation, aberrant remodeling of skeletal tissue and, ultimately, osteopenia and fractures. The skeletal consequences of alcohol intake during adolescence, when the rapid skeletal growth ultimately responsible for achieving peak bone mass is occurring, may be especially harmful. The specific subcellular mechanisms whereby ethanol inhibits cell proliferation are, as yet, unknown. During the last few years, attention has shifted from nonspecific membrane perturbation effects to actions on certain signaling proteins. Specifically, there is increasing evidence that ethanol may exert significant effects on transmembrane signal transduction processes that constitute major branches of cellular control mechanisms. At present, abstinence is the only effective therapy for alcohol-induced bone disease. An improved understanding of the pathogenesis of alcohol-induced bone disease may eventually result in alternative therapeutic avenues for those who are unable to abstain.

Predicting problem drinking in college students: gender differences and the CAGE questionnaire

Adolescents and young adults are among the highest users of alcohol and other drugs in the United States. One of the tools most commonly employed in screening for problem drinking and alcohol dependence is the CAGE questionnaire. Research has indicated, however, that not only may the CAGE be a poor detection device for identifying youthful substance abuse, but it may particularly lack strength in the detection of alcohol abuse by young women. The current study examined the predictive power of the CAGE relative to other common assessment indicators of youthful substance abuse in a sample of college students. It focused on the relative predictive power of the CAGE in detecting a high level of drinking-related problems. In addition, the interaction of gender and a positive CAGE score was included in the logistic regression analysis to test the hypothesis that the CAGE is predictive for men but not for women. Results suggest that the CAGE is a relatively weak predictor of alcohol-related problems in this sample of college students, and it lacks predictive power for detecting, problems in college women. Issues concerning substance-abuse assessment in young people are discussed, with special consideration given to gender differences.

Alcohol and Drug Use by Students on a University Campus in Thailand

This survey was conducted with 501 students from a university in eastern Thailand. The questionnaire was based on the Core Alcohol and Drug Survey designed to survey U.S. higher-education students throughout the United States. It has been translated into Thai language with some modifications in content. Stratified cluster sampling was done based on year in attendance and Faculty (School) affiliation. Two-thirds of the respondents were female. Results showed that males are more involved in alcohol and drug use than females and suffer more consequences as a result. Although Thai students do not use these addictive substances as frequently as U.S. students, there is still cause for concern regarding alcohol use. The number of family members reported by students as having a problem with alcohol or drugs is especially significant.

Ethanol inhibits human osteoblastic cell proliferation

The habitual consumption of alcoholic beverages is clearly associated with low bone mass and an increased prevalence of skeletal fractures. Microscopic analysis of skeletal tissue from alcoholic patients reveals reduced osteoblast number and suppressed bone formation activity with a relative sparing of resorptive indices. The decreased number of osteoblasts observed in alcoholic subjects results from either impaired proliferation or accelerated senescence. Polyamines and ornithine decarboxylase (ODC), the rate-limiting enzyme for polyamine synthesis, are essential for cell proliferation in a variety of cell types. To determine if the adverse effect of ethanol on osteoblast number involves modulation of polyamine biosynthesis, we examined the effect of ethanol on parameters of cell growth and ODC activity in a human osteoblast-like osteosarcoma cell line (TE-85). Ethanol markedly impaired DNA synthesis and cell proliferation in a dose-dependent fashion, but alkaline phosphatase activity (a marker of differentiated osteoblast function) remained intact, and accelerated apoptosis was not evident. Thus, the reduced osteoblastic cell number was a result of a direct effect on proliferative processes rather than a nonspecific toxic effect of ethanol to accelerate cell death. Induction of ODC activity was impaired in ethanol-exposed cell cultures in a dose-dependent fashion that paralleled the antiproliferative effects. Finally, supplemental polyamine administration substantially improved DNA synthesis in ethanol-exposed UMR 106-01 cell cultures. These data confirm a direct inhibitory effect of ethanol on osteoblast proliferation without overt cellular toxicity that may, in part, explain the reduced bone mass observed in those who consume excessive amounts of alcohol.

Retrospective self-report of alcohol consumption: test-retest reliability by telephone

The Timeline Follow-Back (TLFB) is an interview technique for obtaining detailed retrospective self-reports of alcohol consumption with excellent reliability for various composite variables when both administrations are in person. Because the telephone offers practical advantages over face-to-face interviewing for follow-up assessments in longitudinal studies of problem drinkers, this study was undertaken to compare the test-retest reliability of a 12-week TLFB interview when the second administration was by telephone to that when the second interview was in person. In addition, because the reliability of the TLFB has been previously assessed using composite variables, we examined the reliability of the TLFB at the item level. Research participants were 30 adult medical patients who drank frequently, and 75 college students who were problem drinkers. Test-retest reliability as measured by intraclass correlation was generally high, 0.79 or greater for the number of days of drinking > 6 standard drinks, 0.90 or greater for the number of abstinent days, and 0.80 or greater for the greatest number of drinks consumed on any 1 day, in both the most recent 4-week interval and in the entire 12-week interval. Test-retest correlation coefficients for composite variables derived from the interview data were not systematically affected by whether the second interview was in person or by telephone. Furthermore, item-level correlations were also substantial. Findings support the use of the telephone for follow-up interviews, potentially reducing costs of longitudinal studies and facilitating multisite studies with centralized data collection, and lend further general support to the reliability of the TLFB.

Alcohol expectancies and changes in beer consumption of first-year college students

The present study used a prospective design to evaluate the relationship between alcohol expectancies and the progression of beer consumption of first-year college students over a 2-month period. One hundred and fifty-four first-year undergraduate students completed the Alcohol Expectancy Questionnaire (AEQ; Brown, Goldman, Inn, & Anderson, 1980) and a measure of precollege drinking during their first week of college, and completed a retrospective diary account of alcohol consumption also during the first week and at 1-month and 2-month follow-up. Beer was consumed considerably more frequently than other alcoholic beverages and was used as the dependent measure. The results showed that each AEQ subscale was positively correlated with beer consumption at almost all time points, and the magnitude of these correlations was generally higher for male subjects. Furthermore, the expectancies that alcohol increases social assertiveness and that alcohol is associated with global, positive changes were positively correlated with increases in beer consumption from Session 1 to Session 2 and from Session 1 to Session 3 for male, but not female, subjects. The findings extend previous research by demonstrating that certain alcohol expectancies are related to progressive increases over time in the amount of beer consumed.

Criterion variability in problem-drinking research on college students

A persistent issue confronting research on problem drinking (PD) and heavy drinking (HD) among college-age adults is the lack of a consistent, valid definition and criteria for either of the two conditions. This article presents a review and analysis of the criteria used in a selected group of studies on college students' PD and HD from 1974 to 1993. All studies within the time period that employed a random sample of students were analyzed for variations in criteria used to define either PD or HD. Sample characteristics, the specific criteria used, and data on prevalence rates found with those criteria are described. Areas of uniformity and inconsistency were identified and effects of criterion variations were described for the 23 studies reviewed. Of particular note was the lack of differential criteria for gender.

The use of the diary as a data collection technique

The initiation of a research project requires many decisions, not the least of which is the selection of a method for data collection. This decision is, in large measure, guided by the nature of the research question which generally prescribes the selection of a strategy for data collection from among an array of possible alternatives. This article addresses the use of a diary for data collection. Although diaries have traditionally been used in social science and health research, their use in nursing research is more recent. The article begins with a brief discussion of the rationale for using the diary to gather data in a study of personal and professional caregiving. A brief review of the use of diaries in previous studies follows, along with a description of the use of a diary in the caregiving study and a discussion of the possible threats to high quality data as well as measures used to ensure the collection of high quality data. The article concludes with a discussion of the strengths and weaknesses of the diary and makes recommendations regarding its use in nursing research.

Factors in college students' drinking

Associations of age, membership in a sorority or fraternity, and whether a family member had an alcohol-related problem with the number of alcohol-related problem behaviors were examined by asking 160 people on campuses and one Board of Education in the northeastern United States to complete anonymously a 17-item questionnaire reporting the number of drinking-related problem behaviors. A 2 x 2 x 3 factorial analysis of variance with unequal ns yielded significance for age, type of family membership, and the interaction between age and membership in a sorority or fraternity. Younger subjects reported more alcohol-related drinking behaviors as did those with members of their family having drinking problems. Finally, younger members of a Greek organization reported the greatest number of problem behaviors.

Comparison of Timeline Follow-Back and Averaging Methods for Quantifying Alcohol Consumption in Treatment Research

There is as yet no consensus regarding how best to quantify alcohol consumption as an outcome measure in treatment research. Two commonly used methods were compared: the timeline follow-back procedure which reconstructs daily drinking via a calendar, and the grid averaging method employed in the Drinker Profile system. A sample of outpatients being treated for alcoholism was interviewed using both approaches. Similar, though not identical, consumption patterns were obtained with each measure accounting for approximately half of the variance in the other. The relative advantages of these two assessment approaches are considered.

College students' views of excessive drinking and the university's role

Views of college students (N = 133) regarding excessive drinking were explored in terms of the amount of drinking which constitutes a drinking problem, the behaviors that indicate a student has been drinking excessively, and university alcohol policies that students would endorse. Students accepted levels of drinking by peers that markedly exceed definitions of excessive drinking by experts. A sizable minority of students refuse to label very dangerous behaviors associated with excessive drinking as indicating a drinking problem. The views of male and female students differed only marginally. Since students seem to define excessive drinking in ways that differ from professionals, it is suggested that student affairs personnel need to plan programs that recognize the students' views, otherwise students may continue to believe that while excessive drinking is bad, their level of drinking cannot lead to any problems.

Alcohol consumption and presenting problems in an out-patient mental health clinic

Alcohol use has been shown to co-occur with a range of psychiatric disorders and psycho-social problems in both clinical and general population studies. The current survey of 683 out-patient mental health clients examined the relationship of self-reported alcohol use (as measured by the Quantity-Frequency index and the Retrospective Diary) with self-ratings of common mental health concerns. The South Shore Problem Inventory was developed as a brief self-report instrument to be used for routine assessment and research. The inventory yielded three factors after principal components analysis and Varimax rotation: affective/physiological signs and symptoms (Factor 1), interpersonal/family problems (Factor 2), and vocational/legal difficulties (including a self-rating of substance abuse) (Factor 3). MANOVA revealed that heavy drinking predicted significantly higher problem scores for all three factors. The SSPI showed good initial reliability and utility, and the three sub-scales were theoretically congruent with a social learning model of assessment. The use of similar problem scales and substance abuse indices can be used with a wider variety of both mental health and substance abuse treatment populations to provide routine self-report data for clinical and research applications.