Trends in Alcohol's Harms to Others (AHTO) and Co-occurrence of Family-Related AHTO: The Four US National Alcohol Surveys, 2000-2015

National and regional prevalence of interpersonal violence from others' alcohol use: a systematic review and modelling study

Background

While alcohol use is an established risk factor for interpersonal violence, the extent to which people are affected by interpersonal violence from others' drinking has not yet been quantified for different world regions. This modelling study aims to provide the first estimates of the national and regional prevalence of interpersonal violence from others' drinking.

Methods

An international systematic literature search (02/28/2023, Prospero: CRD42022337364) was conducted to identify general adult population studies assessing the prevalence of interpersonal violence from others' drinking with no restrictions to publication date or language. Reports that did not provide data on interpersonal violence from others' drinking (primary outcome), were no original research studies, or captured a selected group of people only, were excluded. Observed prevalence data were extracted and used to build fractional response regression models to predict past-year prevalence of emotional and physical violence from others' drinking in 2019. Random-effects meta-regression models were used to aggregate the observed prevalence of sexual and intimate partner violence. Study risk of bias (ROB) was assessed using a modified version of the Newcastle-Ottawa Scale.

Findings

Out of 13,835 identified reports, 50 were included covering just under 830,000 individuals (women: 347,112; men: 322,331; men/women combined: 160,057) from 61 countries. With an average prevalence of 16·8% (95% CI: 15·2-18·3%) and 28·3% (95% CI: 23·9-32·4%) in men and women combined in the GBD super regions High Income and Central Europe, Eastern Europe, & Central Asia, respectively, emotional violence was the most common form of interpersonal violence from others' drinking. Physical violence averaged around 3% (women) and 5% (men) in both regions. The pooled prevalence of sexual violence from others' drinking in men and women was 1·3% (95% CI: 0·5-3·3%, 95% PI: 0·1-16·9%) and 3·4% (95% CI: 1·4-8·3%, 95% PI: 0·2-35·3%), respectively, and ranged between 0·4% (95% CI: 0·1-1·6%, 95% PI: 0·0-7·3%) and 2·7% (95% CI: 1·1-6·3%, 95% PI: 0·2-30·0%) for different forms of intimate partner violence. ROB was moderate or critical for most reports; accounting for critical ROB did not substantially alter our results.

Interpretation

The share of the population experiencing harms from others' drinking is significant and should be an integral part of public health strategies.

Funding

Research reported in this publication was supported by the Canadian Institutes of Health Research (CIHR; grant: CIHR FRN 477887).

Selling World Health Organization's Alcohol “Best Buys” and Other Recommended Interventions in an Urban Chinese Population: Public Acceptability of Alcohol Harms Reduction Strategies in Hong Kong

Background

To counter the harms caused by alcohol use, the World Health Organization (WHO) outlined a series of evidence-based recommendations, including the highly cost-effective “Best Buys” recommendations. While many Western countries have been actively introducing alcohol harms reduction strategies, it is unclear whether these cost-effective policies would be publicly acceptable in Asian regions with traditionally low alcohol consumption. This study examines the public acceptability of WHO-recommended alcohol harms reduction strategies in an Asian city with few extant alcohol regulations.

Methods

A cross-sectional telephone survey of Hong Kong Chinese residents aged 18–74 (n = 4,000) was conducted from January to August 2018. Respondents were asked about their perceptions of various WHO-recommended strategies and consequences of their implementation. After reducing the strategies into several policy categories by principal component analysis, multivariable linear regression was performed to identify factors associated with endorsement of the various policies.

Results

Among the “Best Buys”, introduction of moderate beer/wine taxes (68.7%) and shortened alcohol retail hours (51.9%) were the most supported while bans on event sponsorships (19.5%) and public drinking events (17.7%) were the least popular. Strategies targeting young drinkers were particularly highly supported. Males, younger adults, Non-abstainers, and those who believed in drinking's social benefits were less likely to endorse stringent control measures (p < 0.05). Adults with higher household income were less supportive, partially due to concerns about infringements on local economy, lifestyles, and economic freedom. Women and older people were generally more supportive, partially because they perceived these policies would lower alcohol-related harms.

Conclusion

In order to reduce barriers to implementing WHO-recommended strategies in the region, it is imperative to increase awareness of alcohol-related harms and to strengthen beliefs in the effectiveness of these countermeasures, especially among men, young adults, and drinkers.

An integrated dual process simulation model of alcohol use behaviours in individuals, with application to US population-level consumption, 1984-2012

INTRODUCTION

The Theory of Planned Behaviour (TPB) describes how attitudes, norms and perceived behavioural control guide health behaviour, including alcohol consumption. Dual Process Theories (DPT) suggest that alongside these reasoned pathways, behaviour is influenced by automatic processes that are determined by the frequency of engagement in the health behaviour in the past. We present a computational model integrating TPB and DPT to determine drinking decisions for simulated individuals. We explore whether this model can reproduce historical patterns in US population alcohol use and simulate a hypothetical scenario, "Dry January", to demonstrate the utility of the model for appraising the impact of policy interventions on population alcohol use.

METHOD

Constructs from the TPB pathway were computed using equations from an existing individual-level dynamic simulation model of alcohol use. The DPT pathway was initialised by simulating individuals' past drinking using data from a large US survey. Individuals in the model were from a US population microsimulation that accounts for births, deaths and migration (1984-2015). On each modelled day, for each individual, we calculated standard drinks consumed using the TPB or DPT pathway. In each year we computed total population alcohol use prevalence, frequency and quantity. The model was calibrated to alcohol use data from the Behavioral Risk Factor Surveillance System (1984-2004).

RESULTS

The model was a good fit to prevalence and frequency but a poorer fit to quantity of alcohol consumption, particularly in males. Simulating Dry January in each year led to a small to moderate reduction in annual population drinking.

CONCLUSION

This study provides further evidence, at the whole population level, that a combination of reasoned and implicit processes are important for alcohol use. Alcohol misuse interventions should target both processes. The integrated TPB-DPT simulation model is a useful tool for estimating changes in alcohol consumption following hypothetical population interventions.

Psychosocial and health problems associated with alcohol use disorder and cannabis use disorder in U.S. adults

BACKGROUND

Although the problems associated with alcohol use disorder (AUD) are well known, little is known about the psychosocial problems associated with cannabis use disorder (CUD), and the harmfulness of CUD relative to AUD. We compared the odds of psychosocial and health-related problems between individuals with DSM-5 AUD-only, CUD-only and co-occurring AUD+CUD.

METHODS

The 2012-2013 NESARC-III, a nationally representative cross-sectional survey of non-institutionalized US adults (n = 36,309), assessed participants for DSM-5 AUD, CUD, and psychosocial (interpersonal, financial, legal) and health-related problems. Based on their responses, participants were categorized into mutually exclusive groups: no AUD/CUD, AUD-only, CUD-only, and AUD+CUD. Multivariable logistic regression models examined the associations between psychosocial problems and the four AUD/CUD groups, adjusting for sociodemographic characteristics.

RESULTS

People with AUD-only, CUD-only, and AUD+CUD had higher odds of most interpersonal problems (adjusted odds ratio [aORs] 1.07-4.01), financial problems (aORs 1.53-4.28), legal problems (aORs 3.34-7.71), and health-related problems (aORs 1.29-1.92). The odds of psychosocial and health-related problems were similar for CUD-only and AUD-only in direct comparisons. Compared to those with AUD-only, those with AUD+CUD had higher odds of most problems examined (aORs 1.42-2.31). In contrast, there were few differences when comparing AUD+CUD with CUD-only.

CONCLUSIONS

AUD and CUD were similarly associated with interpersonal, financial, and legal problems, emergency treatment and suicide attempt. People with AUD+CUD had higher odds of certain problems than individuals with either AUD-only or CUD-only. Although most people who use cannabis do not experience harms, our results indicate that CUD does not appear to be less harmful than AUD.

Rates and predictors of Alcoholics Anonymous attendance across sexual orientations

Sexual minority (e.g., gay, lesbian, bisexual) individuals experience alcohol dependence at 2-6 times the rates of heterosexual individuals. Among the general population, Alcoholics Anonymous (AA) serves as the most common source of support for alcohol-related problems in the United States. Yet, relatively little is known about sexual minority involvement in AA, including rates and predictors of AA attendance among sexual minorities. This paper aims to: 1) Compare rates of AA attendance across sexual orientations; 2) Compare relationships between AA attendance and common predictors of AA attendance across sexual orientations. Using five waves of the National Alcohol Survey (N = 7862 respondents with at least one lifetime AUD symptom), this study found lesbian and bisexual women, but not gay and bisexual men, had greater odds of attending AA, even while controlling for lifetime AUD severity, gender, race/ethnicity, age, religiosity, and current income. Interaction models for women showed there was a stronger association between older age and AA attendance, a stronger association between greater religiosity and AA attendance, and a weaker association between lifetime AUD severity and AA attendance for sexual minority women relative to heterosexual women. This study did not find significant interactions between sexual orientation and these covariates for men. These results suggest AA may serve as a promising resource for sexual minority individuals experiencing alcohol-related problems, particularly for sexual minority women who are older, more religious, and have less severe AUD.

Childhood Experiences and High-Intensity Drinking Among American Indian and Alaska Native Adults: Findings From the 2000-2015 National Alcohol Surveys

OBJECTIVE

The purpose of this study was to examine associations with high-intensity drinking (HID) in American Indian/Alaska Native (AI/AN) populations and compare them to White and other minority groups using four National Alcohol Surveys, 2000 to 2015 (total N = 29,571; AI/ANs = 434).

METHOD

Current drinking and HID (8+ and 12+ drinks on any day) from maximum drinks in the prior 12 months were analyzed with independent variables and race/ethnicity (AI/AN, non-Hispanic White, and other racial/ethnic groups combined). Adjusted logistic regression models comprised gender, age, marital status, employment, education, survey year, rurality, and especially, childhood trauma (physical/sexual abuse), and biological family alcohol problem history (each dichotomous).

RESULTS

In adjusted population models, Whites had twice the odds of current drinking as AI/ANs, with no difference between other racial/ethnic groups and AI/ANs. Descriptively, AI/AN drinkers consumed at higher intensity levels than other groups, with higher prevalence of childhood trauma and family problem drinking than others. However, on a population basis, adjusting for all factors, apparent differences between AI/AN and White HID were eliminated; other minority groups together, compared with AI/ANs, showed lower odds of consuming 8+ drinks.

CONCLUSIONS

AI/ANs had a higher prevalence of childhood trauma and family alcohol problems as well as lower current drinking likelihood compared with Whites. In adjusted population models, the combined other minorities group was less likely to ever consume 8+ drinks than AI/ANs. In all populations, childhood trauma and family alcohol problems increased the risk of HID, strongly so in AI/ANs. Addressing childhood trauma and family problems is important among AI/ANs to break generational cycles of drinking extreme amounts per occasion.

Childhood Experiences and High-Intensity Drinking Among American Indian and Alaska Native Adults: Findings From the 2000-2015 National Alcohol Surveys

OBJECTIVE

The purpose of this study was to examine associations with high-intensity drinking (HID) in American Indian/Alaska Native (AI/AN) populations and compare them to White and other minority groups using four National Alcohol Surveys, 2000 to 2015 (total N = 29,571; AI/ANs = 434).

METHOD

Current drinking and HID (8+ and 12+ drinks on any day) from maximum drinks in the prior 12 months were analyzed with independent variables and race/ethnicity (AI/AN, non-Hispanic White, and other racial/ethnic groups combined). Adjusted logistic regression models comprised gender, age, marital status, employment, education, survey year, rurality, and especially, childhood trauma (physical/sexual abuse), and biological family alcohol problem history (each dichotomous).

RESULTS

In adjusted population models, Whites had twice the odds of current drinking as AI/ANs, with no difference between other racial/ethnic groups and AI/ANs. Descriptively, AI/AN drinkers consumed at higher intensity levels than other groups, with higher prevalence of childhood trauma and family problem drinking than others. However, on a population basis, adjusting for all factors, apparent differences between AI/AN and White HID were eliminated; other minority groups together, compared with AI/ANs, showed lower odds of consuming 8+ drinks.

CONCLUSIONS

AI/ANs had a higher prevalence of childhood trauma and family alcohol problems as well as lower current drinking likelihood compared with Whites. In adjusted population models, the combined other minorities group was less likely to ever consume 8+ drinks than AI/ANs. In all populations, childhood trauma and family alcohol problems increased the risk of HID, strongly so in AI/ANs. Addressing childhood trauma and family problems is important among AI/ANs to break generational cycles of drinking extreme amounts per occasion.

State Alcohol Policies, Binge Drinking Prevalence, Socioeconomic Environments and Alcohol's Harms to Others: A Mediation Analysis

AIMS

Alcohol policy effects on alcohol's harms due to others' drinking (AHTO) and contextual factors that may mediate such policy effects have been understudied. This study examines state binge drinking prevalence as a mediator of the relationship between state alcohol policy and socioeconomic environments and individual-level AHTO.

METHODS

A nationally representative sample of US adults (N = 32,401; 13,873 males, 18,528 females) from the 2000, 2005, 2010 and 2015 National Alcohol Surveys and the 2015 National Alcohol's Harm to Others Survey, administered in telephone interviews and based on random digit dialed sampling, were linked with state-level Alcohol Policy Scale (APS) scores, binge drinking prevalence and socioeconomic status (SES) data. Three 12-month AHTO measures were family/marriage difficulties, assault or vandalism and riding with drunk driver or having traffic accident. Three-level mediation analyses were conducted, controlling for gender, race, education, marital status, family problem-drinking history and state policing rate.

RESULTS

The effects of the APS on reduced risks for assault/vandalism and drinking-driving harms were significantly mediated by reduced state binge drinking prevalence. The APS had no direct or indirect effect on family/marital trouble. State SES had significant indirect effects on increased risks for assault/vandalism and driving-related harm through increased state binge drinking prevalence and a direct effect on reduced family/marital problems.

CONCLUSIONS

A more stringent alcohol policy environment could reduce assault/vandalism and driving-related harm due to another drinker by lowering state binge drinking rates. Alcohol policies may not be effective in reducing family problems caused by another drinker more prevalent in low-SES states.

Using Multi-objective Grammar-based Genetic Programming to Integrate Multiple Social Theories in Agent-based Modeling

Different theoretical mechanisms have been proposed for explaining complex social phenomena. For example, explanations for observed trends in population alcohol use have been postulated based on norm theory, role theory, and others. Many mechanism-based models of phenomena attempt to translate a single theory into a simulation model. However, single theories often only represent a partial explanation for the phenomenon. The potential of integrating theories together, computationally, represents a promising way of improving the explanatory capability of generative social science. This paper presents a framework for such integrative model discovery, based on multi-objective grammar-based genetic programming (MOGGP). The framework is demonstrated using two separate theory-driven models of alcohol use dynamics based on norm theory and role theory. The proposed integration considers how the sequence of decisions to consume the next drink in a drinking occasion may be influenced by factors from the different theories. A new grammar is constructed based on this integration. Results of the MOGGP model discovery process find new hybrid models that outperform the existing single-theory models and the baseline hybrid model. Future work should consider and further refine the role of domain experts in defining the meaningfulness of models identified by MOGGP.

The Association Between Family Violence, Depression and Anxiety Among Women Whose Partners Have Been Treated for Alcohol Dependence

The negative effects of men's excessive alcohol consumption on family members are well known. However, less is known about how men's alcohol dependence is associated with the mental health of their female spouses residing with them. Therefore, the aim of this study was to investigate the prevalence and factors associated with depression, anxiety, and intimate partner violence against women (IPVAW) whose male spouses are undergoing treatment for alcohol dependence. We hypothesize that men with alcohol dependency, who are also violent, present a serious threat to women's mental health. We conducted a cross-sectional study among 104 women whose male partners had been admitted for inpatient treatment for alcohol dependence. Women's depression was measured by the Beck Depression Inventory (BDI-II); anxiety was measured by the Beck Anxiety Inventory (BAI), and exposure to physical and sexual IPVAW was measured by the Conflict Tactics Scale (CTS-2). Multinomial logistic regression analyses were conducted in order to analyze factors associated with depression and anxiety. The prevalence of moderate/severe depression and anxiety among the women was 34.6% and 25.2%, respectively, while almost half (48.1%) experienced IPV during the past 12 months. After adjustments for age, exposure to IPV increased the chances of experiencing moderate/severe depression by 37.5 times (95% CI 7.91-177.76), and 8.15 times for moderate/severe anxiety (95% CI 2.45-27.14). The mental health of women whose partners have alcohol dependence is significantly threatened and should be considered, especially when it is associated with exposure to spousal violence.

Extending the Harm to Others Paradigm: Comparing Marijuana- and Alcohol-Attributed Harms in Washington State

Harms attributed to others' alcohol use have been extensively studied in the US and internationally, but no studies have measured harms from others' marijuana use. We utilize data from five cross-sectional waves of a survey series with representative samples of Washington state residents conducted every 6 months from 2014 to 2016, after the legalization of adult use marijuana. Harms attributed to others' drinking and to others' marijuana use included family and financial problems, assault, harassment, and vandalism experiences, and accidents due to impaired drivers. Past year harms attributed to others' marijuana use were reported by 8.4% of the sample, while 21.3% reported alcohol-attributed harms and 4.3% experienced both. Women were more likely to experience harms from either substance. While heavy drinkers were most likely to experience alcohol harms from others' use, frequent marijuana users reported the least harms from others. About three times as many individuals reported harassment, vandalism, or family problems attributed to someone's alcohol use compared to those harms attributed to someone's marijuana use, with a smaller ratio seen for financial trouble and a wider ratio for physical harm. Harms attributed to other's marijuana use in Washington were found to be substantial, but lower than harms from others' drinking.

Gender differences in social harms from drinking among young Australians: findings from the Mater University Study of Pregnancy and its Outcomes

Background: Despite the growing interest in investigating social harms from drinking, little is known about drinkers' reports of these harms and their gender differences among Australian young adults at age 30. We aimed to examine gender differences of social harms from drinking as reported by drinkers.Methods: 2,200 young adults at age 30 with complete data on social harms from drinking were drawn from the 30-year follow-up of the Mater-University of Queensland Study of Pregnancy. Measures included percentages of 11 past-year drinkers' self-reported social harms stratified by gender. Logistic regression was used to examine associations between gender and each social harm, accounting for relevant confounding.Results: More than one in five young adults (22%) reported at least one social harm in the past year. Among binge drinkers, 44% reported at least one social harm. After adjustments for social roles and binge drinking, we found no gender differences on several self-reported social harms: friendship problems, people criticizing drinking, non-marital family problems, employment problems, and alcohol-fuelled fights. However, men were more likely to report spousal threats to leave, drink-driving legal problems and financial problems.Conclusions: Our findings demonstrate that young adults are still vulnerable to risky drinking at age 30 and the social harm resulting from drinking. Thus, alcohol prevention campaigns should target this age group and include women in their focus. Strategies aiming to reduce alcohol-related harms, such as screening in clinical settings for risky drinking and alcohol-related harms, followed by motivational behavior interventions, could be beneficial among these vulnerable groups.

Reduction in World Health Organization Risk Drinking Levels and Cardiovascular Disease

BACKGROUND

Reductions in World Health Organization (WHO) risk drinking levels have recently been shown to lower the risk of multiple adverse health outcomes, but prior work has not examined reductions in WHO risk drinking levels in relation to cardiovascular disease (CVD), the leading cause of death for men and women in the United States and of global mortality. This study examined associations between reductions in WHO risk drinking levels and subsequent risk for CVD.

METHODS

In a US national survey, 1,058 very-high-risk and high-risk drinkers participated in Wave 1 interviews (2001 to 2002) and Wave 2 follow-ups (2004 to 2005). Self-reported CVD history that was communicated to the participant by a doctor or other healthcare professionals included arteriosclerosis, hypertension, angina, tachycardia, or myocardial infarction. We used logistic regression to estimate adjusted odds ratios (aOR) evaluating relationships between ≥2-level reductions in WHO risk drinking levels from Wave 1 to Wave 2 and the risk of Wave 2 CVD, controlling for baseline characteristics.

RESULTS

Reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD in individuals who at Wave 1 were very-high-risk (aOR = 0.58 [0.41 to 0.80]) or high-risk drinkers (aOR = 0.81 [0.70 to 0.94]). Interaction terms showed that this relationship varied by age. Among individuals >40 years old at Wave 1, reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD among very-high-risk drinkers (aOR = 0.42 [0.28 to 0.63]) but not high-risk drinkers (p = 0.50). Among individuals ≤40 years old at Wave 1, reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD among high-risk drinkers (aOR = 0.50 [0.37 to 0.69]) but not very-high-risk drinkers (p = 0.27).

CONCLUSIONS

These results show that reductions in WHO risk drinking levels are associated with reduced CVD risk among very-high-risk and high-risk drinkers in the US general population, and provide further evidence that reducing high levels of drinking provides important benefit across multiple clinical domains.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Association between state-level alcohol availability and taxation policies on the prevalence of alcohol-related harms to persons other than the drinker in the USA, 2000-2015

INTRODUCTION AND AIMS

Alcohol-related harms to others (AHTO) are consequences of alcohol use borne by persons other than the drinker. This study assessed whether the odds of experiencing AHTO are associated with alcohol availability and taxation policies.

DESIGN AND METHODS

This study pooled data from four waves of the National Alcohol Survey (n = 20656 adults). We measured past-year AHTO exposure using three binary variables: physical (pushed/hit/assaulted or property damage by someone who had been drinking), family or financial (family/marital problems or financial harms by someone who had been drinking) and driving AHTO (riding in a vehicle with a drink-driver or being in a drink-driving crash). Policies included bar and off-premise alcohol outlet density (separately), alcohol retail hours, beer and spirits taxes (separately) and monopoly on retail/wholesale alcohol purchases.

RESULTS

Monopolies were associated with 41.2% lower odds of physical harms [adjusted odds ratio (aOR) = 0.59, 95% confidence interval (CI) 0.45, 0.77, q < 0.001 correcting for multiple analyses], and a 10% increase in bar density was associated with a 1.2% increase in odds of driving-related harms ( e ^{ln(1.1) * β} =1.01, 95% CI 1.00, 1.02, q = 0.03). Among men, beer taxes were associated with lower odds of physical harms ( e^{ln(1.1) * β} =0.93, 95% CI 0.88, 0.98 q = 0.03) and monopolies were associated with lower odds of physical (aOR = 0.45, 95% CI 0.35, 0.59, q < 0.001) and driving harms (aOR = 0.66, 95% CI 1.00, 1.02, q = 0.03).

DISCUSSION AND CONCLUSIONS

Monopolies, taxes and outlet density are associated with odds of some AHTO. Future longitudinal research should test whether physical availability and taxation policies may be protective for bystanders as well as drinkers.

Measuring Coping Among Family Members with Substance-Misusing Relatives: Testing Competing Factor Structures of the Coping Questionnaire (CQ) in England and Italy

Background: The Coping Questionnaire measures affected family members' responses to their relatives' substance misuse related problems. The Coping Questionnaire examines three main coping strategies: engaged, tolerant-inactive, and withdrawal coping. Objectives: The aim of the current study was to compare competing conceptual measurement models across two countries, including one-factor, three-factor, and higher order factor models. Methods: Secondary analysis of data from five previous studies was conducted. Samples of affected family members from England (N = 323) and Italy (N = 165) were aggregated into two country specific groups. Series of confirmatory factor analyses were performed to test the degree of model fit and the effects of socio-demographic variables on the coping factors. Results: A bifactor model fitted the data most closely relative to the one- and three-factor models. High rates of common variance (60-65%) were attributable to the general coping factor, while a high proportion of the variance related to the withdrawal coping subscale score was independent (66-89%) of the general coping factor. Family members' country, age, gender, the type of relationship and the main problematic substance had significant effects on the coping factors. Conclusions: A bifactor model related to coping behaviors is consistent with the theoretical assumptions of the general coping literature. The concept of a general coping factor also fits the theoretical assumptions of the stress-strain-coping-support model, with family members showing a general tendency to cope with the harmful circumstances which arise due to substance misuse.

Racial/Ethnic Variations in Clustered Risk Behaviors in the U.S

INTRODUCTION

Alcohol misuse, cigarette smoking, poor diet, and physical inactivity, known as the "big four" contributors to chronic conditions and mortality, typically co-occur or cluster together, with their synergistic effect more detrimental to health than their cumulative individual effects. Little research has been reported on race/ethnicity-specific analyses of the clustering of these behaviors in the U.S. This study identified clustered risk behaviors among whites, blacks, and Hispanics and examined whether unhealthy clusters were associated with lower SES (assessed by education level and family income) and poor health status.

METHODS

A nationally representative sample of U.S. adults aged 30-69 years (n=9,761) from the 2010 and 2015 National Alcohol Surveys was used to perform latent class analysis and multinomial and logistic regression modeling in 2018-2019. Obesity was used as a proxy for unhealthy diet.

RESULTS

Three lifestyle classes were identified in each group. The relatively healthy lifestyle class was identified among whites and Hispanics. The nonsmoking and low risky drinking class among blacks, though showing a healthier lifestyle than the other 2 classes, still had relatively high prevalence of inactivity and obesity. The inactive and obese class was found in all 3 groups. Also identified were the smoking and risky drinking class among whites; the smoking and inactive class among blacks; and the smoking, inactive, and risky drinking class among Hispanics. For all 3 groups, unhealthy lifestyle classes mostly were associated with lower SES. Unhealthy lifestyle classes were also associated with poorer health status.

CONCLUSIONS

Multi-behavior interventions are warranted to address inactivity and obesity in all 3 groups and unhealthy clusters involving smoking in each group.

Prevention, screening, and treatment for heavy drinking and alcohol use disorder

Heavy drinking and alcohol use disorder are major public health problems. Practitioners not specialising in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and alcohol use disorder. However, a consensus exists that clinically useful and valuable tools are available to address these issues. Here, we review existing information and developments from the past 5 years in these areas. We also include information on heavy drinking and alcohol use disorder among individuals with co-occurring psychiatric disorders, including drug use disorders. Areas covered include prevention; screening, brief intervention, and referral for treatment; evidence-based behavioural interventions; medication-assisted treatment; technology-based interventions (eHealth and mHealth); and population-level interventions. We also discuss the key topics for future research.

Using social network analysis to examine alcohol use among adults: A systematic review

Background

Alcohol use and abuse constitute a major public health problem and identifying their determinants is a priority. Social network analysis can indicate how characteristics of social networks are related to individual health behaviors. A growing number of studies have used social network analysis to examine how social network characteristics influence adult alcohol consumption, but this literature has never been systematically reviewed and summarized. The current paper systematically reviews empirical studies that used social network analysis to assess the influence of social network characteristics on drinking behaviors in adults.

Methods

A literature search of PubMed/MEDLINE, EMBASE, PsycINFO and Web of Science databases and a review of the reference lists of retrieved articles was conducted in March 2019. Two reviewers independently screened 5,510 non-duplicate records, and further screened the full text of 150 articles to determine their eligibility for inclusion. Seventeen articles were judged eligible and included.

Results

Most studies were conducted among young adults (mean age<30), in university settings or follow up visits with adolescent networks moving into adulthood. The objectives and methods of the included studies were heterogeneous. All included studies reported a statistically significant association between a social network characteristic and an alcohol consumption-related outcome. Social network members drinking behaviors were associated with participants’ drinking behaviors in multiple ways.

Discussion

In young adults, among whom the majority of identified studies were conducted, with whom they socialize and how they socialize appears to be associated with alcohol consumption; this was observed across methodologies and settings. We still know very little about the relationship of social networks to drinking in older age groups, and in populations most impacted by alcohol. As social networks appear to play a role in the consumption of alcohol in young adulthood, interventions that utilize social networks to help reduce harmful alcohol consumption should be considered.

Reduction in non-abstinent World Health Organization (WHO) drinking risk levels and drug use disorders: 3-year follow-up results in the US general population

BACKGROUND

To provide information on the clinical relevance of a reduction in the World Health Organization (WHO) drinking risk categories, we examined their relationship to an important indicator of how individuals feel and function: drug use disorders (DUDs), i.e., those involving substances other than alcohol.

METHOD

Current drinkers in a U.S. national survey (n = 22,005) were interviewed in 2001-02 and re-interviewed 3 years later. WHO drinking risk levels and DSM-IV-defined DUD were assessed at both waves. The relationship of changes in WHO drinking risk levels to the presence of DUD were examined using adjusted odds ratios (aOR).

RESULTS

At Wave 1, 2.5% of respondents were WHO very-high-risk drinkers, and 2.5%, 4.8%, and 90.2% were high-risk, moderate-risk, and low-risk drinkers, respectively. Among Wave 1 very-high-risk drinkers, significantly lower odds of DUD at Wave 2 were predicted by reductions in WHO risk levels of one, two or three levels (aOR = 0.15, 0.01, 0.24, respectively; all p-values <.0001). Among participants who initially were drinking at lower risk levels, reductions in drinking or abstinence were generally associated with significantly lower odds of DUD, although the results were less consistent.

CONCLUSIONS

Among very-high-risk drinkers, reduction in the WHO drinking risk categories were associated with lower risk of a DUD. These results add to findings indicating that reductions in WHO drinking risk levels are a meaningful indicator of how individuals feel and function and could therefore serve as informative outcomes in alcohol clinical trials. WHO risk levels can also guide treatment goals and clinical recommendations on drinking reduction.

The Relationship Between the U.S. State Alcohol Policy Environment and Individuals' Experience of Secondhand Effects: Alcohol Harms Due to Others' Drinking

BACKGROUND

Although restrictive state alcohol policy environments are protective for individuals' binge drinking, research is sparse on the effect of alcohol policies on alcohol's harms to others (AHTO). We examined the lagged associations between efficacy of U.S. state alcohol policies and number of harms from others' drinking 1 year later.

METHODS

Individuals with AHTO data in a nationally representative sample of U.S. adults (analytic sample n = 26,744) that pooled the 2000, 2005, 2010, and 2015 National Alcohol Surveys and a 2015 National Alcohol's Harm to Others Survey were linked with prior-year state policy measures. We used 2 measures from the Alcohol Policy Scale (APS)-effectiveness in reducing (i) binge drinking and (ii) impaired driving, based on experts' efficacy judgments regarding 29 state alcohol policies. Three 12-month AHTO measures (due to another drinker) were experiencing: (i) either family/marriage difficulties or financial troubles; (ii) being assaulted or vandalized; and (iii) passenger with drunk driver or traffic accident. Multilevel models accounting for clustering within states and stratified by age-groups (<40 vs. ≥40) examined associations between the APS and AHTO measures, controlling for individual covariates (gender, race, education, employment and marital status, family problem-drinking history) of the victim.

RESULTS

Only for those aged <40, the lagged APS-Binge drinking and APS-Impaired driving scores were each inversely associated with aggression-related harms and, separately, with drunk driving-related harm from someone else's drinking (ps < 0.05 to < 0.01). Family/financial harms were not associated with APS scores for either age-group. Composite AHTO measures (any of 3 harm-types) also were inversely associated with stronger state alcohol policy environments (ps < 0.05 to <0.01).

CONCLUSIONS

State alcohol policies may be effective in reducing, to a meaningful degree, aggression-related harms and vehicular hazards due to other drinkers, but mainly in those under 40.

Alcohol-related harm to others in England: a cross-sectional analysis of national survey data

OBJECTIVES

To estimate the prevalence, the frequency and the perpetrators of alcohol-related harm to others (AHTO) and identify factors associated with experiencing harm and aggressive harm.

DESIGN

Cross-sectional survey.

SETTING

England.

PARTICIPANTS

Adults (general population) aged 16 and over.

OUTCOME MEASURES

Percentage of respondents who experienced harm. Socioeconomic and demographic factors associated with the outcomes. Outcomes were (1) experienced harm/did not experience harm and (2) experienced aggressive harm (physically threatened, physically hurt and forced/pressured into something sexual)/did not experience an aggressive harm (no aggressive harm plus no harm at all).

RESULTS

Data to support a response rate calculation were not collected; 96.3% of people surveyed completed the AHTO questions. The weighted sample was 4874; 20.1% (95% CI 18.9 to 21.4, N=980) reported experiencing harm in the previous 12 months and 4.6% (95% CI 4.0 to 5.4, N=225) reported experiencing an aggressive harm. Friends and strangers were the dominant perpetrators. Most harms (74.8%) occurred less than monthly. Factors associated with experiencing harm were: younger age (p<0.001), drinking harmfully/hazardously (p<0.001), white British (p<0.001 compared to other white groups and Asian groups and p=0.017 compared to black groups), having a disability (p<0.001), being educated (p<0.001 compared to no education) and living in private rented accommodation (p=0.004 compared with owned outright). Being in the family stage of life (defined as having children in the household) had significantly lower odds of harm (p=0.006 compared to being single), as did being retired (p<0.001 compared to being employed). Factors associated with experiencing an aggressive harm were similar.

CONCLUSIONS

This exploratory study, using data collected through the Alcohol Toolkit Survey, shows that AHTO affects 20.1% of the population of England. Even apparently minor harms, like being kept awake, can have a negative impact on health, while aggressive harms are clearly of concern. Using a standard methodology to measure harm across studies would be advantageous. Policies that focus on alcohol must take into consideration the impact of drinking on those other than the drinker.

Reduction in non-abstinent WHO drinking risk levels and depression/anxiety disorders: 3-year follow-up results in the US general population

BACKGROUND

Non-abstinent drinking reductions that predict improvement in how individuals feel or function, such as the World Health Organization (WHO) drinking risk levels, may be useful outcomes in clinical trials for alcohol use disorders (AUD).

METHODS

Current drinkers in a U.S. national survey (n = 22,005) were interviewed in 2001-02 (Wave 1) and re-interviewed 3 years later (Wave 2). WHO drinking risk levels, a 4- level categorization system (very-high-risk, high-risk, moderate-risk, and low-risk drinkers) defined using estimated mean ethanol consumption (grams) per day in the prior 12 months, and DSM-IV depressive and anxiety disorders were assessed at both waves. Logistic regression was used to produce adjusted odds ratios (aOR) testing the associations of changes between Wave 1 and Wave 2 WHO risk levels to the presence or persistence of depression and/or anxiety disorder by each initial Wave 1 risk level.

RESULTS

Among Wave 1 very-high-risk drinkers, lower odds of depression and/or anxiety disorders at Wave 2 were predicted by reductions in WHO risk levels of one-, two- or three-levels (aOR = 0.42, 0.37, 0.67, p-values 0.04-<.0001), as was the persistence of depression and/or anxiety disorders among those with such disorders at Wave 1 (aOR = 0.37, 0.29, 0.51, p-values .03-<.0001). Results were less consistent for participants initially drinking at lower risk levels.

CONCLUSIONS

Among very-high-risk drinkers, reductions in the WHO drinking risk categories were associated with lower risk of depression and/or anxiety disorders. These results add to findings indicating reductions in WHO risk levels are a meaningful indicator of how individuals feel and function.

Reduction in Nonabstinent WHO Drinking Risk Levels and Change in Risk for Liver Disease and Positive AUDIT-C Scores: Prospective 3-Year Follow-Up Results in the U.S. General Population

BACKGROUND

Abstinence is often the treatment aim for alcohol use disorders (AUD), but this may deter individuals who prefer drinking reduction goals from entering treatment, and be an overly restrictive end point in alcohol clinical trials. Nonabstinent drinking reductions that predict improvement in how individuals feel or function may be useful clinical trial outcomes, for example, reductions in the 4-category World Health Organization (WHO) drinking risk levels. To investigate the clinical relevance of these reductions, we examined their relationship with 2 outcomes of interest to medical providers: liver disease, and positive scores on an alcohol screening measure.

METHODS

Current drinkers in a U.S. national survey (n = 21,925) were interviewed in 2001 to 2002 (Wave 1) and re-interviewed 3 years later (Wave 2). WHO drinking risk levels, liver disease, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were assessed at both waves. Adjusted odds ratios (aORs) were used to indicate the association of change in WHO drinking risk levels with Wave 2 liver disease and AUDIT-C scores.

RESULTS

Wave 1 very-high-risk drinkers who reduced 1, 2, or 3 WHO drinking risk levels had significantly lower odds of Wave 2 liver disease (aORs = 0.34, 0.23, 0.17) and positive AUDIT-C scores (aORs = 0.27, 0.09, 0.03). Wave 1 high-risk drinkers who reduced 1 or 2 WHO risk levels had significantly lower odds of positive AUDIT-C scores (aORs = 0.61, 0.25). Adjusting for alcohol dependence or AUDIT-C scoring variations did not affect results.

CONCLUSIONS

In the highest-risk drinkers, reductions in WHO drinking risk levels predicted lower likelihood of liver disease and positive AUDIT-C scores. Results add to findings that reductions in the 4-category WHO drinking risk levels are a meaningful indicator of how individuals feel and function, and could serve as nonabstinent end points in clinical trials. Results also connect the WHO risk drinking levels to commonly used alcohol screening questions, which may be more familiar to healthcare providers.

Estimating mental health impacts of alcohol's harms from other drinkers: using propensity scoring methods with national cross-sectional data from the United States

BACKGROUND AND AIMS

Alcohol's harms to others (AHTO) may cause substantial distress, particularly when harms are perpetrated by close others. One challenge to identifying causal impacts is that people harmed by drinkers differ in many ways from those not so harmed, so our aim was to assess mental health in relation to two serious types of AHTO, financial harm and assault by someone who had been drinking, using propensity score (PS) weighting to adjust for potentially confounding differences.

DESIGN

Cross-sectional, nationally representative, random sample of adults.

SETTING

United States.

PARTICIPANTS

Seventy-six respondents reporting financial harm compared with 4625 with no past-year AHTO; 192 respondents reporting assault compared with 4623 with no past-year AHTO.

MEASUREMENTS

Predictors were reported exposure to financial problems due to someone's drinking and assault by someone who had been drinking. Mental health outcomes were quality of life, distress and positive affect. Confounders included family history of alcohol problems, child physical/sexual abuse, substance use/dependence, impacts of recent economic recession, racial/ethnic discrimination, poverty and other demographics.

RESULTS

In double-robust PS weighted models for financial harm, there were associations with reduced quality of life (B = -0.28, P = 0.02) and increased distress [adjusted odds ratio (aOR) = 4.69, P < 0.001], and for assault by a partner or family member, there were associations with increased distress (aOR = 2.23, P = 0.09). For assault by a friend or stranger, none of the associations are statistically significant after PS weighting (all P > 0.10).

CONCLUSIONS

Financial troubles due to someone else's drinking and assaults perpetrated by drinking intimates (spouses, other partners or family members) are associated with reduced mental health.

Harm from Known Others' Drinking by Relationship Proximity to the Harmful Drinker and Gender: A Meta-Analysis Across 10 Countries

BACKGROUND

Drinking is a common activity with friends or at home but is associated with harms within both close and extended relationships. This study investigates associations between having a close proximity relationship with a harmful drinker and likelihood of experiencing harms from known others' drinking for men and women in 10 countries.

METHODS

Data about alcohol's harms to others from national/regional surveys from 10 countries were used. Gender-stratified random-effects meta-analysis compared the likelihood of experiencing each, and at least 1, of 7 types of alcohol-related harm in the last 12 months, between those who identified someone in close proximity to them (a partner, family member, or household member) and those who identified someone from an extended relationship as the most harmful drinker (MHD) in their life in the last 12 months.

RESULTS

Women were most likely to report a close male MHD, while men were most likely to report an extended male MHD. Relatedly, women with a close MHD were more likely than women with an extended MHD to report each type of harm, and 1 or more harms, from others' drinking. For men, having a close MHD was associated with increased odds of reporting some but not all types of harm from others' drinking and was not associated with increased odds of experiencing 1 or more harms.

CONCLUSIONS

The experience of harm attributable to the drinking of others differs by gender. For preventing harm to women, the primary focus should be on heavy or harmful drinkers in close proximity relationships; for preventing harm to men, a broader approach is needed. This and further work investigating the dynamics among gender, victim-perpetrator relationships, alcohol, and harm to others will help to develop interventions to reduce alcohol-related harm to others which are specific to the contexts within which harms occur.

Changes in Marijuana Use Across the 2012 Washington State Recreational Legalization: Is Retrospective Assessment of Use Before Legalization More Accurate?

OBJECTIVE

The purpose of this study was to evaluate changes in marijuana use prevalence and user characteristics across the 2012 recreational legalization in Washington State. Differences in change estimates between retrospective and contemporaneous pre-legalization measures are compared and considered in relation to potential social acceptability and illegality effects on reporting.

METHOD

Four representative surveys of the Washington State population 18 years and older were conducted by telephone, two in 2014 and two in 2015, which are combined by year for analyses (N = 3,451). Respondents reported their current past-year use frequency and retrospective frequency of use in 2012 before the election in which legalization was passed. They also provided demographic information and details of alcohol use, including simultaneous use with marijuana.

RESULTS

A small and not statistically significant increase of 1.2 percentage points in past-year use prevalence, from 24.3% (22.3-26.5) to 25.6% (23.6-27.6), was found when combining the surveys. No statistically significant change was found in the prevalence of simultaneous use with alcohol, which decreased from 12.9% (11.3-14.7) to 12.6% (11.0-14.4). In contrast, estimates from the National Survey on Drug Use and Health (NSDUH) indicate substantially increased prevalence, from 15.5% (13.8-17.3) in 2010-2012 to 19.1% (16.9-21.4) in 2013-2014, although this change is not statistically significant. Other findings of interest from the Washington State surveys include new users after legalization tending to be older, White, and moderate drinkers who do not use marijuana simultaneously with alcohol.

CONCLUSIONS

A retrospective pre-legalization measure showed only a small increase in marijuana use prevalence in contrast to larger changes found in prospectively assessed use in the NSDUH. Changes in the social acceptability and legal status of marijuana after legalization may have increased reporting of pre-legalization use compared with concurrent assessments.

The GENAHTO Project (Gender and Alcohol's Harm to Others): Design and methods for a multinational study of alcohol's harm to persons other than the drinker

AIMS

Most alcohol research has focused on how drinking harms the drinker. Research on alcohol's harms to others (AHTO) has studied primarily single or small groups of countries. This article describes the methodology of a new multinational study - GENAHTO - of how social and cultural contexts are related to AHTO, from the perspectives of both perpetrators and victims.

DESIGN

The GENAHTO Project uses surveys in 21 countries that provide data from drinkers who report causing harms to others, and surveys in 16 countries that provide data from victims of AHTO. The countries surveyed vary widely in alcohol policies, drinking cultures, gender-role definitions, and socioeconomic conditions.

PARTICIPANTS

More than 140,000 men and women, aged 15-84, participated in the surveys.

MEASURES

Individual-level measures include demographics, alcohol use patterns, and alcohol-related harms. Regional- and societal-level measures include socioeconomic conditions, drinking patterns, alcohol policies, gender inequality, and income inequality.

FINDINGS

The project seeks to identify characteristics of AHTO victims and perpetrators; within-country regional differences in AHTO; and associations between national alcohol polices and individual and regional levels of AHTO.

CONCLUSIONS

GENAHTO is the first project to assess AHTO in diverse societies. Its findings can inform policies to abate AHTO in varying cultural contexts.

The Harms That Drinkers Cause: Regional Variations Within Countries

AIMS

Multinational studies of drinking and the harms it may cause typically treat countries as homogeneous. Neglecting variation within countries may lead to inaccurate conclusions about drinking behavior, and particularly about harms drinking causes for people other than the drinkers. This study is the first to examine whether drinkers' self-reported harms to others from drinking vary regionally within multiple countries.

DESIGN SETTING AND PARTICIPANTS

Analyses draw on survey data from 12,356 drinkers in 46 regions (governmental subunits) within 10 countries, collected as part of the GENACIS project (Wilsnack et al., 2009).

MEASURES

Drinkers reported on eight harms they may have caused others in the past 12 months because of their drinking. The likelihood of reporting one or more of these eight harms was evaluated by multilevel modeling (respondents nested within regions nested within countries), estimating random effects of country and region and fixed effects of gender, age, and regional prevalence of drinking.

FINDINGS

Reports of causing one or more drinking-related harms to others differed significantly by gender and age (but not by regional prevalence of drinking), but also differed significantly by regions within countries.

CONCLUSIONS

National and multinational evaluations of adverse effects of drinking on persons other than the drinkers should give more attention to how those effects may vary regionally within countries.

Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

IMPORTANCE

Lack of current and comprehensive trend data derived from a uniform, reliable, and valid source on alcohol use, high-risk drinking, and DSM-IV alcohol use disorder (AUD) represents a major gap in public health information.

OBJECTIVE

To present nationally representative data on changes in the prevalences of 12-month alcohol use, 12-month high-risk drinking, 12-month DSM-IV AUD, 12-month DSM-IV AUD among 12-month alcohol users, and 12-month DSM-IV AUD among 12-month high-risk drinkers between 2001-2002 and 2012-2013.

DESIGN, SETTING, AND PARTICIPANTS

The study data were derived from face-to-face interviews conducted in 2 nationally representative surveys of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions, with data collected from April 2001 to June 2002, and the National Epidemiologic Survey on Alcohol and Related Conditions III, with data collected from April 2012 to June 2013. Data were analyzed in November and December 2016.

MAIN OUTCOMES AND MEASURES

Twelve-month alcohol use, high-risk drinking, and DSM-IV AUD.

RESULTS

The study sample included 43 093 participants in the National Epidemiologic Survey on Alcohol and Related Conditions and 36 309 participants in the National Epidemiologic Survey on Alcohol and Related Conditions III. Between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, and DSM-IV AUD increased by 11.2%, 29.9%, and 49.4%, respectively, with alcohol use increasing from 65.4% (95% CI, 64.3%-66.6%) to 72.7% (95% CI, 71.4%-73.9%), high-risk drinking increasing from 9.7% (95% CI, 9.3%-10.2%) to 12.6% (95% CI, 12.0%-13.2%), and DSM-IV AUD increasing from 8.5% (95% CI, 8.0%-8.9%) to 12.7% (95% CI, 12.1%-13.3%). With few exceptions, increases in alcohol use, high-risk drinking, and DSM-IV AUD between 2001-2002 and 2012-2013 were also statistically significant across sociodemographic subgroups. Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income. Increases were also seen for the total sample and most sociodemographic subgroups for the prevalences of 12-month DSM-IV AUD among 12-month alcohol users from 12.9% (95% CI, 12.3%-17.5%) to 17.5% (95% CI, 16.7%-18.3%) and 12-month DSM-IV AUD among 12-month high-risk drinkers from 46.5% (95% CI, 44.3%-48.7%) to 54.5% (95% CI, 52.7%-56.4%).

CONCLUSIONS AND RELEVANCE

Increases in alcohol use, high-risk drinking, and DSM-IV AUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis. Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role.

Examination of associations between early life victimisation and alcohol's harm from others

INTRODUCTION AND AIMS

Study aims were to examine: (i) how physical and sexual victimisation in early life are associated with alcohol's harm from others; and (ii) whether respondents' current drinking is a mediator of the association between early life victimisation and alcohol's harm from others among men and women.

DESIGN AND METHODS

Data were from national computer-assisted telephone interviews, using the landline sample (3335 men and 3520 women ages ≥18) from the 2010 US National Alcohol Survey. Harms from someone else's drinking included family/marital problems, financial troubles, assault and vandalism in the past 12 months. Victimisation was measured with severe physical abuse or sexual assault before age 18.

RESULTS

Severe physical or sexual victimisation before age 18 was reported by 3.4% of men and 8.1% of women. Significantly more men (5.2%) than women (2.4%) reported assault by other drinkers, and significantly more women reported family/marital (5.3%) and financial problems (2.8%) than did men (2.6 and 1% respectively). Severe early life victimisation was robustly associated with a greater likelihood of experiencing past-year harms from other drinkers for both men and women. Men's drinking partially mediated associations between early life victimisation and recent assaults and vandalism by other drinkers.

DISCUSSION AND CONCLUSIONS

Early life victimisation may increase risk of harms from someone else's drinking. Health services and interventions that screen for histories of victimisation may help decrease risk of later harms from others' drinking. Reductions in drinking among men with histories of victimisation also could help reduce their exposure to such harms. [Kaplan LM, Greenfield TK, Karriker-Jaffe KJ. Examination of associations between early life victimisation and alcohol's harm from others.

Distress and alcohol-related harms from intimates, friends, and strangers

Alcohol's harms to others (AHTO) has gained increased research and policy attention, yet little information is available on different social relationships involved in such harms or consequences of harms perpetrated by various types of drinkers. Using data from the 2014-15 U.S. National Alcohol Survey (N=5,922), we present analyses comparing frequency and impacts of eight past-year harms from other drinkers. In this sample (53% female; 66% White/Caucasian, 13% Black/African American, and 15% other race; 15% Hispanic/Latino of any race; mean age=47 years), 19% reported at least one harm in the prior 12 months, 8% reported more than one harm, 4.9% reported a family perpetrator, 3.5% a spouse perpetrator, 6.1% a friend perpetrator, and 8.1% a stranger perpetrator. Controlling for basic demographics, the number of harms in the past year and harms perpetrated by known others (but not strangers) were significantly associated with recent distress. When comparing specific harms, financial problems due to a family member's or a spouse/partner's drinking each were associated with significantly greater distress, as were feeling threatened or afraid of family members, spouses/partners or friends who had been drinking. These new data shed light on possible intervention points to reduce negative impacts of AHTO in the U.S.