Environmental predictors of drinking and drinking-related problems in young adults

Alcohol use and abuse in young adulthood: do self-control and parents' perceptions of friends during adolescence modify peer influence? The TRAILS study

AIMS

To assess the influence of peer alcohol use during adolescence on young adults' alcohol use and abuse, and to assess to what extent parents' perception of their adolescent child's friends and adolescent's self-control modify this influence.

METHODS

We analyzed data from the first, third, and fourth wave of a population-based prospective cohort study of 2230 adolescents conducted between 2001 and 2010 (mean ages: 11.1, 16.3, and 19.1, respectively). Alcohol use and abuse were measured at T4 by self-report questionnaires and by the Composite International Diagnostics Interview (CIDI), respectively. Peer alcohol use, self-control, and parents' perception of their adolescent child's friends were measured at T3. We adjusted for gender, age, socioeconomic-status, parental alcohol use, and adolescent baseline alcohol use.

RESULTS

Peer alcohol use during adolescence was related to young adults' alcohol use and abuse [odds ratio (95% confidence interval): 1.31 (1.11-1.54) and 1.50 (1.20-1.87), respectively]. Neither parents' perception of their adolescent child's friends nor self-control modified this relationship. Alcohol abusers were more likely to have low self-control than alcohol users. No differences were found between alcohol users and abusers regarding their parents' perception of their friends and peer alcohol use.

CONCLUSIONS

Peer alcohol use during adolescence affects young adults' alcohol use and abuse. We found that self-control was only related to alcohol abuse. Peer influence was not modified by parents' perception of peers or by self-control. Peer alcohol use and self-control should thus be separate targets in the prevention of alcohol use/abuse.

Economic loss and alcohol consumption and problems during the 2008 to 2009 U.S. recession

BACKGROUND

There is some evidence that individual-level job loss can lead to greater alcohol consumption and problems. While other forms of economic loss were common during the recent recession, these are rarely investigated in studies of macroeconomic decline. This study examined the relationship between types of economic loss in the 2008 to 2009 recession and alcohol outcomes, and whether this varied by gender and age.

METHODS

Data are from the 2009 to 2010 U.S. National Alcohol Survey (N = 5,382). We used multivariable regression to estimate associations between economic loss and alcohol volume, monthly drunkenness, negative drinking consequences, and alcohol dependence in the overall sample and within gender and age groups (18 to 29, 30 to 49, 50+), controlling for demographic and alcohol history covariates.

RESULTS

In the overall sample, severe economic loss (job or housing loss) was positively associated with negative drinking consequences, alcohol dependence, and (marginally) drunkenness, whereas moderate loss (loss of retirement savings, reduced work hours/wages, or trouble paying the rent/mortgage) was unassociated with alcohol outcomes. Important gender and age differences were observed. Women reporting retirement loss, reduced hours/wages, and job loss consumed 41 to 70% more alcohol than women unaffected by the recession, and men who experienced job loss and housing problems had increased risk for drunkenness, drinking consequences, and dependence. Middle-aged Americans affected by partial or complete job loss and housing problems also had greater risk of drunkenness and alcohol-related problems, and older adults who lost retirement savings drank 42% more alcohol than their peers unaffected by the recession. With the exception of negative drinking consequences, young adult alcohol outcomes were largely unrelated to recessionary loss.

CONCLUSIONS

This study highlights the adverse effects of recession-induced economic losses on alcohol use and problems in demographic subgroups. As men and middle-aged Americans were at risk for multiple, adverse alcohol outcomes, these groups may warrant special alcohol screening and intervention efforts in future macroeconomic crises.

Drinking settings, alcohol consumption, and sexual risk behavior among gay men

We sought to 1) describe the settings or groups of settings where men who have sex with men (MSM) consume alcohol in 16 U.S. metropolitan statistical areas (MSA); and 2) investigate whether certain drinking settings or groups of settings are associated with higher levels of alcohol consumption, problem drinking, and sexual risk behavior. Latent class analysis was used to develop our measure of drinking settings. The final latent class model consisted of four distinct classes which captured the typical settings where MSM consumed alcohol: "home" "social," "bar/social," and "general" drinkers (i.e., drinks in all settings). Regression models showed that "general" drinkers were more likely than "social" drinkers to engage in frequent heavy drinking. Compared to 'social' drinkers, general drinkers were also more likely to engage in unprotected anal intercourse (UAIMP) and UAIMP with men met in bars and other venues (e.g., private parties, bath houses) while intoxicated. Assessment of drinking settings may be a means of identifying MSM who are at greater risk for frequent, heavy drinking and related sexual risk behavior.

Social support and non-safe use of licit substances by Greek medical students

This study aims to investigate the relationship between social support and non-safe use of nicotine and alcohol among medical students, in relation to other contributing factors. Data were collected during 2002-2003. Participants (N = 135), medical students at the Democritus University of Thrace, Alexandroupolis, Greece, were allocated into groups per sex according to their smoking and alcohol drinking patterns. Comparisons were made with respect to rating scores on measures assessing perceived social support, psychopathological problems, stressful life events, physical health, and satisfaction with life. Data were analyzed using chi-square, Mann-Whitney U test, and factor analysis. Female students' non-safe use of licit substances is positively related to higher scores on perceived social support and lower scores on psychopathological dimensions. Despite some limitations of this study, findings bring about implications on antismoking and antialcoholic campaigns.

Substance Use Disorders and Cluster B Personality Disorders: Physiological, Cognitive, and Environmental Correlates in a College Sample

Substance use disorders (SUDs) and Cluster B personality disorders (PDs) are both marked by impulsivity and poor behavioral control and may result in part from shared neurobiological or executive cognitive functioning deficits. To examine the potential utility of such models in explaining variance in SUDs and PDs at the lower end of symptom expression and impairment, 123 (73 female) volunteer college students were administered 2 measures of executive cognitive functioning; a task assessing autonomic reactivity to aversive noise blasts; a life events and a peer substance use measure; and structured clinical interviews to assess symptoms of substance abuse/dependence and antisocial, borderline, histrionic, and narcissistic PDs. As expected, symptoms of SUDs and PDs were significantly positively correlated. Antisocial PD, alcohol and cannabis use disorder symptoms were significantly positively related to proportion of friends who use alcohol and drugs regularly and drug use among romantic partners. Number of negative life events was positively related to PD symptoms and to alcohol use disorder symptoms. Executive cognitive functioning was not related to SUD and PD symptoms in the expected direction. Findings suggest that, among higher functioning young adults, environmental factors may be particularly relevant to our understanding of SUDs and certain PDs.

Social Pressures to Drink or Drink a Little More: The Nigerian Experience

I investigated the pressures experienced by different individuals to drink, or drink a little more than intended, by someone who drinks or drinks more than they do. 2099 Nigerian adults between the ages of 18 and 65 years were randomly sampled. Logistic regression was used to identify significant individual predictors of receiving pressure by sources of influence. Focus group discussions examined how these pressures are applied in various settings. Results indicated that male friends or acquaintances were the sources respondents reported influenced them the most to drink or drink more. Significant predictors of pressure varied by source but tended to include religion (five of six sources) and gender (three of six). Results showed that pressure to drink or drink a little more was seen to come more from males than from females. It raises the need to have a better knowledge of these factors, particularly as they may relate to heavy or problematic drinking, and their implications for prevention and treatment.

Alcohol environments and disparities in exposure associated with adolescent drinking in California

OBJECTIVES

We investigated sociodemographic disparities in alcohol environments and their relationship with adolescent drinking.

METHODS

We geocoded and mapped alcohol license data with ArcMap to construct circular buffers centered at 14 595 households with children that participated in the California Health Interview Survey. We calculated commercial sources of alcohol in each buffer. Multivariate logistic regression differentiated the effects of alcohol sales on adolescents' drinking from their individual, family, and neighborhood characteristics.

RESULTS

Alcohol availability, measured by mean and median number of licenses, was significantly higher around residences of minority and lower-income families. Binge drinking and driving after drinking among adolescents aged 12 to 17 years were significantly associated with the presence of alcohol retailers within 0.5 miles of home. Simulation of changes in the alcohol environment showed that if alcohol sales were reduced from the mean number of alcohol outlets around the lowest-income quartile of households to that of the highest quartile, prevalence of binge drinking would fall from 6.4% to 5.6% and driving after drinking from 7.9% to 5.9%.

CONCLUSIONS

Alcohol outlets are concentrated in disadvantaged neighborhoods and can contribute to adolescent drinking. To reduce underage drinking, environmental interventions need to curb opportunities for youth to obtain alcohol from commercial sources by tightening licensure, enforcing minimum-age drinking laws, or other measures.

Individual and community correlates of young people's high-risk drinking in Victoria, Australia

OBJECTIVES

To examine key individual- and community-level correlates of regular very high-risk drinking (more than 20 drinks at least 12 times a year for males and more than 11 drinks at least 12 times a year for females) among young (16-24) drinkers in Victoria.

METHODS

CATI survey of 10,879 young Victorian drinkers. Multi-level modelling of correlates of proportion drinking at very high-risk levels at both individual (e.g. age, gender) and community levels (e.g. alcohol outlet density, remoteness).

RESULTS

One-fifth of the sample reported regular (at least monthly) very high-risk drinking. Significant individual-level correlates of very high-risk drinking included age, gender, cultural background, recreational spending money, life stage, living situation, family conflict and age at first drink. Significant community-level correlates included remoteness (living in a rural area) and packaged liquor outlet density.

CONCLUSIONS

The study highlights a range of important factors relating to regular drinking of dangerous amounts of alcohol by youth. Interventions aimed at preventing early initiation or managing recreational spending should be explored. Further, regulatory management of packaged liquor outlets and or remote rural communities in Victoria with high levels of dangerous drinking should be a priority.

Childhood and current determinants of heavy drinking in early adulthood

AIMS

To explore the association of parental education, childhood living conditions and several adversities with heavy drinking in early adulthood, and to analyze the effect of the respondent's current circumstances on these associations.

METHOD

The analyses were conducted in a sample of 1234 adults aged 18-29 years participating in the Finnish Health 2000 Survey (65% of the original representative two-stage cluster sample, N = 1894). The outcome measure was heavy drinking measured by g/week for pure alcohol (for men >or=280 g/week and for women >or=140 g/week).

RESULTS

8% of young adult men and 5% of women were heavy drinkers. In both genders, parental alcohol problems and other childhood adversities, poor own education, and unemployment status increased the risk of heavy drinking. The impact of childhood on heavy drinking was partly independent and partly mediated by adult characteristics, in particular, for both genders, low level of education.

CONCLUSIONS

Childhood adversities are associated with heavy drinking in early adulthood among both genders. Childhood social circumstances as well as low educational level and unemployment should be taken into account in planning preventive policies to tackle the harms caused by excessive alcohol use at the individual and population level.

Alcohol use and partner expectations among newly married couples

The objective of this work was to determine if a spouse's expectations about a married person's drinking patterns affected his/her partner's alcohol use and alcohol use-related problems. Alcohol use and problems were assessed in a U.S. urban sample of 634 couples at the time they applied for their marriage license (1996-1999) and at their first and second anniversaries. Husbands' expectations about married women's alcohol use, as well as wives' expectations about married men's alcohol use, were assessed at each wave using a three-item scale. Linear regression models were used to identify the longitudinal association between a person's expectations of married individuals' drinking patterns and his/her spouse's alcohol use the following year. Evidence was found to support the relation between one spouse's expectations and his/her partner's alcohol use. However, wives' expectations appeared more influential compared to husbands and this influence is not present at the start of marriage, but rather develops slightly later. The study's limitations are noted.

Adolescent alcohol and cannabis use in relation to peer and school factors. Results of multilevel analyses

The present study used a multilevel approach with multiple informants to determine whether, at individual level, association with substance-using peer groups, and, at class level, incidences of intoxicated students in school premises, are related to students' own substance use. Additionally, it tested the hypothesis that such school incidences affect the closeness of the relation between association with substance-using peers and students' own substance use. Multilevel regression models were estimated separately for drunkenness and cannabis use on the basis of cross-sectional data from 3,925 students of eighth and ninth grades in Switzerland (mean age 15.3, S.D. 0.9) and their teachers (N=220). For both drunkenness and cannabis use, the results confirmed that association with substance-using peers is strongly related to individual substance-use. A higher level of students' own cannabis use and a closer relation between association with cannabis-using peers and the students' own cannabis use were found in classes where students saw others coming cannabis-intoxicated to school or taking cannabis in school premises. Such relations were not found for alcohol. It appears that cannabis use at school or shortly before arriving at school creates an atmosphere that favors cannabis use whether or not students are associated with cannabis-using peers. Establishing an overarching environment of disapproval appears to be an effective means of preventing cannabis use by adolescents.

Drinking locations prior to impaired driving among college students: implications for prevention

Drinking and driving is perhaps the most serious problem associated with heavy drinking among college students in the United States. In this study, the authors examined drinking locations prior to impaired driving in a college student sample. They administered the Impaired Driving Assessment to 91 college students identified as high risk for drinking and driving. Participants reported an average of 7.98 (SD = 7.67) impaired driving episodes during the past 5 weeks. Using a random effects model, the authors found that location was a significant predictor of blood alcohol content (BAC), F(6,89.6) = 3.62, p = 0.0029. After drinking alcohol at a party, students' average estimated BAC prior to driving (geometric M = 0.089) was significantly greater than all other drinking locations (geometric M = 0.033). The findings of this study provide insight into drinking locations prior to impaired driving and can be used by college health practitioners to develop appropriate interventions to reduce the magnitude of this problem.

The marketing of alcohol to college students: the role of low prices and special promotions

BACKGROUND

Heavy episodic or binge drinking has been recognized as a major problem on American college campuses affecting the health, safety, and education of students. The present study examines the alcohol environment surrounding college campuses and assesses the impact on students' drinking. This environment includes alcohol promotions, price specials, and advertising at drinking establishments that serve beer for on-premise consumption as well as retail outlets that sell beer for off-premise consumption.

METHODS

The study used student self-report data from the 2001 College Alcohol Study (CAS) and direct observational assessments by trained observers who visited alcohol establishments in communities where the participating colleges were located. The analytic sample included more than 10,000 students as well as 830 on-premise and 1684 off-premise establishments at 118 colleges.

RESULTS

Alcohol specials, promotions, and advertisements were prevalent in the alcohol outlets around college campuses. Almost three quarters of on-premise establishments offered specials on weekends, and almost one half of the on-premise establishments and more than 60% of off-premise establishments provided at least one type of beer promotion. The availability of large volumes of alcohol (24- and 30-can cases of beer, kegs, party balls), low sale prices, and frequent promotions and advertisements at both on- and off-premise establishments were associated with higher binge drinking rates on the college campuses. In addition, an overall measure of on- and off-premise establishments was positively associated with the total number of drinks consumed.

CONCLUSIONS

The regulation of marketing practices such as sale prices, promotions, and advertisements may be important strategies to reduce binge drinking and its accompanying problems.

Why do they do it? A qualitative study of adolescent drinking and driving

Despite a decline in the prevalence of fatal traffic crashes involving adolescent drinking drivers in recent years, underage drinking and driving (DD) and riding with drinking drivers (RWDD) remain serious problems. This article reports the findings of a qualitative study investigating the influence of beliefs and expectancies on adolescents' decisions to participate in DD or RWDD. Forty-four adolescents, who in a previous survey admitted to having been involved in either DD or RWDD, were interviewed in 2000 about their experiences concerning either driving after drinking or getting into a car with a driver who had been drinking. Findings indicate that adolescent DD and RWDD are complex behaviors. Expectancies and control beliefs do not seem to influence the decision, whereas normative beliefs to some extent do. However, findings also indicate that increased enforcement of the laws may be helpful in preventing young people from getting involved in drinking and driving.

Binge-drinking-related consequences in college students: role of drinking beliefs and mother-teen communications

The present research contrasted theoretical models depicting the nature of the relation among drinking beliefs, drinking tendencies, and behavioral consequences in 266 incoming freshman college students. It also examined the theoretical relations between mother-teen communications and drinking beliefs relevant to behavioral consequences. The findings revealed direct relations between binge-drinking consequences and the drinking beliefs: Alcohol can make positive transformations, can enhance social behavior, and can increase negative affect and normative approval. Direct relations were not observed between consequences and the drinking beliefs regarding physical risk and health orientation. Finally, the present research found consistent support for the relation between mother-teen communications and drinking beliefs relevant to binge-drinking consequences.

Personality, Environment, and Problem Drug Use

We tested a theoretical model that posited direct and Interactive relationships between personality and environment as predictive of problem drug use. Hierarchical regression analyses were performed on data from a nonclinical sample of males and females first tested in adolescence and followed into young adulthood. In main effects analyses, cross-sectional models for marijuana and a composite of “harder” drugs strongly supported our theoretical perspective: several environmental and personality variables significantly predicted concurrent problem use. Longitudinal analyses produced mixed results, with either smaller numbers of significant personality/environment predictors or personality predictors dropping out completely. Peer drug use and depression best predicted problem “hard” drug use, while motivations to use with others and disinhibition best predicted problem marijuana use. Personality/peer group interactions were significant both cross-sectionally and longitudinally, indicating that membership in a problem-using social network enhanced the predictive ability of, or helped bring to fruition, several personality predisposers.

A structural model of health behavior: a pragmatic approach to explain and influence health behaviors at the population level

BACKGROUND

Behavior is influenced by individual-level attributes as well as by the conditions under which people live. Altering policies, practices, and the conditions of life can directly and indirectly influence individual behavior. This paper builds on existing ecological theories of health behavior by specifying structural mechanisms by which population-level factors effect change in individual health behaviors.

METHODS

This paper moves ecological theory from model building to a pragmatic characterization of structural interventions. We examined social and environmental factors beyond individual control and mechanisms as to how they influence behavior.

RESULTS

Four categories of structural factors are identified: (1) availability of protective or harmful consumer products, (2) physical structures (or physical characteristics of products), (3) social structures and policies, and (4) media and cultural messages. The first three can directly influence individuals through facilitating or constraining behavior. The fourth, media, operates by changing individual-level attitudes, beliefs, and cognitions, as well as group norms.

CONCLUSION

Interventions that target the four identified structural factors are a means to provide conditions that not only reduce high-risk behavior but also prevent the adoption of high-risk behaviors. Structural interventions are important and underutilized approaches for improving our nation's health.

Relationships among alcohol availability, drinking location, alcohol consumption, and drinking problems in adolescents

We examined relationships among perceived alcohol availability, drinking location, alcohol consumption, and drinking problems. Subjects were 3,372 adolescent drinkers, ages 16-18, who participated in the Communities Mobilizing for Change on Alcohol Project baseline survey. Mixed-model regression was employed to identify predictors of alcohol consumption and drinking consequences. Perceived alcohol availability was significantly associated with higher levels of alcohol consumption for males. Drinking in a public location with higher levels of alcohol consumption for females. Results underscore the importance of youth alcohol assessibility.