Alcohol use patterns and risk of diabetes onset in the 1979 National Longitudinal Survey of Youth Cohort

One of the major limitations in studying alcohol's effect on risk for diabetes is the issue of classifying drinking patterns across the life course prior to the onset of diabetes. Furthermore, this research often overlooks important life course risk factors such as obesity and early-life health problems that may complicate estimation of the relationship between alcohol and diabetes. This study used data from the US National Longitudinal Survey of Youth 1979 cohort of 14-21 year olds followed through 2012 (n = 8289). Alcohol use was captured through time-varying measures of past month volume and frequency of days with 6+ drinks. Discrete-time survival models controlling for demographics, early-life characteristics and time-varying risk factors of employment, smoking, and body mass index (BMI) group, stratified by sex and race/ethnicity, were estimated. Increased odds of diabetes onset was found among lifetime abstainers for women compared to the low volume reference group (odds ratio (OR) 1.57; 95% Confidence Interval (CI) 1.07-2.3). Increased odds of diabetes onset was also found among women who reported drinking 6+ drinks in a day on a weekly basis during the prior 10 years (OR 1.55; CI 1.04-2.31). Models interacting alcohol and BMI groups found increased odds of diabetes onset from lifetime abstention among overweight women only (OR 3.06; CI 1.67-5.60). This study confirms previous findings of protective effects from low volume drinking compared to lifetime abstention and harmful effects from regular heavy occasion drinking for women. Further, protective effects in this US sample were found to be limited to overweight women only.

Trends and age, period and cohort effects for marijuana use prevalence in the 1984-2015 US National Alcohol Surveys

BACKGROUND AND AIMS

Epidemiological trends show marijuana use in the United States to have increased in recent years. Previous research has identified cohort effects as contributing to the rising prevalence, in particular birth cohorts born after 1945. However, given recent policy efforts to regulate marijuana use at the state level, period effects could also play a contributory role. This study aimed to examine whether cohort or period effects play a larger role in explaining trends in marijuana use.

DESIGN

Using data from seven National Alcohol Surveys, we estimated age-period-cohort decomposition models for marijuana use, controlling for socio-demographic measures.

SETTING

United States.

PARTICIPANTS

US general population aged 18 and older from 1984 to 2015.

MEASUREMENTS

Any past-year marijuana use.

FINDINGS

Results indicated that period effects were the main driver of rising marijuana use prevalence. Models including indicators of medical and recreational marijuana policies did not find any significant positive impacts.

CONCLUSIONS

The steep rise in marijuana use in the United States since 2005 occurred across the population and is attributable to general period effects not linked specifically to the liberalization of marijuana policies in some states.

Risk of Past Year Injury Related to Hours of Exposure to an Elevated Blood Alcohol Concentration and Average Monthly Alcohol Volume: Data from 4 National Alcohol Surveys (2000 to 2015)

BACKGROUND

While a strong association exists between alcohol and injury in emergency department (ED) studies, these studies are not representative of the general population.

METHODS

The association of injury with the number of hours of exposure to a blood alcohol concentration (BAC) ≥ 0.05 and average monthly volume in drinks, both based on self-report of quantity and frequency of drinking in the last year, in a merged sample of respondents (n = 29,571) from 4 U.S. National Alcohol Surveys (2000 to 2015) are analyzed. Risk curves based on categorical step function and fractional polynomial modeling were analyzed separately by gender, and by age and race/ethnicity for males.

RESULTS

Risk of injury increased at 1 hour of a BAC exposure of ≥ 0.05 and at an average monthly volume of 1 drink. Risk of injury for spirits increased to an average daily volume of 1 drink, but no association was found for injury risk and average volume for either wine or beer. Risk of injury increased with both exposure hours and monthly volume among males, but little association was found for either consumption measure with risk of injury for females. Among males, increased risk of injury was greater for whites than for blacks or Hispanics for BAC exposure; Hispanics showed a continued elevated risk up to 8 hours of exposure. After peaking at a monthly volume of 1 drink, injury risk decreased substantially for blacks, but was more gradual for whites, while risk increased very slightly for Hispanics to about 4 drinks per day. Males aged 18 to 29 showed the largest increase in risk associated with the number of hours of exposure to a BAC of ≥0.05, with risk doubling at 1 hour of exposure, but subsequently falling.

CONCLUSIONS

While findings here are weaker than those from ED studies and likely due to the context of drinking, risk of injury appears to increase at relatively low levels of consumption, suggesting the importance of preventive efforts to reduce injury not only for heavier drinkers but also for more moderate drinkers.

Opinions on the Privatization of Distilled-Spirits Sales in Washington State: Did Voters Change Their Minds?

OBJECTIVE

In November 2011, voters in Washington State approved Initiative 1183 (I-1183), which ended the government monopoly on distilled-spirits sales. The current study examined the relationship between demographics, spirits use, and voting outcomes, as well as how these variables related to wanting to change one's vote.

METHOD

The sample consisted of 1,202 adults recruited through random-digit-dial methods and reached via telephone between January and April 2014. Bivariate tests and multivariable regressions were used for statistical analyses.

RESULTS

Most notably, those who voted Yes on I-1183 had almost eight times the odds of wanting to change their votes compared with those who voted No. Older age, higher education, and being a spirits buyer/drinker were significantly associated with voting (vs. not voting). Among nonvoters, a larger proportion of those who reported that I-1183 was a success (vs. not) were spirits drinkers/nonbuyers. Those who reported that I-1183 was not a success were more likely to report that the number of liquor stores should be decreased. Opinions on taxes were not related to wanting to change one's vote or thinking that I-1183 had been a success.

CONCLUSIONS

The result of the I-1183 election likely would have been different if voters could know their future opinions of the actual situation resulting from privatization. This finding is particularly important for states considering privatization. Results also indicate that spirits drinkers/buyers may be more invested in privatization than nonbuyers and that the increased availability of spirits may affect opinions regarding privatization.

Support for marijuana legalization in the US state of Washington has continued to increase through 2016

BACKGROUND

Support for the legalization of recreational marijuana continues to increase across the United States and globally. In 2016, recreational marijuana was legalized in the most populous US state of California, as well as three other states. The primary aim of this study was to examine trends in support for recreational marijuana legalization in Washington, a state which has had legal recreational marijuana for almost four years, using data collected over the four years post-legalization. A secondary aim was to examine trends in support for the cultivation of marijuana for personal use.

METHODS

Data come from geographically representative general population samples of adult (aged 18 and over) Washington residents collected over five timepoints (every six months) between January 2014 and April 2016 (N=4101). Random Digit Dial was used for recruitment. Statistical analyses involved bivariate comparisons of proportions across timepoints and subgroups (defined by age, gender, and marijuana user status), and multivariable logistic regression controlling for timepoint (time) to formally test for trend while controlling for demographic and substance use covariates. All analyses adjusted for probability of selection.

RESULTS

Support for legalization in Washington has significantly increased: support was 64.0% (95% CI: 61.2%-67.8%) at timepoint 1 and 77.9% (95% CI: 73.2%-81.9%) at timepoint 5. With each six months' passing, support increased 19% on average. We found no statistically significant change in support for home-growing.

CONCLUSIONS

Support for marijuana legalization has continued to significantly increase in a state that has experienced the policy change for almost four years.

Economic Recession, Alcohol, and Suicide Rates: Comparative Effects of Poverty, Foreclosure, and Job Loss

INTRODUCTION

Suicide rates and the proportion of alcohol-involved suicides rose during the 2008-2009 recession. Associations between county-level poverty, foreclosures, and unemployment and suicide rates and proportion of alcohol-involved suicides were investigated.

METHODS

In 2015, National Violent Death Reporting System data from 16 states in 2005-2011 were utilized to calculate suicide rates and a measure of alcohol involvement in suicides at the county level. Panel models with year and state fixed effects included county-level measures of unemployment, foreclosure, and poverty rates.

RESULTS

Poverty rates were strongly associated with suicide rates for both genders and all age groups, were positively associated with alcohol involvement in suicides for men aged 45-64 years, and negatively associated for men aged 20-44 years. Foreclosure rates were negatively associated with suicide rates for women and those aged ≥65 years but positively related for those aged 45-64 years. Unemployment rate effects on suicide rates were mediated by poverty rates in all groups.

CONCLUSIONS

Population risk of suicide was most clearly associated with county-level poverty rates, indicating that programs addressing area poverty should be targeted for reducing suicide risk. Poverty rates were also associated with increased alcohol involvement for men aged 45-64 years, indicating a role for alcohol in suicide for this working-aged group. However, negative associations between economic indicators and alcohol involvement were found for four groups, suggesting that non-economic factors or more general economic effects not captured by these indicators may have played a larger role in alcohol-related suicide increases.

Changes in heavy drinking following onset of health problems in a U.S. general population sample

Heavy episodic drinking is a well-established risk factor for heart disease, diabetes, certain cancers, stroke, hypertension and injuries, however, little is known about whether health problems precipitate changes in subsequent drinking patterns. Retrospective cohort analyses of heavy drinking by decade were conducted using data from the 2010 U.S. National Alcohol Survey (n=5240). Generalized estimating equations models were used to predict any, monthly, and weekly heavy (5+) drinking occasions across decades of life following a diagnosis of hypertension, heart problems, diabetes, stroke, cancer, or serious injury. Experiencing heart problems was associated with higher odds of reduced weekly heavy drinking (adjusted odds ratio (ORadj)=3.5; 95% confidence interval (CI); 1.7-7.4). The onset of diabetes was also associated with higher odds of reducing any heavy drinking over the decade (ORadj=1.7; 95% CI; 1.1-2.6). Cancer survivors were less likely to report no heavy drinking (ORadj=0.5; 95% CI; 0.3-0.8) or no weekly heavy drinking (ORadj=0.3; 95% CI; 0.2-0.7). Hypertension, stroke and injury were not found to have any significant associations. Reduced heavy drinking was more likely to be reported by Black drinkers following heart problems and Whites following a diabetes diagnosis. Increased heavy drinking following a cancer diagnosis was significant among women and Whites. Future studies on alcohol's heath and mortality risks should take into consideration effects of health problems on drinking patterns. Additionally, study results support increased prevention efforts targeting heavy drinking among cancer survivors, especially White women, and individuals with or being treated for hypertension.

Health Risk Factors Associated with Lifetime Abstinence from Alcohol in the 1979 National Longitudinal Survey of Youth Cohort

BACKGROUND

The choice and definition of a comparison group in alcohol-related health studies remains a prominent issue in alcohol epidemiology due to potential biases in the risk estimates. The most commonly used comparison group has been current abstainers; however, this includes former drinkers who may have quit drinking due to health problems. Lifetime abstention could be the best option, but measurement issues, selection biases due to health and other risk factors, and small numbers in populations are important concerns. This study examines characteristics of lifetime abstention and occasional drinking that are relevant for alcohol-related health studies.

METHODS

This study used data from the National Longitudinal Survey of Youth 1979 cohort of 14 to 21 year olds followed through 2012 (n = 7,515). Definitions of abstinence and occasional drinking were constructed based on multiple measurements. Descriptive analyses were used to compare the definitions, and in further analysis, lifetime abstainers (n = 718) and lifetime minimal drinkers (n = 1,027) were compared with drinkers across demographics and early-life characteristics (i.e., religion, poverty, parental education, and family alcohol problems) in logistic regression models.

RESULTS

Using a strict measurement of zero drinks from adolescence to the 50s, only 1.7% of the sample was defined as lifetime abstainer compared to a broader definition allowing a total of 1 drink over the lifetime that included 9.5% and to lifetime minimal drinking (a total of 3 drinks or less a month), which accounted for 13.7%. Factors significantly associated with lifetime abstention and lifetime minimal drinking included religion, poverty, having no family alcohol problems, Hispanic ethnicity, foreign-born, and female gender. Importantly, work-related health limitations in early life were significantly associated, but not childhood physical and mental health problems.

CONCLUSIONS

Alcohol-related health studies should utilize lifetime classifications of drinkers and abstainers, and, in doing so, should account for early-life socioeconomic adversity and childhood health factors or consider these as unmeasured confounders.

Estimated increase in cross-border purchases by Washington residents following liquor privatization and implications for alcohol consumption trends

AIMS

To estimate changes in liquor sales occurring in Washington, USA and bordering states following the privatization of government controlled liquor stores.

DESIGN

Trend analyses of data from January 2009 to October 2014 of a natural experiment beginning 1 June 2012, when liquor prices increased and the number of stores selling liquor increased in the state of Washington. Difference-in-differences (DID) models and interrupted time-series methods were used.

SETTING

Washington and bordering counties in Oregon and Idaho.

MEASUREMENTS

Monthly liquor sales in 9-l cases.

FINDINGS

DID model estimates of adjusted change in liquor sales as a result of privatization produced a cross-model average increase of 10.1% in Oregon and 8.2% in Idaho (both P < 0.001). Similar results were found using interrupted time-series. This represents a total loss to Washington of 89 865 l of liquor, 0.226% of total Washington sales, for June 2012 to May 2013. Adding these sales to Washington totals for fiscal years 2013 and 2014, we find that per-capita spirits sales were 5.80 l in both 2012 and 2013, declining slightly to 5.76 l in 2014.

CONCLUSIONS

The privatization of liquor sales in the state of Washington, USA in 2012 and the price increases associated with this resulted in a significant increase in sales in bordering counties in the states of Oregon and Idaho. However, the amount of alcohol sales and revenue lost by Washington was relatively small. Per-capita liquor sales in Washington appear to have remained flat after privatization.

Marijuana policy opinions in Washington state since legalization: Would voters vote the same way?

BACKGROUND

In 2012, voters in Washington state approved Initiative 502 (I-502) which legalized recreational marijuana use at the state level. This study examines the relationship between demographics, marijuana and alcohol use, and voting outcomes, as well as how these variables relate to (i) whether voters would still vote the same way (a reflection of satisfaction with the new policy) and (ii) the likelihood of using marijuana purchased from legal retail stores.

METHODS

The sample consists of 2,007 adult Washington state residents recruited through Random Digit Dial between January and October 2014. Bivariate tests and multivariable regressions were used for analyses.

RESULTS

Less than five percent of those who voted for marijuana legalization would change their votes, whereas 14% of those who voted against legalization would change their votes. In multivariable models controlling for demographics, substance use, and marijuana-related opinions, those who voted for legalization had half the odds of changing their votes than those who voted against it. Among past-year non-marijuana users, almost 10% were somewhat/very likely to use marijuana if they could buy it from a legal store. Past marijuana use, the belief that adults should be allowed to grow marijuana for personal use, and the belief that marijuana is not very risky for health were all related to increased likelihood of using marijuana purchased from legal stores.

CONCLUSION

Since November 2012, support for marijuana legalization in Washington state has increased; accounting for the proportion of voters who would change their votes suggests that I-502 would pass today with even more votes in favor.

Early Life Health, Trauma and Social Determinants of Lifetime Abstention from Alcohol

AIMS

Factors influencing lifetime abstention from alcohol may be relevant to the validity of analyses of alcohol's impact on health outcomes. We evaluate relationships between early life experiences, social factors, and demographic characteristics on lifetime abstainer status in models disaggregating by gender and, among women, race/ethnicity.

METHODS

Analyses use the landline sample (N = 5382) of the 2010 U.S. National Alcohol Survey. Surveyed participants who reported never drinking alcohol were defined as lifetime abstainers. Additional variables assessed included demographics, dispositions to risk taking and impulsivity, and indicators of early life stress like economic difficulty, childhood trauma and early onset of health conditions. Logistic regression models predicting lifetime abstention were estimated.

RESULTS

Lifetime abstainers are more likely to be women and, among women, to be non-White and Latina. Those reporting that their religion discouraged drinking and that religion was very important to them were more likely to be lifetime abstainers. Higher education levels were associated with reduced rates of lifetime abstention among women. Also among women, family problem drinking was associated with lower rates of lifetime abstention. However, childhood economic difficulty significantly predicted lower abstention only for White women, and childhood sexual abuse was significantly related to lower lifetime abstention only for Black women.

CONCLUSIONS

Understanding the characteristics and determinants of individuals who never drink alcohol is relevant to any analysis of alcohol-related health outcomes. Results point to specific factors related to lifetime abstention with potential to bias such analyses if not included as control measures.

SHORT SUMMARY

Analyses evaluating relationships between early life experiences, social factors, and demographics with lifetime abstainer status identified characteristics associated with both poor health and with better health. These included lower risk taking and impulsivity scores and lower rates of family problem drinking, childhood economic difficulties and childhood sexual abuse.

US Time Series Evidence regarding Alcohol-Related Risk of Oral Cancers and Protection against Stomach Cancers: Are Higher Concentration Beverages Different?

Autoregressive integrated moving average modeling procedures are utilized on population-level mortality rates for oral and stomach cancers in relation to per capita consumption of total alcohol, beer, wine, spirits and cigarettes to estimate long-term population-level relationships between alcohol consumption series and oral and stomach cancer mortality rates, and to determine whether higher-concentration alcoholic beverages, as represented by spirits, are more strongly related to these cancers than beer or wine.

Total alcohol consumption is found to increase oral cancer rates by 3.5% per litre of ethanol. Spirits consumption is found to be the only significant predictor in multivariate models. For stomach cancers, total alcohol and especially spirits are found to be protective, with each litre of spirits associated with a 10% reduction in rates. High-concentration beverages, as represented by spirits, are found to be significant risk factors for oral cancers but potentially protective for stomach cancer.

Heavy Alcohol Use Among Suicide Decedents Relative to a Nonsuicide Comparison Group: Gender-Specific Effects of Economic Contraction

BACKGROUND

The primary objective of this gender-stratified study was to assess the rate of heavy alcohol use among suicide decedents relative to a nonsuicide comparison group during the 2008 to 2009 economic crisis.

METHODS

The National Violent Death Reporting System and the Behavioral Risk Factor Surveillance System were analyzed by gender-stratified multiple logistic regression to test whether change in acute intoxication (blood alcohol content ≥0.08 g/dl) before (2005 to 2007), during (2008 to 2009), and after (2010 to 2011) the Great Recession mirrored change in heavy alcohol use in a living sample.

RESULTS

Among men, suicide decedents experienced a significantly greater increase (+8%) in heavy alcohol use at the onset of the recession (adjusted ratio of odds ratio = 1.15, 95% confidence interval = 1.10 to 1.20) (relative to the prerecession period) than did men in a nonsuicide comparison group (-2%). Among women, changes in rates of heavy alcohol use were similar in the suicide and nonsuicide comparison groups at the onset and after the recession.

CONCLUSIONS

Acute alcohol use contributed to suicide among men during the recent economic downturn. Among women who died by suicide, acute alcohol use mirrored consumption in the general population. Women may show resilience (or men, vulnerability) to deleterious interaction of alcohol with financial distress.

Simultaneous versus concurrent use of alcohol and cannabis in the National Alcohol Survey

BACKGROUND

Cannabis is the most commonly used drug among those who drink, yet no study has directly compared those who use cannabis and alcohol simultaneously versus concurrently (i.e., separately) in the adult general population. Here, we assess differences in demographics, alcohol-related social consequences, harms to self, and drunk driving across simultaneous, concurrent, and alcohol-only using groups.

METHODS

Secondary analyses of the 2005 and 2010 National Alcohol Survey (N = 8,626; 4,522 female, 4,104 male), a Computer Assisted Telephone Interview survey of individuals aged 18 and older from all 50 states and DC. Blacks and Hispanics are over-sampled. Data were collected using list-assisted Random Digit Dialing. Multinomial and multivariable logistic regressions were used for analyses.

RESULTS

The prevalence of simultaneous use was almost twice as high as concurrent use, implying that individuals who use both cannabis and alcohol tend to use them at the same time. Furthermore, simultaneous use was associated with increased frequency and quantity of alcohol use. Simultaneous use was also the most detrimental: compared to alcohol only, simultaneous use approximately doubled the odds of drunk driving, social consequences, and harms to self. The magnitudes of differences in problems remained when comparing drunk driving among simultaneous users to concurrent users.

CONCLUSIONS

The overall set of results is particularly important to bear in mind when studying and/or treating problems among alcohol/cannabis co-users because they demonstrate that in the general population, co-users are a heterogeneous group who experience different likelihoods of problems relative to co-use patterns.

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

Various harms from others' drinking have been studied individually and at single points in time. We conducted a US population 15-year trend analysis and extend prior research by studying associations of depression with combinations of four harms - family/marriage difficulties, financial troubles, assault, and vandalism - attributed to partners or family members. Data come from four National Alcohol Surveys conducted by telephone in 2000, 2005, 2010, and 2015 (analytic sample = 21,184). Weighted logistic regression models estimated time trends adjusting for victim characteristics (gender, age, race/ethnicity, marital status, poverty, employment, family history of alcohol problems, and drinking maximum). The 2015 survey asked the source of the harm; we used similar models to examine characteristics, including anxiety and depression, associated with various combinations of family/marriage, financial, and assault harms due to partner's/spouse's/family members' drinking. A significant upward trend (P <0.001) from 2000 to 2015 was seen for financial troubles but not for other harms due to someone else's drinking. In 2015, depression and/or anxiety were strongly associated with exposures to harms and combinations of harms identified as stemming from drinking spouse/partner and/or family members. The results shed new light on 15-year trends and associations of harms with personal characteristics. A replicated finding is how the victim's own heavy drinking pattern is implicated in risks for exposures to harms from someone else's drinking. Documenting risk factors for and mental health impacts is important for interventions to reduce alcohol's harm to others.

Those harmed by others' drinking in the US population are more depressed and distressed

INTRODUCTION AND AIMS

Harms from second-hand smoke were instrumental in enacting tobacco controls. Documenting negative impacts of harms from others' drinking (also called second-hand effects of drinking) is vital to increase political will for optimal alcohol policies. We assessed associations between harms from others' drinking and depression in a national sample of US adults.

DESIGN AND METHODS

Using the landline sample from the 2010 National Alcohol Survey (n = 5388), weighted logistic regression models adjusting for alcohol problems in family of origin, respondent drinking pattern (volume and heaviest drinking), poverty and other demographics were used to analyse associations between experiencing harms from others' drinking in the last 12 months with mild to moderate depression (8-item Center for Epidemiologic Studies Depression scale; alpha = 0.92; using cut point ≥8) and current distress.

RESULTS

Past 12 month family/marital harms, financial troubles, assaults, and vandalised property attributed to others' drinking were each associated with higher depression scores (all P < 0.001). In a combined model, all harms other than assaults remained highly significant. Similar patterns were found for current distress, but with some specific differences because of measurement and analytic approaches chosen also evident.

DISCUSSION

Findings suggest recently experiencing particular harms from others' drinking significantly affects mental health (both depression and distress). This confirms in a US population results recently reported in Australasian samples.

CONCLUSIONS

Studies that quantify the extent to which heavy drinkers victimise others are important for alcohol policy. [Greenfield TK, Karriker-Jaffe KJ, Kerr WC, Ye Y, Kaplan LM. Those harmed by others' drinking in the US population are more depressed and distressed. Drug Alcohol Rev 2015;●●:●●-●●].

Analysis of Price Changes in Washington Following the 2012 Liquor Privatization

AIMS

In June, 2012 the state of Washington ended a wholesale and retail monopoly on liquor sales resulting in about five times as many stores selling liquor. Three-tier restrictions were also removed on liquor, while beer and wine availability did not increase. Substantial taxes at both the wholesale and retail levels were implemented and it was expected that prices would rise.

METHODS

To evaluate price changes after privatization we developed an index of about 68 brands that were popular in Washington during early 2012. Data on final liquor prices (including all taxes) in Washington were obtained through store visits and on-line sources between November 2013 and March of 2014. Primary analyses were conducted on five or six brand indexes to allow the inclusion of most stores.

RESULTS

Washington liquor prices rose by an average of 15.5% for the 750 ml size and by 4.7% for the 1.75 l size, while only small changes were seen in the bordering states of Oregon and Idaho. Prices were found to vary greatly by store type. Liquor Superstores had generally the lowest prices while drugstore, grocery and especially smaller Liquor Store prices were found to be substantially higher.

CONCLUSION

Our findings indicate that liquor prices in Washington increased substantially after privatization and as compared to price changes in bordering states, with a much larger increase seen for the 750 ml size and with wide variation across store types. However, persistent drinkers looking for low prices will be able to find them in certain stores.

U.S. trends in light, moderate, and heavy drinking episodes from 2000 to 2010

BACKGROUND

Risks and potential benefits associated with alcohol use vary with the amount of alcohol consumed on a drinking occasion. Over time, changes in the absolute and relative numbers of light or heavy drinking episodes may occur, impacting health and social problems.

METHODS

Analyses of the 2000, 2005, and 2010 National Alcohol Surveys focus on trends in the volumes of alcohol consumed on days where the drinker had 1 to 2, 3 to 4, or 5 or more drinks separately. These volume measures were obtained from graduated frequency questions with adjustments for estimated drink alcohol content for each drinker based on reported beer brand, spirits drink and pour method, contexts of drinking, and demographic characteristics. Respondents with especially high alcohol content drinks were adjusted up 1 category, and those with especially low alcohol content drinks were adjusted down 1 category. Trend significance was tested with adjusted Wald tests and in negative binomial models with 2000 as the reference year, indicators for race/ethnicity group and interactions between these and survey year, and adjustments for age, educational attainment, income, employment status, and wetness region. Analyses were conducted both in the overall sample including abstainers and in the current drinker sample only.

RESULTS

Overall trend results indicate an increase in drink alcohol content-adjusted alcohol volume of 25% from 2000 to 2010 with similar changes between 2000 to 2005 and 2005 to 2010. Most of the increase from 2000 to 2005 resulted from increased volume from light drinking (1 to 2 drinks) days for men and women and moderate to heavy drinking (3 to 4 drinks) days for women, while the change from 2005 to 2010 resulted mostly from volume from heavy drinking days (5+ drinks per day) for men. Black and Hispanic women were found not to have participated in the overall trend of increased alcohol volume.

CONCLUSIONS

Findings highlight shifts in drinking patterns suggesting increased heavy occasion drinking in 2010, particularly among men.

Racial/Ethnic Disparities in the Risk of Injury Related to the Frequency of Heavy Drinking Occasions

AIMS

To estimate the risk of injury associated with the frequency of heavy drinking days overall and for black, white and Hispanic drinkers in a US sample.

METHODS

Data are from the 2010 National Alcohol Survey and included 6506 respondents comprising the landline sample. Analyses utilize Cox proportional hazards models with age as the timescale in a retrospective cohort design. Life-course drinking is determined by age of onset and questions on heavy drinking by decade of life. The outcome measure is having had a serious injury at a certain age. Models estimate the risk of injury in relation to heavy drinking in each year controlling for demographics, risk taking and time varying measures of smoking and chronic disease.

RESULTS

Results indicate that the risk of injury increases with the frequency of heavy drinking days to a hazard ratio of 2.14 (1.45-3.14) for daily heavy drinkers. Risks for white respondents were similar to the overall results but different risk relationships were found for black respondents among whom only daily heavy drinkers had increased risk of 4.09 (2.11-7.93), and for Hispanic respondents where elevated risk was seen among yearly heavy drinkers 2.71 (1.29-5.68), with a similar risk estimate for monthly heavy drinkers but lower and non-significant risks found for more frequent heavy drinking categories.

CONCLUSIONS

Different risk relationships were found across race/ethnicity groups suggesting elevated risk with less frequent heavy drinking among Hispanic respondents and very high risk from daily heavy drinking among black respondents.

Racial/Ethnic Disparities in the Self-Reported Number of Drinks in 2 Hours Before Driving Becomes Impaired

OBJECTIVES

We used data on self-reported impaired driving and the number of drinks the person states he or she can have in 2 hours before impairment to evaluate predictors of individuals' impairment thresholds by race/ethnicity.

METHODS

Data come from the 2000, 2005, and 2010 US National Alcohol Surveys, with oversamples of Black and Hispanic populations. We estimated negative binomial models overall, by gender, and for those who reported impaired driving. Analyses focused primarily on 8553 respondents who drank alcohol and drove a car in the past year.

RESULTS

In models that controlled for relevant available measures including body weight, sociodemographics, and drinking patterns, we found perceived impairment thresholds to be 30.3% (95% confidence interval = 23%, 38%) higher for Black drinkers and 26.3% (95% confidence interval = 18%, 35%) higher for Hispanic drinkers compared with White drinkers.

CONCLUSIONS

The greater number of standard drinks before perceived impairment reported by Black and Hispanic drivers implies a likely relative underreport of impaired driving and potentially higher severity of impairment when driving relative to White drivers.

Second-hand drinking may increase support for alcohol policies: new results from the 2010 National Alcohol Survey

INTRODUCTION AND AIMS

The harms of second-hand smoke motivated tobacco control legislation. Documenting the effects of harms from others' drinking might increase popular and political will for enacting alcohol policies. We investigated the individual-level relationship between having experienced such harms and favouring alcohol policy measures, adjusting for other influences.

DESIGN AND METHODS

We used the landline sample (n = 6957) of the 2010 National Alcohol Survey, a computer-assisted telephone interview survey based on a random household sample in the USA. Multivariable regression models adjusted for personal characteristics, including drinking pattern (volume and heavy drinking), were used to investigate the ability of six harms from others' drinking to predict a three-item measure of favour for stronger alcohol policies.

RESULTS

Adjusting for demographics and drinking pattern, number of harms from others' drinking predicted support for alcohol policies (P < 0.001). In a similar model, family- and aggression-related harms, riding with a drink driver and being concerned about another's drinking all significantly influenced favour for stronger alcohol policy.

DISCUSSION

Although cross-sectional data cannot prove a causal influence or directionality, the association found is consistent with the hypothesis that experiencing harms from others' drinking (experienced by a majority) makes one more likely to favour alcohol policies. Other things equal, women, racial/ethnic minorities, lower-income individuals and lighter drinkers tend to be more supportive of alcohol controls and policies.

CONCLUSIONS

Studies that estimate the impact of harms from other drinkers on those victimised are important and now beginning. Next we need to learn how such information could affect decision makers and legislators.

Adjustments for drink size and ethanol content: new results from a self-report diary and transdermal sensor validation study

BACKGROUND

Prior studies adjusting self-reported measures of alcohol intake for drink size and ethanol (EtOH) content have relied on single-point assessments.

METHODS

A prospective 28-day diary study investigated magnitudes of drink-EtOH adjustments and factors associated with these adjustments. Transdermal alcohol sensor (TAS) readings and prediction of alcohol-related problems by number of drinks versus EtOH-adjusted intake were used to validate drink-EtOH adjustments. Self-completed event diaries listed up to 4 beverage types and 4 drinking events/d. Eligible volunteers had ≥ weekly drinking and ≥3+ drinks per occasion with ≥26 reported days and pre- and postsummary measures (n = 220). Event reports included drink types, sizes, brands or spirits contents, venues, drinks consumed, and drinking duration.

RESULTS

Wine drinks averaged 1.19, beer 1.09, and spirits 1.54 U.S. standard drinks (14 g EtOH). Mean-adjusted alcohol intake was 22% larger using drink size and strength (brand/EtOH concentration) data. Adjusted drink levels were larger than "raw" drinks in all quantity ranges. Individual-level drink-EtOH adjustment ratios (EtOH adjusted/unadjusted amounts) averaged across all days drinking ranged from 0.73 to 3.33 (mean 1.22). Adjustment ratio was only marginally (and not significantly) positively related to usual quantity, frequency, and heavy drinking (all ps < 0.10), independent of gender, age, employment, and education, but those with lower incomes (both p < 0.01) drank stronger/bigger drinks. Controlling for raw number of drinks and other covariates, degree of adjustment independently predicted alcohol dependence symptoms (p < 0.01) and number of consequences (p < 0.05). In 30 respondents with sufficiently high-quality TAS readings, higher correlations (p = 0.04) were found between the adjusted versus the raw drinks/event and TAS areas under the curve.

CONCLUSIONS

Absent drink size and strength data, intake assessments are downward biased by at least 20%. Between-subject variation in typical drink content and pour sizes should be addressed in treatment and epidemiological research.

Pressure to change drinking behavior: An exploratory analysis of US general population subgroups

BACKGROUND

General population studies have shown that pressure from others to change drinking can come from different sources. Receipt of informal pressure (IP) and formal pressure (FP) is known to vary by quantity and consequences of drinking, but less is known about how pressure varies among subgroups of the population.

METHOD

This exploratory study utilizes data from the National Alcohol Surveys from 1995-2010 (N=26,311) and examines associations between receipt of pressure and subgroups of drinkers.

RESULTS

Increased relative risk of receiving IP and FP were observed for individuals reporting an arrest for driving after drinking and illicit drug use while poverty and lack of private health insurance increased risk of receipt of formal pressures. Regular marijuana use increased IP.

CONCLUSION

The subgroups that were studied received increased pressures to change drinking behavior, though disentangling the societal role of pressure and how it may assist with interventions, help seeking, and natural recovery is needed.