Gender Differences in the Epidemiology of Alcohol Use and Related Harms in the United States

Sexual minority women's perceptions of sober curiosity: Lessons learned from a US pilot study

INTRODUCTION

Sexual minority women (SMW) are more likely than heterosexual women to meet criteria for hazardous drinking (HD). Sober curiosity, which centres on non-pathologising approaches such as mindfulness and support for questioning norms that encourage heavy/hazardous alcohol use, may be a particularly salient non-stigmatising option for SMW to reduce alcohol consumption. However, SMW's perceptions of sober curiosity as a strategy for changing drinking behaviours have not been explored.

METHODS

We conducted in-depth individual interviews with a purposive sample of 17 SMW from the United States who self-reported moderate to heavy alcohol consumption or a desire to reduce their drinking. Questions explored the socio-cultural contexts of SMW's drinking, their desire to examine and/or to reduce their drinking and perceived supports and barriers for doing so.

RESULTS

SMW described heavy drinking norms, the centrality of alcohol in social spaces and events (both queer and non-queer) and alcohol use as a way to reduce stress, as factors that contribute to HD. Although some participants had mixed opinions about the term 'sober curiosity', they described feeling motivated to evaluate their alcohol consumption. Barriers to reducing alcohol use included fear of social rejection and loss of social connections.

DISCUSSION AND CONCLUSION

Overall, findings suggest sexual identity-specific online support and resources reflecting the sober curious philosophy have the potential to be useful for SMW seeking to reduce alcohol consumption. Key facilitators may include access to opportunities for connection in alcohol-free settings, social support and educational resources regarding alcohol and its impact on health.

Association of Brain-derived Neurotrophic Factor Polymorphisms With Alcohol Use Disorder: An Updated Meta-Analysis of Genetic Association Studies

BACKGROUND

Brain-derived neurotrophic factor (BDNF) has been proposed to play a role in chronic alcohol consumption. However, studies investigating the association of single nucleotide polymorphisms (SNPs) in the BDNF gene with alcohol use disorder (AUD), including alcohol dependence, have obtained inconsistent results. This meta-analysis aims to examine the role of BDNF SNPs (rs6265, rs16917204, rs7103411, and rs11030104) in the risk of AUD.

MATERIALS AND METHODS

A multidatabase search identified 17 articles (20 studies) for inclusion. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate associations using standard genetic models (homozygous, recessive, dominant, and codominant). Significant associations were defined as those with a p-value ≤ 0.05 after applying the Bonferroni correction (pBC). Subgroup analysis was conducted based on ethnicity (Caucasian and Asian populations). Sources of heterogeneity were investigated through outlier treatment and meta-regression analysis. Only significant outcomes were further subjected to sensitivity analysis and assessment of publication bias.

RESULTS

This meta-analysis generated four significant pooled ORs, representing the core outcomes, all of which indicated reduced risks. Overall, the results indicated a significant association between the BDNF polymorphism and the risk of AUD in homozygous (OR = 0.72, 95% CIs = 0.60-0.85, pBC = 0.0038) and codominant (OR = 0.84, 95% CIs = 0.78-0.91, pBC = 0.0019) model. In subgroup analysis by ethnicity, homozygous (OR = 0.59, 95% CIs = 0.44-0.78, pBC = 0.0057) and recessive (OR = 0.61, 95% CIs = 0.46-0.81, pBC = 0.0133) models of BDNF polymorphisms were significantly associated with a reduced risk of AUD in Caucasians. However, no significant associations were found in Asians. Meta-regression analysis did not identify any covariates that significantly contributed to the observed heterogeneity. The core significant associations were robust and showed no evidence of publication bias.

CONCLUSION

The current meta-analysis suggests that the examined BDNF SNPs have a protective effect in the overall analysis (homozygous and codominant) and in the Caucasians subgroup (homozygous and recessive) while the Asians exhibited no effects of BDNF SNPs on AUD. BDNF polymorphisms might serve as a protective factor against the risk of AUD and could be useful markers in the clinical genetics of AUD.

Operant ethanol self-administration behaviors do not predict sex differences in continuous access home cage drinking

Understanding sex differences in disease prevalence is critical to public health, particularly in the context of alcohol use disorder (AUD). The goal of this study was to understand sex differences in ethanol drinking behavior and define the precise conditions under which sex differences emerge. Consistent with prior work, C57BL/6J females drank more than males under continuous access two-bottle choice conditions. However, using ethanol self-administration - where an operant response results in access to an ethanol sipper for a fixed time period - we found no sex differences in operant response rates or ethanol consumption (volume per body weight consumed, as well as lick behavior). This remained true across a wide range of parameters including acquisition, when the ethanol sipper access period was manipulated, and when the concentration of the ethanol available was scaled. The only sex differences observed were in total ethanol consumption, which was explained by differences in body weight between males and females, rather than by sex differences in motivation to drink. Using dimensionality reduction approaches, we found that drinking behavior in the operant context did not cluster by sex, but rather clustered by high and low drinking phenotypes. Interestingly, these high and low drinking phenotypes in the operant context showed no correlation with those same categorizations in the home cage context within the same animals. These data underscore the complexity of sex differences in ethanol consumption, highlighting the important role that drinking conditions/context plays in the expression of these differences.

Direct Estimation of Alcohol-Attributable Fractions for Suicide in the United States, 2021

Objectives. To estimate the alcohol-attributable fraction (AAF) for suicide in the United States. Methods. Using restricted-access data from the National Violent Death Reporting System for 2021, we estimated the sex-specific AAF for suicide, among those 15 years of age and older, by sociodemographic characteristics and suicide means. An alcohol-attributable suicide was defined as that for which the decedent had a blood alcohol concentration of 0.10 grams per deciliter or higher. Results. In 2021, the AAF for suicide for males (20.2%) was significantly higher than that for females (17.8%; P < .001). The AAF for suicide was higher for both males and females who used a firearm as the means of suicide (23.4% and 22.8%, respectively) compared with their counterparts who used other means (16.5% and 15.9%, respectively). Conclusions. Despite some variation, AAFs for suicide were consistently high, with about 1 in 5 suicides being attributable to alcohol use. Therefore, suicide prevention initiatives in the United States should also target excessive alcohol use. (Am J Public Health. 2025;115(3):364-368. https://doi.org/10.2105/AJPH.2024.307910).

Pain Predicts Cannabis Initiation Among Emerging Adults: Results from the Population Assessment of Tobacco and Health (PATH) Study

Pain is highly prevalent among emerging adults (18-25 years old), and rates of cannabis use are increasing among this population. Research indicates pain is a unique risk factor and motivator for substance use. However, evidence for pain-cannabis use relations among emerging adults is largely cross-sectional, and the only prospective evidence focuses on the frequency, quantity, and consequences of cannabis use, not initiation. Accordingly, this is the first study to examine pain as a prospective predictor of cannabis initiation among emerging adults. Data were drawn from five annual waves of the Population Assessment of Tobacco and Health Study. Emerging adults who denied cannabis use at baseline (n = 4,185) were included in the analysis. At baseline, a tenth of emerging adults reported moderate/severe pain (≥4/10). Adjusted Cox regression analysis revealed that emerging adults with moderate/severe baseline pain were more likely to initiate cannabis use, and did so earlier over the subsequent 4 years, than those with no/low baseline pain. These findings provide initial evidence for pain as a risk factor for cannabis initiation during emerging adulthood. Future research is needed to identify mechanisms by which pain motivates cannabis initiation and to examine the utility of pain-targeted content in cannabis use prevention and intervention efforts among emerging adults.

Variations in documentation of alcohol use disorder (AUD) diagnoses across race, ethnicity, and sex in a health system that assesses AUD symptoms as part of routine primary care

INTRODUCTION

Prior studies have highlighted potential inequities in provider-documented alcohol use disorder (AUD) across race, ethnicity, and sex. Whether subgroup differences in AUD reflect true variation or diagnostic disparities is unknown. This study aims to describe variations in the prevalence of provider-documented AUD across race, ethnicity, and sex: 1) after adjustment for alcohol consumption, and 2) after additional adjustment for patient-reported AUD symptoms.

METHODS

In Kaiser Permanente Washington, patients with high-risk drinking (AUDIT-C score 7-12; 2.4 % of screened patients) complete a validated Alcohol Symptom Checklist of DSM-5 AUD symptoms with results documented in electronic health records. This study included Asian, Black, Latine, and White patients in primary care settings (03/2015-02/2022) who indicated high-risk drinking and thus completed an Alcohol Symptom Checklist. The prevalence of AUD was estimated for women and men across race or ethnic groups using marginally standardized generalized linear models. Models were first unadjusted, then adjusted for consumption (AUDIT-C scores 7-12), and then consumption plus AUD symptom counts (0-11).

RESULTS

Among 14,442 patients with high-risk drinking (6.0 % Asian, 5.8 % Black, 7.8 % Latine, 80.4 % White; 32.1 % women), provider-documented AUD increased with alcohol consumption and the number of AUD symptoms. The prevalence of AUD across 8 subgroups defined by race, ethnicity, and sex varied in analyses adjusted for alcohol consumption alone (range 11.6 % [95 % CI: 9.3-14.4] to 20.2 % [18.9-21.5]). However, after adjustment for both alcohol consumption and AUD symptoms, the prevalence of AUD ranged from 11.2 % [95 % CI: 7.9-15.6] to 15.0 % [95 % CI: 13.9-16.3] in women, and from 11.0 % [95 % CI: 8.7-13.8] to 15.1 % [95 % CI: 14.3-16.0] in men. AUD did not appear to vary across race or ethnicity.

CONCLUSIONS

In this study of primary care patients with high-risk drinking in a regional healthcare system that routinely assesses AUD symptoms, variations in provider-documented AUD diagnosis across race, ethnicity, and sex were observed after adjusting for alcohol consumption but were diminished after adjusting for AUD symptoms. This may suggest that among patients with similar alcohol consumption and AUD symptoms, intersectional variations in AUD diagnosis may be less apparent. Assessing AUD severity with Alcohol Symptom Checklists may help support equitable clinical AUD diagnosing.

Pain Predicts Past-Month Co-Use of Alcohol and Cannabis Among Emerging Adults: Results from the Population Assessment of Tobacco and Health (PATH) Study

Alcohol use, cannabis use, and pain are public health concerns among emerging adults (18-24 years old). Co-use of alcohol and cannabis is of particular concern since individuals who co-use alcohol and cannabis use more of each substance and experience greater substance-related harm. Pain and substance use frequently co-occur, and a growing body of literature indicates pain is unique risk factor for substance use. The goal of the current study was to examine moderate/severe pain (vs. no/low pain) as a prospective predictor of engaging in co-use of alcohol and cannabis among emerging adults, and to test sex as a moderator of this hypothesized relationship. Data were drawn from Waves 1-5 of the Population Assessment of Tobacco and Health Study (n = 3,544). Unadjusted logistic regression revealed that those with moderate/severe pain at baseline were 1.4 times more likely to engage in past-month co-use of alcohol and cannabis over the next four years (p = .046). The effects of pain on co-use were no longer significant after inclusion of covariates and a pain*sex interaction term, which was also nonsignificant (ps > .05). These findings provide initial support for pain as a risk factor for engaging in co-use of alcohol and cannabis during emerging adulthood. Future research should continue investigating how pain may motivate co-use of alcohol and cannabis, exploring how pain is associated with other measures of co-use, and determining how providers can incorporate pain-substance use psychoeducation for emerging adults in clinical settings.

Developing and testing health warnings about alcohol and risk for breast cancer: Results from a national experiment with young adult women in the United States

BACKGROUND

This study sought to identify effective health warnings about alcohol consumption and breast cancer risk among young adult female participants.

METHODS

We tested a pool of health warnings in a national pilot study. We used the most effective designs from the pilot in the main experiment where young (ages 21-29) U.S. adult female participants (N = 1038) reporting past 30-day alcohol consumption were randomly assigned into 1 of 4 conditions where they viewed a health warning about (1) mortality, (2) mastectomy, (3) hair loss, or (4) control (non-health warning message). Participants were then randomly assigned to view 1 of 2 message types within each condition: text-only or pictorial. Warnings were shown apart from products. Outcomes were message reactions (attention to and cognitive elaboration of warnings, fear, hope, and perceived message effectiveness), attitudes and beliefs (perceived severity and susceptibility to alcohol harms, and perceived response and self-efficacy to prevent alcohol harms), and behavioral intentions to stop or to reduce alcohol consumption in the next month.

RESULTS

Multivariate analysis of covariance (MANCOVA) models testing between warning conditions showed estimated marginal means (EMM) for every health warning condition were significantly higher than the control for attention (control = 5.80 vs. mortality = 6.63, mastectomy = 6.81, hair loss = 6.83, all ps < 0.05), fear (control = 2.45 vs. mortality = 4.11, mastectomy = 4.16, hair loss = 4.02, ps < 0.05), perceived message effectiveness (control = 3.44 vs. mortality = 5.75, mastectomy = 5.82, hair loss = 6.09, ps < 0.05), and perceived severity of alcohol harms (control = 5.51 vs. mortality = 6.25, mastectomy = 6.09, hair loss = 6.35, ps < 0.05). There were no significant differences between the health warnings about cancer effects for perceived message effectiveness. EMMs for intentions to reduce alcohol consumption in the next month were significantly higher in the mortality (6.44) and hair loss (6.35) conditions versus control (5.61, ps < 0.05).

CONCLUSION

Exposure to health warnings about alcohol consumption and breast cancer risk (vs. control) resulted in greater attention, fear, perceived message effectiveness, perceived severity of alcohol harms, and intentions to reduce alcohol consumption.

Prevalence and Association of Suicidal Ideation and High Risk Drinking in Men and Women: Results from a Representative German Household Survey

BACKGROUND

Alcohol abuse and suicide are significant public health problems. Specifically, more than three million people die each year from alcohol abuse and 700,000 from suicide. Research indicates that alcohol abuse is associated with suicidality, and that there are significant gender differences in both. By means of a large representative population sample, this study quantifies the associations between suicidal ideation and alcohol misuse in the German population.

METHODS

Based on a survey of 2,513 individuals from 2015, prevalence estimates and logistic regression models were used to estimate the association between suicidal ideation (i.e., past-year suicidal ideation according to the Suicidal Behavior Questionnaire Revised [SBQ-R] and alcohol consumption (i.e., past year high-risk drinking according to the Alcohol Use Disorders Identification Test [AUDIT-C]).

RESULTS

High-risk drinking (24.78%) and suicidal ideation (5.09%) were highly prevalent in this representative German population sample. These estimates differed significantly between men and women: Men were more likely to report high-risk drinking (30.14%) compared to women (20.56%), while a greater proportion of women (5.95%) reported suicidal ideation when compared to men (4.00%). Moreover, the association of suicidal ideation and high-risk drinking was weaker in women (OR = 1.64 CI 95% [1.03-2.62]) than in men (OR = 5.62 CI 95% [2.72-11.60]).

CONCLUSION

The high prevalence of suicidal ideation and high-risk drinking in women and underscores the necessity for low-level interventions and public health initiatives aimed at prevention and intervention against the escalation of high-risk drinking and suicidal behavior. Prevention efforts should consider gender-specific patterns of risk.

Adolescent extraversion and agreeableness predict adult alcohol use: A 22-Year prospective study

The Five Factor Model (FFM or Big 5) traits of extraversion, agreeableness, conscientiousness, neuroticism and openness, have all been associated with alcohol use. However, the vast majority of these studies have used cross-sectional designs, limiting the ability to evaluate the temporal relationships between childhood personality traits in adult alcohol use patterns. In the current prospective community cohort study (N = 329), we examine the predictive value of FFM traits measured in childhood and adolescence (starting at 6-9 years of age; well before the typical age at which adolescents begin drinking) for alcohol use in adulthood (27-30 years of age), spanning an average of 22 years. Personality was assessed with the Hierarchical Personality Inventory for Children (HiPIC) across 5 consecutive waves utilizing multiple informants (child, mother, father, and teachers). Alcohol use was measured by the self-report Quantity-Frequency Variability Index (QFV). A series of regression analyses indicates that during adolescence, high levels of extraversion and low levels of agreeableness are both (independently) associated with heavier drinking. These associations are robust and consistent from the first adolescent wave (age 12-15 years) to the last adolescent wave. Notably, informant-dependent measures from early childhood waves (ages 6-9) were not significant predictors, highlighting the importance of considering developmental context and informant variability. By leveraging a longitudinal design with temporally separated measures of personality and alcohol use, this study minimizes concerns about reverse causality. The results highlight the long-term relevance of adolescent personality traits in understanding adult drinking behavior and suggest that targeted prevention strategies focusing on highly extraverted and low-agreeable adolescents may help reduce harmful drinking patterns later in life.

Alcohol Misuse, Marital Functioning and Marital Instability: An Evidence-Based Review on Intimate Partner Violence, Marital Satisfaction and Divorce

Alcohol use is a primarily social behavior, and marriage is an important aspect of social relationships. This article reviews alcohol use and its impact on several facets of the marital relationship, including the impact of alcohol use on intimate partner violence (IPV), marital satisfaction, marital functioning, and divorce. There is considerable evidence of the role alcohol plays in IPV and recent research identifies moderators of the alcohol-IPV relationship. These include personality constructs, social pressure, marital satisfaction, and traits, such as hostility and impulsivity. Marital satisfaction and alcohol use demonstrate bidirectional causality, whereas marital satisfaction predicts alcohol use behaviors, and alcohol use also predicts marital satisfaction. Longitudinal studies provide evidence that divorce is temporally associated with alcohol use, including Alcohol Use Disorder. Finally, there are a number of causative factors that interplay in the dissolution of marriage; alcohol use is one of these factors. Excessive alcohol consumption is a common reason for divorce among many couples. Across all associations between alcohol use and IPV, marital satisfaction, marital functioning, and divorce, sex and gender consistently appear as a moderator in these relationships. Another consistent finding is in respect to concordant drinking, such that marital partners who have similar patterns of alcohol consumption fare better than those with discrepant patterns of consumption. Future research should focus on greater inclusion of same-sex, LGBTQQ+, and socio-culturally diverse couples. Additionally, future studies should use Actor-Partner Interdependence Modeling (APIM) to effectively examine non-independent partner data.

Sex disparity in the association between alcohol consumption and sarcopenia: a population-based study

Background

Previous studies have shown inconsistent findings regarding the association of alcohol consumption with sarcopenia. Therefore, this study comprehensively investigated the association of alcohol consumption with sarcopenia in a nationally representative sample of US adults.

Methods

This population-based study included adults aged 18 years and older from the National Health and Nutrition Examination Survey (NHANES) III. Alcohol exposure was defined as daily alcohol intake, alcohol drinking history, number of drinking days per week, and frequency of binge drinking days per month. Weighted logistic regressions were used to determine associations.

Results

Four cohorts were selected from the NHANES III: cohort 1 (n = 7,592), cohort 2 (n = 12,060), cohort 3 (n = 7,608), and cohort 4 (n = 7,649), corresponding to alcohol exposure categories of daily alcohol intake, drinking history, number of drinking days per week, and frequency of binge drinking days per month. In the full model, the risk of sarcopenia was significantly associated with mild (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.08-2.51), moderate (OR: 2.04; 95% CI: 1.12-3.71), and heavy drinkers (OR: 2.42; 95% CI: 1.17-4.97) compared to nondrinkers. There was an association between the development of sarcopenia and current drinkers (OR: 1.69; 95% CI: 1.12-2.56) but not former drinkers (OR: 1.21; 95% CI: 0.88-1.66). Compared to nondrinkers, an increased risk of developing sarcopenia was observed in participants who consumed alcohol 2 days (OR: 2.36; 95% CI: 1.40-3.99) or > 2 days (OR: 1.84; 95% CI: 1.10-3.07) per week, and those who engaged in binge drinking for ≤1 day per month (OR: 1.68; 95% CI: 1.09-2.60) or > 1 day per month (OR: 2.10; 95% CI: 1.10-4.01). Sensitivity analyses based on different definitions of sarcopenia yielded similar results. Stratified analyses revealed that these associations were present in females but not males.

Conclusion

Alcohol intake was associated with an increased risk of sarcopenia in all individuals, with this association being primarily observed in females rather than males.

Chronic intermittent ethanol produces nociception through endocannabinoid-independent mechanisms in mice

Alcohol use disorder (AUD) affects millions of people and represents a significant health and economic burden. Pain represents a frequently under-treated aspect of hyperkatifeia during alcohol withdrawal, yet to date no drugs have received FDA approval for the treatment of this indication in AUD patients. This study aims to evaluate the potential of targeting bioactive lipid signaling pathways as a therapeutic approach for treating alcohol withdrawal-related pain. We utilized a chronic intermittent ethanol (CIE) vapor exposure model in C57BL/6J mice of both sexes to establish alcohol dependence, and demonstrated that CIE mice developed robust tactile allodynia and thermal hyperalgesia during withdrawal that was independent of prior blood alcohol levels. Next, we evaluated four drugs for their efficacy in reversing tactile allodynia during abstinence from CIE using a cross-over treatment design that included FDA-approved naltrexone as well as commercially available inhibitors targeting inflammatory lipid signaling enzymes including fatty acid amide hydrolase (FAAH), monoacylglycerol lipase (MAGL), and 15-Lipoxygenase (LOX). None of these compounds produced significant therapeutic benefit in reversing established CIE-induced tactile allodynia, despite attenuating pain-like behaviors at these doses in other chronic pain models. Additionally, we assessed plasma endocannabinoid levels in both sexes during withdrawal. We found that there is an inherent sex difference in the endogenous anti-inflammatory endocannabinoid tone in naive mice and CIE treatment affected endocannabinoids levels in female mice only. These findings underscore the need to better understand the driving causes of AUD induced pain and to develop novel therapeutic approaches to mitigate pain in AUD patients.

Sex and gender differences in the molecular etiology of Parkinson's disease: considerations for study design and data analysis

Parkinson's disease (PD) is more prevalent in men than women, and presents with different clinical features in each sex. Despite widespread recognition of these differences, females are under-represented in clinical and experimental studies of PD, and much remains to be elucidated regarding the biological underpinnings of sex differences in PD. In this review, we summarize known contributors to sex differences in PD etiology across the life course, with a focus on neurological development and gene regulation. Sex differences that are established at conception and heightened during adolescence and midlife may partially embed future PD risk, due to the complex interactions between gonadal hormones, gene regulation, lifestyle factors, and aging. While the neuroprotective properties of estrogen are strongly implicated in reduced prevalence of PD in women, interactions with genotype and gender-biased lifestyle factors are incompletely understood. Consideration of sex and gender-related factors in study design, data analysis, and interpretation have the power to expedite our knowledge of the etiology of PD in men and in women, and to inform prevention and therapeutic strategies tailored to each sex.

Macro-level determinants of gender differences in the prevalence of major depression and alcohol use disorder in the United States and across Europe

BACKGROUND

Major depressive disorder (MDD) and alcohol use disorder (AUD) are leading psychiatric causes of burden of disease. Although research has found pronounced gender differences in these disorders, the magnitude of these differences varies substantially between settings. However, integrated analyses of both disorders are lacking, limiting the comparability of findings. Moreover, few studies conceptualize political and socio-cultural characteristics as separate macro-level determinants of gender differences. This paper analyzes the association between gender differences in the prevalence of both MDD and AUD with social policy expenditures and indicators of gender equality.

METHODS

Data for adults from the U.S. Behavioral Risk Factor Surveillance System 2006/2008 (n = 234,020) and the European Social Survey 2014 (n = 30,416) were used. Cross-sectional analyses were conducted using modified Poisson regression models adjusted for individual-level and macro-level covariates; multiplicative and additive interaction were evaluated.

RESULTS

Social policy expenditures and support for gender equality were negatively associated with gender differences in AUD in Europe (p < 0.001), with the male excess prevalence varying between 26.1 % at lowest and 9.4 % at highest observed levels of expenditures, and between 23.3 % at lowest and 6.8 % at highest levels of gender equality. In the U.S., state-level reproductive rights were negatively associated with gender differences in AUD (p = 0.036). No equivalent effects were observed for gender differences in MDD.

CONCLUSION

The prevalence of AUD among men and women tends to converge in settings with higher levels of social policy generosity and gender equality, respectively. This effect does not seem to apply to gender differences in MDD in either setting.

Assessing the 53-Year Epidemiological Trends of Oral Squamous Cell Carcinoma (OSCC) in Northeastern Iran

OBJECTIVES

This study aimed to assess the epidemiological trends of oral squamous cell carcinoma (OSCC) in Northeast Iran over a 53-year period.

MATERIAL AND METHODS

In this retrospective study, we obtained data on OSCC cases in Northeast Iran spanning 53 years (1970-2022), including demographic details, such as age, sex, site, and histopathological grade. Descriptive analysis was conducted, and frequencies were compared using the chi-squared test to evaluate differences between sexes, age groups, cancer sites, and histopathological grades. Additionally, we assessed the associations of each OSCC site with age, sex, and histopathological grade. Statistical significance was set at p < 0.05, with a confidence interval of 95%.

RESULTS

This study examined 13,769 cases, among which 507 were diagnosed with OSCC, accounting for 3.68% of the total cases. The mean age was 59.27 ± 14.94 years, with a significantly higher prevalence of OSCC among individuals older than 50 years (p < 0.001). There were nearly equal proportions of males and females, with the tongue being the most common site (28.4%), followed by the gingiva (26.4%) and buccal mucosa (19.5%). Grade 1 (well differentiated) OSCC was significantly more prevalent (54%) than other grades. There was a significant association between sex and tongue SCC in females (p = 0.006) and between sex and lip SCC in males (p = 0.008). Prevalence in individuals above 50 was significant for the tongue, buccal mucosa, gingiva, and lip (p = 0.001, < 0.001, < 0.001, 0.028, respectively). In the tongue, buccal mucosa, gingiva, and floor of the mouth, grade 1 was significantly more prevalent (p < 0.001).

CONCLUSIONS

Our study revealed that OSCC predominantly affects individuals older than 50 years, with nearly equal prevalence between sexes. The most commonly affected sites are the tongue and gingiva, often exhibiting grade 1 histopathological findings. Enhanced community awareness of risk factors and regular oral examinations are essential for reducing the incidence of OSCC.

Estrogen and alcohol use in women: a targeted literature review

PURPOSE

Alcohol is posited to affect sex steroid hormone concentrations, and a growing body of research has demonstrated menstrual cycle effects on women's use of alcohol. The present targeted review synthesizes the literature examining the relationship between alcohol use and estradiol in women and suggests directions for future research.

METHODS

Articles were identified using the PubMed database using the following criteria: published in English, presented original findings for women, were peerreviewed, and included measures of estradiol levels in the analyses. Twenty-nine articles were identified for inclusion.

RESULTS

Results from this review indicate acute alcohol use temporarily increases estradiol levels in women, and this may be strongest when gonadotropins are high. Regular alcohol use (≥1 drink per day) increases estradiol levels, but estradiol appears to be suppressed in women with alcohol use disorders and physiologic dependence. Alcohol use tends to be highest in women during ovulation, when estradiol is high, and progesterone is low.

CONCLUSION

Alcohol use increases estradiol levels in women, particularly in the presence of gonadotropins. More research is needed to assess the effect of estradiol on alcohol use in women. Research on the relationship of estrogen and alcohol use in women is needed to elucidate health outcomes through the lifespan.

Temporal stability and volatility in population-level high-risk illicit polysubstance use by gender and marital status in the United States, 2002-2019

Population-level patterns in determinants of risky polysubstance use receive little attention despite rising mortality. We use secondary data from the National Survey on Drug Use and Health, 2002-2019 (N = 706,891), and weighted logistic regression to test trends and associations between gender and marital status on the probability of high-risk polysubstance use (i.e., illicit use of pharmacologically-distinct overdose-associated drugs). Our results show that at the population-level about 0.7% of adults engaged in high-risk illicit polysubstance use in the past month. Our regression analyses reveal that polysubstance use was lowest among married women (pˆ = 0.27%) and highest among never married and previously married men (pˆ = 1.06%). When we predicted polysubstance use from 2002 to 2019, the estimates were remarkably stable for women and married adults, with no statistically significant differences for women across the span and few for married adults. Yet, polysubstance use among men had statistically significant variation (ranging from pˆ = 0.55 to pˆ = 0.96%), and the gender gap was larger and more consistently significant as illicit drugs became prominent later in the study period. This pattern suggests that use among men is shaped by drug contexts and availability. Our findings also highlight the important roles of family structure in shaping high-risk drug use. Rising polysubstance use mortality may not stem from rising rates of use or large changes in patterns among high-risk groups, but may be related to the growing share of non-married adults, especially men, who are high-risk relative to married adults and women.

The Relationship Between Intimate Partner Violence, Depression, Alcohol Abuse in Black and Hispanic Women

The relationship between intimate partner violence (IPV), depression, and risky alcohol use is complex and multi-dimensional. Depression has been documented as a common consequence of experiencing IPV, where depressed individuals might turn to substances like alcohol as a coping mechanism. Thus, assessing the indirect effect of depression in the relationship between IPV and alcohol abuse in African American and Hispanic women is warranted. Cross-sectional data was collected from 152 African American and Hispanic women living in Miami, Florida. Descriptive statistics, correlation analysis, and Hayes' direct and indirect mediation analyses were conducted. A total of 77% reported IPV. The mean age was 42.84 (SD = 10.69). About 57% of participants identified as African American, and 62% identified as Hispanic/Latino. On average, participant depression scores (8.6, SD = 5.7) showed mild-to-moderate severity, and the average alcohol abuse score was 15.5 (±8.9), suggesting risky alcohol use. IPV was directly associated with alcohol abuse (β = .50, 95% CI [.18, .82]; [R2 = .059, F(1, 150) = 9.37, p < .001), and with depression (β = .48, 95% CI [.27, .69]; [R2 = .119, F(1, 150) = 20.43, p < .001). Depression modified the effect of IPV on alcohol abuse by about 19% (β = .56, 95% CI [.33, .80]; [R2 = .185, F(2, 149) = 16.87, p < .0026). Results of this study suggest that depression is an important component to be considered when addressing alcohol abuse among women with experiences of IPV. This study highlights the importance of assessing women who report IPV for depressive symptoms when treating alcohol use disorders.

Rethinking gender differences: An investigation of comorbid psychopathology and alcohol use disorder in veterans

BACKGROUND

While men have been found to drink more alcohol and have higher rates of alcohol-related mortality, women tend to experience higher rates of alcohol-related consequences, including psychological comorbidities and worse alcohol use disorder (AUD) outcomes. However, gender differences in comorbid psychopathology and associations with AUD outcomes among veterans are less well understood.

METHODS

Veterans (N = 126; 32 women) receiving inpatient treatment for AUD completed baseline clinical measures including the Beck Depression Inventory-II, Beck Anxiety Inventory, Early Life Stress Questionnaire, and PTSD Checklist for DSM-5. Alcohol use was assessed with the Timeline Followback for the 90 days prior to the baseline assessment and again at 1-, 3-, and 6-month follow-ups. Gender differences in baseline alcohol and psychopathology measures were examined using Fisher's exact test and Mann-Whitney U test. Linear/logistic regression was used to examine associations between comorbid psychopathology and alcohol relapse/use severity post-study.

RESULTS

Consistent with prior literature, statistically significant gender differences in psychopathology were observed, with women reporting higher anxiety (p < 0.001), depression (p = 0.001), early life stress (p < 0.001), and PTSD (p < 0.001) at baseline. Higher early life stress was also associated with higher anxiety, depression, and PTSD. Statistically significant gender differences were not observed for alcohol use in the 90 days prior to the study. Similarly, gender was not associated with relapse or severity of use at 1-, 3-, or 6-month follow ups (ps > 0.05). Psychopathology measures were not associated with relapse or severity of use at any time point (ps > 0.05).

CONCLUSION

Our study highlights that women veterans are drinking similar quantities of alcohol to men, supporting emerging evidence of a narrowing gender gap in alcohol use. Women also have a higher psychiatric burden than men; thus, identifying ways to mitigate comorbidity among women veterans should be a health priority.

Impact of smartphone distraction and alcohol intoxication on pedestrian risk-taking

BACKGROUND

An estimated 7,388 pedestrians died in motor-vehicle crashes in the United States in 2021. Two significant risks for pedestrian injuries and deaths are alcohol intoxication and smartphone distraction. The present research used a virtual reality simulator to evaluate the individual and joint impact of pedestrian distraction and intoxication on risk-taking while crossing the street.

METHODS

Thirty-nine participants completed two laboratory visits, during which they crossed the virtual street either after drinking alcohol to produce a BAC of 0.08 or after drinking a placebo, in randomized order. During each visit, they crossed the street both while distracted by texting and without distraction, also in randomized order. Five pedestrian safety outcomes were considered: unsafe crossings, time to contact with oncoming vehicles, start gap before entering a safe gap in traffic, distance to the closest oncoming vehicle as the crossing started, and missed opportunities to cross safely.

RESULTS

Intoxicated participants were more likely to cross unsafely. While distracted, participants missed more safe crossing opportunities, started crossing while closer to oncoming vehicles, and experienced more unsafe crossings. The interactional effect of intoxication and distraction was significant for the number of unsafe crossings and time to contact, with intoxicated pedestrians experiencing more unsafe crossings only when they were not distracted and distraction increasing unsafe crossings only among sober pedestrians.

CONCLUSIONS

Both alcohol intoxication and smartphone distraction impacted pedestrian safety, individually and jointly. Results should inform the development of multifaceted prevention strategies, including road engineering, law enforcement, and efforts to reduce pedestrian risk through strategies like responsible beverage service practices.

PRACTICAL APPLICATIONS

Overall, this study explored the isolated and interactional effects of alcohol intoxication and phone distraction on pedestrians, which should inform development of interventions to reduce risky pedestrian behavior and address pedestrian injury and mortality rates globally.

Determinants of alcohol consumption among men and women aged 15-49 years in Cambodia: Evidence from the Cambodia demographic and health survey 2021-2022

INTRODUCTION

Alcohol consumption is a global health issue linked to over 200 diseases and accounts for 5.3% of all deaths annually. We aimed to determine the sociodemographic factors associated with alcohol consumption among Cambodian women and men aged 15-49 years.

METHODS

We used data from the 2022 Cambodia Demographic and Health Survey, including 19,496 women and 8825 men aged 15-49. Multiple logistic regressions were performed using STATA V18 to examine factors associated with alcohol consumption.

RESULTS

Nearly 70% of men (95% CI 67.6-70.9) and 16.3% of women (95% CI 15.3-17.3) reported consuming alcohol in the past months. Among men, predictors of alcohol consumption, including those aged 19-24 years, had higher odds of consuming alcohol than the younger ages ≤18 years (AOR 2.14; 95% CI 1.65-2.77). Married men consumed alcohol more than unmarried men and smokers had higher odds of alcohol use than non-smokers with AOR 1.80 (95% CI 1.52-2.14). Similar patterns were found among women, including increased ages, marriage and smoking were predictors of alcohol consumption.

DISCUSSION AND CONCLUSIONS

The study highlights the high prevalence of alcohol consumption among the Cambodian adult population, particularly among men. For both sexes, increased ages greater than 18 years, those who were married, had jobs, and smoking were the main predictors of alcohol consumption. Health promotion efforts should be focused on younger adults aged 19-24, who are increasingly engaging in risky behaviours, including alcohol intake and smoking, by raising awareness about the health consequences of harmful alcohol consumption.

The epidemiology of alcohol involved facial injuries

PURPOSE

Alcohol use has been shown to affect injury patterns and risk of trauma. This study aims to characterize the epidemiologic characteristics of alcohol involved facial injuries presenting to US emergency departments.

METHODS

This study reports a cross-sectional analysis of patients with facial injuries within the National Electronic Injury Surveillance System (NEISS). Demographics, disposition, and mechanism of injury were compared between facial injury patients with reported/suspected alcohol consumption prior to or during the time of injury (AIFI+) and facial injury patients with no alcohol consumption (AIFI-).

RESULTS

A total of 37,777 facial injuries were reported within the NEISS. Out if these, 3,336 patients experienced an alcohol involved facial injury (AIFI+). AIFI + patients were younger than AIFI- patients (47 vs. 57, p < 0.001), more likely to be male (68.5% vs. 31.5%, p < 0.001), and more likely to be White (51.6% vs. 53.6%, p = 0.03). Patients with AIFI were less likely to be injured at home (41.5% vs. 45.5%, p < 0.001) and more likely to be injured in the street (8.5% vs. 4.5%, p < 0.001). Disposition differed with AIFI + patients less likely to be treated and released (78.8% vs. 83.3%, p < 0.001) and more likely to leave without being seen (3.8% vs. 1.8%, p < 0.001).

CONCLUSIONS

Our study reports that AIFI + patients are younger, more likely to be injured on the street, and more likely to be injured by stairs than AIFI- patients. Additionally, patients with an AIFI + are more likely to leave the hospital without being seen.

Neighborhood Violence Exposure and Alcohol and Tobacco Use Initiation Among Ethnic Minority Adolescents

Background/Objectives: Although the extant literature has recognized the importance of neighborhood contexts for adolescent alcohol and tobacco use, less is known about the effects of exposure to neighborhood violence on the prevalence and timing of initiation across gender and race/ethnic groups. Methods: This secondary analysis of administrative and survey data from a natural experiment in Denver examines the influence of neighborhood contexts on the health and well-being of 1100 Latino/a and African American adolescents. Cox Proportional Hazard models were used to (1) estimate the effects of exposure to neighborhood violence on the prevalence and timing of adolescent alcohol and tobacco use initiation; (2) examine gender and race/ethnic variations in alcohol and tobacco use initiation after controlling for adolescent, caregiver, household, and other neighborhood characteristics; and (3) test for threshold effects. Results: Prevalence rates among all adolescents were 12.9% for alcohol use initiation and 13.7% for tobacco use initiation but were 14.6% and 17.3%, respectively, among adolescents exposed to higher levels of neighborhood violence. The average age of initiation was 16.1 and 15.6 years for alcohol and tobacco use, respectively, but 2-8 months earlier for adolescents exposed to higher levels of neighborhood violence. Heightened exposure to neighborhood violence increased the hazards of alcohol use initiation by 32% for all adolescents and 38% for adolescent males. The hazards of tobacco use initiation were 1.3 to 1.5 times higher for male, Latino/a, and African American adolescents. Exposure to neighborhood violence suggests threshold effects of diminishing returns on adolescent tobacco use initiation. Conclusions: Findings underscore the need to examine gender and race/ethnic group differences in adolescent alcohol and tobacco initiation, the multiple pathways to such use, and interventions aimed at reducing neighborhood violence.

Assessing self-determined motivation for drinking alcohol via the Comprehensive Relative Autonomy Index for Drinking

Introduction

Self-Determination Theory (SDT) examines human motivation in multiple domains; however, the only existing measure assessing SDT-informed behavioral regulations for drinking focuses on responsible drinker behaviors, rather than drinking per se, which is important given the alignment between SDT and harm reduction approaches to alcohol use. The aim of this study was to test the structural validity of the SDT-informed Comprehensive Relative Autonomy Index for Drinking (CRAI-Drinking) among college students.

Methods

Participants included two convenience samples with a total of 630 adult drinkers (Mage = 21.5, 55% female, 88% undergraduates). Participants rated drinking behavioral regulations on the 24 original CRAI-Drinking items on a 5-point Likert Scale. Multi-dimensional scaling analyses and factor analyses were used to investigate the underlying autonomy continuum and factor structure of the CRAI-Drinking.

Results

In Sample 1 (n = 274), multi-dimensional scaling analyses confirmed that CRAI-Drinking item and subscale order aligned with SDT's autonomy continuum. Confirmatory factor analyses supported a five factor, 19-item model of the CRAI-Drinking with factors for intrinsic, identified, positive introjected, external, and amotivation regulations (Cronbach's α: 0.68-0.85). In Sample 2 (n = 356), a confirmatory factor analysis confirmed that the 19-item model fit was comparable to Sample 1.

Discussion

This study provides evidence for the structural validity of CRAI-Drinking scores for assessing SDT-based behavioral regulations for drinking in adults.

Prevalence of indications of alcohol and drug use among patients treated for injurious falls by Emergency Medical Services in the USA

OBJECTIVE

The association between alcohol consumption and increased injuries from falls is well established, but there is a lack of data on the prevalence of substance use by fall type. This study aims to describe the distribution of alcohol and drug involvement in injurious falls.

METHODS

Using the 2019 National Emergency Medical Services (EMS) Information System data set, we identified 1 854 909 patients injured from falls requiring an EMS response and determined the fall location (eg, indoors or on street/sidewalk). We analysed data on the EMS clinician's notation of alcohol or drug involvement and Glasgow Coma Scale.

RESULTS

Overall, for 7.4% of injurious falls, there was a notation of substance use: 6.5% for alcohol alone, 0.6% for drugs and 0.3% for alcohol and drugs. 21.2% of falls that occurred on a street or sidewalk had a notation of substance use. Substance use prevalence was highest, at 30.3%, in the age group 21-64 years, for falls occurring on streets and sidewalks, without syncope or heat illness as contributing factors. Reported substance use involvement was more frequent for men compared with women for each location type. Glasgow Coma Scale scores indicative of moderate or severe trauma were more prevalent among falls involving alcohol and/or drugs.

CONCLUSIONS

Overall, one in five injurious falls on streets and sidewalks and requiring EMS attention involved substance use, and these numbers likely underestimate the true burden. As cities seek to expand nightlife districts, design strategies to protect pedestrians from falls should be enacted.

A narrative review on alcohol use in women: insight into the telescoping hypothesis from a biopsychosocial perspective

Background: There has been a dramatic rise in alcohol consumption and alcohol use disorder (AUD) among women. Recently, the field has made substantial progress toward better understanding sex and gender differences in AUD. This research has suggested accelerated progression to AUD and associated health consequences in women, a phenomenon referred to as "telescoping."Objective: To examine evidence for the telescoping hypothesis from a biopsychosocial perspective.Methods: This narrative review examined and integrated research on biological, psychological, and socio-environmental factors that may contribute to the development and progression of AUD in women.Results: Biopsychosocial research has revealed sex- and gender-specific risk factors and pathways to AUD onset and progression. Biological sex differences render females more vulnerable to alcohol-related toxicity across various biological systems, including the brain. Notably, sex and gender differences are consistently observed in the neural circuitry underlying emotional and stress regulation, and are hypothesized to increase risk for an internalizing pathway to AUD in women. Psychological research indicates women experience greater negative emotionality and are more likely to use alcohol as a means to alleviate negative emotions compared with men. Socio-environmental factors, such as familial and peer isolation, appear to interact with biological and psychological processes in a way that increases risk for negative emotionality and associated alcohol use in women.Conclusion: There appears to be a complex interplay of biopsychosocial factors that increase risk for AUD onset and progression in women through an internalizing pathway. Developing targeted interventions for women with AUD that specifically target internalizing processes is critical.

The Influence of Substance Use on Sleep Duration Among South Korean Adolescents by Sex: A Secondary Analysis

PURPOSE

Although insufficient sleep influences cognitive function and physical and mental health in adolescents, many still get less sleep than the recommended duration. Adolescent substance use, including alcohol and tobacco, influences sleep disturbance. However, sex differences in the relationship between substance use and sleep health have not been extensively studied. This study aimed to examine the effect of substance use on sleep duration among South Korean adolescents by sex.

DESIGN AND METHODS

This secondary data analysis used the 4th Wave of the Korean Children and Youth Panel Survey 2018 and applied a multiple regression analysis. Tobacco use and alcohol consumption were assessed by asking whether the participants had ever smoked or drunk alcohol during the previous year. Sleep duration was calculated based on the participants' reports related to sleep and awake times on weekdays and weekends.

RESULTS

For male adolescents, substance use, either tobacco use or alcohol consumption, did not significantly affect sleep duration, whereas for female adolescents, alcohol consumption was found to influence sleep duration. Age and subjective health were additional influential factors for adolescents' sleep duration, regardless of sex.

PRACTICE IMPLICATIONS

Interventions for alcohol consumption should be considered to enhance sleep health in female South Korean adolescents. Further studies are needed to understand the underlying mechanisms of sleep health, particularly the effects of substance use, among male adolescents.

Altered gut microbial profiles in drug-treated rats with alcoholic heart disease

Introduction. Alcohol abuse can lead to significant cardiac injury, resulting in Alcoholic heart disease (AHD). The interplay between cardiac health and gut microbiota composition in the context of alcohol consumption is not well understood.Hypothesis. Shen Song Yang Xin (SSYX) capsule and amiodarone are common drugs used to treat alcoholic heart disease, but little is known about their microbial regulatory mechanisms in alcoholic heart disease.Aim. To investigate the effects of SSYX and amiodarone on cardiac injury and gut microbiota composition in a rat model of AHD induced by alcohol consumption.Methodology. We evaluated body weight, cardiac function, changes in gut morphology, and gut microbiota composition to assess the effects of SSYX and amiodarone on AHD.Results. Alcohol consumption significantly reduced body weight and aggravated cardiac fibrosis. However, SSYX attenuated fibrosis and improved cardiac function. SSYX also improved intestinal morphological changes caused by chronic alcoholism and activated the expression of ZO-1 and occludin, which are important in maintaining intestinal barrier function. The gut microbiota composition was altered in rats with AHD, with an increase in Actinobacteria abundance. Both SSYX and amiodarone affected the gut microbiota composition, and their effects were positively correlated. SSYX plays a protective role against heart injury caused by alcohol consumption. It improves cardiac function, intestinal morphological changes and gut microbiota composition.Conclusion. SSYX and amiodarone may have potential therapeutic options for AHD. Actinobacteria/Firmicutes ratio and the abundance of Christensenellaceae R7 group, norank_flachnospiraceae and Roseburia may serve as potential biomarkers for detecting alcoholic heart disease.

Disaggregating Trends in Alcohol Involvement Among Hispanic, Black, and White Female and Male U.S. Adolescents: 2002 to 2019

OBJECTIVE

Alcohol involvement is declining among U.S. adolescents; however, studies examining population-level trends in alcohol involvement among females and males from diverse racial and ethnic backgrounds are scarce. Therefore, the current study examined alcohol involvement from 2002 to 2019 among Hispanic, Black, and White U.S. adolescent females and males.

METHOD

Data were from the National Survey on Drug Use and Health, years 2002-2019. Participants were between 12 and 17 years old and Hispanic, non-Hispanic Black, or non-Hispanic White. Annualized change estimates within each subgroup were analyzed separately for the following four alcohol variables: (a) lifetime alcohol use; (b) age at alcohol initiation; (c) past-year drinking days; and (d) respondent's perceived risk of alcohol misuse.

RESULTS

Lifetime alcohol use decreased for all groups, and the decrease was strongest for Hispanic males. Age at alcohol initiation similarly increased for Hispanic and White females and males, with no change in age at alcohol initiation for Black adolescents. Past-year drinking days declined for all groups but was not significant for Black females. Perceiving alcohol misuse as a "great risk" increased only for Hispanic males and females.

CONCLUSIONS

Although alcohol involvement is declining among U.S. adolescents, results from this study highlight that engaging with alcohol is normative among many adolescent groups. Also, when considering sex as well as race and ethnicity, there are important distinctions in patterns of decline in alcohol involvement that should be accounted for to inform future research and screening.

Sexual Identity and Heavy Drinking Among Adults in Canada by Racially Minoritized Status and Income, 2015-2020

Purpose: Our objective was to estimate inequities in heavy drinking between heterosexual, gay or lesbian, and bisexual or pansexual individuals, by sex/gender, and to determine whether this association is heterogeneous across racially minoritized status and income groups in Canadians aged 15 and older. Methods: We pooled three Canadian Community Health Survey cycles (2015-2020) and used separate modified Poisson regressions to explore the sex/gender-specific association between sexual identity and heavy drinking prevalence by racially minoritized status, and income, adjusted for survey cycle, age, marital status, and region. Results: With racially minoritized status, and income categories collapsed, heavy drinking was 1.3 times higher (95% confidence interval [CI] = 1.0-1.7) among bisexual or pansexual women compared with heterosexual women, with no differences among men. Among racially minoritized women, heavy drinking was 2.9 (95% CI = 1.3-6.4) times higher among bisexual or pansexual women and 1.9 (95% CI = 0.7-5.2) times higher among gay or lesbian women compared with heterosexual women. Among racially minoritized men, heavy drinking was 1.9 (95% CI = 0.9-4.0) times higher among gay men compared with heterosexual men. No differences were observed across sexual identity in White men or women. Bisexual or pansexual women reported increased heavy drinking relative to heterosexual women across income quintiles. Conclusion: Heavy drinking is distributed heterogeneously across sexual identity, sex/gender, racially minoritized status, and income. These results encourage equity-focused interventions to reduce heavy drinking among intersecting sociodemographic groups experiencing a greater burden of heavy drinking.

Prevalence of hazardous alcohol consumption and evaluation of associated factors in university students

PURPOSE

The aim of the study was to determine the prevalence of hazardous alcohol consumption (HAC) according to gender among university students and associated factors.

METHODS

This is a cross-sectional study conducted on undergraduate students. We used a stratified sampling technique to represent 26036 students from all grade levels and 11 faculties, and the survey was administered to 2349 undergraduate students. The prevalence of HAC was determined with the Alcohol Use Disorders Identification Test (AUDIT). HAC was defined as getting 8 points or more from the AUDIT. Multivariate logistic regression analyses were performed to examine HAC related factors in both genders.

RESULTS

In this study, 53.2% of the participants were male. The prevalence of HAC in the study group was 13.5% and prevalence of lifetime drinker was 65.3%. In males; those whose fathers [OR = 1.72; 95% CI: (1.17-2.52)], mothers [1.49; (1.02-2.18)], close friends [2.42; (1.28-4.60)] drink alcohol and smoking [3.16; (2.09- 4.77)], use illicit substance [2.35; (1.66-3.34)], have mental health problems [1.65; (1.04-2.62)] were more likely to report HAC. Meanwhile in females, those whose fathers [OR = 1.92; 95%CI: (1.03-3.57)], close friends [5.81; (1.73-19.45)] drink alcohol and smoking [4.33; (2.31-8.15)], use illicit substance [4.34; (2.34-8.06)] have mental health problems [3.01; (1.67-5.43)] were more likely to report HAC.

CONCLUSIONS

HAC prevalence is high among university students. The risk of HAC increases with the use of alcohol in family and circle of friends, smoking, illicit substance use and mental health problems. The factors associated with the risk of HAC in both genders are similar.

Comparison of NAFLD, MAFLD, and MASLD Prevalence and Clinical Characteristics in Asia Adults

Background/Aims

The principal limitations of the term non-alcoholic fatty liver disease (NAFLD) are the reliance on exclusionary confounder terms and the use of potentially stigmatizing language. Within three years, NAFLD went through two name changes, from NAFLD to metabolic-dysfunction-associated fatty liver disease (MAFLD) to metabolic dysfunction-associated steatotic liver disease (MASLD). However, there is no Asian consensus statement on the renaming of MASLD, and evidence on the epidemiology and characteristics in the Asia population under different diagnostic criteria remain limited. This study aimed to fill these gaps by analyzing the prevalence and characteristics of MASLD, NAFLD, and MAFLD in an Asian population.

Methods

A retrospective, cross-sectional study was conducted in regional China with participants from the health management database in 2017-2022. Demographic and laboratory metabolic profile and body composition data were obtained. Hepatic steatosis were diagnosed by ultrasound. The likelihood of having fibrosis was assessed using the NAFLD fibrosis score (NFS). Recently proposed criteria for metabolic dysfunction-associated steatotic liver disease (MASLD) were applied.

Results

A total of 20,226 subjects were included for final analysis. 7465 (36.91%) participants were categorized as MASLD patients, 10,726 (53.03%) participants were MAFLD, and 7333 (36.26%) participants were NAFLD. Compared with MAFLD, body composition of MASLD and NAFLD patients were obviously different. MASLD patients were older, had a higher body mass index and percentage of male gender, and had a higher ALT, diastolic blood pressure, triglyceride, and waist circumference but lower High-Density Lipoprotein Cholesterol (HDL-C) than non-MASLD patients. Using binary regression analysis, we found for the first time that putative bone mass (OR = 4.62, 95CI% 3.12-6.83) is associated with the risk of developing MASLD. The area under the receiver operating curve (AUC) for predicting cardiovascular outcomes (CV) was 0.644 for MAFLD and 0.701 for MASLD.

Conclusion

MASLD (36.91%) prevalence was closed to NAFLD (36.26%) and lower than MAFLD (53.03%). Presumed bone mass might be the predictor of disease progression in MASLD patients. MASLD better identifies patients likely to have a higher risk of metabolic disorders or CV events.

Drink like a man? Modified Poisson analysis of adolescent binge drinking in the US, 1976-2022

This study estimates temporal trajectories and sociodemographic disparities in underage adolescent binge drinking in the United States over the past four decades. By compiling 47 waves of national representative data from the Monitoring the Future (MTF) study between 1976 and 2022, we analyzed two types of adolescent binge drinking behaviors, past-two-week excessive drinking and drunkenness in the past 30 days, using the innovative modified Poisson (mixture) approach to grouped and right-censored counts (GRC). The overall decrease in incidence rates was attributable to substantial reductions in the risks of excessive drinking (45.77% in 1980 and 12.62% in 2022) and drunkenness (35.12% in 1998 and 14.81% in 2022). However, at-risk adolescents only showed mild reductions in incidence rates over time. While males consistently drank more often and were at a higher risk of binge drinking and drunkenness than females, the sex disparities tended to converge over time. The modified Poisson approach is a useful tool to estimate incidence, risk, and at-risk incidence in epidemiological studies with GRC counts. The alarming high incidence rates of at-risk adolescents, especially males, warrant further investigation.

Alcohol use disorder, cannabis use disorder, and eating disorder symptoms among male and female college students

BACKGROUND AND OBJECTIVES

Eating disorders (EDs) and substance use disorders are prevalent among college students in the United States, with underlying common mechanisms suggesting co-occurrence of these in the student population. As treatment prognosis of EDs improves when they are identified and treated with early intervention, it is essential to understand which substance use behaviors associate with EDs in students.

METHODS

Using a sample of 471 college students recruited for a study on high risk drinking (i.e., students needed to pregame regularly to be included), we explored the associations between ED symptomatology and two common substances used in this population: alcohol and cannabis. As most research on EDs focuses on female students only or does not separate out males and females, we examined whether sex assigned at birth moderated the association between ED symptomatology and substance use outcomes.

RESULTS

About one-third (32.4%) of the sample screened positive for an ED, with females significantly more likely to screen positive. Males were significantly more likely to screen positive for an alcohol or cannabis use disorder. Screening positive for an ED associated with cannabis use frequency and cannabis use disorder symptoms, but not with alcohol outcomes. Sex moderated the association between ED and cannabis use disorder symptoms, with positive ED screen male students experiencing the highest cannabis use disorder symptoms.

DISCUSSION AND CONCLUSIONS

It is necessary to further assess how sex differences in substance use and ED symptomatology inform each other.

SCIENTIFIC SIGNIFICANCE

Findings underscore the need to assess and screen for cannabis use disorder among students who screen positive for an ED, and, more specifically, with focused attention on male students with ED symptoms.

Rapid nongenomic estrogen signaling controls alcohol drinking behavior in mice

Ovarian-derived estrogen can signal non-canonically at membrane-associated receptors in the brain to rapidly regulate neuronal function. Early alcohol drinking confers greater risk for alcohol use disorder in women than men, and binge alcohol drinking is correlated with high estrogen levels, but a causal role for estrogen in driving alcohol drinking has not been established. We found that female mice displayed greater binge alcohol drinking and reduced avoidance when estrogen was high during the estrous cycle than when it was low. The pro-drinking, but not anxiolytic, effect of high endogenous estrogen occurred via rapid signaling at membrane-associated estrogen receptor alpha in the bed nucleus of the stria terminalis, which promoted synaptic excitation of corticotropin-releasing factor neurons and facilitated their activity during alcohol drinking. Thus, this study demonstrates a rapid, nongenomic signaling mechanism for ovarian-derived estrogen in the brain controlling behavior in gonadally intact females.

Trends in Incidence of Invasive Lobular Carcinoma of the Breast by Race: Patterns by Age, Cancer Stage, and Socioeconomic Factors in the United States, 1992-2019

PURPOSE

There is scarce literature about the role of race/ethnicity and socioeconomic status on the incidence of invasive lobular carcinoma (ILC). We sought to assess trends in ILC incidence by race/ethnicity across age, cancer stage, and socioeconomic status subgroups in the United States from 1992 to 2019.

METHODS

This population-based cross-sectional study included data from SEER12 registries. We used the NCI's Join point Regression Program to estimate longitudinal trends in age-adjusted breast cancer incidence rates from 1992 to 2019, reported as average annual percent change (AAPC) or annual percent change (APC). We evaluated incidence trends by a combination of race/ethnicity and stage, county-level poverty, county-level metro/nonmetro status, high school education, and age.

RESULTS

From 1992 to 2019, ILC incidence rates increased across all race/ethnicity groups, with the greatest increase in non Hispanic Black (AAPC 2.6%), followed by Hispanic (AAPC 2.2%), and non Hispanic White women (AAPC 1.6%). The stronger increase in ILC incidence among Hispanic and non Hispanic Black women was predominantly seen among those living in low poverty or metropolitan areas and those older than 70. In recent years, from 2002 to 2019, the largest increase in ILC incidence was found in Hispanic women (APC 3.3%).

CONCLUSION

Although the incidence of ILC continues to be highest in non Hispanic White women, in recent years the largest increases are seen in non Hispanic Black women and Hispanic women. Further research is warranted to better understand these trends and appropriately target at-risk populations for screening.

Potentially traumatic events and the association with hazardous alcohol use in 19,128 middle aged and elderly adults: the Tromsø Study 2015-2016

PURPOSE

The aim was to examine the association between a wide range of potentially traumatic events (PTEs) experienced in childhood, adulthood or both, and hazardous alcohol use, including the relationship between the total sum of PTEs and hazardous alcohol use in middle aged and elderly adults. Previous studies have predominantly focused on childhood PTEs or isolated PTEs and more severe alcohol problems, little focus has been given to middle aged and elderly adults with hazardous alcohol use and PTE experiences.

METHODS

We used logistic regression analysis to study the relation between a broad range of PTEs and hazardous alcohol defined by the alcohol use disorder identification test (AUDIT) in 19,128 women and men aged 40 years and above participating in the seventh survey of the Norwegian population-based Tromsø Study in 2015-2016. Alcohol abstainers were excluded from the analyses.

RESULTS

Experience of violence, sexual abuse, bullying, painful or frightening medical and dental treatments, and serious illness or accident by a loved one were associated with higher odds for hazardous alcohol use. Further, there were higher odds of hazardous alcohol use per additional experienced PTE (OR = 1.22, 95% CI 1.20-1.25, p ≤ 0.001).

CONCLUSION

PTEs were prevalent among participants who had a hazardous alcohol use. Also, most of the PTEs occurring in childhood, adulthood or both were independently related to hazardous alcohol use. Moreover, the findings indicate an association in the relationship between the number of PTEs and hazardous alcohol use.

Expectancies for Alcohol Analgesia Among Emerging Adults: Confirmatory Factor Analysis, Reliability, and Validity

BACKGROUND

Alcohol and pain frequently co-occur and interact in a positive feedback loop that maintains and exacerbates both conditions. The Expectancies for Alcohol Analgesia (EAA) is a recently developed, single-factor measure that assesses the extent to which individuals expect alcohol will reduce their pain. Alcohol-related outcome expectancies motivate drinking and predict drinking trajectories among emerging adults (18-24). The EAA was initially validated among adults with chronic pain who drink alcohol and has been associated with several indices of pain and alcohol. We are unaware of prior work that examined the psychometric properties of the EAA among emerging adults, who are at high-risk for developing positive expectancies regarding the utility of alcohol for pain management.

OBJECTIVES

The goal of this study was to examine the factor structure, reliability, and validity of the EAA among emerging adult college students.

METHODS

Emerging adult college students who endorsed lifetime alcohol use and varying pain levels (N = 555, 74.4% Female, 75.2% White) completed an online survey of pain and alcohol use.

RESULTS

Confirmatory factor analysis indicated the single-factor structure was a good fit (CFI = 0.99, TLI = 0.99, SRMR = 0.01, RMSEA = 0.04). Internal consistency was excellent (α = .95), and EAA scores were positively associated with alcohol consumption, alcohol-related consequences, drinking motives, and pain intensity and disability (ps < .01).

CONCLUSION

These findings suggest the EAA is a valid and reliable measure for assessing expectancies for alcohol analgesia among emerging adult college students, which may also be a promising intervention target to include in expectancy challenge interventions.

Molecular Mechanisms of Fibrosis in Cholestatic Liver Diseases and Regenerative Medicine-Based Therapies

The aim of this review is to explore the potential of new regenerative medicine approaches in the treatment of cholestatic liver fibrosis. Cholestatic liver diseases, such as primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and biliary atresia (BA), due to the accumulation of bile, often progress to liver fibrosis, cirrhosis, and liver failure. When the disease becomes severe enough to require liver transplantation. Deeply understanding the disease's progression and fibrosis formation is crucial for better diagnosis and treatment. Current liver fibrosis treatments mainly target the root causes and no direct treatment method in fibrosis itself. Recent advances in regenerative medicine offer a potential approach that may help find the ways to target fibrosis directly, offering hope for improved outcomes. We also summarize, analyze, and discuss the current state and benefits of regenerative medicine therapies such as mesenchymal stem cell (MSC) therapy, induced pluripotent stem cells (iPSCs), and organoid technology, which may help the treatment of cholestatic liver diseases. Focusing on the latest research may reveal new targets and enhance therapeutic efficacy, potentially leading to more effective management and even curative strategies for cholestatic liver diseases.

Alcohol Use Disorder Polygenic Score Compared With Family History and ADH1B

Importance

Identification of individuals at high risk of alcohol use disorder (AUD) and subsequent application of prevention and intervention programs has been reported to decrease the incidence of AUD. The polygenic score (PGS), which measures an individual's genetic liability to a disease, can potentially be used to evaluate AUD risk.

Objective

To assess the estimability and generalizability of the PGS, compared with family history and ADH1B, in evaluating the risk of AUD among populations of European ancestry.

Design, Setting, and Participants

This genetic association study was conducted between October 1, 2023, and May 21, 2024. A 2-stage design was used. First, the pruning and thresholding method was used to calculate PGSs in the screening stage. Second, the estimability and generalizability of the best PGS was determined using 2 independent samples in the testing stage. Three cohorts ascertained to study AUD were used in the screening stage: the Collaborative Study on the Genetics of Alcoholism (COGA), the Study of Addiction: Genetics and Environment (SAGE), and the Australian Twin-Family Study of Alcohol Use Disorder (OZALC). The All of Us Research Program (AOU), which comprises participants with diverse backgrounds and conditions, and the Indiana Biobank (IB), consisting of Indiana University Health system patients, were used to test the best PGS. For the COGA, SAGE, and OZALC cohorts, cases with AUD were determined using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) or Fifth Edition (DSM-5) criteria; controls did not meet any criteria or did not have any other substance use disorders. For the AOU and IB cohorts, cases with AUD were identified using International Classification of Diseases, Ninth Revision (ICD-9) or International Classification of Diseases, Tenth Revision (ICD-10) codes; controls were aged 21 years or older and did not have AUD.

Exposure

The PGS was calculated using single-nucleotide variants with concordant effects in 3 large-scale genome-wide association studies of AUD-related phenotypes.

Main Outcomes and Measures

The main outcome was AUD determined with DSM-IV or DSM-5 criteria and ICD-9 or ICD-10 codes. Generalized linear mixed models and logistic regression models were used to analyze related and unrelated samples, respectively.

Results

The COGA, SAGE, and OZALC cohorts included a total of 8799 samples (6323 cases and 2476 controls; 50.6% were men). The AOU cohort had a total of 116 064 samples (5660 cases and 110 404 controls; 60.4% were women). The IB cohort had 6373 samples (936 cases and 5437 controls; 54.9% were women). The 5% of samples with the highest PGS in the AOU and IB cohorts were approximately 2 times more likely to develop AUD (odds ratio [OR], 1.96 [95% CI, 1.78-2.16]; P = 4.10 × 10-43; and OR, 2.07 [95% CI, 1.59-2.71]; P = 9.15 × 10-8, respectively) compared with the remaining 95% of samples; these ORs were comparable to family history of AUD. For the 5% of samples with the lowest PGS in the AOU and IB cohorts, the risk of AUD development was approximately half (OR, 0.53 [95% CI, 0.45-0.62]; P = 6.98 × 10-15; and OR, 0.57 [95% CI, 0.39-0.84]; P = 4.88 × 10-3) compared with the remaining 95% of samples; these ORs were comparable to the protective effect of ADH1B. PGS had similar estimabilities in male and female individuals.

Conclusions and Relevance

In this study of AUD risk among populations of European ancestry, PGSs were calculated using concordant single-nucleotide variants and the best PGS was tested in targeted datasets. The findings suggest that the PGS may potentially be used to evaluate AUD risk. More datasets with similar AUD prevalence as in general populations are needed to further test the generalizability of PGS.

Corticotropin releasing hormone receptor 1 in the medial prefrontal cortex mediates aversion resistant alcohol intake

RATIONALE

Alcohol consumption despite negative consequences is a core symptom of Alcohol Use Disorder. In animal models, this is studied by pairing aversive stimuli with alcohol access, and continuation of drinking under these conditions is known as aversion resistance. Previously, we found that female mice are more aversion resistant than males. Corticotropin releasing hormone (Crh) and the Crh receptor 1 (Crhr1) regulate stress-induced reinstatement, alcohol dependence, and binge-like drinking. However, the role of the Crh system in aversion resistance has not been assessed.

OBJECTIVES

We aimed to identify sex differences in the Crh system during quinine-adulterated alcohol intake.

METHODS

We used two-bottle choice and adulterated the alcohol solution with quinine. Next, we measured Crh and Crhr1 levels in brain tissue using real-time polymerase chain reaction (RT-qPCR) and RNAscope in situ hybridization. We then infused a Crhr1 antagonist into the medial prefrontal cortex (mPFC) prior to quinine-alcohol intake.

RESULTS

After quinine-alcohol consumption, females exhibited increased mPFC Crhr1 mRNA levels as measured by RT-qPCR. This was confirmed with greater anatomical specificity using RNAscope, with females exhibiting an increased number of Crhr1 + cells in the dorsomedial PFC and the ventromedial PFC. mPFC Crhr1 antagonist treatment reduced quinine-alcohol consumption in females but did not impact consumption in males. Quinine-free alcohol intake was unaffected by Crhr1 antagonist treatment.

CONCLUSIONS

Our findings suggest that Crhr1 in mPFC plays a role in aversion resistant alcohol intake in females. Future experiments will examine the sources of Crh innervation to the mPFC and their distinct roles in alcohol seeking.

Does self-affirmation augment the effects of a mandated personalized feedback intervention? A randomized controlled trial with heavy drinking college students

OBJECTIVE

Theory and evidence indicate that affirming the value of the self before exposure to a threatening message fosters more open-minded appraisal of message content. We predicted that college students mandated to a computer-delivered personalized feedback intervention (PFI) and who engaged in a self-affirmation (SA) exercise would demonstrate reduce drinking and consequences relative to those who received an attention control.

METHOD

Participants were 484 undergraduates (age 18-24, 56% male, 78% White) mandated to participate in an alcohol intervention following a first-time alcohol policy violation. After a baseline assessment, each was randomized to SA (n = 256) or attention control (n = 227) prior to a computer-delivered PFI intervention. Posttest measures included an affirmation manipulation check; primary outcomes (past month weekly quantity, peak drinks, binge frequency, consequences) were assessed at 1-, 3-, 6-, 9-, and 12-month follow-ups. We used latent growth curve modeling to test study hypotheses.

RESULTS

The SA exercise increased positive self-evaluation at posttest (p < .001). Overall reductions in drinking and consequences were observed at early follow-up (all p < .05), but the SA manipulation was not associated with intercept or slope factor differences in the models. Engaging in assessments during COVID restrictions was generally associated with reduced drinking and consequences.

CONCLUSIONS

The SA exercise did not differentially affect trajectories of alcohol use and consequences, despite evidence that the exercise had the predicted effect on participant's self-evaluations. The lack of SA effects could be attributed to a nonthreatening PFI intervention that is generally accepted among mandated students. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Forecasting Alcohol-Related Liver Disease Mortality Trends in Younger Populations Using Advanced Time-Series Models: A 1999-2030 Analysis

Objective

Alcohol-related liver disease (ALD) has emerged as a significant public health concern, particularly among younger populations. ALD remains the leading cause of alcohol-attributable deaths. This study aims to forecast ALD mortality trends up to 2030, focusing on individuals under 55 years.

Methods

We utilized data from the CDC WONDER database (1999-2022) to examine ALD-related deaths, identified by ICD-10 codes (K70.0-K70.9). Crude mortality rates (CMRs) per 100 000 were analyzed and temporal trends were assessed using annual and average annual percent changes (APC/AAPC) with empirical quantile confidence intervals. An Autoregressive Integrated Moving Average (ARIMA) model was employed to project mortality rates until 2030, validated through time series cross-validation.

Results

From 1999 to 2022, there were 181 862 ALD-related deaths among individuals under 55, with mortality rates increasing from 3.9 per 100 000 in 1999 to 9.7 per 100 000 in 2022 (AAPC 4.66%, 95% CI: 3.90%-5.86%). Projections suggest rates will continue to rise, reaching 14.4 per 100 000 by 2030. From 1999 to 2022, the 25-34 age group experienced the highest increase, with an AAPC of 10.27% (95% CI: 9.19%-11.35%), while the 35-44 and 45-54 age groups showed more moderate increases, with AAPCs of 5.03% and 4.38%, respectively. Projections indicate an AAPC of 3.86% for ages 25-34, 3.90% for ages 35-44, and 6.17% for ages 45-54 by 2030.

Conclusion

Forecasts indicate a continued rise in ALD mortality among individuals under 55, necessitating immediate public health strategies to mitigate this trend.

Sex differences in clinically diagnosed psychiatric disorders over the lifespan: a nationwide register-based study in Sweden

Background

Limited studies exist on sex differences in incidence rates of psychiatric disorders across the lifespan. This study aims to analyze sex differences in the incidence rates of clinically diagnosed psychiatric disorders over the lifespan.

Methods

We conducted a nationwide register-based cohort study, including all individuals who were born in Sweden and lived in Sweden between 2003 and 2019, including 4,818,071 females and 4,837,829 males. We calculated sex- and age-specific standardized incidence rates for any and 10 major types of psychiatric disorders. Multivariable-adjusted incidence rate differences (IRDs) for diagnosed psychiatric disorders between females and males were estimated.

Findings

During a follow-up of 119,420,908 person-years, males showed a higher incidence rate of any diagnosed psychiatric disorder than females at age 5-9 (IRD = -8.93; 95% CI: -9.08 to -8.79; per 1000 person-years), whereas females showed a higher rate than males at age 15-19 (IRD = 9.33; 95% CI: 9.12-9.54) and onwards (except age 60-69). Specifically, among females, excess rates were apparent for depressive, anxiety, eating, stress-related and bipolar disorders at age 10-54, whereas among males, excess rates were pronounced for autism and attention deficit hyperactivity disorders before age 14, drug use disorders at age 15-54, and alcohol use disorders in adulthood. For schizophrenia, the male excess at age 15-49 shifted to female excess at age 60-79. The magnitude of IRDs were greater in recent years and individuals with lower socioeconomic status.

Interpretation

Knowledge about the lifespan and socioeconomic variations in the sex differences in rates of diagnosed psychiatric disorders may inform targeted screening/intervention strategies.

Funding

Vetenskapsrådet, FORTE, Karolinska Institutet Strategic Research Area in Epidemiology and Biostatistics, and Icelandic Research Fund.

Alcohol, flexible behavior, and the prefrontal cortex: Functional changes underlying impaired cognitive flexibility

Cognitive flexibility enables individuals to alter their behavior in response to changing environmental demands, facilitating optimal behavior in a dynamic world. The inability to do this, called behavioral inflexibility, is a pervasive behavioral phenotype in alcohol use disorder (AUD), driven by disruptions in cognitive flexibility. Research has repeatedly shown that behavioral inflexibility not only results from alcohol exposure across species but can itself be predictive of future drinking. Like many high-level executive functions, flexible behavior requires healthy functioning of the prefrontal cortex (PFC). The scope of this review addresses two primary themes: first, we outline tasks that have been used to investigate flexibility in the context of AUD or AUD models. We characterize these based on the task features and underlying cognitive processes that differentiate them from one another. We highlight the neural basis of flexibility measures, focusing on the PFC, and how acute or chronic alcohol in humans and non-human animal models impacts flexibility. Second, we consolidate findings on the molecular, physiological and functional changes in the PFC elicited by alcohol, that may contribute to cognitive flexibility deficits seen in AUD. Collectively, this approach identifies several key avenues for future research that will facilitate effective treatments to promote flexible behavior in the context of AUD, to reduce the risk of alcohol related harm, and to improve outcomes following AUD. This article is part of the Special Issue on "PFC circuit function in psychiatric disease and relevant models".

Development of Comorbid Alcohol Use and Depressive Symptoms During Late Adolescence: Examining the Roles of Emotion Regulation and Gender Differences

Depression and alcohol use are highly comorbid, and often emerge during adolescence. Depressive symptoms may precede alcohol use, via the self-medication pathway, or alcohol use may precede depressive symptoms, via the alcohol induced disruption pathway. Yet little is known about other risks for developing comorbidity via either path. The present study hypothesized that poor cognitive and physiological emotion regulation (ER) are risk factors implicated in the development of comorbid depression and alcohol use during late adolescence. Participants were 229 (113 girls) Mexican-origin youth who reported on depressive symptoms and alcohol use at ages 17 (Time 1) and 19 years (Time 2). At age 17, cognitive reappraisal (CR), an adaptive ER strategy, and baseline respiratory sinus arrhythmia (RSA), a physiological index of ER capacity, were assessed. CR, RSA and gender were examined as predictors and moderators of the developing comorbidity of alcohol use and depression in cross-lagged panel models. Lower use of CR was concurrently associated with more depressive symptoms at age 17 and predicted greater depression at age 19. Age 17 alcohol use predicted age 19 depressive symptoms for boys. Lower RSA at age 17 also predicted more depressive symptoms at age 19 for boys. Neither CR nor RSA moderated the predicted relations between depression and alcohol use. Findings supported the alcohol induced disruption model of comorbidity for boys, and showed that poor cognitive and physiological ER increased risk for exacerbating depressive symptoms in late adolescence.