Birth cohort effects and gender differences in alcohol epidemiology: a review and synthesis

A century of sexual abuse victimisation: A birth cohort analysis

This study examined changes in the reported prevalence of adult and child sexual abuse over the last century and explored how changes in social and political circumstances may have affected rates. Data from two population-based face-to-face surveys conducted in New Zealand (samples of 2855 women in 2003 and 1464 women in 2019) were used to produce birth cohort prevalence estimates of three forms of sexual abuse including by an intimate partner (lifetime and 12-month), by non-partners, and child sexual abuse. A timeline of major population influences that might be associated with violence occurrence was developed. There were no changes in reported lifetime intimate partner sexual abuse prevalence estimates found over the past century. The most recent birth cohort reported the lowest rates of 12-month prevalence estimates for intimate partner sexual abuse, lifetime rates of non-partner sexual abuse, and also suggest lower reported rates of child sexual abuse. Macro-social events including feminist movements, changes in legislation, and an increase in public awareness might have contributed to women's awareness about the non-acceptability of violent behaviour, and their ability to leave relationships after violence has occurred. This may have contributed to the small recent decreases in reported 12-month rate of sexual IPV and CSA, as women's ability to leave relationships may be protective for their children. The recent decrease in reported non-partner sexual violence may also be attributed to women's greater awareness of, and agency to avoid sexual abuse. The lack of change for the lifetime prevalence of sexual IPV over the past century highlights the need for ongoing prevention efforts. While recent reductions in reported rates of child and adult sexual abuse are encouraging, even reduced rates are high and warrant sustained implementation of prevention policies and programs.

Associations of Binge Drinking With Vascular Brain Injury and Atrophy in Older American Indians: The Strong Heart Study

Objectives: American Indians (AIs) generally consume less alcohol than the US general population; however, the prevalence of alcohol use disorder is higher. This is the first large cohort study to examine binge drinking as a risk factor for vascular brain injury (VBI). Methods: We used linear and Poisson regression to examine the association of self-reported binge drinking with VBI, measured via magnetic resonance imaging (MRI), in 817 older AIs who participated in the Strong Heart and Cerebrovascular Disease and Its Consequences in American Indians studies. Results: Any binge drinking at multiple time-points was associated with increased sulcal (β = 0.360, 95% CI [0.079, 0.641]) and ventricle dilatation (β = 0.512, 95% CI [0.174, 0.850]) compared to no binge drinking. Discussion: These observed associations are consistent with previous findings. Identifying how binge drinking may contribute to VBI in older AIs may suggest modifiable health behaviors for neurological risk reduction and disease prevention.

Association between antipsychotic use and acute ischemic heart disease in women but not in men: a retrospective cohort study of over one million primary care patients

BACKGROUND

Research comparing sex differences in the effects of antipsychotic medications on acute ischemic heart disease (IHD) is limited and the findings ambiguous. This study aimed to investigate these associations within a primary care setting.

METHODS

Hong Kong public general outpatient electronic records of patients aged 45+ during 2007-2010 were extracted, with the last consultation date as the baseline for a 4-year follow-up period to observe acute IHD hospitalizations (2011-2014). Antipsychotic use was defined as any prescription over the previous 12 months from a list of 16 antipsychotics, while acute IHD was defined by ICD-9: 410.00-411.89. Both sex-specific and sex-combined (both sexes) mixed-effects Cox models (random intercept across 74 clinics) were implemented to examine the association and test the interaction between antipsychotics and sex.

RESULTS

Among 1,043,236 included patients, 17,780 (1.7%) were prescribed antipsychotics, and 8342 (0.8%) developed IHD. In sex-specific analyses, antipsychotic prescription was associated with a 32% increased hazard rate of acute IHD among women (95% CI 1.05-1.67) but not among men. A likelihood ratio test comparing sex-combined models with and without the interaction between antipsychotic use and sex suggested significant interaction (χ² = 4.72, P = 0.030). The association between antipsychotic use and IHD among women attenuated and became non-significant when haloperidol was omitted from the operationalization of antipsychotic use (HR = 1.23, 95% CI 0.95-1.60).

CONCLUSION

Our results suggest that antipsychotic prescription is moderately associated with an increased risk of acute IHD among women in primary care and this relationship may be explained by specific antipsychotics. Further research should observe and capture the potential intermediary mechanisms and the dose-response relationship of this association to provide more rigorous evidence to establish causality and inform clinical practices.

Outcomes of Pregnant Women With Cirrhosis and Their Infants in a Population-Based Study

BACKGROUND & AIMS

The incidence of cirrhosis is increasing among women of childbearing age. Contemporary outcomes of pregnant women with cirrhosis and their infants, as well as liver-related complications, have not been described in North America, to our knowledge. We investigated the association between cirrhosis and perinatal outcomes and evaluated perinatal liver-related events.

METHODS

We performed a retrospective cohort study using population-based administrative health care data from Ontario, Canada (2000-2017). We identified pregnant women with compensated cirrhosis (n = 2022) using validated case definitions and routine mother-infant linkage; the women were matched to 10,110 pregnant women in the general population (1:5) based on birth year and socioeconomic status. Maternal and infant outcomes up to 6 weeks postpartum and liver-related complications up to 1 year postpartum were evaluated by using multivariate log-binomial regression.

RESULTS

After we adjusted for demographic and metabolic risk factors, cirrhosis was independently associated with intrahepatic cholestasis of pregnancy (relative risk [RR], 10.64; 95% confidence interval [CI], 7.49-15.12), induction of labor (RR, 1.15; 95% CI, 1.03-1.28), puerperal infections (RR, 1.32; 95% CI, 1.02-1.70), preterm birth (RR, 1.60; 95% CI, 1.35-1.89), infants who were large for gestational age (RR, 1.24; 95% CI, 1.05-1.46), and neonatal respiratory distress (RR, 1.20; 95% CI, 1.02-1.42). Fewer than 2% of pregnant women with cirrhosis had liver-related complications, but these occurred in a significantly higher proportion of women with a history of hepatic decompensation (13%) than women with compensated cirrhosis (1.2%) (P < .001).

CONCLUSIONS

In a population-based study, we found that cirrhosis is an independent risk factor for adverse perinatal outcomes. However, liver-related complications are rare. Multidisciplinary teams are needed to coordinate care for pregnant women with cirrhosis during pregnancy and postpartum to optimize outcomes.

'As Long as It Comes off as a Cigarette Ad, Not a Civil Rights Message': Gender, Inequality and the Commercial Determinants of Health

Scholarship on the commercial determinants of health (CDoH) has sought to understand the multiple ways corporate policies, practices and products affect population health. At the same time, gender is recognised as a key determinant of health and an important axis of health inequalities. To date, there has been limited attention paid to the ways in which the CDoH engage with and impact on gender inequalities and health. This review seeks to address this gap by examining evidence on the practices and strategies of two industries-tobacco and alcohol-and their interaction with gender, with a particular focus on women. We first describe the practices by which these industries engage with women in their marketing and corporate social responsibility activities, reinforcing problematic gender norms and stereotypes that harm women and girls. We then examine how tobacco and alcohol companies contribute to gender inequalities through a range of strategies intended to protect their market freedoms and privileged position in society. By reinforcing gender inequalities at multiple levels, CDoH undermine the health of women and girls and exacerbate global health inequalities.

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

Over the past century, differences in alcohol use and related harms between males and females in the United States have diminished considerably. In general, males still consume more alcohol and experience and cause more alcohol-related injuries and deaths than females do, but the gaps are narrowing. Among adolescents and emerging adults, gaps in drinking have narrowed primarily because alcohol use among males has declined more than alcohol use among females. Among adults, alcohol use is increasing for women but not for men. Rates of alcohol-related emergency department visits, hospitalizations, and deaths all have increased among adults during the past two decades. Consistent with the changing patterns of alcohol use, increases in these outcomes have been larger for women. Recent studies also suggest that females are more susceptible than males to alcohol-induced liver inflammation, cardiovascular disease, memory blackouts, hangovers, and certain cancers. Prevention strategies that address the increases in alcohol consumption and unique health risks for women are needed.

Cross-country and historical variation in alcohol consumption among older men and women: Leveraging recently harmonized survey data in 21 countries

BACKGROUND

Alcohol consumption causes greater harm in older than younger adults. As the population ages, understanding cross-country and time-varying drinking patterns of older adults is of critical importance. Available evidence relies primarily on ecological data.

METHODS

We harmonized survey data for 179,881 adults age 50+ observed repeatedly between 1998 and 2016 in 21 countries. Next, we estimated historical variation in consumption across countries (overall and stratified by gender and age group 50-64/65+).

RESULTS

On average, 51.95 % of older adults consumed any alcohol over the observed period. For 13 countries, the proportion of older adults who drink increased (mean annual increase: 0.76 percent points). Heavy drinking (men drinks/day>3 or binge>5, women drinks/day>2 or binge>4) peaked at 23.54 % for England in 2010 and lifetime abstainers at 69.65 % for China in 2011. Across countries and among drinkers, consumption frequency was 2.57 days/week, the number of standard drink units when drinking was 2.57, and the average number of drinks/day over a week was 1.12. Consumption patterns varied substantially across countries and historical time. Overall probability and frequency of consumption were higher in men than women, with the largest gaps observed in 2011 for China, but gender gaps decreased (even reversed) in the young old and varied across country and time.

CONCLUSIONS

Wide variation in older adults' alcohol consumption across countries and time suggests that broad scale prevention and intervention efforts can be harnessed for potential population-level health benefits. Further variation by gender and age reflect physiological and social factors simultaneously shaping alcohol consumption.

The Neurophysiology of Implicit Alcohol Associations in Recently Abstinent Patients With Alcohol Use Disorder: An Event-Related Potential Study Considering Gender Effects

BACKGROUND

Neuroscientific models of alcohol use disorders (AUDs) postulate an imbalance between automatic, implicit, and controlled (conscious) processes. Implicit associations towards alcohol indicate the automatically attributed appeal of alcohol-related stimuli. First, behavioral studies indicate that negative alcohol associations are less pronounced in patients compared to controls, but potential neurophysiological differences remain unexplored. This study investigates neurophysiological correlates of implicit alcohol associations in recently abstinent patients with AUD for the first time, including possible gender effects.

METHODS

A total of 62 patients (40 males and 22 females) and 21 controls performed an alcohol valence Implicit Association Test, combining alcohol-related pictures with positive (incongruent condition) or negative (congruent condition) words, while brain activity was recorded using 64-channel electroencephalography. Event-related potentials (ERPs) for alcohol-negative and alcohol-positive trials were computed. Microstate analyses investigated the effects of group (patients, controls) and condition (incongruent, congruent); furthermore, possible gender effects in patients were analyzed. Significant effects were localized with standardized low-resolution brain electromagnetic topography analysis.

RESULTS

Although no behavioral group differences were found, ERPs of patients and controls were characterized by distinct microstates from 320 ms onwards. ERPs between conditions differed only in patients with higher signal strength during incongruent trials. Around 600 ms, controls displayed higher signal strength than patients. A gender effect mirrored this pattern with enhanced signal strength in females as opposed to male patients. Around 690 ms, a group-by-valence interaction indicated enhanced signal strength in congruent compared to incongruent trials, which was more pronounced in controls.

CONCLUSIONS

For patients with AUD, the pattern, timing, and source localization of effects suggest greater effort regarding semantic and self-relevant integration around 400 ms during incongruent trials and attenuated emotional processing during the late positive potential timeframe. Interestingly, this emotional attenuation seemed reduced in female patients, thus corroborating the importance of gender-sensitive research and potential treatment of AUD.

Changes over time in young adults' harmful alcohol consumption: A cross-temporal meta-analysis using the AUDIT

BACKGROUND

Recent studies suggest that young adult participation in, and volume of, alcohol consumption has decreased. However, the evidence on trends in harmful alcohol consumption in this age group is limited. The current paper aims to examine changes over time in harmful alcohol consumption using a robust, widely employed measure.

METHODS

The literature was systematically searched for articles reporting on Alcohol Use Disorders Identification Test (AUDIT) scores in young adults aged 18-24 years. The key data extracted were year of measurement and mean AUDIT score (proportion above clinical cut-off was not relevant for these analyses). Cross-temporal meta-analysis was applied to the extracted data.

RESULTS

A decrease was found in young adults' AUDIT scores measured between 1989 and 2015 (b=-0.13, β=-0.38, p = 0.015, 95 % CI=-0.24, -0.03), representing a 0.63 standard deviation change over this period. Variance did not change over this time, suggesting scores decreased equally over the distribution.

CONCLUSIONS

Results indicate that harmful alcohol consumption in young adults may have declined between 1989 and 2015. Despite the continued problems posed by dependence and short and long-term harms, these promising findings offer hope that the considerable alcohol-related disease burden in this age group may be reduced. Ongoing data collection is required to evaluate whether these declines in young adulthood persist into later life, and future research should explore the reasons for declining harmful alcohol consumption in young adults.

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

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

Ageing and Alcohol: Drinking Typologies among Older Adults

Objectives: Alcohol consumption and harms among older people are increasing. We examined different demographic characteristics and drinking patterns among an older population. Methods: Secondary analyses of nationally representative Australian data; subjects aged 50+ years (N = 10,856). Two-step cluster analysis was performed to identify demographic groups and alcohol consumption behaviours. Results: Three groups were identified: Group 1 (older, unmarried, and lived alone): >65 years, moderate drinkers, poorest health, psychological distress, social disadvantage, smokers, illicit drug users, and more frequent previous alcohol treatment. Group 3 (older married): >65 years, good health, low psychological distress, less likely to drink at risky levels, and one in five drank daily. Group 2 (younger married): 50-64 years, mostly employed, highest proportion of risky drinkers and of 5+ standard drinks per session, and liberal drinking attitudes with most concern from others about their drinking. Discussion: These demographic typologies can inform targeted prevention efforts for an estimated 1.3 million adults older than 50 years drinking at risky levels.

Why are Spanish Adolescents Binge Drinkers? Focus Group with Adolescents and Parents

Binge drinking in adolescents is a worldwide public healthcare problem. The aim of this study was to explore the perceptions about determinants of binge drinking in Spanish adolescents from the perspective of adolescents and parents. A qualitative study using fourteen semi-structured focus groups of adolescents was conducted during the 2014/2015 school year (n = 94), and four with parents (n = 19), based on the I-Change Model for health behaviour acquisition. Students had a low level of knowledge and risk perception and limited self-efficacy. Girls reported more parental control, and when they get drunk, society perceives them worse. Adolescents suggested focus preventive actions to improve self-efficacy and self-esteem. Parents were permissive about alcohol drinking but rejected binge drinking. They offered alcohol to their children, mainly during celebrations. A permissive family environment, lack of control by parents, adolescents’ low-risk perception, low self-esteem and self-efficacy, as well as the increase of binge drinking in girls as part of the reduction of the gender gap, emerge as risk factors for binge drinking. Future health programmes aimed at reducing binge drinking should focus on enhancing motivational factors, self-esteem, and self-efficacy in adolescents; supervision and parental control; as well as pre-motivational factors by increasing knowledge and risk awareness, considering gender differences.

Alcohol, age at first sexual intercourse and number of sexual partners in young Mexican women

AIM

To identify the relationship between use of alcohol, number of sexual partners and age of sexual initiation.

METHOD

Descriptive-correlational study. A random sample of 319 young women (age 18-25) from Nuevo Laredo, Mexico was recruited. A sociodemographic data sheet and the AUDIT questionnaire were used. Non-parametric Spearman's rank correlation coefficient and Kruskal-Wallis H test were selected.

RESULTS

On average the participants were 20.70 years old (±2.1), had had 1.86 sexual partners (±1.27), started drinking alcohol at the age of 16.82 (±1.79), and their first sexual intercourse was at the age of 17.38 (±1.65). There was a decrease in the age of onset of alcohol use (H=16.646, p <.001) and the age at first sexual intercourse (H=26.749, P<.001) on the lower their current age. The overall AUDIT score negatively correlated with the age of the participants on their first sexual intercourse (rs=-.168, P<.001) and positively correlated with the number of sexual partners (rs=.243, P<.001). The aforementioned correlations were more intense among the younger participants (18- and 19-year olds; P<.01).

CONCLUSIONS

There was an association between higher use of alcohol, early age of sexual initiation and number of sexual partners. Nursing professionals may address such variables simultaneously through preventive strategies directed specifically at young women.

Gender differences in the effects of cannabidiol on ethanol binge drinking in mice

The purpose of this study was to explore the effects of cannabidiol (CBD) on binge drinking and evaluate potential gender-related differences. To this aim, male and female C57BL/6J mice (n = 60 per sex) were exposed to the drinking in the dark (DID) model for 4 weeks (DID-1 to DID-4). Dose-response effects of CBD on the ethanol intake were tested by acute (day-4 of DID-3) or repeated administration (day-1 to 4 of DID-4) (experiment 1: CBD 15, 30, and 60 mg/kg, i.p.; experiment 2: CBD 90 mg/kg, i.p.). Finally, we analyzed the relative gene expression of tyrosine hydroxylase (TH) and μ-opioid receptor (OPRM1) and cannabinoid CB1 receptor (CB₁ r) in the ventral tegmental area (VTA) and in the nucleus accumbens (NAc), respectively, by real-time quantitative PCR. Females exhibited higher ethanol intake during each DID session. Interestingly, females also showed higher expression of TH and OPRM1, without any difference in CB₁ r. Only the acute administration of CBD at the highest dose (90 mg/kg) reduced significantly ethanol consumption in both sexes. Chronic CBD administration (30, 60 and 90 mg/kg) reduced ethanol intake in males, whereas in females a significant reduction was only achieved with the highest dose (90 mg/kg). Repeated administration with CBD (60 mg/kg) significantly reduced TH and OPRM1 in males. In addition, CBD (30 and 60 mg/kg) significantly reduced CB₁ r in males. No effect was observed in females. Taken together, these findings suggest that CBD may be of interest for treating binge-drinking patterns and that gender-related difference may affect the treatment outcome.

Fetal Alcohol Spectrum Disorders in a Southeastern County of the United States: Child Characteristics and Maternal Risk Traits

OBJECTIVE

To detail the characteristic traits of children with fetal alcohol spectrum disorders (FASDs) and maternal risk factors in a southeastern U.S. County.

METHODS

Independent samples were drawn from 2 different cohorts of first-grade students. All consented children (49.8%) were measured for height, weight, and head circumference, and those ≤ 25th centile entered the study along with a random sample drawn from all enrolled students. Study children were examined for physical growth, dysmorphology, and neurobehavior, and their mothers were interviewed.

RESULTS

Total dysmorphology scores discriminated well the physical traits of children across the FASD continuum: fetal alcohol syndrome (FAS) = 15.8, partial FAS (PFAS) = 10.8, alcohol-related neurobehavioral disorder (ARND) = 5.2, and typically developing controls = 4.4. Additionally, a neurobehavioral battery distinguished children with each FASD diagnosis from controls. Behavioral problems qualified more children for FASD diagnoses than cognitive traits. Significant proximal maternal risk variables were as follows: reports of prepregnancy drinking, drinking in any trimester, and comorbid use of other drugs in lifetime and during pregnancy, especially alcohol and marijuana (14.9% among mothers of children with FASD vs. 0.4% for controls). Distal maternal risks included reports of other health problems (e.g., depression), living unmarried with a partner during pregnancy, and a lower level of spirituality. Controlling for other drug use during pregnancy, having a child diagnosed with a FASD was 17.5 times greater for women who reported usual consumption of 3 drinks per drinking day prior to pregnancy than for nondrinking mothers (p < 0.001, 95% CI = 5.1 to 59.9). There was no significant difference in the prevalence of FASD by race, Hispanic ethnicity, or socioeconomic status. The prevalence of FASD was not lower than 17.3 per 1,000, and weighted estimated prevalence was 49.0 per 1,000 or 4.9%.

CONCLUSION

This site had the second lowest rate in the CoFASP study, yet children with FASD are prevalent.

Fetal Alcohol Spectrum Disorders in a Rocky Mountain Region City: Child Characteristics, Maternal Risk Traits, and Prevalence

OBJECTIVE

To document prevalence and traits of children with fetal alcohol spectrum disorders (FASD) and maternal risk factors in a Rocky Mountain city.

METHODS

Variations on active case ascertainment methods were used in 2 first-grade cohorts in all city schools. The consent rate was 59.2%. Children were assessed for physical growth, dysmorphology, and neurobehavior and their mothers interviewed.

RESULTS

Thirty-eight children were diagnosed with FASD and compared with 278 typically developing controls. Total dysmorphology scores summarized well the key physical indicators of FASD and defined specific diagnostic groups. On average, children with FASD performed significantly poorer than controls on intellectual, adaptive, learning, attention, and behavioral tasks. More mothers of children with FASD reported drinking prior to pregnancy and in the first and second trimesters, and had partners with drinking problems than mothers of controls; however, reports of comorbid alcohol use and 6 other drugs were similar for mothers of children with FASD and mothers of controls. Mothers of children with FASD were significantly younger at pregnancy, had lower average weight before pregnancy and less education, initiated prenatal clinic visits later, and reported more health problems (e.g., stomach ulcers and accidents). Children with FASD had significantly lower birth weight and more problems at birth, and were less likely to be living with biological mother and father. Controlling for other drug and tobacco use, a FASD diagnosis is 6.7 times (OR = 6.720, 95% CI = 1.6 to 28.0) more likely among children of women reporting prepregnancy drinking of 3 drinks per drinking day (DDD) and 7.6 times (OR = 7.590, 95% CI = 2.0 to 31.5) more likely at 5 DDD. Prevalence of FAS was 2.9-5.8 per 1,000 children, and total FASD was 34.9 to 82.5 per 1,000 children or 3.5 to 8.3% at this site.

CONCLUSION

This site had the second highest prevalence of FASD of the 4 Collaboration on FASD Prevalence sites and clearly identifiable child and maternal risk traits.

Consequences of alcohol use, and its association with psychological distress, sensitivity to emotional contagion and age of onset of alcohol use, in Uruguayan youth with or without college degree

Psychological distress can promote alcohol consumption during emerging adulthood. Still unknown is, however, how predisposition to emotional contagion alters psychological distress, and how these phenomena are affected by level of education. The present study analyzed the effect of psychological distress, age of first contact with alcohol (early, late), and predisposition to emotional contagion on alcohol-induced negative consequences and on the volume of alcohol consumed during the last year. We also described alcohol-use behaviors as a function of sex, maximum level of education and age of first contact with alcohol, in 1505 youth from Uruguay (18-30 years). A survey measured alcohol use (Alcohol Use Disorders Identification Test and ad-hoc questionnaire), negative consequences of alcohol use [young adult alcohol consequences questionnaire (YAACQ)], psychological distress (Kessler scale) and proclivity to emotional contagion (Doherty Emotional contagion scale). The patterns of alcohol use were greater in men vs. women and in those featuring an early age of first alcohol use, yet similar in college and non-college graduates. Early drinkers had greater levels of psychological distress than late-onset drinkers. There was a significant bivariate and multiple correlation between psychological distress and the number of negative consequences of alcohol experienced during the last year, which remained significant even after controlling for total volume of alcohol consumed. Significant associations emerged between YAACQ scores and frequency of heavy episodic or binge drinking, and between psychological distress and emotional contagion, but not between emotional contagion and any of the remaining variables. Psychological distress was not significantly correlated with heavy episodic or binge drinking. The study indicates that, during adolescence and youth, psychological distress is associated with experiencing negative consequences of alcohol consumption. The study also suggested that greater levels of psychological distress may underlie the facilitating effect of an early age of drinking onset upon alcohol drinking patterns.

Sex Differences in Neural Correlates of Inhibitory Control

This chapter reviews the current evidence for sex differences in neural function underlying inhibitory control. Specifically, the chapter focuses on sex differences in functional magnetic resonance imaging (fMRI) measures of brain engagement during response inhibition on stop signal and go/no-go tasks. Sex differences appear to exist in these measures, but the direction of effect depends on the population studied, the task used, and whether successful or unsuccessful inhibition is examined. For successful inhibition, healthy men typically show greater brain engagement in right frontal regions typically implicated in inhibitory control (e.g., inferior frontal gyrus and supplementary motor area) than women, especially when performing the stop signal task. However, in younger populations or when controlling for the effects of age, women tend to show greater brain engagement than men, especially when performing the go/no-go task. For unsuccessful inhibition, women tend to show greater brain engagement compared to men in the anterior cingulate cortex and thalamus. Taken together, findings suggest that sex differences in neural responses to response inhibition depend on the specific type of inhibition studied and on whether the inhibition is successful or unsuccessful. Men exhibit greater response during successful inhibition, whereas women consistently display greater neural responses during unsuccessful inhibition. The chapter highlights limitations and gaps in this research to date, including a lack of consideration of the role of sex hormones and menstrual cycle phase, and suggests future directions for this line of research.

Fact or artefact? Childhood adversity and adulthood trauma in the U.S. population-based Health and Retirement Study

Background: Despite the well-known deleterious health effects of childhood adversity (CA) and adulthood trauma (AT) and ageing of the global population, little is known about self-reported CA and AT in older populations. Existing findings are mixed due to methodological and sampling artefacts, in particular, recall and selection biases, and due to age-period-cohort effects. Objectives: We aim to first, provide data on the prevalence of retrospective self-reported CA and AT in a large population-based sample of older adults and, second, to discuss the data in the context of major methodological and sampling artefacts, and age-period-cohort effects. Method: Data are derived from the U.S. population-based Health and Retirement Study (N = 19,547, mean age = 67.24 ± 11.33, 59% female). Seven birth-cohorts were included (<1924, 1924-1930, 1931-1941, 1942-1947, 1948-1953, 1954-1959, >1959). Results: Overall, 35% of participants reported CA and 62% AT, with strong variability among birth-cohorts. Opposing trends were observed regarding prevalence of CA and AT. As age of cohorts increased, prevalence of CAs decreased while that of ATs increased. Investigating the distributions of incidence of specific ATs across age and period per cohort revealed incidence of exposure was associated with (1) age (e.g. having lost a child), (2) time-period (e.g. major disaster), and (3) cohort (e.g. military combat). Conclusions: Retrospective self-reported CA and AT in older samples should be interpreted with caution and with regard to major methodological challenges, including recall and selection biases. Untangling fact from artefact and examining age, period, and cohort effects will help elucidate profiles of lifetime exposures in older populations.

Changes in Gender Inequality and Intimate Partner Violence From 1958-2003: A Birth Cohort Analysis

This article uses a birth cohort analysis to examine whether the sociopolitical environments in which a woman forms attitudes around intimate partner violence (IPV) influence report of physical, sexual, and emotional IPV, and IPV justification in 25 low- and middle-income countries. Cohort effect is then examined across countries by rate of decline in gender inequality over time as measured by the Gender Inequality Index (GII). Results suggest a birth cohort effect for all types of IPV, with women reporting greater odds of IPV with each successive cohort. This is reversed when countries are stratified by rate of GII decrease, but wanes as the rate slows.

Gender and age differences in the associations between family social roles and excessive alcohol use

BACKGROUND

Familial social roles are known to have important links with both acute and chronic excessive alcohol use. However, whether and how these links vary across adulthood and by gender is not well understood and would provide insight into populations most at risk for excessive alcohol use.

METHODS

This study used data from those ages 18 to 60 in the National Epidemiologic Study of Alcohol and Related Conditions-III survey (N=28,475). We examined the gender- and age-varying associations of current marital status (married vs. divorced/separated vs. never married) and parental status (parent vs. not) with acute (binge drinking) and chronic (exceeding weekly drinking guidelines) excessive alcohol use using time-varying effect modelling.

RESULTS

Both marital and parental statuses were inversely associated with acute and chronic excessive alcohol use at most ages, however the magnitude of these associations and gender differences in these associations varied by age. There were greater differences between adults who were married vs. never married and parents vs. not in excessive alcohol use during young adulthood as compared to later adulthood. The association of parental status with acute excessive alcohol use was stronger for women compared to men in young adulthood.

CONCLUSIONS

Gender and age should be considered when examining risk and protective factors, particularly in examining the role of parenthood in acute excessive alcohol use. These findings will help target populations most at risk for chronic and acute excessive alcohol use.

Heavy and binge alcohol drinking and parenting status in the United States from 2006 to 2018: An analysis of nationally representative cross-sectional surveys

BACKGROUND

Binge and heavy drinking are preventable causes of mortality and morbidity. Alcohol consumption by women who parent is damaging to child health, and it is concerning that women in the United States in their reproductive years have experienced increased drinking over the past decade. Although media attention has focused on the drinking status of women who are child-rearing, it remains unclear whether binge and heavy drinking vary by parenting status and sex.

METHODS AND FINDINGS

We examined national trends in binge drinking, defined as 5 or more drinks in a single day for men and 4 or more drinks for women, and heavy drinking, defined as 60 or more days with binge episodes in a year. We used survey-weighted logistic regression from the 2006-2018 waves of the cross-sectional National Health Interview Survey (NHIS, N = 239,944 eligible respondents) to study time trends in drinking outcomes by sex, age, and parenting status. Binge drinking increased for both sexes in nearly all age groups, with the largest increase among women ages 30-44 without children (from 21% reporting binge drinking in 2006 to 42% in 2018); the exception was young men (ages 18-29) with children, among whom binge drinking declined. By 2012, the prevalence of binge drinking among young men with children (38.5%) declined to below that of young women without children (39.2%) and stayed lower thereafter. Despite widespread increases in binge drinking, heavy drinking declined or remained stable for all groups except older women (ages 45-55) without children (odds ratio [OR] for heavy drinking each year = 1.06, 95% CI 1.02-1.10) and women ages 30-44, regardless of parenting status. For binge drinking outcomes only, we saw evidence of interaction in drinking trends by parenting status, but this was shown to be confounded by sex and age. Men and women with children reported consistently lower levels of drinking than those without children. Rates of abstention mirrored trends in binge outcomes for both sexes, limiting concerns about invariance. Study limitations include self-reported data and measurement invariance in binge drinking cutoffs across study years.

CONCLUSIONS

This study demonstrated that trends in binge and heavy drinking over time were not differential by parenting status for women; rather, declines and increases over time were mainly attributable to sex and age. Women both with and without children are increasing binge and heavy drinking; men, regardless of parenting status, and women without children consumed more alcohol than women with children. Regardless of impact on child health, increased drinking rates in the past decade are concerning for adult morbidity and mortality: binge drinking has increased among both sexes, and heavy drinking has increased among older women. Men and women of all ages and parenting status should be screened for heavy alcohol use and referred to specialty care as appropriate.

Gender differences among Veterans with alcohol use disorder nationally in the Veterans Health Administration

Alcohol use among women is increasing relative to men but no study has compared rates and characteristics of women with alcohol use disorder (AUD) to men among Veterans Health Administration (VHA) service users. To compare male and female VHA service users on rates of AUD, and among those with AUD, on sociodemographic characteristics, medical and physical comorbidities, and service and medication use national VHA data from fiscal year (FY) 2012 were used to identify Veterans diagnosed with AUD. Bivariate analyses evaluate gender differences in: sociodemographic characteristics; comorbid medical and psychiatric diagnoses; service use and psychotropic prescription fills. Multivariate stepwise logistic regression was used to identify a parsimonious set of differences. About 13,797 of all 349,430 women served by VHA in FY 2012 (3.94%) were diagnosed with AUD as compared to 331,407 of 5,102,877 men (6.50%) for a risk ratio of 0.608 for AUD among women. Women were younger, more likely to have served in recent Middle East conflicts and had more comorbid psychiatric and substance use diagnoses than men. They filled fewer psychotropic prescriptions (after taking greater number of psychiatric diagnoses in to account), but were more likely to fill a prescription for naltrexone than men. Women had fewer comorbid medical diagnoses than men. Women Veterans with an AUD have higher rates of psychiatric comorbidities than men, highlighting the need for better integration of treatment for AUD and comorbid psychiatric conditions, and suggesting different pathways and potential interventions for AUD in women.

Alcohol Consumption in Later Life and Mortality in the United States: Results from 9 Waves of the Health and Retirement Study

BACKGROUND

Alcohol consumption in later life has increased in the past decade, and the relationship between alcohol consumption and mortality is controversial. Recent studies suggest little, if any, health benefit to alcohol. Yet most rely on single-time point consumption assessments and minimal confounder adjustments.

METHODS

We report on 16 years of follow-up from the Health and Retirement Study (HRS) cohorts born 1931 to 1941 (N = 7,904, baseline mean age = 61, SD = 3.18). Respondents were queried about drinking frequency/quantity. Mortality was established via exit interviews and confirmed with the national death index. Time-varying confounders included but were not limited to household assets, smoking, body mass index, health/functioning, depression, chronic disease; time-invariant confounders included baseline age, education, sex, and race.

RESULTS

After adjustment, current abstainers had the highest risk of subsequent mortality, consistent with sick quitters, and moderate (men: HR = 0.74, 95% CI: 0.60 to 0.91; women: HR = 0.82, 95% CI: 0.63 to 1.07) drinking was associated with a lower mortality rate compared with occasional drinking, though smokers and men evidenced less of an inverse association. Quantitative bias analyses indicated that omitted confounders would need to be associated with ~4-fold increases in mortality rates for men and ~9-fold increases for women to change the results.

CONCLUSIONS

There are consistent associations between moderate/occasional drinking and lower mortality, though residual confounding remains a threat to validity. Continued efforts to conduct large-scale observational studies of alcohol consumption and mortality are needed to characterize the changing patterns of consumption in older age.

Risk factors for alcohol use among pregnant women, ages 15-44, in the United States, 2002 to 2017

Fetal alcohol exposure can lead to severe birth and developmental defects. Determining which pregnant women are most likely to drink is essential for targeting interventions. In National Survey on Drug Use and Health data on pregnant women from 2002 to 2017 (N = 13,488), logistic regression was used to produce adjusted odds ratios (aOR) indicating characteristics associated with two past-month outcomes: any alcohol use and binge drinking. Risk factors were sociodemographic (age, race/ethnicity, marital status, education level, income) and clinical (trimester, substance use, alcohol use disorder, major depression). Where associations differed by pregnancy stage (trimester 1 vs. trimesters 2 and 3), association was evaluated by stage. Overall, higher risk for any and binge drinking was observed among those with other substance use (aORs 2.9-25.9), alcohol use disorder (aORs 4.5-7.5), depression (aORs = 1.6), and unmarried women (aORs 1.6-3.2). For any drinking, overall, higher risk was observed in adolescents (aOR = 1.5) and those with higher education (aOR = 1.4), while lower risk was observed in those with lower income (aORs = 0.7). For binge drinking, associations differed by pregnancy stage. In trimester 1, lower risk was observed in middle ages (aOR = 0.4). In trimesters 2/3, higher risk was observed in Blacks (aOR = 3.3) and those with lower income (aORs 3.5-3.9), while lower risk was observed in those with higher education (aOR = 0.3). To prevent severe prenatal harm, health care providers should focus on women at higher risk for binge drinking during pregnancy: women with tobacco or drug use, alcohol use disorder, or depression, and women who are unmarried, Black, or of lower socioeconomic status.

Is There a Recent Epidemic of Women's Drinking? A Critical Review of National Studies

Alcohol consumption is increasing in the United States, as is alcohol-attributable mortality. Historically, men have had higher rates of alcohol consumption than women, though evidence for birth cohort effects on gender differences in alcohol consumption and alcohol-related harm suggests that gender differences may be diminishing. We review studies using U.S. national data that examined time trends in alcohol consumption and alcohol-related harm since 2008. Utilizing a historical-developmental perspective, here we synthesize and integrate the literature on birth cohort effects from varying developmental periods (i.e., adolescence, young adulthood, middle adulthood, and late adulthood), with a focus on gender differences in alcohol consumption. Findings suggest that recent trends in gender differences in alcohol outcomes are heterogeneous by developmental stage. Among adolescents and young adults, both males and females are rapidly decreasing alcohol consumption, binge and high-intensity drinking, and alcohol-related outcomes, with gender rates converging because males are decreasing consumption faster than females. This pattern does not hold among adults, however. In middle adulthood, consumption, binge drinking, and alcohol-related harms are increasing, driven largely by increases among women in their 30s and 40s. The trend of increases in consumption that are faster for women than for men appears to continue into older adult years (60 and older) across several studies. We conclude by addressing remaining gaps in the literature and offering directions for future research.

Gender-specific substance use patterns and associations with individual, family, peer, and school factors in 15-year-old Portuguese adolescents: a latent class regression analysis

BACKGROUND

Adolescence is a critical period of vulnerability to substance use. Recent research has shown that gender differences in adolescence substance use are complex and in constant flux. The present study aims to investigate gender differences in substance use and initiation patterns in male and female adolescents, and to assess individual, family, peer, and school associated factors of these patterns.

METHODS

We applied latent class regression analysis to a Portuguese representative population sample of 1551 15-year-old adolescents, drawn from the 2010 'Health Behavior in School-Aged Children' survey, to characterise different profiles of substance use and initiation for boys and girls, and to identify factors associated with latent class membership, stratifying the associations analysis by gender.

RESULTS

Three common classes were found for both genders, specifically, Non-Users (boys [B] 34.42%, girls [G] 26.79%), Alcohol Experimenters (B 38.79%, G 43.98%) and Alcohol and Tobacco Frequent Users (B 21.31%, G 10.36%), with two additional unique classes: Alcohol Experimenters and Tobacco Users in girls (18.87%), and Early Initiation and Poly-Substance Users in boys (5.48%). Poor school satisfaction, bullying, fighting and higher family affluence scale score formed a common core of associated factors of substance use, although we found gender differences in these associations. In girls, but not in boys, family factors were associated with more problematic substance use. Not living with both parents was associated with girl's Alcohol and Tobacco Frequent Users (gATFU) class (OR 3.78 CI 1.18-12.11) and Alcohol Experimenters and Tobacco Users (AETU) class (OR 3.22 CI 1.4-7.44). Poor communication with mother was also associated with gATFU class membership (OR 3.82 CI 1.26-11.53) and AETU class (OR 3.66 CI 1.99-6.75). Additionally, a higher psychological symptoms score was associated with gATFU class membership (OR 1.16 CI 1.02-1.31).

CONCLUSION

Although we found common patterns and associated factors between boys and girls, we report two unique patterns of substance use in boys and girls and specific associations between family, school and peers, and individual factors with these patterns. These findings underscore the need for substance use prevention and health promotion programmes that address potential differences in substance use patterns and associated factors.

Sex differences in binge-like EtOH drinking, corticotropin-releasing hormone and corticosterone: effects of β-endorphin

Binge drinking is an increasingly common pattern of risky use associated with numerous health problems, including alcohol use disorders. Because low basal plasma levels of β-endorphin (β-E) and an increased β-E response to alcohol are evident in genetically at-risk human populations, this peptide is thought to contribute to the susceptibility for disordered drinking. Animal models suggest that the effect of β-E on consumption may be sex-dependent. Here, we studied binge-like EtOH consumption in transgenic mice possessing varying levels of β-E: wild-type controls with 100% of the peptide (β-E +/+), heterozygous mice constitutively modified to possess 50% of wild-type levels (β-E +/-) and mice entirely lacking the capacity to synthesize β-E (-/-). These three genotypes and both sexes were evaluated in a 4-day, two-bottle choice, drinking in the dark paradigm with limited access to 20% EtOH. β-E deficiency determined sexually divergent patterns of drinking in that β-E -/- female mice drank more than their wild-type counterparts, an effect not observed in male mice. β-E -/- female mice also displayed elevated basal anxiety, plasma corticosterone and corticotropin-releasing hormone mRNA in the extended amygdala, and all of these were normalized by EtOH self-administration. These data suggest that a heightened risk for excessive EtOH consumption in female mice is related to the drug's ability to ameliorate an overactive anxiety/stress-like state. Taken together, our study highlights a critical impact of sex on neuropeptide regulation of EtOH consumption.

Birth cohort effects on the quantity and heritability of alcohol consumption in adulthood: a Finnish longitudinal twin study

AIMS

To estimate birth cohort effects on alcohol consumption and abstinence in Finland and to test differences between birth cohorts in genetic and environmental sources of variation in Finnish adult alcohol use.

DESIGN

The Older Finnish Twin Cohort longitudinal survey study 1975-2011.

SETTING

Finland.

PARTICIPANTS

A total of 26 121 same-sex twins aged 18-95 years (full twin pairs at baseline n = 11 608).

MEASUREMENTS

Outcome variables were the quantity of alcohol consumption (g/month) and abstinence (drinking zero g/month). Predictor variables were 10-year birth cohort categories and socio-demographic covariates. In quantitative genetic models, two larger cohorts (born 1901-20 and 1945-57) were compared.

FINDINGS

Multi-level models in both sexes indicated higher levels of alcohol consumption in more recent birth cohorts and lower levels in earlier cohorts, compared with twins born 1921-30 (all P < 0.003). Similarly, compared with twins born 1921-30, abstaining was more common in earlier and less common in more recent cohorts (all P < 0.05), with the exception of men born 1911-20. Birth cohort differences in the genetic and environmental variance components in alcohol consumption were found: heritability was 21% [95% confidence interval (CI) = 0-56%] in the earlier-born cohort of women [mean age 62.8, standard deviation (SD) = 5.3] and 51% (95% CI = 36-56%) in a more recent cohort (mean age 60.2, SD = 3.7) at the age of 54-74. For men, heritability was 39% (95% CI = 27-45%) in both cohorts. In alcohol abstinence, environmental influences shared between co-twins explained a large proportion of variation in the earlier-born cohort (43%, 95% CI = 23-63%), whereas non-shared environmental (54%, 95% CI = 39-72%) and additive genetic influences (40%, 95% CI = 13-61%) were more important among more recent cohorts of men and women.

CONCLUSION

The contribution of genetic and environmental variability to variability in alcohol consumption in the Finnish population appears to vary by birth cohort.

Assessing Heavy Episodic Drinking: A Random Survey of 18 to 34-Year-Olds in Four Cities in Four Different Continents

Background: Heavy episodic drinking (HED) can have health and social consequences. This study assesses the associations between HED and demographic, socioeconomic, motivation and effects indicators for people aged 18–34 years old living in four cities in different regions of the world. Method: Multistage random sampling was consistent across the four cities (Ilorin (Nigeria), Wuhan (China), Montevideo (Uruguay) and Moscow (Russia)). The questionnaire was forward/back translated and face-to-face interviewing was undertaken. A total of 6235 interviews were undertaken in 2014. Separate univariable and multivariable modelling was undertaken to determine the best predictors of HED. Results: HED prevalence was 9.0%. The best predictors differed for each city. The higher probability of HED in the final models included beliefs that they have reached adulthood, feeling relaxed as an effect of drinking alcohol, and forgetting problems as an effect of drinking alcohol. Lower probability of HED was associated with not being interested in alcohol as a reason for limiting alcohol, and the belief that drinking alcohol is too expensive or a waste of money. Conclusion: Although some indicators were common across the four cities, the variables included in the final models predominantly differed from city to city. The need for country-specific prevention and early intervention programs are warranted.

Prevalence and Correlates of Lifetime Alcohol Use among Adult Urban Populations in Iran: A Knowledge, Attitude, and Practice Study

Globally, alcohol use is one of the leading contributors to the burden of disease. The aim of this study was to provide data on prevalence and correlates of lifetime alcohol use among Iranian adults living in urban areas. This cross-sectional study investigated knowledge, attitude, and practice (KAP) of Iranian adults towards drug and alcohol use. Participants were recruited from the capital cities of five provinces-Tehran, West Azerbaijan, Markazi, Kerman, and Khorasan Razavi-in 2015. We used multivariate logistic regression models to conduct data analysis. Completing the questionnaire were 2,065 participants (44.06% female). Prevalence of lifetime alcohol use was 28% (95% CI: 25-29%). Lifetime alcohol use was significantly associated with male gender (Odds Ratio (OR) = 1.74, 95% Confidence Interval (CI): 1.26- 2.39), positive attitude towards alcohol (OR = 2.15, CI: 1.60-4.34), lifetime stimulants use (OR = 5.73, CI: 3.56- 9.23), and lifetime opioids use (OR = 4.47, CI: 3.12- 6.39). Estimated lifetime prevalence of alcohol use in our study was higher than the regional average. Primary alcohol prevention programs need to target sub- populations who are at risk for alcohol use and provide services that impede the development of positive attitudes towards alcohol.

Mood Disorders and Severity of Addiction in Alcohol-Dependent Patients Could Be Mediated by Sex Differences

Background: Alcohol dependence is highly prevalent in the general population; some differences in alcohol use and dependence between women and men have been described, including outcomes and ranging from biological to social variables. This study aims to compare the severity of alcohol dependence with clinical and psychopathological characteristics between sexes. Methods: A cross-sectional descriptive study was conducted in alcohol-dependent outpatients; the recruitment period was 7 years. The assessment of these patients was carried out by obtaining sociodemographic characteristics and using the Semi-structured Clinical Interview for Axis I and II (SCID-I and SCID-II), European version of the Addiction Severity Index (EuropASI), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI) scales. Variables were compared and analyzed. Results: The sample was composed of 178 patients (74.2% males and 25.8% females) with a mean age of 46.52 ± 9.86. No sociodemographic differences were found between men and women. Females had a higher rate of suicide attempts and depression symptoms at the treatment onset. When results of EuropASI were compared, females had worse psychological and employment results than males. According to consumption variables, males had an earlier onset of alcohol use, had more regular alcohol use, and develop alcohol dependence earlier than females. Conclusions: According to results, there are sex-dependent differences (severity and other variables such as mood or suicide) in alcohol dependence. Thus, this may implicate the need of future specific research and treatment programs based on the specific necessities of each sex.

Incidence of cirrhosis in young birth cohorts in Canada from 1997 to 2016: a retrospective population-based study

BACKGROUND

Recent data show that the prevalence of chronic liver disease and cirrhosis is increasing in adolescents and young adults in the USA. We aimed to describe the epidemiology of cirrhosis using an age-period-cohort approach to define birth-cohort effects on the incidence of cirrhosis in Ontario, Canada.

METHODS

We did a retrospective population-based cohort study in Ontario, Canada, using linked administrative health data from the databases of ICES, formerly the Institute for Clinical Evaluative Sciences. Patients aged at least 18 years with cirrhosis were identified by use of a validated case definition (defined as at least one inpatient or outpatient visit with a diagnosis of cirrhosis or oesophageal varices without bleeding). We calculated annual standardised incidence and prevalence in the general population. We used an age-period-cohort approach to assess the independent association between birth cohort and incidence of cirrhosis in men and women.

FINDINGS

Between Jan 1, 1997, and Dec 31, 2016, 165 979 individuals with cirrhosis were identified. The age-standardised incidence increased over the study (from 70·6 per 100 000 person-years in 1997 to 89·6 per 100 000 person-years in 2016) as did the prevalence (from 0·42% in 1997 to 0·84% in 2016). Using age-period-cohort modelling and the median birth year as the reference, the incidence of cirrhosis was higher in participants born in 1980 (incidence rate ratio 1·55, 95% CI 1·50-1·59, p<0·0001); and in participants born in 1990 (2·16, 95% CI 2·06-2·27, p<0·0001) compared with a person of the same age born in 1951. The increase in incidence of cirrhosis was greater in women than in men (eg, women born in 1990: 2·60, 95% CI 2·41-2·79; men born in 1990: 1·98, 1·85-2·12).

INTERPRETATION

The incidence of cirrhosis has increased over the past two decades, and more so in younger birth cohorts and in women. Future studies to define the cause and natural history of cirrhosis in these groups are essential to develop strategies that could reverse these trends for future generations.

FUNDING

Southeastern Ontario Academic Medical Association New Clinician Scientist Award; American Association for the Study of Liver Disease (AASLD) Foundation Clinical, Translational and Outcomes Research Award in Liver Disease (JAF).

Women's role in the rise in drinking in Australia 1950-80: an age-period-cohort analysis of data from the Melbourne Collaborative Cohort Study

BACKGROUND AND AIMS

In Australia, as in many countries, alcohol consumption increased dramatically during the second half of the 20th century, with increased availability of alcohol, relaxation of attitudes towards drinking and shifting roles and opportunities for women as facilitating factors. We sought to investigate drinking trends by gender and birth cohort in Australia during this period.

DESIGN

Retrospective cohort study.

SETTING, PARTICIPANTS AND MEASUREMENTS

Using the usual frequency and quantity of beverage-specific alcohol intake for 10-year periods from age 20, reported retrospectively from 40 789 participants aged 40-69 years (born 1920-49) at recruitment to the Melbourne Collaborative Cohort Study in 1990-94, we compared trends in alcohol consumption by sex in Australia between 1950 and 1990. Participants' average daily consumption for age decades were transformed to estimated intakes for 1950, 1960, 1970, 1980 and 1990.

FINDINGS

Alcohol consumption was higher for men than women during each decade. Alcohol consumption increased for both sexes in the 1950s, 1960s and 1970s, and fell after 1980. The rise before 1980 was roughly equal in absolute terms for both sexes, but much greater relative to 1950 for women. Women born during 1930-39 and 1940-49 drank more alcohol during early-middle adulthood (ages 20-40) than women born during 1920-29. In the 1980s, the fall was greater in absolute terms for men, but roughly equal relative to 1950 for both sexes. In both sexes, the decline in drinking in the 1980s for birth-decade cohorts was roughly in parallel.

CONCLUSIONS

Specific birth cohorts were influential in the rise in alcohol consumption by Australian women born in 1920-49 after World War II. Much of the convergence with men's drinking after 1980 reflects large reductions in drinking among men.

Sex and β-Endorphin Influence the Effects of Ethanol on Limbic Gabra2 Expression in a Mouse Binge Drinking Model

Binge drinking is a widespread problem linked to increased risk for alcohol-related complications, including development of alcohol use disorders. In the last decade, binge drinking has increased significantly, specifically in women. Clinically, sexually dimorphic effects of alcohol are well-characterized, however, the underlying mechanisms for these dimorphisms in the physiological and behavioral effects of alcohol are poorly understood. Among its many effects, alcohol consumption reduces anxiety via the inhibitory neurotransmitter GABA, most likely acting upon receptors containing the α-2 subunit (Gabra2). Previous research from our laboratory indicates that female mice lacking the endogenous opioid peptide β-endorphin (βE) have an overactive stress axis and enhanced anxiety-like phenotype, coupled with increased binge-like alcohol consumption. Because βE works via GABA signaling to reduce anxiety, we sought to determine whether sexually dimorphic binge drinking behavior in βE deficient mice is coupled with differences in CNS Gabra2 expression. To test this hypothesis, we used βE knock-out mice in a "drinking in the dark" model where adult male and female C57BL/6J controls (βE +/+) and βE deficient (βE -/-; B6.129S2-Pomc^tm1Low/J) mice were provided with one bottle of 20% ethanol (EtOH) and one of water (EtOH drinkers) or two bottles of water (water drinkers) 3 h into the dark cycle for four consecutive days. Following a binge test on day 4, limbic tissue was collected and frozen for subsequent qRT-PCR analysis of Gabra2 mRNA expression. Water-drinking βE +/+ females expressed more Gabra2 in central nucleus of the amygdala and the bed nucleus of the stria terminalis than males, but this sex difference was absent in the βE -/- mice. Genotype alone had no effect on alcohol consumption or drug-induced increase in Gabra2 expression. In contrast, βE expression had bi-directional effects in females: in wildtypes, Gabra2 mRNA was reduced by binge EtOH consumption, while EtOH increased expression in βE -/- females to levels commensurate with drug-naïve βE +/+ females. These results support the contention that βE plays a role in sexually dimorphic binge-like EtOH consumption, perhaps through differential expression of GABA_A α2 subunits in limbic structures known to play key roles in the regulation of stress and anxiety.

Increased Alcohol Consumption Among Swedish 70-Year-Olds 1976 to 2016: Analysis of Data from The Gothenburg H70 Birth Cohort Studies, Sweden

BACKGROUND

The older adult population is increasing worldwide, as is the number of older adults who consume alcohol. Although there is a growing body of research on alcohol consumption among older people, few studies focus on changes in at-risk consumption over time across well-defined birth cohorts of older adults.

METHODS

This study used a serial cross-sectional design in order to compare alcohol consumption patterns among birth cohorts of Swedish 70-year-olds (total n = 2,268) examined in 1976 to 1977 (n = 393), 1992 to 1993 (n = 248), 2000 to 2002 (n = 458), and 2014 to 2016 (n = 1,169). Participants took part in a multidisciplinary study on health and aging. Face-to-face interviews were conducted by healthcare professionals. Protocols regarding alcohol consumption were similar for all cohorts. The volume of weekly alcohol consumption was estimated during the past month. At-risk consumption was defined as ≥100 g alcohol/wk corresponding roughly to the National Institute on Alcohol Abuse and Alcoholism definition of heavy consumption.

RESULTS

The proportion of at-risk consumers among men increased from 16.1% in 1976 to 1977 to 29.9% in 2000 to 2002 (p = 0.001) and 45.3% in 2014 to 2016 (p < 0.001). In women, proportions were low in 1976 to 1977 (0.5%) and 1992 to 1993 (2.0%; p = 0.134), but increased to 9.5% in 2000 to 2002 (p < 0.001) and 24.3% in 2014 to 2016 (p < 0.001). The male:female ratio regarding consumption of ≥100 g/wk decreased from 32.2:1 in 1976 to 1977 to 3.1:1 in 2000 to 2002 to 1.9:1 in 2014 to 2016. Spirit consumption decreased dramatically among men during the study period, while women reported very low spirit consumption at all examinations. Wine consumption increased in both sexes between 2000 to 2002 and 2014 to 2016. Beer consumption increased among men between 2000 to 2002 and 2014 to 2016.

CONCLUSIONS

Recent cohorts of 70-year-olds in Sweden report significantly higher levels of alcohol consumption than previous cohorts. There was a dramatic increase in at-risk consumption among 70-year-olds from the 1970s to the mid-2010s, and this was particularly pronounced among women.

Is there gender convergence in risky drinking when taking birth cohorts into account? Evidence from an Australian national survey 2001-13

BACKGROUND AND AIMS

Recent studies have argued that there has been substantial gender convergence in alcohol consumption. However, many of these rely on comparisons of different cohorts and do not adjust for age differences in male and female drinking patterns. We aimed to examine (1) whether the gender gap in risky drinking in Australia narrowed between 2001 and 2013, (2) if the evidence for gender convergence (or divergence) was consistent across age groups and (3) how a cohort-focused analysis of gender convergence compared with an age-focused approach.

DESIGN

Repeated cross-sectional data from five waves of the National Drug Strategy Household Survey (2001, 2004, 2007, 2010, 2013). Interaction terms in logistic and linear regression models were used to test for significantly different trends between men and women.

SETTING

Australia.

PARTICIPANTS

Australians aged 14 years and older (n = 125 215) who provided data on alcohol consumption in the National Drug Strategy Household Survey.

MEASUREMENTS

Prevalence of long-term risky drinking (average of 20 g or more per day) and prevalence of risky single occasion drinking (12 or more sessions of 50 g or more).

FINDINGS

Gender differences were large for all age groups except adolescents (14-17-year-olds), with men typically reporting levels of drinking at least twice as high as women across the study period. Overall, there was statistically significant gender convergence in alcohol use measures showing a slight decrease in men's drinking and a slight increase in women's drinking. However, when age-specific analyses were conducted gender convergence was only observed for 50-69-year-olds.

CONCLUSIONS

In Australia, gender convergence in risky drinking since 2001 has been evident only in people aged 50-69 years.

Sexual dimorphism in the neural impact of stress and alcohol

Alcohol use disorder is a widespread mental illness characterized by periods of abstinence followed by recidivism, and stress is the primary trigger of relapse. Despite the higher prevalence of alcohol use disorder in males, the relationship between stress and behavioral features of relapse, such as craving, is stronger in females. Given the greater susceptibility of females to stress-related psychiatric disorders, understanding sexual dimorphism in the relationship between stress and alcohol use is essential to identifying better treatments for both male and female alcoholics. This review addresses sex differences in the impact of stressors on alcohol drinking and seeking in rodents and humans. As these behavioral differences in alcohol use and relapse originate from sexual dimorphism in neuronal function, the impact of stressors and alcohol, and their interaction, on molecular adaptations and neural activity in males and females will also be discussed. Together, the data reviewed herein, arising from a symposium titled "Sex matters in stress-alcohol interactions" presented at the Fourth Volterra Conference on Stress and Alcohol, will highlight the importance of identifying sex differences to improve treatments for comorbid stress and alcohol use disorder in both sexes.

State-of-the-art behavioral and pharmacological treatments for alcohol use disorder

BACKGROUND

Alcohol use disorder (AUD) and its associated consequences remain significant public health concerns. Given that AUD represents a spectrum of severity, treatment options represent a continuum of care, ranging from single-session brief interventions to more intensive, prolonged, and specialized treatment modalities.

OBJECTIVE

This qualitative literature review seeks to describe the best practices for AUD by placing a particular emphasis on identifying those practices which have received the most empirical support.

METHOD

This review summarizes psychological and pharmacological intervention options for AUD treatment, with a focus on the relapse prevention phase of recovery. Psychological and pharmacological treatments are summarized in terms of the empirical evidence favoring each approach and the level of AUD severity for which they are most indicated.

SCIENTIFIC SIGNIFICANCE

One of the broad assertions from this review is that while AUD is highly prevalent, seeking treatment for AUD is not. There are a myriad of behavioral and pharmacological treatments that have shown compelling evidence of efficacy for the treatment of AUD. In the behavioral treatment literature, cognitive behavioral therapy has received the most consistent support. Opioid antagonism (via naltrexone) has been the most widely studied pharmacotherapy and has produced moderate effect sizes. While none of the treatments reviewed herein represents a so-called silver bullet for AUD, they each have the potential to significantly improve the odds of recovery. Precision medicine, or the identification of best treatment matches for individual patients, looms as an important overarching goal for the field, although specific matches are not yet sufficiently reliable in their empirical evidence to warrant clinical dissemination.

Male-female differences in the onset of heavy drinking episode soon after first full drink in contemporary United States: From early adolescence to young adulthood

BACKGROUND

Globally, there is a male excess in the occurrence of heavy drinking once alcoholic beverages are consumed and some new evidence that this 'gender gap' might be null among underage drinkers. Here, we estimate age-specific male-female differences in heavy drinking episode (HDE) incidence across the first eight calendar-quarters after first full drink.

METHODS

Study population is non-institutionalized civilians in the United States (2006-2014). Standardized audio computer-assisted self-interviews were used to assess the date of first full drink and the date of first HDE (i.e., 5+ drinks on one occasion) among ∼33,000 12-to-21-year-old newly incident drinkers (all with 1st full drink and HDE evaluated within 24 months of drinking onset). Time-to-HDE survival analyses are used to estimate age-specific male-female ratios in the hazard of HDE onset.

RESULTS

We found that among early adolescent new drinkers (drinking onset at age 11-14), the newly incident drinking females progress to HDE more quickly than males (HR = 1.3, 95% CI = 1.1, 1.6). In contrast, male excess risk is observed when drinking starts at or after age 15 years. For underage drinkers, age-specific hazard ratios (HR) depend upon age at first full drink.

CONCLUSIONS

Based on recent survey data from the US, this study's survival analyses support early adolescent female excess in the onset of HDE. When drinking starts at or after age 15 years, a male excess becomes apparent within two years since first full drink. Future studies may probe any sex-specific mechanisms toward the rapid onset of HDE at different age groups.

Effect of childhood adversities on alcohol problems is mainly mediated by depression

BACKGROUND AND OBJECTIVES

We aimed to study how five childhood adversities and trauma (CAT) core domains: emotional abuse (EmoAb), physical abuse (PhyAb), sexual abuse (SexAb), emotional neglect (EmoNeg), physical neglect (PhyNeg), associate with alcohol problems (APs), and whether there are any gender differences in these associations.

METHODS

Altogether, 690 adult participants drawn from the general population completed a mailed questionnaire, including the trauma and distress scale, as an indicator of CAT, and questions concerning sociodemographic background, depressive symptoms, and APs.

RESULTS

In univariate analyses, male gender, middle age, divorced/separated marital status and lower education, frequency of use of alcohol, previous treatment for mental problems, as well as depressive symptoms and CAT domain scores were associated with APs. Of the CAT domains, females reported more EmoAb and SexAb than males, but there was no gender difference in other CAT domains and depressive symptoms. In multivariate analyses, when the effects of background characteristics were controlled, CAT sum and all its domains had indirect effects via depressive symptoms on APs with no significant direct effect except in females, in whom PhyAb and SexAb associated directly with APs even when the effects of other CAT domains were taken into account.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

All CAT domains associate extensively with APs. Generally, their effect on APs is mainly mediated via depressive symptoms. In females, PhyAb and SexAb also have a considerable direct effect on APs. In treating individuals with CAT experiences and alcohol problems, treatment of depression is also important. (Am J Addict 2018;XX:1-9).

The Mediating Role of Anxiety Sensitivity in Uncontrolled Drinking: A Look at Gender-Specific Parental Influences

BACKGROUND

Anxiety sensitivity (AS) reflects an individual's belief that experiencing anxiety will cause illness or embarrassment, and may be a reason individuals self-medicate with alcohol. Harsh or indulgent parenting could contribute to the development of AS. We examined the direct and indirect associations between parenting styles and alcohol-related variables through AS and impaired control over drinking (IC; i.e., perceived failure to adhere to limits on alcohol consumption in the future).

METHODS

A multiple-group structural equation model with 614 university students (344 men; 270 women) was examined. Structural invariance tests were conducted to evaluate moderation by gender. We used a bias corrected bootstrap technique to obtain the mediated effects.

RESULTS

Father authoritarianism and mother permissiveness were directly linked to AS among women, whereas father permissiveness was directly linked to AS among men. This suggests unique parental influences based on gender regarding AS. While AS was directly linked to alcohol-related problems for both men and women, several gender-specific associations were found. AS was directly linked to IC for men but not for women. For men, father permissiveness was directly related to AS, and AS mediated the indirect link between father permissiveness and IC along both the heavy episodic drinking and alcohol-related problems pathways. Similar to other internalizing constructs (e.g., neuroticism and depression), higher AS was directly associated with less heavy episodic drinking but more alcohol-related problems.

CONCLUSIONS

Our findings highlight the dangers of AS for men as an important correlate of under-controlled drinking behaviors. Additionally, permissive parenting of the same-gender parent was associated with AS, which is consistent with the gender-matching hypothesis. Together, these results underscore the importance of measuring the independent influence of both parents.

Educational differences in alcohol consumption and heavy drinking: An age-period-cohort perspective

BACKGROUND

Low socioeconomic status (SES) has been associated with lower alcohol consumption, but also with heavier drinking. To explain this contradictory relationship, we examined SES differences in drinking patterns from an age-period-cohort (APC) perspective.

METHODS

Data are from seven waves of the U.S. National Alcohol Surveys from 1979 to 2010. As a proxy for SES, educational attainment was used. Past-year alcohol volume was calculated from frequency (never-to-every day) and usual quantity (1-2, 3-4, or 5-6 drinks). Past-year frequency of heavy episodic drinking was labelled as total days of 5+ drinks. Gender-stratified APC fixed-effects models were conducted controlling for demographics and adjusting for survey design and weights.

RESULTS

Significant APC effects by education were found, but the direction varied by alcohol measure. Education and total volume were positively associated across APC. Cross-over effects for age occurred with a positive education-heavy drinking relationship in young adulthood and negative relationship in mid-adulthood. Cohort-by-education effects showed greater heavy drinking among less educated women in 1956-60 cohort and more educated men and women in younger cohorts (post-1976).

CONCLUSIONS

Higher SES is consistently associated with total volume across age, period, and cohort, but less consistently with heavy drinking. While there are currently significant intervention efforts to reduce heavy drinking in young adulthood, our study suggests the need for age-specific strategies targeting lower-SES groups in mid-adulthood and cohort-specific strategies for lower-SES women in the baby boomer cohort and higher-SES men and women in younger birth cohorts.

Ten-Year Trend in Women's Reasons for Abstaining or Limiting Drinking: The 2000 and 2010 United States National Alcohol Surveys

BACKGROUND

Data on individual and cultural factors contributing to drinking can inform screening and brief intervention in clinical practice. Our aims were to examine 10-year trends in women's reasons for abstaining/limiting drinking and to document changes in associations with drinking status for population subgroups defined by race/ethnicity and age.

MATERIALS AND METHODS

Using repeated cross-sectional data from White, Black and Hispanic women in the 2000 and 2010 United States National Alcohol Surveys (combined N = 5501), population-weighted multiple linear and multinomial logistic regression models assessed changes in three reasons for abstaining or limiting drinking (health concerns, religious prohibition, and upsetting family or friends) and drinking status (past-year abstainer, low-risk drinker, or at-risk drinker), and their associations over time.

RESULTS

Adjusting for key demographics, reasons for limiting alcohol consumption declined in importance over time, with reductions in both health concerns and religious prohibition particularly noteworthy for older women of all three racial/ethnic backgrounds. Despite these reductions in importance, both health concerns and religious prohibition were most consistently associated with increased abstinence relative to low-risk drinking; these reasons were not strongly associated with at-risk drinking, however.

CONCLUSIONS

It is essential for healthcare providers and others to disseminate accurate information about the risks of drinking to counter cultural shifts that suggest greater acceptance of moderate-to-heavy drinking by women aged 40 and older.

The impact of cohort substance use upon likelihood of transitioning through stages of alcohol and cannabis use and use disorder: Findings from the Australian National Survey on Mental Health and Wellbeing

INTRODUCTION AND AIMS

We used population-level Australian data to estimate prevalence, age of onset and speed of transitions across stages of alcohol and cannabis use, abuse and dependence, and remission from disorder, and consider the potential impacts that an individual's age cohort's level of substance use predicted transitions into and out of substance use.

DESIGN AND METHODS

Data on use, DSM-IV use disorders, and remission from these disorders were collected from participants (n = 8463) in the 2007 Australian National Survey of Mental Health and Wellbeing using the Composite International Diagnostic Interview.

RESULTS

Lifetime prevalence (95% confidence interval) of alcohol use, regular use, abuse and dependence were 94.1% (93.3-94.8%), 64.5% (62.9-66.2%), 18.7% (17.4-19.9%) and 4.0% (3.4-4.6%). Lifetime prevalence of cannabis use, abuse and dependence were 19.8% (18.6-20.9%), 4.4% (3.8-5.0%) and 1.9% (1.5-2.4%). Among those with the disorder, rates of remission from cannabis abuse, alcohol abuse, cannabis dependence and alcohol dependence were 90.5% (87.4-93.6%), 86.2% (83.8-88.7%), 79.6% (71.1-88.1%) and 53.8% (46.6-61.0%). Increases in the estimated proportion of people in the respondent's age cohort who used alcohol/cannabis as of a given age were significantly associated with most transitions from use through to remission beginning at the same age.

DISCUSSION AND CONCLUSIONS

Clear associations were documented between cohort-level prevalence of substance use and personal risk of subsequent transitions of individuals in the cohort from use to greater substance involvement. This relationship remained significant over and above associations involving the individual's age of initiation. These findings have important implications for our understanding of the causal pathways into and out of problematic substance use.

How Healthy Are Survey Respondents Compared with the General Population?: Using Survey-linked Death Records to Compare Mortality Outcomes

BACKGROUND

National surveys are used to capture US health trends and set clinical guidelines, yet the sampling frame often includes those in noninstitutional households, potentially missing those most vulnerable for poor health. Declining response rates in national surveys also represent a challenge, and existing inputs to survey weights have limitations. We compared mortality rates between those who respond to surveys and the general population over time.

METHODS

Survey respondents from 20 waves of the National Health Interview Survey from 1990 to 2009 who have been linked to death records through 31 December 2011 were included. For each cohort in the survey, we estimated their mortality rates along with that cohort's mortality rate in the census population using vital statistics records, and differences were examined using Poisson models.

RESULTS

In all years, survey respondents had lower mortality rates compared with the general population when data were both weighted and unweighted. Among men, survey respondents in the weighted sample had 0.86 (95% confidence interval = 0.853, 0.868) times the mortality rate of the general population (among women, RR = 0.887; 95% confidence interval, 0.879, 0.895). Differences in mortality are evident along all points of the life course. Differences have remained relatively stable over time.

CONCLUSION

Survey respondents have lower death rates than the general US population, suggesting that they are a systematically healthier source population. Incorporating nonhousehold samples and revised weighting strategies to account for sample frame exclusion and nonresponse may allow for more rigorous estimation of the US population's health.

Joint Effects of Age, Period, and Cohort on Conduct Problems Among American Adolescents From 1991 Through 2015

Although arrest rates among juveniles have substantially decreased since the 1990s, US national trends in conduct problems are unknown. Population variation in conduct problems would imply changes in the social environment, which would include emergent or receding risk factors. In the present study, we separated age, period, and cohort effects on conduct problems using nationally representative surveys of 375,879 US students conducted annually (1991-2015). The summed score of 7 items measuring the frequency of conduct problems was the outcome. Conduct problems have decreased during the past 25 years among boys; the total amount of the decrease was approximately 0.4 standard deviations (P < 0.01), and by item prevalence, the total amount of the decrease was 8%-11%. Declines are best explained by period effects beginning approximately in 2008, and a declining cohort effect beginning among those born after 1992, which suggests not only declines in population levels, but more rapid declines among younger cohorts of boys. Trends were also consistent with age-period-cohort effects on evenings spent out, which suggest a possible mechanism. Conduct problems among girls were lower than boys and did not demonstrate trends across time. These changes may reflect the changing nature of adolescence toward less unsupervised interaction.