Daily stress and alcohol consumption: modeling between-person and within-person ethnic variation in coping behavior

Regular drinking may strengthen the beneficial influence of social support on depression: findings from a representative Israeli sample during a period of war and terrorism

BACKGROUND

Social support is consistently associated with reduced risk of depression. Few studies have investigated how this relationship may be modified by alcohol use, the effects of which may be particularly relevant in traumatized populations in which rates of alcohol use are known to be high.

METHODS

In 2008 a representative sample of 1622 Jewish and Palestinian citizens in Israel were interviewed by phone at two time points during a period of ongoing terrorism and war threat. Two multivariable mixed effects regression models were estimated to measure the longitudinal association of social support from family and friends on depression symptoms. Three-way interaction terms between social support, alcohol use and time were entered into the models to test for effect modification.

RESULTS

Findings indicated that increased family social support was associated with less depression symptomatology (p=<.01); this relationship was modified by alcohol use and time (p=<.01). Social support from friends was also associated with fewer depression symptoms (p=<.01) and this relationship was modified by alcohol use and time as well (p=<.01). Stratified analyses in both models revealed that the effect of social support was stronger for those who drank alcohol regularly than those who did not drink or drank rarely.

CONCLUSIONS

These findings suggest that social support is a more important protective factor for depression among regular drinkers than among those who do not drink or drink rarely in the context of political violence. Additional research is warranted to determine whether these findings are stable in other populations and settings.

Race, coping strategies, and substance use behaviors: a preliminary analysis examining white and American Indian adolescents

The association between stress exposure and substance use has been the subject of numerous studies. However, no prior study has explored the role of coping strategies in moderating the stress-substance use association for American Indian adolescents. Our preliminary study of coping strategies and substance use among a sample (n = 568) of rural American Indian and white adolescents revealed a number of similarities across both groups, but also some important differences. Results of logistic regression analyses revealed that the relationship between an avoidant coping strategy and marijuana use differed for whites and American Indians. Study limitations and future research directions are discussed.

Systematic review and meta-analysis: prevalence of alcohol use among young people in eastern Africa

Objective

Systematic review and meta-analysis of published studies of alcohol use among young people (age 15–24 years) in eastern Africa to estimate prevalence of alcohol use and determine the extent of use of standardised screening questionnaires in alcohol studies.

Methods

Five databases (MEDLINE, EMBASE, Global Health, Africa-wide, and PsycINFO) were searched for publications until 30th June 2013. Results were summarised using the guidelines on preferred reporting items for systematic reviews and meta-analyses (PRISMA) and on quality assessment using the modified quality assessment tool for systematic reviews of observational studies (QATSO). Heterogeneity was assessed using the I² statistic (DerSimonian-Laird).

Results

We identified 2785 potentially relevant studies, of which 56 were eligible for inclusion. Only two studies (4%) used the standardised Alcohol Use Disorder Identification Test (AUDIT) questionnaire, and six studies (13%) used the Cut down, Annoyed, Guilt, Eye opener (CAGE) questionnaire. The reported median prevalence of alcohol use was ever-use 52% [interquartile range (IQR): 20–58%], use in the last month 28% (IQR: 17–37%), use in the last year 26% (IQR: 22–32%), and problem drinking as defined by CAGE or AUDIT 15% (IQR: 3–36%). We observed high heterogeneity between studies, with the highest prevalence of ever use of alcohol among university students (82%; 95%CI: 79–85%) and female sex workers (66%; 95%CI: 58–74%). Current use was most prevalent among male sex workers (69%; 95%CI: 63–75%).

Conclusions

Reported alcohol use and problem drinking were common among diverse groups of young people in eastern Africa, indicating the urgent need for alcohol-focused interventions in this population. Few studies have used standardised alcohol screening questionnaires. Epidemiological research to investigate alcohol-focused interventions in young people should aim to apply such questionnaires that should be validated for use in this population.

Associations between coping, affect, and social support among low-income African American smokers

OBJECTIVE

Previous research has documented disparities in smoking cessation between African Americans and Caucasians. Many low-income African American smokers face a range of circumstances that may inhibit effective coping during quit attempts, yet previous research has not considered factors that influence coping in this population. This study examined (a) affect (positive and negative) and (b) perceived social support in association with coping strategies.

METHODS

The baseline assessment of African American smokers (N = 168) enrolled in a randomized controlled trial included the Positive and Negative Affect Schedule, the Multidimensional Scale of Perceived Social Support, and the Brief COPE. A factor analysis of the Brief COPE resulted in two factors, adaptive and maladaptive strategies.

RESULTS

Participants were mostly single (64%), women (61%), with ≥12 years of education (68%), and low-income. They were middle aged (M = 46.1, SD = 8.7), smoked 21.8 (SD = 13.3) cigarettes/day for 24.3 (SD = 11) years, and were moderately nicotine dependent. Results demonstrated that adaptive coping was positively correlated with positive affect and social support. Maladaptive coping was positively correlated with negative affect, and inversely related to positive affect and social support. Multivariate analyses revealed that positive affect and social support were independently associated with adaptive coping strategies. In contrast, maladaptive coping was independently associated with negative affect, but not social support.

CONCLUSIONS

Interventions that harness positive resources, such as social support and positive mood, may facilitate adaptive coping. Also, addressing negative affect among low-income African American smokers may be important to reduce maladaptive coping strategies.

Relations among stress, coping strategies, coping motives, alcohol consumption and related problems: a mediated moderation model

Although prominent models of alcohol use and abuse implicate stress as an important motivator of alcohol consumption, research has not consistently identified a relationship between stress and drinking outcomes. Presumably stress leads to heavier alcohol consumption and related problems primarily for individuals who lack other adaptive methods for coping effectively with stressful experiences. To test this hypothesis, we examined four adaptive coping approaches (active coping, planning, suppression of competing activities, and restraint), as predictors of alcohol use and related problems as well as moderators of relations between stress and drinking outcomes in an undergraduate population (N=225). Further, we examined coping motives for drinking as potential mediators of the effects of coping strategies as well as stress by coping strategy interactions. Analyses supported both restraint and suppression of competing activities as moderators of the influence of stress on alcohol use but not problems. The stress by restraint interaction was also evident in the prediction of coping motives, and coping motives were related to higher levels of both weekly drinking and alcohol-related problems. Finally, coping motives for drinking served to mediate the stress by restraint interaction on weekly drinking. Overall, these results suggest that efforts to suppress competing activities and restrain impulsive responses in the face of stress may reduce the risk for heavy drinking during the transition from high school to college.

Increases in alcohol consumption in women and elderly groups: evidence from an epidemiological study

BACKGROUND

In most Western countries, alcohol consumption continues to increase, specifically among women and older adults. Insight into these trends may aid intervention strategies. Here we present data on alcohol consumption by age and sex as well as associations between alcohol use and demographic lifestyle/traits. The data are from a large (N>16,000) population-based Dutch sample, ascertained based on the presence of twins in the family.

METHODS

A set of 16 indicators of normative and problematic alcohol use was assessed in participants of the Netherlands Twin Register between 2009-2012 (ages 18-97; 6,052 men; 10,535 women). Alcohol consumption and demographic/lifestyle traits, including educational attainment, work-related/financial stress, urbanization, religiousness, smoking/cannabis initiation, and BMI were described by age and sex. Associations were examined by regressing aspects of alcohol use on age, sex, their interaction, and demographic/lifestyle variables.

RESULTS

Age, sex, and initiation of cigarette and cannabis use were the most important predictors of alcohol use. Frequency of alcohol use was lowest between 18-25 years, with 3.2% of men and .6% of women drinking 6-7 times/week, and highest above age 65 years, with 30.6-32.7% of men and 20.2-22.0% of women drinking 6-7 times/week. Women consumed the lowest quantities of alcohol between 25-45 years, with a 5.7-5.9% prevalence of excessive drinking (>14 glasses/week), and the largest quantities between 55-65 years (15.5% excessive drinkers). Age at alcohol initiation, onset of regular drinking, and first alcohol intoxication were lowest between ages 18-25 years and highest above age 65 years. Among older participants, men initiated alcohol use and regular drinking earlier, and had lower age at first intoxication than women, but among young adults, no sex differences were observed.

CONCLUSIONS

Alcohol consumption was high in the elderly Dutch population, especially among women. Alcohol initiation, onset of regular drinking, and first alcohol intoxication occur at increasingly younger ages, and the previous gap between men and women in age at alcohol initiation, onset of regular drinking, and first alcohol intoxication has closed almost entirely. Heavy alcohol use was most strongly predicted by older age, sex (male), and initiation of smoking and cannabis use.

Drinking behaviors by stress level in Korean university students

The purposes of this study are to estimate the stress level of university students, and to verify the relationships between stress level and drinking behavior. A questionnaire survey was administered to 430 university students in the Gangwon area in Korea from November 5 to November 28, 2008, and data from 391 students were used for the final statistical analysis. The most stressful factor was "Worry about academic achievements" (2.86 by Likert-type 4 point scale). The subjects were divided into two groups, a low stress group (≤ 65.0) and a high stress group (≥ 66.0), by the mean value (65.1) and median value (66.0) of the stress levels. The drinking frequency was not different between the two stress groups, but the amount of alcohol consumption was significantly different (P < 0.05). The portion of students reporting drinking "7 glasses or over" was higher in the lower stress group than in the higher stress group. In addition, factor 6, "Lack of learning ability", was negatively correlated with drinking frequency and the amount of alcohol consumption (P < 0.05), and factor 3, "Worry about academic achievements", was negatively correlated with the amount of drinking (P < 0.05). The major motive for drinking was "When overjoyed or there is something to celebrate" (2.62), and the main expected effect of drinking was "Drinking enables me to get together with people and shape my sociability" (2.73). The higher stress group showed significantly higher scores on several items in the categories of motives (P < 0.01), negative experience (P < 0.05), and expected effects (P < 0.05) of drinking than the lower stress group. Our results imply that university students at the lower stress level may drink more from social motives in positive drinking environments, while those at the higher stress level may have more problematic-drinking despite their smaller amount of alcohol consumption.

"Have a drink, you'll feel better." Predictors of daily alcohol consumption among extraverts: the mediational role of coping

An abundance of information exists pertaining to individual differences in college drinking behaviors with much attention being provided to the role of personality. However, plausible explanations for what prompts engagement in or avoidance of these behaviors have remained largely ambiguous or underexplored, particularly with respect to extraversion (E). Research has since explored how coping behaviors contribute to these associations. The present study built on this research by evaluating differences in daily alcohol consumption as a function of coping choice. The mediational effects of two specific strategies frequently observed in high E individuals (i.e., problem-focused coping and social support) were examined. Using a daily diary approach, 365 undergraduates reported their most stressful experience, how they coped with it, and the number of drinks consumed for five consecutive days. Resulting multilevel-models were consistent with hypotheses indicating the relationship between E and alcohol consumption was partially mediated by problem-focused and support-seeking strategies. The use of problem-focused coping by high E individuals was associated with lower levels of daily alcohol consumption, suggesting this strategy may play a protective role in influencing drinking behaviors. Conversely, the positive effect observed for social support approached significance (p=.054) and was indicative of a potential risk-factor for daily alcohol consumption.

Stress and the HPA axis: role of glucocorticoids in alcohol dependence

Stress has long been suggested to be an important correlate of uncontrolled drinking and relapse. An important hormonal response system to stress-the hypothalamic-pituitary-adrenal (HPA) axis-may be involved in this process, particularly stress hormones known as glucocorticoids and primarily cortisol. The actions of this hormone system normally are tightly regulated to ensure that the body can respond quickly to stressful events and return to a normal state just as rapidly. The main determinants of HPA axis activity are genetic background, early-life environment, and current life stress. Alterations in HPA axis regulation are associated with problematic alcohol use and dependence; however, the nature of this dysregulation appears to vary with respect to stage of alcohol dependence. Much of this research has focused specifically on the role of cortisol in the risk for, development of, and relapse to chronic alcohol use. These studies found that cortisol can interact with the brain's reward system, which may contribute to alcohol's reinforcing effects. Cortisol also can influence a person's cognitive processes, promoting habit-based learning, which may contribute to habit formation and risk of relapse. Finally, cortisol levels during abstinence may be useful clinical indicators of relapse vulnerability in alcohol-dependent people.