A 10-year national trend study of alcohol consumption, 1984-1995: is the period of declining drinking over?

A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization

BACKGROUND

Alcohol use disorders (AUDs) are highly prevalent and associated with non-adherence to antiretroviral therapy, decreased health care utilization and poor HIV treatment outcomes among HIV-infected individuals.

OBJECTIVES

To systematically review studies assessing the impact of AUDs on: (1) medication adherence, (2) health care utilization and (3) biological treatment outcomes among people living with HIV/AIDS (PLWHA).

DATA SOURCES

Six electronic databases and Google Scholar were queried for articles published in English, French and Spanish from 1988 to 2010. Selected references from primary articles were also examined.

REVIEW METHODS

Selection criteria included: (1) AUD and adherence (N=20); (2) AUD and health services utilization (N=11); or (3) AUD with CD4 count or HIV-1 RNA treatment outcomes (N=10). Reviews, animal studies, non-peer reviewed documents and ongoing studies with unpublished data were excluded. Studies that did not differentiate HIV+ from HIV- status and those that did not distinguish between drug and alcohol use were also excluded. Data were extracted, appraised and summarized.

DATA SYNTHESIS AND CONCLUSIONS

Our findings consistently support an association between AUDs and decreased adherence to antiretroviral therapy and poor HIV treatment outcomes among HIV-infected individuals. Their effect on health care utilization, however, was variable.

Age differences in long-term patterns of change in alcohol consumption among aging adults

OBJECTIVE

To estimate patterns of long-term, within-person, changes in alcohol consumption among adults of different ages and assess key predictors of alcohol-use patterns over time.

METHOD

Data came from 3,617 adults, interviewed up to four times between 1986 and 2002. Multilevel multinomial logit models estimated the odds of abstinence and heavy drinking relative to moderate drinking.

RESULTS

The odds of abstinence increased and the odds of heavy drinking decreased during the study period. Older adults experienced faster increases in abstinence than younger adults. However, data extrapolations suggest that current younger adults are more likely to be abstinent and less likely to be heavy drinkers during late life than current older adults. Time-varying health, social, and lifestyle factors account for some of these patterns.

DISCUSSION

Drinking behavior in our aging population appears to be on a relatively promising course, perhaps reflecting the effectiveness of public health efforts.

Validating alcohol use measures among male drinkers in Goa: implications for research on alcohol, sexual risk, and HIV in India

Assessment of heavy drinking patterns is vital for HIV/AIDs studies in India and developing countries. A population survey in northern Goa included urban and rural male drinkers (n = 743) who completed a new Fractional Graduated Frequencies (F-GF) alcohol patterns measure assessing seven beverage types and drink sizes for the largest daily amount, then drinking frequencies at fractional amounts. The new measure was compared to a simpler quantity-frequency (QF) summary and, in a validity subsample of hazardous drinkers (n = 56), 28-day diaries of drinking events. Approximately 56% of total volume came from peak drinking (averaging 60 g ethanol/day). For AUDIT-based Hazardous Drinkers, QF and F-GF volumes (drinks/day) were not significantly different from diary volume (correlations 0.65 and 0.57, respectively). F-GF well captured the profile of daily amounts in drinking event data. In addition, the F-GF showed evidence of better predicting any sexual risk behavior or partner violence perpetration than the QF measure. Summary drinking pattern measures, especially the new F-GF, are more cost efficient than intensive event records, and appear valid when carefully assessing quantities with local beverage types and drink ethanol content.

Age at regular drinking, clinical course, and heritability of alcohol dependence in the San Francisco family study: a gender analysis

We examined gender differences in age of onset, clinical course, and heritability of alcohol dependence in 2,524 adults participating in the University of California San Francisco (UCSF) family study of alcoholism. Men were significantly more likely than women to have initiated regular drinking during adolescence. Onset of regular drinking was not found to be heritable but was found to be significantly associated with a shorter time to onset of alcohol dependence. A high degree of similarity in the sequence of alcohol-related life events was found between men and women, however, men experienced alcohol dependence symptoms at a younger age and women had a more rapid clinical course. Women were found to have a higher heritability estimate for alcohol dependence (h(2)= .46) than men (h(2)= .32). These findings suggest that environmental factors influencing the initiation of regular drinking rather than genetic factors associated with dependence may in part underlie some of the gender differences seen in the prevalence of alcohol dependence in this population. (Am J Addict 2010;00:1-10).

Consumo abusivo e dependência de álcool em população adulta no Estado de São Paulo, Brasil

OBJETIVO: Descrever as prevalências de consumo abusivo e dependência de álcool em população adulta de 20 a 59 anos no Estado de São Paulo, e suas associações com variáveis demográficas e socioeconômicas. MÉTODOS: Inquérito domiciliar do tipo transversal (ISA-SP), em quatro áreas do Estado de São Paulo: a) Região Sudoeste da Grande São Paulo, constituída pelos Municípios de Taboão da Serra, Itapecerica da Serra e Embu; b) Distrito do Butantã, no Município de São Paulo; c) Município de Campinas e; d) Município de Botucatu. Foi considerado consumo abusivo de álcool a ingestão em dia típico de 30 gramas ou mais de etanol para os homens, e 24 gramas ou mais para as mulheres. A dependência de álcool foi caracterizada pelo questionário CAGE. Análises bivariadas e multivariadas dos dados foram realizadas a partir de Modelos de Regressão de Poisson. Todas as análises foram estratificadas por sexo. RESULTADOS: Em 1.646 adultos entrevistados, a prevalência de consumo abusivo de álcool foi de 52,9% no sexo masculino e 26,8% no sexo feminino. Quanto à dependência de álcool, foram observadas duas ou mais respostas positivas no teste CAGE em 14,8% dos homens e em 5,4% das mulheres que relataram consumir álcool. Isto corresponde a uma prevalência populacional de dependência de 10,4% nos homens e 2,6% nas mulheres. O consumo abusivo de álcool no sexo masculino apresentou associação inversa à faixa etária e associação direta à escolaridade e ao tabagismo. No sexo feminino, observou-se associação direta do consumo abusivo de álcool com a escolaridade e o tabagismo, e com as situações conjugais sem companheiro. A dependência de álcool no sexo masculino associou-se a não exercer atividade de trabalho e à baixa escolaridade. No sexo feminino não houve associação do CAGE com nenhuma das variáveis estudadas. CONCLUSÕES: Pela alta prevalência de consumidores e dependentes, é essencial a identificação dos segmentos sociodemográficos mais vulneráveis ao consumo abusivo e dependência de álcool. As associações entre a dependência/abuso e não estar exercendo atividade de trabalho, no sexo masculino, e a maior prevalência em mulheres de escolaridade universitária, sugerem componentes para programas de intervenção e controle.

Measurement invariance of alcohol use motivations in junior military personnel at risk for depression or anxiety

Measurement invariance is typically assumed when assessing drinking-related constructs across distinct groups of respondents. However, measurement properties of motivations related to mood maintenance and stress relief may differ in those experiencing symptoms of depression or anxiety. Invariance of social and coping drinking motives were explored with a sample of 4133 junior enlisted Air Force and Navy personnel. Measurement did not differ in those with depression symptoms. In contrast, those with anxiety symptoms differed in measurement of both motives. The impact of non-equivalence was demonstrated with a mediation model in which anxiety and depression predicted drinking motives, which in turn predicted heavy drinking. Incorporation of the partial invariance of the social motives factor attenuated the estimate of the mediated effect of social drinking motives by almost half compared to the estimate with invariance assumed. These results suggest that lack of measurement invariance could seriously bias or alter conclusions from tests of theoretical models and highlight the need for researchers to carefully consider the measurement properties of their constructs prior to model estimation.

Alcoholic liver disease

These recommendations provide a data-supported approach. They are based on the following: (i) a formal review and analysis of the recently published world literature on the topic (Medline search); (ii) American College of Physicians Manual for Assessing Health Practices and Designing Practice Guidelines (1); (iii) guideline policies, including the American Association for the Study of Liver Diseases (AASLD) Policy on the development and use of practice guidelines and the AGA Policy Statement on Guidelines (2); and (iv) the experience of the authors in the specified topic. Intended for use by physicians, these recommendations suggest preferred approaches to the diagnostic, therapeutic, and preventive aspects of care. They are intended to be flexible, in contrast to the standards of care, which are inflexible policies to be followed in every case. Specific recommendations are based on relevant published information. To more fully characterize the quality of evidence supporting the recommendations, the Practice Guideline Committee of the AASLD requires a Class (reflecting the benefit vs. risk) and Level (assessing the strength or certainty) of Evidence to be assigned and reported with each recommendation (Table 1, adapted from the American College of Cardiology and the American Heart Association Practice Guidelines) (3,4).

Changes in alcohol consumption and drinking patterns during 11 years of follow-up among ageing men: the FinDrink study

BACKGROUND

Alcohol consumption is often reported to decrease with ageing. We investigated alcohol consumption and drinking patterns in an ageing population-based male sample during an 11-year follow-up period.

METHODS

This study with baseline and two follow-up examinations (at 4 and 11 years) included 1516 randomly selected participants, aged 42, 48, 54 and 60 years from Eastern Finland. Alcohol consumption and drinking patterns during the year preceding the examination were assessed. Data were analysed using Generalized Estimating Equations and Mixed Models.

RESULTS

Over the 11-year study period, the amount of alcohol consumed weekly increased among the 42-year-olds (P < 0.001) and remained constant among the older cohorts. The risk of frequent drinking (alcohol consumption at least twice weekly) increased among all cohorts (OR = 2.04, 95% CI = 1.50-2.79 for 42-year-olds; OR = 1.71, 95% CI = 1.13-2.58 for 48-year-olds; OR = 1.67, 95% CI = 1.16-2.39 for 54-year-olds and OR = 1.67, 95% CI = 1.21-2.29 for 60-year-olds). There was also an increasing probability of heavy consumption (more than 14 weekly drinks) among the 42-year-olds (OR = 1.47, 95% CI = 1.09-2.00). The risk of binging (six-plus drinks at one occasion) decreased among the older participants (OR = 0.65, 95% CI = 0.47-0.89 for 54-year-olds, and OR = 0.56, 95% CI = 0.39-0.81 for 60-year-olds).

CONCLUSION

Finnish men born in 1926-1946 do not seem to decrease drinking while ageing. In contrast those born in 1944-1946 increase drinking until their 60's. This should be taken into consideration in planning health services for aged men in the near future.

Self-reported alcohol consumption and its association with adherence and outcome of antiretroviral therapy in the Swiss HIV Cohort Study

Background

Alcohol consumption leading to morbidity and mortality affects HIV-infected individuals. Here, we aimed to study self-reported alcohol consumption and to determine its association with adherence to antiretroviral therapy (ART) and HIV surrogate markers.

Methods

Cross-sectional data on daily alcohol consumption from August 2005 to August 2007 were analysed and categorized according to the World Health Organization definition (light, moderate or severe health risk). Multivariate logistic regression models and Pearson's χ2 statistics were used to test the influence of alcohol use on endpoints.

Results

Of 6,323 individuals, 52.3% consumed alcohol less than once a week in the past 6 months. Alcohol intake was deemed light in 39.9%, moderate in 5.0% and severe in 2.8%. Higher alcohol consumption was significantly associated with older age, less education, injection drug use, being in a drug maintenance programme, psychiatric treatment, hepatitis C virus coinfection and with a longer time since diagnosis of HIV. Lower alcohol consumption was found in males, non-Caucasians, individuals currently on ART and those with more ART experience. In patients on ART ( n=4,519), missed doses and alcohol consumption were positively correlated ( P<0.001). Severe alcohol consumers, who were pretreated with ART, were more often off treatment despite having CD4+ T-cell count <200 cells/μl; however, severe alcohol consumption per se did not delay starting ART. In treated individuals, alcohol consumption was not associated with worse HIV surrogate markers.

Conclusions

Higher alcohol consumption in HIV-infected individuals was associated with several psychosocial and demographic factors, non-adherence to ART and, in pre-treated individuals, being off treatment despite low CD4+ T-cell counts.

Modeling cognitive influences on drinking and alcohol problems

OBJECTIVE

We explored the relationships between two domains of alcohol-related cognitions (expectations and reasons for drinking) and their associations with alcohol consumption and alcohol dependence. It is hypothesized that alcohol-related cognitions will relate directly to drinking behaviors and indirectly to alcohol dependence.

METHOD

Data came from the 1995 National Alcohol Survey, which included black and Hispanic oversamples. The analysis was restricted to 2,817 respondents who reported alcohol consumption at least once in the past year. Path analysis, including key demographic factors, modeled the associations between expectations, reasons for drinking, frequency of heavy drinking, and alcohol dependence.

RESULTS

Exploratory and confirmatory factor analyses yielded separate latent variables for expectations (positive and negative), reasons for drinking (social and escape), frequency of heavy alcohol use, and alcohol-dependence symptoms. Associations between positive expectations and frequency of heavy drinking were partially mediated by social and escape reasons for drinking. Associations between negative expectancies and alcohol dependence were partially mediated by escape reasons for drinking. Associations between reasons for drinking and alcohol dependence were partially mediated by the frequency of heavy drinking. Associations between demographic variables and alcohol dependence were mediated by the frequency of heavy drinking; black race and Hispanic ethnicity also showed additional direct effects on dependence.

CONCLUSIONS

Alcohol-related cognitions exhibit complex associations with drinking behaviors and alcohol dependence. Implications for research on ethnic minority health disparities and public policy are discussed.

Social disadvantage, stress, and alcohol use among black, Hispanic, and white Americans: findings from the 2005 U.S. National Alcohol Survey

OBJECTIVE

Despite growing evidence of the adverse health effects of social disadvantage on minority populations, few studies have investigated whether such effects extend to alcohol problems. This study examines social disadvantage as a source of stress and analyzes its association with alcohol use and problems in the three largest racial/ethnic groups in the United States.

METHOD

Data on white, black, and Hispanic Americans (n = 6,631) were obtained from the 2005 U.S. National Alcohol Survey, a nationally representative telephone-based survey of adults ages 18 and older. Social disadvantage was measured by poverty level, frequency of unfair treatment, racial/ethnic stigma consciousness, and cumulative disadvantage. Outcomes included drinking status, at-risk drinking, and problem drinking.

RESULTS

Blacks and Hispanics reported greater exposure to social disadvantage than whites, including greater poverty, unfair treatment, racial/ethnic stigma, and cumulative disadvantage. In all three racial/ethnic groups, exposure to disadvantage was associated with problem drinking. Frequent unfair treatment, high racial stigma (among minorities), and multiple sources of extreme disadvantage corresponded to a twofold to sixfold greater risk of alcohol problems, partially explained by psychological distress.

CONCLUSIONS

These results are consistent with other studies of stress and adverse health consequences associated with social disadvantage. Although there is a clear disparity in exposure to such hardship, experiences of disadvantage appear to have similar effects on problem drinking among both racial/ethnic minorities and whites. Future research should attempt to assess causal directions in the relationships among social and economic hardship, stress, and alcohol problems.

Alcohol use and sexual risk behavior among college students: understanding gender and ethnic differences

OBJECTIVES

The purpose of the current study was to assess the role of gender and ethnicity in the relationship between alcohol use and risky sexual behavior.

METHOD

Sexually active college students (n = 425) reported on alcohol expectancies, perceived risk of HIV, and drinking and sexual behavior in the context of a larger health behavior survey.

RESULTS

Approximately one-third of participants reported binge drinking 3 or more times in the past two weeks. African-American women reported less drinking and less positive alcohol expectancies than other women. Older men engaged more often than younger men in binge drinking and reported more sexual partners in the past year. Younger age and greater perceived risk for HIV were positively associated with condom use for both women and men.

CONCLUSION

Collectively, these findings suggest that alcohol abuse and HIV prevention efforts among young adults need to consider gender, ethnicity, and age.

Indicators of sense of coherence and alcohol consumption-related problems: the 2000 U.S. National alcohol survey

This paper assesses the relationship of Sense of Coherence (SOC) and alcohol consumption-related problems in the 2000 U.S. National Alcohol Survey (4,630 current drinkers). Measures include a 3-item SOC scale, a 15-item social consequences scale, and DSM-IV alcohol dependence. Using logistic regression, a strong SOC was significantly related to not reporting either consequences or dependence. Results underscore the importance of using theoretically-based approaches to examine nonproblematic drinking. The development of interventions that could strengthen SOC deserves future research attention. The study's limitations are noted. Funded by a National Alcohol Research Center Grant (AA-05595-16) from the U.S. National Institute on Alcohol Abuse and Alcoholism to the Alcohol Research Group.

Temporal trend in the U.S. black-white disparity in mortality rates from selected alcohol-related chronic diseases

The disparities between the U.S. African American (black)-white mortality rates for liver cirrhosis are often cited in the literature, but disparities in mortality from other chronic diseases largely attributable to alcohol have received less attention. This study analyzes U.S. age-standardized mortality rates (ASMRs) for those 25 years old or more for a 25-year period (1979-2003) for blacks and whites by gender for certain chronic diseases entirely attributable to alcohol and for certain cancers with a large fraction attributable to alcohol. Declines in ASMRs were much larger for blacks than whites, and black-white disparities disappeared for alcoholic gastritis, as also previously reported to alcoholic cirrhosis of the liver. Substantial disparities remained in 2003, at much lower ASMRs than in the past, for males for alcoholic cardiomyopathy, chronic pancreatitis, and cancers of the oral cavity-pharynx, which may reflect black-white disparities in risk factors (other than alcohol) and in medical care.

The temporal relationship between alcohol consumption and HIV-medication adherence: a multilevel model of direct and moderating effects

Previous studies documenting an association between alcohol use and HIV medication nonadherence, have been unable to distinguish between-persons characteristics from within-person characteristics representing the temporally linked effects of alcohol. Hierarchical Linear Modeling (HLM) explored within- and between-person predictors of adherence during the past 14 days, as well as factors that moderate the event-level effects of alcohol consumption among 272 HIV-positive men and women with alcohol problems. On days in which participants drank, they had almost 9 times higher odds of medication nonadherence, with each drink increasing the odds by 20%. The cognitive and alcohol factors had significant between-person effects on adherence. Individuals with strong and rigid beliefs about the importance of strict medication adherence were significantly more affected by each dose of alcohol, while individuals with more alcohol use and problems were less affected by each drink. Regimen complexity increased the effects of having 1 or more drinks. These results highlight the importance of promoting medication adherence among alcohol-using adults, especially among patients with complex regimens or with high confidence and positive attitudes toward HIV medication.

Socio-demographic correlates of alcohol consumption in the Danish general population

Aims: Little is known about specific Danish drinking patterns. This paper investigates how various socio-demographic factors are related to Danish alcohol consumption with special focus on age and sex. Methods: Data come from a national telephone survey of the Danish general population conducted in 2003 with a final sample size of 2,030 cases. Measures of beverage specific current drinking, overall drinking, daily drinking, heavy episodic drinking, mean consumption, volume per drinking occasion and frequency of drinking were analysed. Results: A little over 5% of the population are abstainers. Fourteen per cent of men and 9% of women are heavy drinkers; 38% of men and 18% of women are heavy episodic drinkers. Youth of both sexes drink heavily, and especially in a binge drinking style. Regular, more temperate drinking is associated with increasing age. Multivariate analyses suggest that other than age and sex, classical socioeconomic factors do not play a great a role in determining drinking patterns. Social integrative factors in particular influence women's drinking. Conclusions: With respect to the rest of Europe and North America, Danes consume high levels of alcohol with a large percentage of youth drinking in a binge pattern. Classical socioeconomic factors play a lesser role in determining drinking patterns compared to other Western countries. Longitudinal studies and studies of alcohol-related consequences in the Danish general population should be conducted to better formulate alcohol and public health policy.

No higher risk of problem drinking or mental illness for women in male-dominated occupations

A sample of 562 women were drawn from the general population study "Women and alcohol in Goteborg" (N = 8335). An initial screening phase was followed by interviews regarding work, alcohol, and mental illness. Data from 1990 and 1995 were analyzed. Logistic regressions were used to calculate odds ratios. Contradictory to earlier studies we found no higher risk for alcohol problems/mental illness among women in male-dominated occupations. Selection and changes in cultural norms can be explanations. Study limitations included use of occupations at an aggregated level. The Swedish Council financially supported the study for Working Life and Social Research.

Comparison of longitudinal phenotypes based on alternate heavy drinking cut scores: a systematic comparison of trajectory approaches III

The goal of the present study was to empirically determine the effect of employing different cut scores for frequency of heavy episodic drinking (HED; an often-used indicator of problematic alcohol involvement) within a longitudinal framework. Using data from a large prospective (9-wave) college student sample, the authors used latent class growth analyses to characterize developmental trajectories of HED based on alternate cut scores that varied in frequency of HED (defined by 5+ drinks per occasion), as well as to measure very heavy episodic drinking (12+ drinks per occasion). As cut score severity increased and base rates for HED correspondingly decreased, individuals were increasingly categorized into less severe classes. Concordance between trajectories ranged from small to moderate, with concordance using highly discrepant definitions of frequent HED being particularly low. HED trajectories based upon different cut scores were validated against a range of etiological and consequential correlates. No single cut score was superior to others in explaining variance in external validity indicators, suggesting that the choice of cut score should be based upon theoretical and clinical considerations. This study further extends the authors' prior work examining the effects of methodological factors that are critical to characterizing the developmental course of alcohol involvement.

Under-estimation of Alcohol Consumption among Women At-risk for Drinking during Pregnancy

This study adds to a growing literature showing that definitions for "standard drinks" are often difficult to conceptualize and that people often underestimate their actual drink sizes. As part of an intervention aimed at reducing negative neonatal and maternal outcomes, insured at-risk women were asked to identify the vessels from which they drank each of 6 beverages (n=266). We calculated differences between their actual and standard drink sizes. Additionally, differences were compared to those reported in an earlier study of uninsured inner city minority women that used identical vessels methodology. Over half of the spirits, fortified wine and malt liquor drinkers underestimated the actual number of ounces their drinks contained. Most spirits drinkers (90%) and approximately three-quarters of the wine and malt liquor drinkers drank larger-than-standard drink sizes, with the median drink size 1.5 to 2.0 times larger than the standard size for those beverages. Heavier drinkers (>/=3 drinks per sitting) were more likely than lighter drinkers to underestimate their drink sizes. Findings were similar to those in the previous study using identical drink size measurements. Accurately assessing true drink sizes is underscored when the social, health and epidemiologic consequences associated with miscalculation are considered.

Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial

OBJECTIVE

To assess the efficacy of a behavioral intervention designed to improve HIV medication adherence and reduce alcohol consumption among HIV-positive men and women.

DESIGN

A randomized controlled trial conducted between July 2002 and August 2005.

SETTING

A behavioral research center in New York City.

PARTICIPANTS

HIV-positive men and women (n = 143) who were on HIV antiretroviral medication and met criteria for hazardous drinking.

INTERVENTION

Participants were randomly assigned to an 8-session intervention based on motivational interviewing and cognitive-behavioral skills building or a time- and content-equivalent educational condition.

OUTCOME MEASURES

Viral load, CD4 cell count, and self-reported adherence and drinking behavior were assessed at baseline and at 3- and 6-month follow-ups.

RESULTS

Relative to the education condition, participants in the intervention demonstrated significant decreases in viral load and increases in CD4 cell count at the 3-month follow-up and significantly greater improvement in percent dose adherence and percent day adherence. There were no significant intervention effects for alcohol use, however, and effects on viral load, CD4 cell count, and adherence were not sustained at 6 months.

CONCLUSIONS

An 8-session behavioral intervention can result in improvement in self-report and biologic markers of treatment adherence and disease progression. This type of intervention should be considered for dissemination and integration into HIV clinics providing comprehensive care for HIV-positive persons with alcohol problems. Although the effect was attenuated over time, future studies might test the added effectiveness of booster sessions or ongoing adherence counseling.

Sexual orientation and alcohol use: identity versus behavior measures

BACKGROUND

Few population-based national studies include complete measures of alcohol consumption, alcohol-related problems, and sexual orientation. When measures of sexual orientation are included in alcohol surveys, typically only one measure is included. The purpose of this paper is to compare two ways of measuring sexual orientation and to explore the relationship of each measure with alcohol use and alcohol-related problems.

METHODS

Data were used from the 2000 National Alcohol Survey, a telephone national alcohol probability survey representative of U.S. adults 18 and over (N = 7,612). Sexual orientation was measured by two self-reported measures: sexual orientation identity and sexual behavior. Alcohol use and problems were assessed by number of drinks in the last year, number of days drank 5 or more drinks in the last year, social consequences, and DSM-IV alcohol dependence.

RESULTS

There is no consistent pattern of alcohol use or alcohol-related problems based on how sexual orientation is measured for men. For women, bisexual identity or bisexual behavior was consistently associated with greater alcohol use and problems as compared to heterosexual identity or heterosexual behavior. Use of behavior measures alone appears to provide lower estimates of alcohol- related consequences and dependence among lesbian respondents.

CONCLUSIONS

These results underscore the utility of using both identity and behavior items to measure sexual orientation particularly for women when assessing alcohol use and alcohol-related problems.

Stress and Binge Drinking: A Daily Process Examination of Stressor Pile-up and Socioeconomic Status in Affect Regulation

The goal of this study was to enhance understanding of the interconnections between stress, negative mood, and alcohol use. To achieve this goal, daily diary data collected over eight consecutive nights from a nationally representative adult cohort were used to identify if: 1) both daily stress and stress pile-up were associated with increased risk of binge drinking, 2) negative affect mediated associations between stressor variables and binge drinking, and 3) associations among stress, negative affect and binge drinking were moderated by educational attainment as an indicator of socioeconomic status. Results from hierarchical linear models indicated that the odds of binge drinking was higher on days that individuals experienced more severe stressors in contrast to no stress days. Further, the odds of binge drinking also increased as stressors piled-up over consecutive days. There was no evidence indicating that negative affect mediated the effect of stressor exposure on binge drinking. Associations between stressor exposure (both daily stress and stress pile-up) and binge drinking were moderated by educational attainment. The findings of this study are consistent with previous daily process studies examining the association between stress and alcohol. However, the pattern of results from this study suggest that affect regulation researchers need to handle "stress" in a multidimensional way and better situate stressors and individuals stress responses within their social context.

Time trends in heavy drinking among middle-aged and older adults in Denmark

BACKGROUND

Studies have indicated an increasing proportion of heavy drinking among middle-aged and older Danes. Trends in consumption are often extremely sensitive to influence from various components of the time trends but only few have explored the age, period and cohort-related influences on late life alcohol consumption. By using age, period, and cohort modeling this study explores the time trends in heavy drinking.

METHODS

Data derive from five National Health and Morbidity Surveys conducted by the Danish National Institute of Public Health in 1987, 1994, 2000, 2003, and 2005. A total of 15,144 randomly selected Danes between the age of 50 and 74 were interviewed about their alcohol intake on the last weekday and their alcohol intake in the last week. By applying the age-period-cohort model the probability of heavy alcohol drinking is estimated to separate the influence of age, period (calendar time) and cohort (year of birth).

RESULTS

The unadjusted probability of heavy drinking declines by age and increases by calendar year and year of birth for both men and women. However, the negative effect of age is attenuated for women when adjusted for birth cohort, indicating that the proportion of heavy drinking women increases in younger birth cohorts. This trend is not observed for men as their drinking pattern mainly increase slightly by calendar year.

CONCLUSIONS

Our Danish observations for older aged individuals correspond to the social and cultural changes in the 1960s and 1970s that possibly have affected the drinking behavior of the cohorts. Time trend analyses, such as this may serve as an excellent opportunity to extrapolate and forecast alcohol mortality and morbidity.

A historical look at alcohol abuse trends in army and civilian populations, 1980-1995

OBJECTIVES

The purpose of this study was to compare civilian and Army alcohol-related hospitalization trends and to plot temporal changes in rates relative to alcohol-related legislation and social policies.

METHOD

We compared population-based civilian and Army annual hospitalization rates for overall alcohol-related diagnoses and for alcohol-related diagnostic subgroups (1980-1995) and plotted them against civilian and military substance abuse regulations. Civilian data were adjusted to Army age, gender, and race.

RESULTS

Although overall civilian and Army alcohol hospitalization rates were similar, alcohol subgroup rates varied. Simultaneous drug and alcohol abuse (polyabuse) rates were higher among civilians (16.6 per 10,000) than Army soldiers (5.1 per 10,000). Army rates for dependent alcohol-related disorders were higher and increased. Army nondependent alcohol disorders tracked with alcohol-related regulations as rates fell 69% between 1985 and 1995.

CONCLUSION

Army and civilian alcohol abuse trends vary by abuse type. Without longitudinal, diagnosis-specific subgroup analyses, these trends would not have emerged. Army policies and screening may explain divergent nondependent alcohol abuse and lower polyabuse rates.

Concurrent and simultaneous drug and alcohol use: results of the 2000 National Alcohol Survey

This study estimates the prevalence, assesses predictors and evaluates factors associated with concurrent and simultaneous use of drugs and alcohol in the United States population. Using data from the 2000 National Alcohol Survey (n=7612), respondents were asked if they used specific drugs in the last 12 months. Current drinkers who reported using each type of drug were asked if they used alcohol and the drug at the same time. Approximately 10% reported using marijuana in the last 12 months (concurrent use); 7% reported drinking alcohol and using marijuana at the same time (simultaneous use). Approximately 5% of current drinkers reported using drugs other than marijuana in the last 12 months; 1.7% reported drinking alcohol and using drugs other than marijuana at the same time. Being younger, having less than a high school education, not having a regular partner and having heavier drinking patterns were associated with using alcohol and marijuana simultaneously. Simultaneous use of marijuana and alcohol as well as other drugs and alcohol were significantly related to social consequences, alcohol dependence, and depression. These results mirror clinical populations in which increasingly younger clients report use of alcohol and drugs and need treatment for both.

Substance use trends among active duty military personnel: findings from the United States Department of Defense Health Related Behavior Surveys, 1980-2005

AIMS

This study was designed to assess trends in cigarette, illicit drug, and heavy alcohol use among active-duty military personnel from 1980 to 2005 and to examine the influence of socio-demographic changes within the military on patterns of substance use.

DESIGN

Substance use prevalence rates were estimated from cross-sectional data obtained from nine self-report surveys administered to more than 150 000 active-duty service members world-wide over a 25-year period. Direct standardization was used to adjust for socio-demographic changes.

MEASUREMENTS

Measures included self-reported cigarette use, illicit drug use and heavy alcohol use in the 30 days prior to the survey. Heavy alcohol use was defined as drinking five or more drinks per typical drinking occasion at least once a week in the past 30 days.

FINDINGS

Cigarette and illicit drug use among military personnel declined sharply and significantly from 1980 to 1998. Heavy alcohol use decreased in the mid-1980s but was stable from 1988 to 1998. Both cigarette smoking and heavy alcohol use increased significantly between 1998 and 2002 and remained at those levels in 2005. Illicit drug use remained low. Logistic regression analyses indicated that trends were influenced by other factors besides socio-demographic changes across survey years.

CONCLUSIONS

The military has made notable progress in decreasing cigarette smoking and illicit drug use, but has made less progress in reducing heavy alcohol use. Additional emphasis should be placed on understanding recent increases in substance use and on planning effective interventions and prevention programs to reduce use in this high-risk population.

Epidemiological trends in drinking by age and gender: providing normative feedback to adults

OBJECTIVE

The purpose of this research was to evaluate drinking rates as a function of age and gender and to disseminate current estimates of U.S. population drinking norms based on age and gender.

METHODS

Participants included 42,706 men and women 18 years and older who provided information about their drinking from the National Epidemiologic Survey on Alcohol and Related Conditions [National Alcohol Survey on Alcohol and Related Conditions (NESARC, 2001) dataset collected between 2001 and 2002 from a representative, non-institutionalized sample.

RESULTS

Results revealed greater frequency and typical quantity of alcohol consumption among men versus women. Age differences in drinking frequency suggests a sharp increase with legal drinking age followed by a period of reduced frequency, in turn followed by gradual increase up to retirement age. Age differences in typical drinking quantity suggest a sharp increase with legal drinking age followed by a gradual linear decline in number of drinks per occasion. Age differences in typical quantity were more pronounced among men.

CONCLUSIONS

Analyses provide epidemiological trends in drinking rates by age and gender, and emphasize the importance of within group differences when examining drinking rates. Discussion focuses on explaining how to incorporate norms information in prevention and treatment.

Patient-related factors predicting HIV medication adherence among men and women with alcohol problems

The study explored the relationship between HIV medication adherence and alcohol, cognitive, social and affective factors in 272 persons with alcohol problems. Alcohol and cognitive factors significantly differentiated those who did and did not adhere. Specifically, adherence confidence and number of drinks emerged as subfactors driving the associations to adherence. Among those who were less than perfectly adherent (n = 154), only alcohol factors predicted levels of nonadherence. Cognitive factors play a role in understanding some of the differences between those who do and do not adhere to their HIV medications, but they do not differentiate among levels of nonadherence.

Are Americans Receptive to Smokefree Bars?

It is not known whether the American public accepts smokefree bars and restaurants. Anticipating public displeasure with these ordinances, tobacco, liquor and restaurant industry trade associations have helped to stall efforts to pass laws curbing bar and restaurant smoking in the expectation that diminished patronage would inevitably result. This cross-sectional trend study uses data from the May 1993 and January 1999 Current Population Surveys, Tobacco Use Supplements to compare tobacco-control attitudes among American bar and restaurant workers, all other workers, smokers and nonsmokers (total n = 90,661). It was found that by 1999, smokefree workplaces were widely accepted by two-thirds of adults, with half favoring completely smokefree restaurants. Completely smokefree bars remained less popular, with nearly equal numbers (about 30%) preferring them or favoring unrestricted bar smoking. Even among bar and restaurant industry workers less than 10% favored unrestricted restaurant smoking. Greater acceptances of smokefree bars are now taking hold, especially in places like California, where acceptance rose 15% in six years, and 45% preferred them. Opponents to smokefree bars and restaurants may have underestimated the levels of support and growing acceptance of smokefree living areas now taking hold among the general public.

Positive, negative, unknown: assumptions of HIV status among HIV-positive men who have sex with men

Serosorting (i.e., engaging in unprotected sex with partners known to be of the same serostatus) can be a difficult process for men who have sex with men (MSM) who frequently make assumptions about their partners' serostatus. This process can be further complicated by a partner's dishonesty as well as other individual and contextual factors. The present study specifically examined how assumptions of serostatus made about unknown serostatus partners impact on the sexual behavior of 110 alcohol-abusing HIV-positive MSM. Although previous research has shown that HIV-positive MSM are more likely to serosort with other known HIV-positive men than with known HIV-negative men, our data suggest that unprotected sex behavior may not be specifically driven by whether or not they made assumptions of seroconcordance or serodiscordance. The types of assumptions these HIV-positive MSM made about their unknown status sexual partners and the basis for such assumptions were also examined. Owing to the ambiguities involved in assumptions of a partner's serostatus in sexual encounters, the 'unknown status' partner category is analytically distinct from 'known status' categories, and needs to be more fully explored because of its impact on perceived serosorting, rather than actual serosorting, among HIV-positive men.

Re-examining whether and why acculturation relates to drinking outcomes in a rigorous, national survey of Latinos

BACKGROUND

Fundamental limitations have hampered conclusions surrounding acculturation's effects among Latinos. This research re-examines associations between acculturation and alcohol use, addressing the most troubling of these limitations. The research also explores mediators of the association, and the dimensional structure of acculturation.

METHODS

Linear regressions and scale analyses were used to analyze data from Latino adults in the U.S. (825 women, 761 men) sampled in the 1995 National Alcohol Survey. Analyses used a standard, reliable acculturation scale and well-validated drinking measures; systematically accounted for demographic covariates; and analyzed men and women separately.

RESULTS

As expected, higher acculturation was positively associated with a higher probability of drinking (vs. abstinence) among women, and higher average volumes and more frequent drunkenness among female drinkers. Acculturation was unrelated to alcohol use among men. Also as expected, mediational analyses of average volume supported expectations that gender-specific drinking norms would mediate acculturation's effects (though norms did not explain acculturation's associations with either drinking status or frequency of drunkenness). Analyses investigating depressive symptoms showed no support for the acculturation-stress model. Factor analyses of the acculturation scale supported the hypothesized distinctions between linguistic acculturation, attitudinal acculturation, and the social environment of acculturation. Further, items implying more intimate exposure to Anglo culture (i.e., language use) were most strongly related to drinking outcomes among women, supporting the normative interpretation of acculturation's effects on drinking.

CONCLUSIONS

Results underline acculturation's influence on alcohol consumption among Latina women, and highlight the role of drinking norms in mediating this association. Results also suggest a multidimensional view of acculturation. The article recommends further research on drinking norms and other potential mediators of acculturation's effects among Latina women.

The 12-Month Prevalence and Trends in DSM–IV Alcohol Abuse and Dependence

Background

Alcohol abuse and dependence can be disabling disorders, but accurate information is lacking on the prevalence of current Diagnostic and Statistical Manual, Fourth Edition (DSM–IV) alcohol abuse and dependence and how this has changed over the past decade. The purpose of this study was to present nationally representative data on the prevalence of 12-month DSM–IV alcohol abuse and dependence in 2001–2002 and, for the first time, to examine trends in alcohol abuse and dependence between 1991–1992 and 2001–2002.

Methods

Prevalences and trends of alcohol abuse and dependence in the United States were derived from face-to-face interviews in the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC: n = 43,093) and NIAAA’s 1991–1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES: n = 42,862).

Results

Prevalences of DSM–IV alcohol abuse and dependence in 2001–2002 were 4.65 and 3.81 percent. Abuse and dependence were more common among males and among younger respondents. The prevalence of abuse was greater among Whites than among Blacks, Asians, and Hispanics. The prevalence of dependence was higher in Whites, Native Americans, and Hispanics than Asians. Between 1991–1992 and 2001–2002, abuse increased while dependence declined. Increases in alcohol abuse were observed among males, females, and young Black and Hispanic minorities, while the rates of dependence rose among males, young Black females, and Asian males.

Conclusions

This study underscores the need to continue monitoring prevalence and trends and to design culturally sensitive prevention and intervention programs.

Longitudinal trajectories of heavy drinking in adults in the United States of America

AIMS

To estimate age, period, cohort and other demographic influences on heavy alcohol consumption and trajectories of heavy drinking in American adults.

DESIGN

Prospective cohort of 14 127 participants, aged 25-74 years at baseline. Generalized estimating equations to model longitudinal change in the probability of heavy drinking and its association with demographic factors. Setting National, population-based sample of non-institutionalized civilians.

MEASUREMENTS

Heavy alcohol consumption (usual number of drinks per occasion >or= five for men; >or= four for women) at baseline (1971-74) and three follow-ups until 1992.

FINDINGS

Heavy alcohol consumption declined with increasing age (age effect) and tracked national average consumption (period effect). There was no cohort effect. Higher probability of heavy drinking was associated with male gender (relative risk: RR = 2.4), being not married (RR = 1.4), having less than high school education (RR = 1.7), having annual income below the median (RR = 1.5), not living in the South-east (RR = 1.7), and smoking (RR = 3.4). Getting married and quitting smoking during the study were each associated with reduction in heavy drinking (RR = 0.55 and 0.61, respectively). Slower age-related decline in the probability of heavy drinking was seen in men (P < 0.0001), married individuals (P = 0.03), and smokers (P = 0.05).

CONCLUSIONS

Demographic predictors of trends in heavy drinking are different from those for trends in average alcohol consumption. The likelihood of heavy drinking declined more slowly with increasing age in men and smokers, suggesting that the negative health effects of alcohol in older ages may be greatest in these groups.

The Type A-Type B classification in a community sample of problem drinkers: structural and predictive validity

OBJECTIVE

The Type A-Type B multidimensional classification model has been useful for identifying a subgroup of alcohol dependent drinkers with more severe psychosocial problems and a poor prognosis. Evidence suggests its dimensions may be useful for identifying problem drinkers in the general population at risk for developing alcohol dependence. To date, the model has not yet been investigated for this purpose. The present study investigated the Type A/Type B distinction in a community sample of problem drinkers as well as its predictive validity among problem drinkers with no history of alcohol dependence.

METHOD

Households from a geographically delimited area in the United States were designated via random digit dialing and randomly designated members were screened for eligibility. A total of 876 participants met eligibility criteria and completed a structured interview (AUDADIS) on alcohol and other health related behaviors at baseline and at 1-year follow-up. A k-means cluster analysis was performed to identify subgroups of problem drinkers.

RESULTS

A two-cluster solution adequately fit the data and identified two main subgroups of problem drinkers consistent with a Type A-Type B distinction. The group differences held among those with and without a history of alcohol dependence and the subset of Type B drinkers with no history of alcohol dependence were approximately five times (beta = 1.56, p< or =0.01) more likely to have an initial onset of dependence than Type A drinkers at 1-year follow-up. In contrast, a DSM-IV alcohol abuse diagnosis at baseline did not predict 1-year onset of dependence.

CONCLUSIONS

The Type A-Type B model is useful for identifying untreated problem drinkers at risk for developing alcohol dependence. This model may facilitate the development of more targeted prevention efforts.

Trends and determinants of alcohol consumption in Portugal: results from the national health surveys 1995 to 1996 and 1998 to 1999

BACKGROUND

There is very little information on trends and determinants of alcohol consumption in the Portuguese population, which is usually characterized by high wine consumption.

METHODS

A cross-sectional studies was conducted in 1995/1996 and 1998/1999 in a representative sample of 0.5% of the mainland Portuguese population (49,768 participants in 1995/1996 and 48,606 in 1998/1999), aged 15 years or more. Alcohol consumption was assessed by asking whether the participants had consumed alcohol in the previous week and how many drinks of wine/beer/whiskey/Port wine they consumed on average during that week.

RESULTS

Prevalence of reported alcohol consumption decreased slightly between 1995/1996 and 1998/1999 (men: 65.7 vs. 64.0%, p < 0.001; women: 26.9 vs. 26.0%, p < 0.001). Among drinkers, the most frequently consumed alcoholic beverage was wine, followed by beer, whiskey, and Port wine. The amount of alcohol and wine consumed decreased in both sexes, whereas the amount of beer, whiskey, and Port wine consumed increased in men and the increase in beer consumption was borderline significant in women (p = 0.056). In both sexes, participants <50 years of age tended to consume less wine and more beer, whiskey, and Port wine than their older counterparts. Also, higher education was related to a higher frequency of alcohol consumption, whereas smoking was related to a lower consumption of wine [odds ratio (OR): 0.69 (95% confidence interval [CI]: 0.62-0.77) for men and OR: 0.76 (95% CI: 0.61-0.95) for women] and a higher consumption of beer [OR: 1.43 (95% CI: 1.33-1.54) for men and OR: 2.13 (95% CI: 1.84-2.42) for women and whiskey [OR: 1.28 (95% CI: 1.21-1.35) for men and OR: 2.61 (95% CI: 2.25-3.02) for women].

CONCLUSIONS

The pattern of alcohol consumption is changing in Portugal: the prevalence of drinkers is decreasing, and younger generations are shifting from wine to beer and spirits. Educational level seems to be a powerful mediator in the choice of alcoholic beverage.

Disparities in patterns of alcohol use among reservation-based and geographically dispersed American Indian populations

BACKGROUND

High rates of alcohol use and alcohol-related morbidity and mortality among American Indians (AI) are major public health concerns. The purpose of this paper is to describe patterns of alcohol consumption among three distinct samples of American Indians (AIs) compared to a U.S reference population.

METHODS

Data were drawn from two epidemiologic studies: 1) a study of 2,927 AIs living on or near reservations from two culturally distinct tribes in the Southwest (SW-AI) and Northern Plains (NP-AI); and 2) the National Longitudinal Alcohol Epidemiologic Study (NLAES), which included data from a geographically dispersed sample of AIs (n = 780) as well as the US reference population (all-race excluding AIs, n = 30,063). Multivariate analyses were used to assess drinking patterns.

RESULTS

After controlling for demographic characteristics, the prevalence of drinking during the past year was similar among males in the NP-AI, NLAES-AI, and the US populations. SW-AI males and females were significantly less likely to drink during the past year (Odds Ratios of 0.74 and 0.41, respectively), while the odds of NP-AI females being current drinkers were twice that of US females. Among those who drank during the past year, the AIs consumed a larger quantity of alcohol per drinking day than the US reference population. However, the reservation-based AIs consumed alcohol less frequently (Odds Ratios between 0.18-0.40, p < 0.01) than the NLAES-AI and US populations.

CONCLUSIONS

Patterns of alcohol consumption varied substantially between the two reservation-based AI populations, the geographically dispersed sample of AIs, and the US reference population. Careful consideration of these variations may improve the effectiveness of alcohol prevention and treatment programs as they may reflect important underlying differences in the cultures of alcohol consumption across these populations.

RECENT TRENDS IN INCIDENCE RATES FOR SELECTED ALCOHOL-RELATED CANCERS IN THE UNITED STATES

AIMS

To examine recent trends in incidence rates for cancer types most strongly associated with alcohol use, using data from US cancer registries.

METHODS

Age-standardized annual incidence rates (ASIRs) for squamous cell carcinomas of the oral cavity and pharynx, esophagus and larynx diagnosed in the most recent 10-year period (1992-2001) were examined for geographic areas included in the US National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program of high-quality cancer registries.

RESULTS

For all geographic areas combined, ASIRs for these cancers declined over time, with no evidence for a recent plateau or upturn. This also held true for ASIRs in younger adults (age 20-54 years at diagnosis). For white males, declines in ASIRs occurred in each of the 11 geographic areas, and were statistically significant in nine areas. The declines in ASIRs were consistent with temporal declines in apparent alcohol consumption by state, although the prevalence of binge and heavy drinking in adults increased in some states.

CONCLUSIONS

Although there was no evidence for a recent plateau in ASIRs, continued surveillance is needed, in view of recent increases in the prevalence of binge and heavy drinking among US adults.

Neighbourhood deprivation and alcohol consumption: does the availability of alcohol play a role?

BACKGROUND

Previous studies suggest that the physical availability of alcohol may mediate the association between neighbourhood-level material deprivation and alcohol consumption. This study tests the relationships between neighbourhood-level deprivation, alcohol availability, and individual-level alcohol consumption using a multilevel analysis.

METHODS

Data are from cross-sectional surveys conducted between 1979 and 1990 as part of the Stanford Heart Disease Prevention Program (SHDPP). Women and men (n = 8197) living in four northern/central California cities and 82 neighbourhoods were linked to neighbourhood deprivation variables derived from the US census (e.g. unemployment, crowded housing) and to measures of alcohol availability (density of outlets in the respondent's neighbourhood, nearest distance to an outlet from the respondent's home, and number of outlets within a half mile radius of the respondent's home). Separate analyses were conducted for on- and off-sale outlets.

RESULTS

The most deprived neighbourhoods had substantially higher levels of alcohol outlet density than the least deprived neighbourhoods (45.5% vs 14.8%, respectively). However, multilevel analyses showed that the least deprived neighbourhoods were associated with the heaviest alcohol consumption, even after adjusting for individual-level sociodemographic characteristics (OR 1.30, CI 1.08-1.56). Alcohol availability was not associated with heavy drinking and thus did not mediate the relationship between neighbourhood deprivation and heavy alcohol consumption.

CONCLUSIONS

Although alcohol availability is concentrated in the most deprived neighbourhoods, women and men in least deprived neighbourhoods are most likely to be heavy drinkers. This mismatch between supply and demand may cause people in the most deprived neighbourhoods to disproportionately suffer the negative health consequences of living near alcohol outlets.

The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002

BACKGROUND

Alcohol abuse and dependence can be disabling disorders, but accurate information is lacking on the prevalence of current DSM-IV alcohol abuse and dependence and how this has changed over the past decade. The purpose of this study was to present nationally representative data on the prevalence of 12-month DSM-IV alcohol abuse and dependence in 2001-2002 and, for the first time, to examine trends in alcohol abuse and dependence between 1991-1992 and 2001-2002.

METHODS

Prevalences and trends of alcohol abuse and dependence in the United States were derived from face-to-face interviews in the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC: n = 43, 093 ) and NIAAA's 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES: n= 42, 862 ).

RESULTS

Prevalences of DSM-IV alcohol abuse and dependence in 2001-2002 were 4.65 and 3.81%. Abuse and dependence were more common among males and among younger respondents. The prevalence of abuse was greater among Whites than among Blacks, Asians, and Hispanics. The prevalence of dependence was higher in Whites, Native Americans, and Hispanics than Asians. Between 1991-1992 and 2001-2002, abuse increased while dependence declined. Increases in alcohol abuse were observed among males, females, and young Black and Hispanic minorities, while the rates of dependence rose among males, young Black females and Asian males.

CONCLUSIONS

This study underscores the need to continue monitoring prevalence and trends and to design culturally sensitive prevention and intervention programs.

Trends in alcohol use and binge drinking, 1985-1999: results of a multi-state survey

BACKGROUND

Alcohol abuse is a major public health problem in the United States. Binge drinking and drinking among youth are of special concern. The purpose of this study is to examine trends in alcohol use and binge drinking and correlates of the behaviors with a focus on drinking among persons 18 to 20 years of age.

METHODS

Data are from telephone interviews of 449,110 adults aged > or =18 years residing in the 19 states that participated in the Behavioral Risk Factor Surveillance System (BRFSS) from 1985 to 1999. The percentages reporting current alcohol use and binge use (> or =5 drinks per occasion) were calculated by year, age, gender, race, and level of education. Data were analyzed in 2003.

RESULTS

From 1985 to 1999, the prevalence of current alcohol use dropped 7.3%, and binge drinking dropped 3.3%. Among all age groups, most of the decline occurred before 1990. The greatest decline in both current (12.6%) and binge use (7.3%) occurred in the 18- to 20-year-old group. Between 1997 and 1999, however, respondents in this age group reported increases in these behaviors. Throughout the survey period, the proportion of current users who binge changed very little and remained highest among persons aged 18-20 years (52.1%).

CONCLUSIONS

Alcohol use leveled off in the 1990s, but may be increasing, especially among persons 18-20 years of age. Those who drink are about as likely to report binge drinking as were drinkers 15 years ago.

Geographic pattern of cancers related to tobacco and alcohol in Connecticut: implications for cancer control

The purpose of this study was to examine the geographic distribution of standardized incidence ratios (SIRs) for Connecticut's 169 towns for 18,382 cancers diagnosed in 1995-2000 at sites most strongly associated with tobacco and/or alcohol (i.e, lung, oral cavity-pharynx, and esophagus), with consideration of census-derived indicators of socioeconomic status (SES) at the town level. For males, the state's four largest towns, all in the highest poverty-rate quartile, had statistically significantly elevated SIRs for both lung cancer and oral cavity-pharynx cancers, and also had elevated SIRs for esophageal cancer. Two of these four towns also had statistically significantly elevated SIRs for oral cavity-pharynx cancer for females. SIRs for both males and females were lowest for the lowest poverty quartile and highest for the highest poverty quartile, for each cancer-site group. Among 15,271 patients diagnosed with their first cancer at any of the selected sites in 1995-2000, risk of diagnosis of a second primary cancer at any of these sites (139 patients) was highest in the highest poverty-rate quartile. These surveillance methods should be useful for targeting cancer control efforts aimed at prevention or cessation of tobacco and/or heavy alcohol use, and early detection or chemoprevention of these cancers, including second primary cancers.

Definitions of drunkenness

This study examined definitions of drunkenness in a general population using both quantitative and qualitative data. Using data from 1366 adult current drinkers from the 1995 National Alcohol Survey, frequency of drunkenness and number of drinks to feel drunk were compared. Qualitative data from 58 current drinkers were also examined to determine how they define drunkenness. Overall, there is a positive linear relationship between frequency of drunkenness and number of drinks to feel drunk. For women, the mean number of drinks to feel drunk is below five in all age and ethnicity categories. Several themes emerged from the qualitative data to describe drunkenness that were both negative and positive. These results suggest a possible reframing of how we measure at-risk drinking; a "one-size-fits-all" question of five or more drinks may not be the best way to assess risk for women.

Long-term trends in cancer mortality in the United States, 1930-1998

BACKGROUND

Progress against cancer can be examined by analyzing long-term trends in cancer incidence and mortality. The recent directive from the U.S. Department of Health and Human Services to adopt the 2000 U.S. standard population for the age adjustment of death rates prompted the American Cancer Society to update historical cancer mortality statistics using the new standard.

METHODS

Mortality data were abstracted by race, gender, year, and age at death for 1930 through 1959 from annual volumes of Vital Statistics of the United States. For 1960 through 1998, these data were obtained from data tapes provided by the National Center for Health Statistics. Two U.S. standard million populations (1970 and 2000) were used to calculate age-adjusted rates. Average annual percent change was estimated for each decade by site, gender, and age, and the statistical significance of the change was assessed at p < 0.05.

RESULTS

After long-term increases or mostly level trends that date from the 1930s for some sites, death rates for cancers of the lung (in males), prostate, female breast, colon-rectum, pancreas, leukemia, and ovary were decreasing in the 1990s. Liver cancer death rates were increasing in the 1990s. Throughout the study period, death rates for female lung cancer increased, while death rates for stomach and uterine cancers declined.

CONCLUSIONS

The trends of decreasing cancer death rates for the leading cancer sites in the 1990s are encouraging. However, surveillance researchers must continue to monitor these declines to assess whether the progress seen in this decade persists. Efforts also must be made to study the sites with increasing trends and identify potential underlying causes.

Co-occurring psychiatric symptoms and drug dependence or heavy drinking among HIV-positive people

This study sought to establish population-based estimates of the prevalence of co-occurring psychiatric symptoms and either or both drug dependence symptoms or heavy drinking among individuals who test positive for the human immunodeficiency virus (HIV) and to identify the factors associated with such comorbidity. Data from the HIV Cost and Services Utilization Study (HCSUS), a nationally representative sample of HIV-infected adults receiving medical care in the U.S. in 1996 (N = 2,864), were used to estimate the prevalence of comorbidity. Logistic regression was used to identify the independent influences of sociodemographic and HIV-related variables on comorbidity. The authors estimate that 13% of people with HIV receiving care in the U.S. in 1996 had co-occurring psychiatric symptoms and either or both drug dependence symptoms or heavy drinking. The odds of having a comorbid condition were higher for males, heterosexuals, and people with more HIV-related symptoms. The odds were lower for people living with AIDS, African Americans, people who were gay or sexually abstinent, those living with a spouse, those aged 50 years or older, and those with private insurance. Sixty-nine percent of those with a substance-related condition also had psychiatric symptoms; 27% of those with psychiatric symptoms also had a substance-related condition.