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Stangeland H, Aakvaag HF, Baumann-Larsen M, Wentzel-Larsen T, Storheim K, Zwart JA, Dyb G, Stensland SØ. Problematic alcohol use in young adults exposed to childhood trauma: The Trøndelag Health (HUNT) Study. J Trauma Stress 2023; 36:968-979. [PMID: 37665694 DOI: 10.1002/jts.22965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 09/06/2023]
Abstract
Problematic alcohol use (PAU) severely impacts the health, functioning, and long-term prospects of young people. Prior research indicates that childhood trauma exposure may be an important risk factor for PAU, but few longitudinal studies have looked at how specific trauma types influence this risk. The aim of this study was to investigate the association between childhood trauma exposure and PAU in a large, population-based cohort of young people. The study sample included 1,913 adolescents who participated in the Trøndelag Health Study (HUNT) between 2006 and 2008 (age range: 12-20) and completed follow-up 10 years later as young adults (age range: 22-32). The results revealed an increased risk of PAU in young adults exposed to childhood trauma, especially direct physical violence, OR = 2.38, [95% CI 1.56, 3.64]. Young adults who had witnessed violence, OR = 1.55, [95% CI 1.11, 2.17], or experienced an accident, disaster, or other traumatic event, OR = 1.60, [95% CI 1.19, 2.15], also had higher odds of PAU compared to those without such experiences. These associations remained consistent after adjusting for symptoms of headaches and pain as well as posttraumatic and general psychological distress as reported by the participants in adolescence. Future prevention efforts targeting PAU among adolescents and young adults should address violence and other trauma exposure as potential drivers of problematic drinking.
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Affiliation(s)
- Helle Stangeland
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Monica Baumann-Larsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Kjersti Storheim
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - John Anker Zwart
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Synne Øien Stensland
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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ADHD and Mental Health Symptoms in the Identification of Young Adults with Increased Risk of Alcohol Dependency in the General Population-The HUNT4 Population Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111601. [PMID: 34770114 PMCID: PMC8583619 DOI: 10.3390/ijerph182111601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 12/04/2022]
Abstract
Symptoms of ADHD are strongly associated with alcohol use disorders, and mental health symptoms attenuate this relationship. There is limited knowledge about how specific symptoms of inattentiveness and hyperactivity/impulsivity can explain this association. We aimed to identify self-reported executive cognitive functioning and mental health and variables that may help identify subjects with an elevated risk of alcohol dependence in the general population. Data included 3917 subjects between 19 and 30 years old in the 4th Trøndelag Health Study. The Adult ADHD Self report Scale—Screener, the Hospital Anxiety and Depression Scale, and demographic variables were used as input variables. The alcohol screening instrument CAGE was used as the response variable for binary alcohol dependence risk. We used logistic regression and automated model selection to arrive at our final model that identified sex, age, inattentiveness, hyperactivity/impulsivity symptoms, and anxiety as predictors of having a CAGE score ≥2, achieving an area under the receiver operating characteristic curve of 0.692. A balanced accuracy approach indicated an optimal cut-off of 0.153 with sensitivity 0.55 and specificity 0.74. Despite attrition in the data, our findings may be important in the assessment of individual risk for alcohol dependency and when developing algorithms for risk triage in public health.
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Validity of the CAGE questionnaire for men who have sex with men (MSM) in China. Drug Alcohol Depend 2016; 160:151-6. [PMID: 26850511 PMCID: PMC4767580 DOI: 10.1016/j.drugalcdep.2015.12.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/03/2015] [Accepted: 12/31/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Detection of heavy drinking among men who have sex with men (MSM) is crucial for both intervention and treatment. The CAGE questionnaire is a popular screening instrument for alcohol use problems. However, the validity of CAGE for Chinese MSM is unknown. METHOD Data were from three waves of cross-sectional assessments among general MSM (n=523) and men who sell sex to other men ("money boys" or MBs, n=486) in Shanghai, China. Specifically, participants were recruited using respondent-driven, community popular opinion leader, and venue-based sampling methods. The validity of the CAGE was examined for different cutoff scores and individual CAGE items using self-reported heavy drinking (≥14 drinks in the past week) as a criterion. RESULTS In the full sample, 75 (7.4%) of participants were classified as heavy drinkers. 32 (6.1%) of general MSM and 43 (8.9%) of MBs were heavy drinkers. The area under curve statistics for overall sample was 0.7 (95% CI: 0.36-0.77). Overall, the sensitivities (ranging from 18.7 to 66.7%), specificities (ranging from 67.5 to 95.8%), and positive predictive values (ranging from 14.1 to 26.4%) for different cutoff scores were inadequate using past week heavy drinking as the criterion. The ability of CAGE to discriminate heavy drinkers from non-heavy drinkers was limited. CONCLUSIONS Our findings showed the inadequate validity of CAGE as a screening instrument for current heavy drinking in Chinese MSM. Further research using a combination of validity criteria is needed to determine the applicability of CAGE for this population.
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Skogen JC, Øverland S, Knudsen AK, Mykletun A. Concurrent validity of the CAGE questionnaire. The Nord-Trøndelag Health Study. Addict Behav 2011; 36:302-7. [PMID: 21167648 DOI: 10.1016/j.addbeh.2010.11.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 11/06/2010] [Accepted: 11/20/2010] [Indexed: 12/14/2022]
Abstract
The aim of this study was to examine the psychometric properties of the CAGE questionnaire, and the questionnaire's concurrent validity with current and previous alcohol consumption. This study employed data from the Nord-Trøndelag Health Survey wave 1 (HUNT-1 in 1984-86: N=24,900) and wave 2 (HUNT-2 in 1995-97: N=36,350). The concurrent validity of the CAGE questionnaire was examined both as a dichotomous variable with the recommended cut-off (≥2 affirmative answers) for alcohol problems, and as a categorical scale. The categorical scale was constructed by counting responses from 0 to 4, and a separate category for current abstainers in HUNT-2. Current self-reported consumption above the gender specific 80th percentile was defined as "current excessive consumption". "Previous excessive consumers" were defined by meeting at least one of the two following criteria at the time of HUNT-1: reporting drinking too much alcohol in any period of their life, or reporting a high level of alcohol consumption. The internal reliability of CAGE was adequate, and in relation to alcohol consumption, there was a linear relationship between the CAGE score and both the current and previous excessive consumption. In conclusion, this study indicates good concurrent validity and adequate psychometric properties of the CAGE questionnaire. The dose-response pattern seen between the CAGE score and alcohol consumption, suggests that it can be used as an ordinal measure, rather than with a cut-off of two or more. The concurrent validity of the CAGE is better in women than in men.
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Etter JF, Gmel G. Paradoxical Changes in Alcohol Consumption and CAGE Ratings Between 1996 and 2006 in the General Population of Geneva. Alcohol Alcohol 2011; 46:128-32. [DOI: 10.1093/alcalc/agq102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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da Rocha MIDUM, Barrio-Lera JP, Jardim GBG, Mucellini AB, Cirolini L, Jung IEDC, Mânica-Cattani MF, da Silveira AF, de Souza OC, da Cruz IBM. Lifestyle, health characteristics and alcohol abuse in young adults who are non-daily smokers. SAO PAULO MED J 2010; 128:354-9. [PMID: 21308159 PMCID: PMC10948070 DOI: 10.1590/s1516-31802010000600008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 01/18/2010] [Accepted: 10/19/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVES Despite the decline in the prevalence of tobacco use in many countries, including Brazil, there are growing numbers of smokers who continue to smoke at a low daily rate, or less frequently (non-daily smokers). This group needs to be better characterized in order to direct preventive actions and public health policies. The aim here was to compare lifestyle, health characteristics and alcoholism problems among young adult smokers, non-daily smokers and non-smokers. DESIGN AND SETTING This was a cross-sectional study in which volunteers from the university community and its surrounds in Santa Maria, State of Rio Grande do Sul, Brazil, were included between October 2007 and January 2008. METHODS Out of 1240 volunteers initially contacted in a university cafeteria, a total of 728 participants of mean age 22.45 ± 3.32 years were selected for final analysis. Data were collected using structured questionnaires. RESULTS In general, it was observed that the non-daily smokers showed intermediate characteristics in relation to the smokers and non-smokers. However, there was a significant association between non-daily smoking and alcohol abuse. The non-daily smokers presented an odds ratio of 2.4 (95% confidence interval: 1.10-5.48) in relation to the daily smokers and an odds ratio of 3.3 (confidence interval: 1.7-6.5) in relation to the non-smokers, with regard to presenting a positive CAGE test, thereby indicating alcohol abuse or dependence. CONCLUSION The study suggested that non-daily smoking and alcohol consumption were concomitant behaviors.
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Affiliation(s)
- Maria Izabel de Ugalde Marques da Rocha
- MSc, PhD. Professor of Morphology, Department of Morphology, Health Science Center, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
| | - Juan Pablo Barrio-Lera
- MSc, PhD. Professor of Physiology, Postdoctoral Program on Biomedicine, Department of Biomedicine, Universidad de León (UNILEON), Spain.
| | - Gabriel Behr Gomes Jardim
- Undergraduate medical student, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
| | - Amanda Brondani Mucellini
- Undergraduate biology student, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
| | - Luiza Cirolini
- Undergraduate medical student, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
| | - Ivo Emilio da Cruz Jung
- Undergraduate psychology student, Centro Universitário Franciscano (UNIFRA), Santa Maria, Rio Grande do Sul, Brazil.
| | - Maria Fernanda Mânica-Cattani
- Postgraduate student of Toxicological Biochemistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
| | - Aron Ferreira da Silveira
- MD, PhD. Professor of Morphology, Department of Morphology, Health Science Center, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
| | - Olmiro Cezimbra de Souza
- MSc. Professor of Education, Department of Morphology, Health Science Center, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
| | - Ivana Beatrice Mânica da Cruz
- MSc, PhD. Professor of Genetics and Molecular Biology, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
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van Praag L, Bracke P, Christiaens W, Levecque K, Pattyn E. Mental health in a gendered context: Gendered community effect on depression and problem drinking. Health Place 2009; 15:990-8. [PMID: 19457700 DOI: 10.1016/j.healthplace.2009.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 03/10/2009] [Accepted: 04/19/2009] [Indexed: 10/20/2022]
Abstract
Socio-economic features of a community influence people's health. However, not all inhabitants are affected similarly. The present study explores gendered contextual effects on problem drinking and depression with the differential exposure, vulnerability and expression hypotheses of the social stress model in mind. Analyses are based on the pooled data of the Belgian Health Interview Survey 2001 and 2004 (N=21.367 respondents, N=589 municipalities). Results reveal that living in an area with high unemployment is more detrimental for women in terms of depression, but has the same impact on men and women when problem drinking is the outcome.
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Affiliation(s)
- Lore van Praag
- Health & Demographic Research-HeDeRa, Department of Sociology, Ghent University, Korte Meer 5, 9000 Ghent, Belgium
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Messiah A, Encrenaz G, Sapinho D, Gilbert F, Carmona E, Kovess-Masféty V. Paradoxical increase of positive answers to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of decreasing alcohol consumption: results from two population-based surveys in Ile-de-France, 1991 and 2005. Addiction 2008; 103:598-603. [PMID: 18261191 DOI: 10.1111/j.1360-0443.2007.02120.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To describe trends of responses to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of declining alcohol consumption, in a country with no temperance history. DESIGN Two random-sample surveys, conducted in 1991 and 2005, respectively. SETTING The adult population of Ile-de-France. PARTICIPANTS A total of 1183 subjects in 1991 and 5382 subjects in 2005. MEASUREMENTS Responses to CAGE questions, obtained by face-to-face interviews in 1991 and by telephone in 2005. RESULTS were standardized on the 2005 population structure. FINDINGS The proportion of subjects giving at least two positive answers has increased by 4.2 times; the biggest increase was observed for the Guilt question (4.8 times) and the smallest for the Eye-opener question (2.6 times). Several increases were higher for women than for men: 12.9 times versus 3.3 times for two or more positive answers, 9.8 times versus 3.8 times for the Guilt question. Increases did not vary consistently by age. CONCLUSION These paradoxical trends do not support the use of CAGE in general population surveys. They confirm previous reports suggesting that CAGE was sensitive to community temperance level. They might reflect the emergence of a temperance movement in France, with stronger impact among women. This movement might be responsible for the fall in alcohol consumption.
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Affiliation(s)
- Antoine Messiah
- INSERM, Research Center U-897, Equipe Avenir, Prévention et prise en charge des Traumatismes/Injury Prevention and Control, Bordeaux, France.
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Flowers NT, Naimi TS, Brewer RD, Elder RW, Shults RA, Jiles R. Patterns of alcohol consumption and alcohol-impaired driving in the United States. Alcohol Clin Exp Res 2008; 32:639-44. [PMID: 18341648 DOI: 10.1111/j.1530-0277.2008.00622.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol-related motor vehicle crashes kill approximately 17,000 Americans annually and were associated with more than $51 billion in total costs in 2000. Relatively little is known about the drinking patterns of alcohol-impaired (AI) drivers in the United States. METHODS 2006 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed for alcohol consumption and self-reported AI driving among U.S. adults aged > or =18 years for all states. Alcohol consumption was divided into 4 categories: binge/heavy, binge/nonheavy, nonbinge/heavy, and nonbinge/nonheavy. Binge drinking was defined as > or =5 drinks for men or > or =4 drinks for women on one or more occasions in the past month, and heavy drinking was defined as average daily consumption of >2 drinks/day (men) or >1 drink/day (women). The prevalence of AI driving was examined by drinking pattern and by demographic characteristics. Logistic regression analysis was used to assess the association between drinking patterns and AI driving. RESULTS Five percent of drinkers were engaged in AI driving during the past 30 days. Overall, 84% of AI drivers were binge drinkers and 88% of AI driving episodes involved binge drinkers. By drinking category, binge/nonheavy drinkers accounted for the largest percentage of AI drivers (49.4%), while binge/heavy drinkers accounted for the most episodes of AI driving (51.3%). The adjusted odds of AI driving were 20.1 (95% CI: 16.7, 24.3) for binge/heavy, 8.2 (6.9, 9.7) for binge/nonheavy, and 3.9 (2.4, 6.3) for nonbinge/heavy drinkers, respectively. CONCLUSIONS There is a strong association between binge drinking and AI driving. Most AI drivers and almost half of all AI driving episodes involve persons who are not heavy drinkers (based on average daily consumption). Implementing effective interventions to prevent binge drinking could substantially reduce AI driving.
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Affiliation(s)
- Nicole T Flowers
- Emerging Investigations and Analytic Methods Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Rikoon SH, Cacciola JS, Carise D, Alterman AI, McLellan AT. Predicting DSM-IV dependence diagnoses from Addiction Severity Index composite scores. J Subst Abuse Treat 2006; 31:17-24. [PMID: 16814007 DOI: 10.1016/j.jsat.2006.03.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 03/17/2006] [Indexed: 11/18/2022]
Abstract
This study, using data from the Drug Evaluation Network System and a study conducted through the Center for Studies on Addiction of the University of Pennsylvania/Philadelphia Veterans Administration Medical Center, sought to determine the potential of the Addiction Severity Index (ASI) to serve as a screening instrument for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) substance dependence. A significant positive correlation was found between ASI composite scores (CSs) and DSM-IV diagnoses of dependence in both the alcohol (r > .7) and drug (r > .5) domains (p < .01). Receiver operating characteristic analyses were run to predict DSM-IV alcohol and drug dependence diagnoses from the respective ASI CSs. Results showed good to strong prediction; ASI CSs identified dependent clients with approximately 85% sensitivity and 80% specificity. We recommend strategies for using ASI CSs as a diagnostic screening instrument in both research and treatment delivery environments.
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Fauerbach JA, Lezotte D, Hills RA, Cromes GF, Kowalske K, de Lateur BJ, Goodwin CW, Blakeney P, Herndon DN, Wiechman SA, Engrav LH, Patterson DR. Burden of Burn: A Norm-Based Inquiry into the Influence of Burn Size and Distress on Recovery of Physical and Psychosocial Function. ACTA ACUST UNITED AC 2005; 26:21-32. [PMID: 15640730 DOI: 10.1097/01.bcr.0000150216.87940.ac] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This prospective, longitudinal study examined the influence of baseline physical and psychological burden on serial assessments of health-related quality of life among adults with major burns from three regional burn centers (n = 162). Physical burden groups were defined by % TBSA burned: <10%, 10% to 30%, or >30%. Psychological burden groups were defined by in-hospital distress using the Brief Symptom Inventory Global Severity Index T-score with scores of < 63 or > or = 63. Analyses compared groups across level of burden and with published normative data. Assessments reflected health and function (Short Form 36) during the month before burn, at discharge, and at 6 and 12 months after burn. Physical functioning was significantly more impaired and the rate of physical recovery slower among those with either large physical burden or large psychological burden. Notably, psychosocial functioning also was more impaired and the rate of psychosocial recovery slower among those with greater psychological burden. These results suggest that, in addition to aggressive wound closure, interventions that reduce in-hospital distress may accelerate both physical and psychosocial recovery.
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Affiliation(s)
- James A Fauerbach
- Johns Hopkins University School of Medicine, c/o Baltimore Regional Burn Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA
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