Binge drinking among youths and young adults in the United States: 1979-2006

What Causes Premature Coronary Artery Disease?

PURPOSE OF REVIEW

This review provides an overview of genetic and non-genetic causes of premature coronary artery disease (pCAD).

RECENT FINDINGS

pCAD refers to coronary artery disease (CAD) occurring before the age of 65 years in women and 55 years in men. Both genetic and non-genetic risk factors may contribute to the onset of pCAD. Recent advances in the genetic epidemiology of pCAD have revealed the importance of both monogenic and polygenic contributions to pCAD. Familial hypercholesterolemia (FH) is the most common monogenic disorder associated with atherosclerotic pCAD. However, clinical overreliance on monogenic genes can result in overlooked genetic causes of pCAD, especially polygenic contributions. Non-genetic factors, notably smoking and drug use, are also important contributors to pCAD. Cigarette smoking has been observed in 25.5% of pCAD patients relative to 12.2% of non-pCAD patients. Finally, myocardial infarction (MI) associated with spontaneous coronary artery dissection (SCAD) may result in similar clinical presentations as atherosclerotic pCAD. Recognizing the genetic and non-genetic causes underlying pCAD is important for appropriate prevention and treatment. Despite recent progress, pCAD remains incompletely understood, highlighting the need for both awareness and research.

Age 18-30 trajectories of binge drinking frequency and prevalence across the past 30 years for men and women: Delineating when and why historical trends reversed across age

Historical analyses based on US data indicate that recent cohorts engage in lower binge drinking at age 18 relative to past cohorts, but by the mid- to late-20s the reverse is true: recent cohorts engage in higher binge drinking relative to past cohorts. We pinpoint when - both developmentally and historically - this reversal manifested, examine possible reasons for this reversal, and examine sex convergence in these developmental and historical patterns. As part of the US national Monitoring the Future Study, over 75,000 youths from the high school classes of 1976-2006 were surveyed biennially between ages 18 and 30. We found that the reversal primarily manifested between ages 18 and 24 for men and 18 and 22 for women. We also found that the reversal emerged gradually across the last three decades, suggesting it is the result of a broad and durable historical shift. Our findings indicated that historical variation in social roles and minimum legal drinking age collectively accounted for only a modest amount of the reversal, although marriage was the most influential among the factors examined here. Finally, we found evidence that sex convergence in binge drinking was developmentally limited and far more pronounced at the beginning of the transition to adulthood.

Health differences by entry stream among Canadian Armed Forces officer cadets

LAY SUMMARY

This study compared the baseline physical and mental health of officer candidates attending military college and officer training programs (i.e., non-direct-entry officer or non-DEO stream) with those of officers entering through a direct stream (direct-entry officer or DEO stream). Overall, DEO candidates had better health than non-DEO candidates. Female DEO and non-DEO candidates also reported more physical activity than male DEO and non-DEO candidates, and female non-DEO candidates had more symptoms of mental illness than male non-DEO candidates. A better understanding of these groups may lead to opportunities to customize health screening and supports depending on officer entry stream and sex; however, more research is needed to inform policy.

Cohabitation dissolution and psychological distress among young adults: The role of parenthood and gender

Cohabitation has become a normative experience for American young adults and a common setting for childbearing in recent decades. However, the high dissolution rate of cohabitation exposes young adults to the potential stress of intimate relationship dissolution and single parenthood during early adulthood. Drawing on data from the National Longitudinal Survey of Youth 1997, we apply growth curve models to analyze how cohabitation dissolution associates with trajectories of depressive symptoms and binge drinking behaviors for young adults (aged 17 to 35). We investigate how the presence of children moderates this association for men and women. We find that cohabitation dissolution is associated with increased depressive symptoms for both men and women. However, cohabitation dissolution is only positively associated with binge drinking behaviors for men, and a significant gender difference is observed. The presence of children when cohabitation dissolves strengthens the positive association between cohabitation dissolution and depressive symptoms among women, and this positive moderation fades away as young women age. These findings suggest that gender differences in the association of cohabitation dissolution with psychological distress are contingent on the types of psychological distress under consideration and also reveal that cohabitation dissolution intertwined with non-marital parenthood is harmful to mental health, especially for young women.

Ethnic/Racial Differences in Alcohol Use: Does Drinking Refusal Self-Efficacy Matter?

Introduction: College students-including those of Hispanic backgrounds-are at risk for hazardous drinking. Research has shown robust group differences between Hispanic and White individuals in alcohol use outcomes. The ability to resist alcohol consumption can be leveraged to reduce hazardous drinking; however, little research has examined Hispanic-White differences and whether drinking refusal self-efficacy accounts for group differences in hazardous drinking. Considering Hispanic individuals make up the largest ethnic/racial minority group in the United States, it is important to identify malleable psychological factors that prevent and reduce drinking problems. Method: Hispanic and White college students at two predominantly White institutions (N = 389; 58.6% women, M_age= 20.22) completed measures assessing drinking refusal self-efficacy, hazardous drinking, and negative drinking consequences. Results: Hispanic students reported lower levels of hazardous drinking, alcohol-related problems, and drinking refusal self-efficacy than White students. Drinking refusal self-efficacy was found to partially explain Hispanic-White differences in the levels of hazardous drinking and drinking-related problems. Specifically, drinking refusal self-efficacy was associated with alcohol use outcomes only among White students and not Hispanic students. Conclusion: The correspondence between drinking refusal self-efficacy and actual behaviors to turn down drinks, ethnic/racial distinctiveness in ratings of self-efficacy and cultural orientations, and situational contexts that surround drinking should be examined in future research.

A Hematological Travesty in the Setting of Alcohol Use Disorder and Liver Cirrhosis

Excessive ethanol consumption is associated with an increased risk of developing health complications, especially in individuals with pre-existing thrombocytopenia and cirrhosis. Here, we describe a case of a patient with a history of alcoholic cirrhosis, hypertension, and thrombocytopenia, presenting with significant decline following an incidence of binge drinking. Radiography identified a large non-lobar intraparenchymal hemorrhage. However, due to severe thrombocytopenia that was unresponsive to platelet therapy, the possibility of pursuing any form of surgical intervention was negated. Surgical contraindication and a lack of response to subsequent medical management contributed to the family’s decision to opt for conservative medical treatment and comfort care. This case showcases the potential for liver cirrhosis in the setting of chronic alcohol use disorder to pave the way for terminal intracerebral hemorrhage.

At-Risk Drinking, Operant Demand, and Cross-Commodity Discounting as Predictors of Drunk Driving in Underage College Women

Behavioral economics offers unique tools for assessing value and motivation associated with college drinking. Tasks that model changes in consumption as a function of price (operant demand) or the decline in an outcome's subjective value as a function of time-to-occurrence (delay discounting) provide valuable information that may efficiently supplement clinical screening instruments when characterizing alcohol use severity. The first aim of this investigation was to examine the extent to which at-risk drinking, operant demand for alcohol, and single- and cross-commodity discounting of money and alcohol predict adverse consequences of past-month drinking in underage college women (N = 72). The second aim was to determine whether these clinical and behavioral economic measures could significantly predict the odds of past-month drunk driving, a serious public health concern due to the increasing prevalence of heavy episodic drinking among women in their first 1 - 2 years of college. Results showed that higher scores on the consumption factor of the Alcohol Use Disorder Identification Test (AUDIT-C), greater Persistence (consumption amidst constraint) and Amplitude (maximum consumption) of demand, as well as lower rates of discounting for choices between receiving alcohol now or double the amount after a delay (choosing the larger amount of alcohol even when it is delayed) significantly predicted adverse consequences of past-month drinking. Moreover, scores on the AUDIT-C, Amplitude of demand, and higher rates of discounting for choices between receiving alcohol now and money later (choosing immediately available alcohol at the expense of double the equivalent in delayed money) significantly predicted past-month drunk driving. We contend that operant demand along with single- and cross-commodity discounting can be viewed as intersecting measures of reinforcer value with clinical relevance to college women.

Forecasting future prevalence and gender differences in binge drinking among young adults through 2040

BACKGROUND

Binge drinking among adolescents and young adults has changed over time, but patterns differ by age and gender. Identifying high-risk groups to target future efforts at reducing drinking in this population remains a public health priority. Forecasting methods can provide a better understanding of variation and determinants of future binge drinking prevalence.

METHODS

We implemented regression-based forecasting models to estimate the prevalence and gender differences in binge drinking among cohort groups of U.S. young adults, ages 18, 23-24, and 29-30 through 2040. Forecasting models were adjusted for covariates accounting for changes in demographic, Big-5 social roles (e.g., residential independence), and drinking norms and related substance use, to understand the drivers of forecasted binge drinking estimates.

RESULTS

From the last observed cohort group (years varied by age) through 2040, unadjusted binge drinking prevalence was forecasted to decrease from 26% (95% CI: 20, 33%) (2011-15) to 11% (95% CI: 4, 27%) at age 18, decrease from 38% (95% CI: 30, 45%) (2006-2010) to 34% (95% CI: 18, 55%) at ages 23/24, and increase from 32% (95% CI: 25, 40%) (2001-2005) to 35% (95% CI: 16, 59%) at ages 29/30. Gender-stratified forecasts show a continuation in the narrowing of binge drinking prevalence between young men and women, though the magnitude of narrowing differs by age. Estimated trends were partially explained by changing norms regarding drinking and other substance use, though these indirect effects explained less of the total trend as age increased.

CONCLUSIONS

Understanding how covariates influence binge drinking trends can guide public health policies to leverage the most important determinants of future binge drinking to reduce the harm caused by binge drinking from adolescence to adulthood.

Cohort and age trends in age 35-45 prevalence of alcohol use disorder symptomology, by severity, sex, race, and education

AIMS

To present national trends by age and cohort among middle-aged adults in the prevalence of AUD symptomology, by severity, sex, race, and education.

DESIGN

National, multi-cohort longitudinal probability samples of US adults, with data collected at ages 35, 40, and 45 among 14 cohorts who reached age 45 between 2003 and 2016.

SETTING

Data were collected via self-administered questionnaires to adults in the United States.

PARTICIPANTS

The sample consisted of 20,634 individuals.

MEASUREMENTS

5-year prevalence of symptoms consistent with a DSM-5 AUD.

FINDINGS

Between ages 35-45 prevalence of any AUD symptoms decreased 19 %; decreases were most evident between ages 35-40. From 2003 to 2016, AUD symptoms were steady across cohort. However, because the pace of decrease across ages 35-45 slowed across cohort, cohort differences emerged at specific ages: age 35 prevalence decreased 18 % across cohort, but age 45 prevalence was equivalent across cohort. Age and cohort effects, and their interaction, did not vary by AUD severity level. Declines in AUD symptoms across age were 17 % slower for women, and declines in AUD symptoms across age and cohort were 11 % and 29 % slower, respectively, for those with a college degree. The protection afforded by a college degree was reversed among mild AUD and most pronounced for severe AUD.

CONCLUSIONS

AUDs may be more plastic and responsive to intervention during early mid-life than later. Despite progress in reducing the burden of AUD in the US population among younger middle-aged adults, an increased focus remains necessary as they continue to age.

Consideration of an upper-bound continuous maximum drinks measure for adolescent binge and high-intensity drinking prevalence

BACKGROUND

The degree to which binge and high-intensity drinking prevalence estimates vary from fixed threshold frequency and continuous maximum drinks measures is unknown. The current study compared prevalence estimates for adolescent binge and high-intensity drinking (5+ drinks, 10+ drinks, respectively) and sex-specific thresholds using fixed threshold frequency and continuous maximum drinks measures.

METHODS

Data were obtained from 7911 respondents participating in the 2018 and 2019 nationally representative Monitoring the Future 12th-grade surveys. Comparisons of frequency prevalence (e.g., any occasions of 5+ drinking using the frequency measure) versus maximum drinks prevalence (e.g., reporting 5 or more drinks using the maximum number of drinks measure) were made using all respondents and then separately within males and females.

RESULTS

Among the sample overall and within sex, binge drinking estimates from the 5+ frequency prevalence and 5+ maximum drinks prevalence measures evidenced overlapping confidence intervals (estimates were slightly higher for frequency prevalence); similar results were observed for high-intensity drinking 10+ frequency prevalence and 10+ maximum drinks prevalence. For example, among the sample overall, 5+ frequency prevalence was 11.4% [95% CI 10.3, 12.6]; 5+ maximum drinks prevalence was 10.7% [9.6, 11.8]; 10+ frequency prevalence was 5.1% [4.4, 5.8]; and 10+ maximum drinks prevalence was 4.1% [3.5, 4.7]. Using sex-specific thresholds (i.e., 4+ drinks for females and 5+ drinks for males), binge frequency and maximum drinks levels also had overlapping confidence intervals. Binge drinking prevalence estimates for females were approximately 1.5 times higher using sex-specific (4+) versus universal (5+) thresholds.

CONCLUSIONS

In this nationally representative sample of 12th-grade students, prevalence levels for 5+ and 10+ drinking did not differ significantly when using frequency versus maximum drinks measures. Among females, binge drinking prevalence was higher using sex-specific versus universal thresholds. Both the frequency and maximum drinks measures provided comparable estimates of binge and high-intensity drinking prevalence among older adolescents.

Drinking games among university students in five countries: Participation rates, game type, contexts, and motives to play

Most published studies, regarding students' participation in drinking games (DGs), originate from the United States of America (USA). This study extends research to the United Kingdom (UK) and countries of mainland Europe. University students from five countries completed an anonymous online questionnaire which included measures of the frequency of DG participation, along with types, contexts and motives for participation. Responses are compared by the gender, and country of domicile of the participants. The study is based on the results of the questionnaire administered to 306 Social Work students from five universities/countries of which 72.2% are females, with a mean age of 22.6 years. This included students in Austria, Germany, the Netherlands, the UK and the USA. A high proportion of students, irrespective of gender, or country of domicile, stated that they participated in DGs. To 'meet people' and 'to get drunk' are the most important reasons stated for DG participation. Less benign motives, to 'control others' or 'get other people drunk', are reported as 'not important'. The most common types of DGs were consumption and team DGs. The pre-partying involved in DGs and associated consequences show important targets in alcohol harm minimization interventions. Harm minimization/public health messages regarding safer drinking need to recognize that younger students often feel they are immortal and do not fully appreciate risks and adverse effects of DGs and drink to have fun and be sociable.

C.A.R.E.S: A mobile health program for alcohol risk reduction in community college students

BACKGROUND

Compared to students at four-year residential colleges, Community College Students (CCS) are at greater risk for binge drinking and alcohol related risks, however few interventions have been developed specifically for the needs of CCS.

METHODS AND DESIGN

This study design tests the efficacy of a smartphone app (CARES) compared to an existing online alcohol education (AE) program. CCS (n = 250) will be recruited using a nationwide social media campaign and randomly assigned to either arm, stratified by sex and age (over/under 21). Eligibility screening, consent and assessments are conducted online and both interventions are accessible by smartphone. Assessments will be conducted at baseline, 4- and 8- weeks, end of treatment (12-weeks) and at 6-month follow-up. The primary outcomes are heavy episodic drinking (past 2 weeks), and alcohol related problems Confidence in refusing alcohol, use of protective behavioral strategies and expectations regarding alcohol use. Demographics including age, sex, race/ethnicity, marital and parental status and employment will be analyzed as potential covariates.

DISCUSSION

Community colleges serve approximately half of all US college students but frequently lack the resources to implement full-service alcohol prevention and education programs. The specific needs of CCS also differ from those of residential college students for whom most alcohol prevention programs have been developed. If proven efficacious, the CARES intervention may offer a scalable, easily disseminable program designed for the needs of community colleges and their students. ClinicalTrials.gov Registration: NCT03927482.

Association between perceived risk of harm and self-reported binge drinking, cigarette smoking, and marijuana smoking in young adults

OBJECTIVES

Evaluate the association between perceived risk of harm and self-reported binge drinking, cigarette smoking, and marijuana smoking among college students.

PARTICIPANTS

Participants were 599 students (ages 19-28) at a large Midwestern university recruited from October 2015 to December 2017.

METHODS

Hurdle regression was used to test the relationship between perceived risk of harm from substance use (i.e., binge drinking, cigarette smoking, and marijuana smoking), and self-reported use. Demographic characteristics were tested as moderators of this relationship.

RESULTS

Engagement in all three substance use behaviors was less likely when perceived risk was high. Age moderated the association between perceived risk and self-reported marijuana smoking with younger participants demonstrating a stronger relationship between perceived risk of smoking marijuana and self-reported marijuana smoking.

CONCLUSION

Intervention programs will be most effective when perceived risk of substance use is high. Therefore, intervention programs should aim to increase college students' perceived risk of substance use.

Shared and non-shared risk and protective factors of binge eating and binge drinking from adolescence to young adulthood

This study aimed to elucidate the shared and non-shared behavioral, sociocultural, and personal risk factors underlying binge eating and binge drinking among a sample (n = 1764) of participants from Project EAT at baseline and 10-year follow-up. Longitudinal and cross-sectional analyses revealed a range of risk factors associated with binge eating and binge drinking at 10 years, which varied by gender. The results revealed that risks associated with binge eating and binge drinking often differed, and thus full-scale dual preventive interventions for concurrent binge eating and binge drinking may be less effective. However, general prevention and intervention programs may emphasize shared risk factors.

Examining the Intended and Unintended Impacts of Raising a Minimum Legal Drinking Age on Primary and Secondary Societal Harm and Violence from a Contextual Policy Perspective: A Scoping Review

Raising a minimum legal drinking age (MLDA) has generated interest and debate in research and politics, but opposition persists. Up to now, the presentation of impacts focussed on effectiveness (i.e., intended impact); to our knowledge, no literature syntheses focussed on both intended and unintended impacts. A systematic scoping review was conducted in which a search strategy was developed iteratively and literature was obtained from experts in alcohol research and scientific and grey databases. Ninety-one studies were extracted and analysed using formative thematic content analysis. Intended impacts were reported in 119 units of information from the studies (68% positive), forming four paths: implementation, primary and (two) on secondary societal harm and violence. Unintended developments were reported in 43 units of information (30% positive), forming five themes. Only eight studies reported on implementation. Furthermore, a division between primary and secondary paths and the use of a bridging variable (drinking patterns in analyses or methodology) was discovered. These results provide an insight into how well legislation works and can be used to discover or implement new means of curbing underage drinking and alcohol-related violence and harm. They also offer valuable starting points for future research and underline the importance of considering unintended developments.

Assessment of Changes in Alcohol and Marijuana Abstinence, Co-Use, and Use Disorders Among US Young Adults From 2002 to 2018

IMPORTANCE

Recent information on the trends in past-year alcohol abstinence and marijuana abstinence, co-use of alcohol and marijuana, alcohol use disorder, and marijuana use disorder among US young adults is limited.

OBJECTIVES

To assess national changes over time in past-year alcohol and marijuana abstinence, co-use, alcohol use disorder, and marijuana use disorder among US young adults as a function of college status (2002-2018) and identify the covariates associated with abstinence, co-use, and marijuana use disorder in more recent cohorts (2015-2018).

DESIGN, SETTING, AND PARTICIPANTS

This study examined cross-sectional survey data collected in US households annually between 2002 and 2018 as part of the National Survey on Drug Use and Health. The survey used an independent, multistage area probability sample for all states to produce nationally representative estimates. The sample included 182 722 US young adults aged 18 to 22 years. The weighted screening and weighted full interview response rates were consistently above 80% and 70%, respectively.

MAIN OUTCOMES AND MEASURES

Measures included past-year abstinence, alcohol use, marijuana use, co-use, alcohol use disorder, marijuana use disorder, prescription drug use, prescription drug misuse, prescription drug use disorder, and other drug use disorders based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.

RESULTS

The weighted sample comprised 51.1% males. Between 2002 and 2018, there was an annual increase in past-year alcohol abstinence among young adults (college students: 0.54%; 95% CI, 0.44%-0.64%; non-college students: 0.33%; 95% CI, 0.24%-0.43%). There was an annual increase in marijuana use from 2002 to 2018 (college: 0.46%; 95% CI, 0.37%-0.55%; non-college: 0.49%; 95% CI, 0.40%-0.59%) without an increase in marijuana use disorder for all young adults. Past-year alcohol use disorder decreased annually (college: 0.66%; 95% CI, 0.60%-0.74%; non-college: 0.61%; 95% CI, 0.55%-0.69%), while co-use of alcohol and marijuana increased annually between 2002 and 2018 among all young adults (college: 0.60%; 95% CI, 0.51%-0.68%; non-college: 0.56%; 95% CI, 0.48%-0.63%). Young adults who reported co-use of alcohol and marijuana or met criteria for alcohol use disorder and/or marijuana use disorder accounted for 82.9% of young adults with prescription drug use disorder and 85.1% of those with illicit drug use disorder. More than three-fourths of those with both alcohol use disorder and marijuana use disorder reported past-year prescription drug use (78.2%) and illicit drug use (77.7%); 62.2% reported prescription drug misuse.

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that US colleges and communities should create and maintain supportive resources for young adults as the substance use landscape changes, specifically as alcohol abstinence, marijuana use, and co-use increase. Interventions for polysubstance use, alcohol use disorder, and marijuana use disorder may provide valuable opportunities for clinicians to screen for prescription drug misuse.

Changes in alcohol use and heavy episodic drinking in U.S. Women of childbearing-age and peripartum between 2001-2002 and 2012-2013

BACKGROUND

Heavy episodic drinking (HED) is a frequent pattern of alcohol use in women of childbearing age with severe consequences for both women and child, making it a major public health issue. Some states in the US have reported laws that target the use of alcohol during pregnancy. Our aim was to examine the evolution of 12-month alcohol use and 12-month HED prevalence in childbearing age, pregnant and postpartum women between 2001 and 2002 and 2012-2013.

METHODS

Our data were drawn from the National Epidemiologic Study of Alcohol and Related Conditions (NESARC) conducted in 2001-2002 and NESARC-III conducted in 2012-2013, two independent, representative samples of U.S.

POPULATION

Past-year alcohol use and HED was evaluated according face-to-face interview for all participants.

RESULTS

Our sample consisted of 24,536 women of childbearing age, including 2846 pregnant and postpartum women. Prevalence of 12-month alcohol use increased from 2001 to 2002 to 2012-2013, in both childbearing-aged women (66.14% to 75.48%; aOR = 1.62, 95%CI = 1.46-1.80) and pregnant and postpartum women (57.81% to 66.19%; aOR = 1.56, 95%CI = 1.25-1.94). Prevalence of 12-month HED increased from 2001 to 2002 to 2012-2013, in both childbearing-aged women (22.57% to 36.34%; aOR = 1.97, 95%CI = 1.79-2.16) and pregnant and postpartum women (17.85% to 28.21%; aOR = 1.84, 95%CI = 1.47-2.30).

CONCLUSIONS

Alcohol use and HED increased in last 10 years in both childbearing age and pregnant and postpartum US women. That questions the impact of implemented laws, policies and alcohol guidelines in this population within the last 10 years.

Examining the relationship between ethnic identity, depression, and alcohol use among students at historically black colleges/universities (HBCUs)

Alcohol abuse among college populations is a serious public health issue and is associated with many negative consequences; however, few studies have examined the drinking behavior of African American students at Historically Black Colleges/Universities (HBCUs). Alcohol abuse, including binge drinking, has historically been lower among African American than Caucasian college students; however, recent studies indicate that HBCU undergraduates are reporting increased rates of alcohol consumption, raising the question of which potential risk and protective factors are associated with alcohol consumption in this population. Ethnic identity has been identified as one protective factor for ethnic minorities, yet the processes that facilitate this relationship are little known. This study sought to further investigate the relationship between ethnic identity, depression, and alcohol use in a sample of 171 African American HBCU students. Participants were tightly clustered toward the desirable end on all measures, which restricted variability and thus attenuated correlational analyses to evaluate the relationships between study variables. There was a consistent pattern of high ethnic identification, minimal mental health distress, and low alcohol and substance use. Results suggest HBCU students are maintaining lower rates of alcohol consumption and binge drinking compared to nationally-stratified samples of undergraduates. Furthermore, these findings suggest African Americans attending HBCUs score highly on ethnic identity and resiliency. Cultural and social norms at HBCUs may help explain low rates of substance and alcohol misuse among HBCU students. Recommendations for culturally-informed alcohol use prevention and intervention strategies and for future research are provided.

Modifiable risk and protective factors for anxiety disorders among adults: A systematic review

Anxiety disorders are highly prevalent in the general population and associated with high rates of impairment and disability. This burden highlights the need to identify risk factors that individuals can modify without professional intervention. A systematic review was conducted to identify studies that examined modifiable risk and protective factors for anxiety disorders among adults in the general population. Searches were conducted in PubMed, PsycINFO and MEDLINE using medical subject headings and text words related to risk factors, protective factors, and each anxiety disorder. Screening, data extraction, and quality assessment were performed by three study authors. Modifiable risk and protective factors from 19 studies across seven countries were identified. Risk factors identified included cigarette smoking, alcohol use, cannabis use, negative appraisals of life events, avoidance, and occupational factors. Protective factors included social support, coping, and physical activity. Cigarette smoking was the most studied risk factor. Support was found for cigarette smoking as a risk factor for agoraphobia and panic disorder. Mixed results were found for generalized anxiety disorder and specific phobia. Across disorders, smoking frequency was associated with greater risk. Results indicate an important gap in the literature in that few studies have examined modifiable risk factors for anxiety disorders.

The relation between ADHD symptoms, perceived stress and binge drinking in college students

Binge drinking is a major public health problem associated with various negative short-term and long-term clinical and social outcomes. If there is evidence to suggest a relationship between ADHD and alcohol use in college students, no study has investigated the role of ADHD symptomatology in binge drinking. Thus, this research was designed to explore the relative contributions of inattention and hyperactivity/impulsivity symptoms to binge drinking in a sample of French college students while controlling for effects of perceived stress. Participants (N = 7011; mean age = 20.9; 74.9% of females) completed self-report surveys assessing ADHD symptoms, perceived stress, sociodemographic characteristics, and binge drinking frequency. Multinomial logistic regression revealed significant associations between higher levels of ADHD symptoms in general, but not perceived stress, and increasing frequency of binge drinking. Moreover, higher levels of inattention and hyperactivity/impulsivity symptoms were independently associated with greater frequency of binge drinking. The association was stronger between high rates of binge drinking and inattention than for hyperactivity/impulsivity. These findings, which remained statistically significant after adjusting for a range of potential confounders (including perceived stress), suggest that the presence of ADHD symptoms may be an important factor related to binge drinking.

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

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

[Excessive alcohol intake and dissatisfaction with body image among adolescents and young adults in a municipality in Bahia State, Brazil]

The study aimed to analyze the association between excessive alcohol intake and dissatisfaction with one's body image in a population of adolescents and young adults. This was a cross-sectional study with a household survey design in a sample of 1,582 individuals 15 to 24 years of age living in Camaçari, Bahia State, Brazil. Excessive alcohol intake was identified by the Alcohol Use Disorder Identification Test (AUDIT), and dissatisfaction with body image was measure with the Silhouette Figure Scale. Confounding variables were: sex, age, race, schooling, work, religion, family composition, number of close friends, marital status, and children. The association between excessive alcohol intake and body dissatisfaction was estimated by logistic regression. Prevalence of excessive alcohol intake was 21.9% (higher in males), and prevalence of body image dissatisfaction was 79.5% (higher in females). No statistically significant association was found between excessive alcohol intake and dissatisfaction with body image. After adjustment of the final model, the variables that remained associated with excessive alcohol intake were religion (OR = 2.02), schooling (OR = 1.63), family composition (OR = 1.61), age (OR = 0.55), and work (OR = 0.61). Although the analyses did not show an association between excessive alcohol intake and dissatisfaction with body image, the study's results call attention to the high prevalence rates for the two phenomena. This shows the need to develop interventions focused on practices of care for this specific population.

Heavy Episodic Drinking Is Associated With Poorer Bone Health in Adolescent and Young Adult Women

OBJECTIVE

Osteoporosis is a costly bone disease characterized by low bone mineral density (BMD) that primarily affects postmenopausal women. One factor that may lead to osteoporosis is a failure to reach peak bone mass (PBM) in early adulthood. In older adults and animal models, heavy episodic drinking (HED) has been found to predict failure to reach PBM. However, this relationship has yet to be investigated in adolescent human females.

METHOD

Female college students (N = 87; 60% White) reported age at menarche, hormonal contraceptive use, physical activity, smoking habits, and HED history via an online survey and then received a dual energy x-ray absorptiometry bone scan to assess both lean body mass and BMD at the lumbar spine.

RESULTS

Frequent HED (having four or more drinks within 2 hours on 115 or more occasions since the start of high school, which is approximately equal to 1.6 episodes per month over this period) was associated with decreased vertebral BMD even when variables most commonly associated with bone health (lean body mass, physical activity, age at menarche, smoking, and oral contraception use) were controlled for. However, early HED initiation (beginning HED at age 15 years or younger) was not significantly related to BMD.

CONCLUSIONS

This is the first study to assess the impacts of early HED initiation and frequent HED during adolescence on the bone health of young women. Results suggest frequency of HED before reaching PBM, but not age at initiation, may be negatively related to skeletal health during young adulthood. These findings encourage research into the association between HED and BMD in late adolescence.

Alcohol Use and Intimate Partner Violence Among Community College Women: An Exploration of Protective Factors

Little is known regarding the association between alcohol use and violence among community college women. Accordingly, this study investigated daily-level associations between alcohol use and intimate partner victimization (IPV) in a sample of young women (ages 18-24) in a community college setting, and the potentially protective role of education aspirations and living with family. Using a calendar-based assessment, women enrolled in a large community college (N = 212) completed past-month surveys of IPV and alcohol use. Unadjusted Generalized Estimating Equations showed nonsignificant positive associations between alcohol consumption (any alcohol use and number of drinks) and IPV at the daily level. Adjusted models showed a slight (but nonsignificant) increase in the odds of experiencing IPV on a drinking day. Those reporting a family income above $20,000 were at increased risk of experiencing violence. Living with family and wanting to attain a master's or doctoral degree reduced the risk of experiencing IPV on drinking days. Although the literature suggests that drinking among 4-year college women elevates the odds of experiencing IPV, our findings suggest the importance of examining contextual variables when understanding risk among community college women. Particularly, the role of family and educational aspirations may serve as protective factors in the association between alcohol use and IPV on a daily basis. As this is the first day-level study of IPV and alcohol use among community college women, further research is warranted to better explicate these findings.

The Role of Sex and Age on Pre-drinking: An Exploratory International Comparison of 27 Countries

Aims

This exploratory study aims to model the impact of sex and age on the percentage of pre-drinking in 27 countries, presenting a single model of pre-drinking behaviour for all countries and then comparing the role of sex and age on pre-drinking behaviour between countries.

Methods

Using data from the Global Drug Survey, the percentages of pre-drinkers were estimated for 27 countries from 64,485 respondents. Bivariate and multivariate multilevel models were used to investigate and compare the percentage of pre-drinking by sex (male and female) and age (16–35 years) between countries.

Results

The estimated percentage of pre-drinkers per country ranged from 17.8% (Greece) to 85.6% (Ireland). The influence of sex and age on pre-drinking showed large variation between the 27 countries. With the exception of Canada and Denmark, higher percentages of males engaged in pre-drinking compared to females, at all ages. While we noted a decline in pre-drinking probability among respondents in all countries after 21 years of age, after the age of 30 this probability remained constant in some countries, or even increased in Brazil, Canada, England, Ireland, New Zealand and the United States.

Conclusions

Pre-drinking is a worldwide phenomenon, but varies substantially by sex and age between countries. These variations suggest that policy-makers would benefit from increased understanding of the particularities of pre-drinking in their own country to efficiently target harmful pre-drinking behaviours.

Alcohol Advertising on Social Media: Examining the Content of Popular Alcohol Brands on Instagram

BACKGROUND

There is considerable evidence that exposure to alcohol marketing increases the likelihood of adolescents initiating and engaging in alcohol consumption. There is a paucity of research, however, specifically examining industry generated alcohol marketing occurring on social media/networking platforms.

OBJECTIVE

The purpose of this investigation was to analyze the content of promotional advertisements by alcohol brands on Instagram.

METHODS

For a 30-day period, Instagram profiles of 15 distinct alcohol brands were examined. Pictorial posts/updates from each profile were screen captured and individually documented. Approximately 184 distinct posts constituted our final sample. The Content Appealing to Youth Index was independently employed by two raters to assess each post. For each characteristic, Cohen's Kappa measures, and associated 95% confidence intervals, were calculated. Descriptive statistics were performed.

RESULTS

Posts increased throughout the week and peaked on Thursday and Friday. The production value of the posts examined was generally high, frequently featuring color, texture, shine, contrast, faces, and action. Character appeals and use of youth-oriented genres were uncommon. Many of the posts used product appeals and physical benefits to consumption. The posts also emphasized the following rewarding appeal characteristics: positive emotional experiences, achievement, individuality, and camaraderie. The most commonly coded risk-related feature was inappropriate use. Conclusions/Importance: This investigation represents an initial attempt to provide insights into the content alcohol brands are including in their promotional materials on social networking sites.

Self-schema as a non-drinker: a protective resource against heavy drinking in Mexican-American college women

Alcohol use is considered less acceptable for women than men in the Mexican culture. However, recent studies of Mexican-American (MA) women show that prevalence and rates of alcohol use are escalating, particularly in those with high acculturation to Western standards. Building on recent studies that demonstrated that drinking-related identities (self-schemas) are important predictors of alcohol use in college populations, this secondary data analysis investigated the association between acculturation, MA cultural values, and acculturative stress, drinking-related self-schemas and heavy drinking over time in college-enrolled MA women. Data were drawn from a 12-month longitudinal study of self-schemas and health-risk behaviors in 477 college-enrolled MA women. Drinking-related self-schemas, acculturation, MA cultural values and acculturative stress were measured at baseline, and heavy drinking was measured at baseline, 3, 6, 9 and 12 months. Thirty-six percent of women had a non-drinker self-schema but only 3% had a drinker self-schema. Higher spirituality was protective against heavy drinking, and this effect can be partially explained by presence of a non-drinker self-schema. Interventions that emphasize the personal relevance of being a non-drinker and support the importance of spirituality may help to prevent heavy drinking in MA college women.

High-intensity binge drinking is associated with alterations in spontaneous neural oscillations in young adults

Heavy episodic alcohol consumption (also termed binge drinking) contributes to a wide range of health and cognitive deficits, but the associated brain-based indices are poorly understood. The current study used electroencephalography (EEG) to examine spontaneous neural oscillations in young adults as a function of quantity, frequency, and the pattern of their alcohol consumption. Sixty-one young adults (23.4 ± 3.4 years of age) were assigned to binge drinking (BD) and light drinking (LD) groups that were equated on gender, race/ethnic identity, age, educational background, and family history of alcoholism. EEG activity was recorded during eyes-open and eyes-closed resting conditions. Each participant's alpha peak frequency (APF) was used to calculate absolute power in individualized theta and alpha frequency bands, with a canonical frequency range used for beta. APF was slower by 0.7 Hz in BD, especially in individuals engaging in high-intensity drinking, but there were no changes in alpha power. BD also exhibited higher frontal theta and beta power than LD. Alpha slowing and increased theta power in BD remained after accounting for depression, anxiety, and personality characteristics, while elevated beta power covaried with sensation seeking. Furthermore, APF slowing and theta power correlated with various measures of alcohol consumption, including binge episodes and blackouts, but not with measures of working and episodic memory, cognitive flexibility, processing speed, or personality variables, suggesting that these physiological changes may be modulated by high-intensity alcohol intake. These results are consistent with studies of alcohol-use disorder (AUD) and support the hypothesis that binge drinking is a transitional stage toward alcohol dependence. The observed thalamocortical dysrhythmia may be indicative of an excitatory-inhibitory imbalance in BD and may potentially serve as an index of the progressive development of AUD, with a goal of informing possible interventions to minimize alcohol's deleterious effects on the brain.

Injuries associated with bunk beds occurring at schools: results using a US national data base

Objective

To investigate bunk bed injuries occurring across all educational institutions using a national data base.

Methods

National Electronic Injury Surveillance System data for the years 2006–2015 associated with bunk beds was analysed.

Results

There were an estimated 639 700 emergency department (ED) visits for bunk bed injuries; 1.3% occurred at school. Those occurring at school were older than those not at school (18.2 vs 12.8 years), and more commonly female (56.4% vs 40.6%), Caucasian (91.7% vs 68.3%) and associated with alcohol (10.8% vs 0.4%). For those occurring at school, the average age for those involving the trunk, upper extremity, lower extremity and head/neck areas was 17.9, 14.9, 19.2 and 18.7 years, respectively (p<10−4). A fracture was present in 6.4%, 52.3%, 21.2% and 9.6% of the trunk, upper extremity, lower extremity and head/neck areas, respectively (p=0.009). Males had a higher percentage of lacerations and females had a higher percentage of internal organ injuries. The vast majority of the fractures and strain/sprains occurred in the extremities; lacerations in the head/neck and contusion/abrasions predominantly involved the extremities and head/neck.

Conclusions

1.3% of all ED visits due to bunk bed injuries occurred in places of education. The majority of these were during college age. Prevention strategies should be directed at educational institutions and students, as well as following proper bunk bed equipment guidelines. Education regarding alcohol risks might assist college age students.

Effects of exposure to polychlorinated biphenyls during different periods of development on ethanol consumption by male and female rats

In two experiments, male and female Sprague-Dawley rats were exposed to Polychlorinated Biphenyls (PCBs) to assess the effect PCBs, an estrogenic endocrine disrupting chemical (EEDC), would have on the voluntary consumption of alcohol. There are several EEDCs in our food that are known to increase estrogen in adolescent females. Our objective was to assess the effect that increasing estrogen, by adding the EEDC PCBs would have on volitional intake of alcohol. In Experiment 1, pregnant dams were exposed from gestational days 5-19 to a 1:1 mixture of Aroclor 1254/1260. In Experiment 2, lactating females were exposed to the same dose of 1254:1260 from postnatal days 1-21. In both experiments, a fade-in procedure was used to gradually introduce the rats to the taste of alcohol. At the end of the fade-in series all animals were given limited access (1 h/day) to a water/alcohol solution. We found that females exposed to PCBs, at two developmental periods, consumed significantly more alcohol than unexposed females and exposed and unexposed males. Results of the experiments are discussed in terms of how PCB exposure can disrupt endocrine processes (e.g., estrogenic endocrine disrupting chemicals, EEDC) that increase estrogen in females, thereby leading to increased alcohol consumption. Thus, the present findings suggest that EEDCs, such as PCBs, could contribute to the increase abuse of alcohol in adolescent females.

Adolescents drink less: How, who and why? A review of the recent research literature

ISSUES

Today's teenagers have been described as a sober generation and we asked: 'What is known about the recent decline in youth drinking?'

APPROACH

A literature review (2005-2017).

KEY FINDINGS

Research from wealthier parts of the world provides solid evidence of less alcohol use by youth since the millennium shift. Some studies show that this is reflected at all levels of consumption, but there are also indications that the heaviest drinkers have not reduced their drinking. The decrease is predominately seen in underage youth, and has been larger for boys than for girls in several countries. Teenagers across social strata drink less, but some disadvantaged subgroups have not followed the downward trend. Underage drinkers have apparently not become a more deviant group as the prevalence of drinking has dropped, indicating no hardening of the group. The major gap in the literature pertains to the issue of underlying driving forces. We found no evidence in support of the widespread assumption that the digital revolution has been of importance. A decline in parenting practices that are conductive to underage drinking has occurred in several countries, but studies examining whether these changes have contributed to less alcohol use by youth are almost non-existent.

IMPLICATIONS

To inform alcohol policy and prevention, it is imperative to find out why teenage drinking has decreased in a fairly consistent way across numerous countries.

CONCLUSION

Future research into the issue of falling prevalence rates of youth drinking should focus on possible explanatory factors at the population level rather than at the individual level.

Binge drinking differentially affects cortical and subcortical microstructure

Young adult binge drinkers represent a model for endophenotypic risk factors for alcohol misuse and early exposure to repeated binge cycles. Chronic or harmful alcohol use leads to neurochemical, structural and morphological neuroplastic changes, particularly in regions associated with reward processing and motivation. We investigated neural microstructure in 28 binge drinkers compared with 38 matched healthy controls. We used a recently developed diffusion magnetic resonance imaging acquisition and analysis, which uses three‐compartment modelling (of intracellular, extracellular and cerebrospinal fluid) to determine brain tissue microstructure features including neurite density and orientation dispersion index (ODI). Binge drinkers had reduced ODI, a proxy of neurite complexity, in frontal cortical grey matter and increased ODI in parietal grey matter. Neurite density was higher in cortical white matter in adjacent regions of lower ODI in binge drinkers. Furthermore, binge drinkers had higher ventral striatal grey matter ODI that was positively correlated with binge score. Healthy volunteers showed no such relationships. We demonstrate disturbed dendritic complexity of higher‐order prefrontal and parietal regions, along with higher dendritic complexity of a subcortical region known to mediate reward‐related motivation. The findings illustrate novel microstructural abnormalities that may reflect an infnce of alcohol bingeing on critical neurodevelopmental processes in an at‐risk young adult group.

Gender Differences in Binge Drinking

Just as binge drinking rates differ for men and women, the predictors and consequences of binge drinking vary by gender as well. This article examines these differences and how binge drinking definitions and research samples and methods may influence findings. It also describes the relationship between age and binge drinking among men and women, and how drinking culture and environment affect this relationship. It examines gender-specific trends in binge drinking, predictors of binge drinking for men and women, and binge drinking in the context of smoking. The article reviews current findings on gender differences in the health consequences of binge drinking, including morbidity and mortality, suicidality, cancer, cardiovascular disorders, liver disorders, and brain and neurocognitive implications. It also discusses gender differences in the behavioral and social consequences of binge drinking, including alcohol-impaired driving, sexual assault, and intimate partner violence, and includes implications for treatment and prevention.

ELSA 2016 Cohort: Alcohol, Tobacco, and Marijuana Use and Their Association with Age of Drug Use Onset, Risk Perception, and Social Norms in Argentinean College Freshmen

The transition from high school to college is a high-risk stage for the initiation and escalation of substance use. Substance use and its associated risk factors have been thoroughly described in developed countries, such as the United States, but largely neglected in Argentina, a South American country with patterns of a collectivist culture. The present cross-sectional study describes the occurrence of alcohol, tobacco, and marijuana use and the association between these behaviors and the age of onset of substance use and cognitive (i.e., risk perception) and social (i.e., prescriptive) variables in a large sample of Argentinean college freshmen (n = 4083, 40.1% men; mean age = 19.39 ± 2.18 years). The response rate across courses was ≥90% and was similarly distributed across sex. Participants completed a survey that measured substance use (alcohol [with a focus on heavy drinking and binge drinking behaviors], tobacco, and marijuana), age of onset of the use of each substance, perceived risk associated with various substance use behaviors, prescriptive norms associated with substance use, and descriptive norms for alcohol use (AU). The results indicated that AU is nearly normative (90.4 and 80.3% with last year and last month use, respectively) in this population, and heavy drinking is highly prevalent (68.6 and 54.9% with heavy episodic and binge drinking, respectively), especially among those with an early drinking onset (97.8 and 93.6% with last year and last month use and 87.8 and 76.3% with heavy episodic and binge drinking, respectively). The last-year occurrence of tobacco and marijuana use was 36 and 28%, respectively. Early substance use was associated with the greater use of that specific substance. The students overestimated their same-sex friend's AU, and women overestimated the level of AU of their best male friend. At the multivariate level, all of the predictors, with the exception of the parents' prescriptive norms, significantly explained the frequency of marijuana and tobacco use and frequency of hazardous drinking. Overall, despite important cultural and contextual differences between Argentina and the United States, our findings suggest that certain vulnerability factors have a similar influence across these cultural contexts.

Undifferentiated Gender Role Orientation, Drinking Motives, and Increased Alcohol Use in Men and Women

BACKGROUND

Alcohol misuse has historically affected men more than women. However, the differences in drinking behaviors across sex have steadily decreased over time and accumulating research suggests that gender role orientation, or culturally scripted gender-specific characteristics, and negative reinforcement drinking motives may better explain risk for alcohol use and related problems than sex.

OBJECTIVES

The current study tested a mediational model of the undifferentiated orientation (low masculinity and low femininity), an oft neglected orientation despite evidence that it could carry much weight in drinking behaviors, versus the other three gender role orientations, coping and conformity drinking motives, and hazardous alcohol use.

METHOD

Participants were 426 current drinkers over age 21 (41% men; 77.8% Caucasian; M_age = 34.5, range = 21-73) residing across the United States who completed an online survey.

RESULTS

Structural equation modeling analyses suggested that individuals with an undifferentiated orientation (n = 99), compared to masculine (high masculinity, low femininity; n = 102), feminine (high femininity, low masculinity; n = 113), or androgynous (high masculinity, high femininity; n = 112) orientations, reported higher coping drinking motives, which were positively associated with levels of hazardous alcohol use. Although analyses suggested that undifferentiated individuals reported drinking for conformity motives more often than masculine and androgynous individuals, conformity motives were not associated with increased use. Conclusions/Importance: An undifferentiated gender role orientation may contribute a unique risk for alcohol use and related problems by increasing frequency of drinking to cope, a motive specifically associated with hazardous use trajectories.

Reported Alcohol and Tobacco Use and Screening Among College Women

OBJECTIVE

To describe the reports of young women in their senior college years related to alcohol and tobacco use and to describe their health screening experiences in college health centers.

DESIGN

A secondary analysis of data collected as part of a cross-sectional study of college women.

SETTING

For the original study, women were recruited from two accredited 4-year universities in the Northeastern United States. The first was a private university, and the second was a public university; both had on-campus health centers.

PARTICIPANTS

The participants were 615 female undergraduate students enrolled in their senior year of college.

METHODS

A Web-based survey was sent to approximately 1,200 women at each university. Women were asked about their alcohol and tobacco use and about screening experiences in college health centers. The mean response rate was 25.8%.

RESULTS

Nearly 90% (n = 550) of the women reported drinking alcohol in the last 3 months, and of those, more than two thirds (n = 370) met the Centers for Disease Control and Prevention definition of hazardous drinking. However, only 21.5% (n = 56) reported being screened for alcohol use. Similarly, only 19.7% (n = 52) reported being screened for tobacco use.

CONCLUSION

College health centers are ideally positioned to screen and provide interventions for young women who are at high risk for alcohol misuse and tobacco use. Despite prevalence of use and importance of screening, reported screening is low. Future research is needed to understand barriers to screening and implement recommendations for college health centers.

Binge Drinking and Depression: The Influence of Romantic Partners in Young Adulthood

Although research shows that spouses influence each other's health behaviors and psychological well-being, we know little about whether these patterns extend to young people in nonmarital as well as marital relationships. We use the National Longitudinal Study of Adolescent to Adult Health to consider how a romantic partner's binge drinking and depression influence the respondent's binge drinking and depression within 1,111 young adult couples and explore whether these processes are moderated by gender. We find that partners' binge drinking is associated with increased odds of binge drinking for respondents, and partners' depression is associated with increased odds of depression for respondents. Further, depression among men is associated with reduced odds of binge drinking among their female partners. Findings suggest that processes of partner influence begin even in young adulthood with implications for cumulative effects on lifelong health behaviors and mental health.

Reducing drinking to cope among heavy episodic drinking college women: Secondary outcomes of a web-based combined alcohol use and sexual assault risk reduction intervention

College students are at high risk for engaging in heavy episodic drinking and for experiencing sexual assault. Further, drinking to cope with anxiety motives are associated with sexual assault history and drinking, and thus should be examined when targeting both sexual assault and drinking in college populations. The current study examined the effectiveness of decreasing coping with anxiety drinking motives among underage heavy episodic drinking college women (n=264). Results indicate that a web-based combined alcohol use and sexual assault risk reduction intervention was effective at decreasing drinking to cope with anxiety motives among those with stronger drinking to cope with anxiety motives at baseline. However, the alcohol-only and sexual assault-only interventions were not. Decreases in drinking motives were associated with decreases in heavy episodic drinking. This suggests that alcohol interventions in college populations may not be effectively targeting drinking motives and this preliminary study provides evidence indicating that targeting alcohol and sexual assault together may decrease drinking to cope motives among a high risk population.

Trends in Alcohol Use among Adolescents from 2000 to 2011: The Role of Socioeconomic Status and Depression

AIMS

To assess temporal trends of adolescent alcohol use in Finland from 2000 to 2011, according to socio-economic status and depression.

METHODS

Classroom self-administered questionnaires concerning health, health behaviours and school experiences were administered biennially from 2000-2001 to 2010-2011 to nationwide samples of 14- to 16-year-olds (n = 618,084). Alcohol use was measured as the frequencies of drinking and drunkenness. Socioeconomic status was measured using parental education and unemployment. Depression was measured using a Finnish modification of the Beck Depression Inventory. Cross-tabulations and a logistic regression analysis were applied.

RESULTS

Over the study period, rates of frequent drinking and frequent drunkenness decreased among both boys and girls. Low levels of parental education and unemployment as well as adolescent depression increased the likelihoods of frequent drinking and drunkenness. Unlike the general decreasing trend observed for alcohol use, the likelihoods of frequent drinking and drunkenness increased among adolescents who were depressed and had unemployed parents with low levels of education. The prevalence of frequent drunkenness was 75.8% among the boys in this group during 2008-2011, whereas the corresponding prevalence was 2.3% for boys without depression and with highly educated, employed parents. The corresponding figures for girls were 41.7% and 1.4%, respectively.

CONCLUSIONS

The overall decreasing trend in frequent alcohol use was not observed among socioeconomically deprived adolescents with depression. Thus, alcohol prevention programmes should treat these youth as special targets.

The Impact of the Minimum Legal Drinking Age on Alcohol-Related Chronic Disease Mortality

BACKGROUND

The minimum legal drinking age (MLDA) of 21 has been associated with a number of benefits compared to lower MLDAs, including long-term effects, such as reduced risk for alcoholism in adulthood. However, no studies have examined whether MLDA during young adulthood is associated with mortality later in life. We examined whether individuals exposed to permissive MLDA (<21) had higher risk of death from alcohol-related chronic disease compared to those exposed to the 21 MLDA. Because prior work suggests that MLDA affects college students differently, we also conducted conditional analyses based on ever having attended college.

METHODS

Data from the 1990 through 2010 U.S. Multiple Cause-of-Death files were combined with data on the living population and analyzed. We included individuals who turned 18 during the years 1967 to 1990, the period during which MLDA varied across states. We examined records on death from several alcohol-related chronic diseases, employing a quasi-experimental approach to control for unobserved state characteristics and stable time trends.

RESULTS

Individuals who reported any college attendance did not exhibit significant associations between MLDA and mortality for the causes of death we examined. However, permissive MLDA for those who never attended college was associated with 6% higher odds for death from alcoholic liver disease, 8% higher odds for other liver disease, and 7% higher odds for lip/oral/pharynx cancers (odds ratio [OR] = 1.06, 95% confidence interval [CI] [1.02, 1.10]; OR = 1.08, 95% CI [1.03, 1.13]; OR = 1.07, 95% CI [1.03, 1.12], respectively).

CONCLUSIONS

The 21 MLDA likely protects against risk of death from alcohol-related chronic disease across the lifespan, at least for those who did not attend college. This is consistent with other work that shows that the long-term association between MLDA and alcohol-related outcomes is specific to those who did not attend college.

Converging Patterns of Alcohol Use and Related Outcomes Among Females and Males in the United States, 2002 to 2012

BACKGROUND

Females in the United States consume less alcohol and cause and experience fewer alcohol-related harms than males. However, recent research suggests such gaps might be narrowing. The purpose of this study was to explore changes in alcohol use and associated outcomes among females and males in the United States between 2002 and 2012.

METHODS

Data from the National Survey on Drug Use and Health were used to assess the prevalence and trends for females and males aged 12+ in lifetime abstinence, age of onset, current drinking, binge drinking, drinking and driving, reaching DSM-IV criteria for an alcohol use disorder, combining alcohol with other drugs such as marijuana, and other variables. Of particular interest was whether differences between females and males narrowed during the decade under study.

RESULTS

Differences in the drinking patterns of females and males aged 12+ narrowed between 2002 and 2012 for current drinking, number of drinking days per month, past year DSM-IV alcohol abuse, and past-year driving under the influence of alcohol. In addition, convergence was noted in 1 or more age subgroups for the prevalence of binge drinking and DSM-IV alcohol dependence and mean age at drinking onset. Divergence in drinking habits did not occur for any measure in any age subgroups with the exception of a greater increase in the prevalence of combining alcohol with marijuana among young adult male drinkers than female drinkers aged 18 to 25.

CONCLUSIONS

Between 2002 and 2012, differences in alcohol consumption and related outcomes narrowed for females and males. Reasons for converging patterns of alcohol use are unclear and do not appear to be easily explainable by recent trends in employment status, pregnancy status, or marital status. More research is needed to identify the psychosocial and environmental contributors to these changes and to assess implications for prevention and treatment efforts.

Family functioning and adolescent alcohol use: A moderated mediation analysis

The primary goals of this longitudinal study were to examine the relationship between family functioning and adolescent alcohol use and to examine whether depressed mood mediates this relationship. An additional goal was to explore whether these relations were moderated by gender. The sample included 1031 high school students from the Mid-Atlantic United States. Participants completed surveys in school during the spring of 2007, 2008, and 2009. Path analysis results indicated that family functioning predicted alcohol use for girls. Moreover, depressed mood mediated this relationship. None of the direct paths between family functioning and adolescent alcohol use were significant for boys. However, similar to girls, depressed mood negatively predicted alcohol use for boys. Taken together, the findings highlight the need for prevention programs targeting adolescent substance use to consider gender-specific trajectories.

Did the 18 Drinking Age Promote High School Dropout? Implications for Current Policy

OBJECTIVE

Disagreement exists over whether permissive minimum legal drinking age (MLDA) laws affected underage adolescents (e.g., those age 17 years with the MLDA of 18). We used MLDA changes during the 1970s and 1980s as a natural experiment to investigate how underage exposure to permissive MLDA affected high school dropout.

METHOD

MLDA exposure was added to two data sets: (a) the 5% public use microdata samples of the 1990 and 2000 censuses (n = 3,671,075), and (b) a combined data set based on the 1991-1992 National Longitudinal Alcohol Epidemiological Survey (NLAES) and the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC; n = 16,331). We used logistic regression to model different thresholds of MLDA on high school dropout. We also estimated models conditioned on demographic variables and familial risk of developing alcohol problems.

RESULTS

Only the MLDA of 18 predicted high school dropout. Exposure was associated with 4% and 13% higher odds of high school dropout for the census and NLAES/NESARC samples, respectively. We noted greater impact on women (5%-18%), Blacks (5%-19%), and Hispanics (6%). Self-report of parental alcohol problems was associated with 40% higher odds, which equals a 4.14-point increase in dropout rate for that population.

CONCLUSIONS

The MLDA of 18 likely had a large impact on high school dropout rates, suggesting that the presence of legal-aged peers in a high school setting increased access to alcohol for younger students. Our results also suggest that policy can promote less dangerous drinking behavior even when familial risk of alcohol use disorders is high.

Reflection impulsivity in binge drinking: behavioural and volumetric correlates

The degree to which an individual accumulates evidence prior to making a decision, also known as reflection impulsivity, can be affected in psychiatric disorders. Here, we study decisional impulsivity in binge drinkers, a group at elevated risk for developing alcohol use disorders, comparing two tasks assessing reflection impulsivity and a delay discounting task, hypothesizing impairments in both subtypes of impulsivity. We also assess volumetric correlates of reflection impulsivity focusing on regions previously implicated in functional magnetic resonance imaging studies. Sixty binge drinkers and healthy volunteers were tested using two different information-gathering paradigms: the beads task and the Information Sampling Task (IST). The beads task was analysed using a behavioural approach and a Bayesian model of decision making. Delay discounting was assessed using the Monetary Choice Questionnaire. Regression analyses of primary outcomes were conducted with voxel-based morphometry analyses. Binge drinkers sought less evidence prior to decision in the beads task compared with healthy volunteers in both the behavioural and computational modelling analysis. There were no group differences in the IST or delay discounting task. Greater impulsivity as indexed by lower evidence accumulation in the beads task was associated with smaller dorsolateral prefrontal cortex and inferior parietal volumes. In contrast, greater impulsivity as indexed by lower evidence accumulation in the IST was associated with greater dorsal cingulate and precuneus volumes. Binge drinking is characterized by impaired reflection impulsivity suggesting a deficit in deciding on the basis of future outcomes that are more difficult to represent. These findings emphasize the role of possible therapeutic interventions targeting decision-making deficits.