'I have no interest in drinking': a cross-national comparison of reasons why men and women abstain from alcohol use

Countering stereotypes: Exploring the characteristics of Aboriginal Australians who do not drink alcohol in a community representative sample

INTRODUCTION

Contrary to stereotypes, Aboriginal and Torres Strait Islander Australians are more likely to abstain from drinking than other Australians. We explored characteristics and experiences of Aboriginal and Torres Strait Islander Australians who do not drink alcohol.

METHOD

We conducted a cross-sectional, representative survey of 775 Aboriginal and Torres Strait Islander Australians (16+ years) in remote and urban South Australia. We explore correlates of not drinking alcohol using multi-level logistic regression. We describe reasons for non-drinking and harms participants experienced in past 12 months from others' drinking.

RESULTS

Non-drinking participants were more likely to be older (OR 1.35 [95% CI 1.21, 1.50] per decade) and unemployed (OR 2.72 [95% CI 1.77, 4.20]). Participants who spoke Aboriginal Australian languages at home were three times more likely to be lifetime abstainers from drinking (OR 3.07 [95% CI 1.52, 6.21]). Common reasons for not drinking alcohol were health and family. Most did not report harms from others' alcohol consumption (79.6%, 76.9%, urban and remote respectively). Stress from others' alcohol consumption was the most reported harm by non-drinkers (14.5% and 23.1%, urban and remote, respectively).

DISCUSSION AND CONCLUSIONS

Culture such as speaking Aboriginal Australian languages might have protective effects that promote abstaining but was rarely explicitly cited as a reason for not drinking. A greater understanding of local values held by people who do not drink alcohol could help inform health messaging and other interventions to reduce alcohol-related harms. Understanding local reasons for abstaining can help tailor health messaging to suit local contexts.

The prevalence of alcohol consumption and its related factors in adolescents: Findings from Global School-based Student Health Survey

BACKGROUND

Alcohol consumption has become very common among adolescents in recent years and its prevalence varies in different countries. This study aimed to investigate the prevalence of alcohol consumption and related factors in adolescents aged 11 to 16 years.

METHODS

This descriptive cross-sectional study was performed on 288385 adolescents (girls, 53.9% of total) aged 11 to 16 years. In the present study, the GSHS data (2003-2018) available to public on the websites of the US Centers for Disease Control and Prevention (CDC) and WHO was used. To investigate the factors affecting alcohol consumption, univariate and multivariate logistics models with 95% confidence limits were used.

RESULTS

The overall prevalence of alcohol consumption in adolescents was 25.2%, which was 28.3% and 22.4% in boys and girls, respectively. Among the surveyed countries, the highest prevalence was in Seychelles (57.9%) and the lowest in Tajikistan (0.7). Multivariate analysis showed that the Age for 16 and more than 16 years old (OR = 3.08,95%CI: 2.54-3.74), truancy for more than 10 days (OR = 1.24, 95%CI: 1.08-1.43), loneliness at sometimes of the times (OR = 1.04, 95%CI: 1.01-1.07), insomnia at most of the times (OR = 1.85, 95%CI: 1.70-2.01), daily activity (OR = 1.03, 95%CI: 1.00-1.07), bullied for 1-9 Days in a month (OR = 1.24, 95%CI: 1.09-1.40), cigarette (OR = 4.01, 95%CI: 3.86-4.17), used marijuana for more than 10 days in a month (OR = 5.58, 95%CI: 4.59-7.78), had sex (OR = 2.76, 95%CI: 2.68-2.84), and suicide plan (OR = 1.48, 95%CI: 1.42-1.54) were important factors affecting drinking alcohol. (Table 4). In this study, the sensitivity, specificity, positive predictive value, and negative predictive value were 42.79%, 93.96%, 70.80%, and 82.75.

CONCLUSIONS

According to the results of the present study, the prevalence of alcohol consumption among teenagers was high. Therefore, it is suggested that demographic, family, and psychological factors should be taken into consideration in health programs for the prevention and treatment of alcohol consumption in adolescents.

Multimorbidity and complex multimorbidity, their prevalence, and associated factors on a remote island in Japan: a cross-sectional study

BACKGROUND

Evidence is still limited on the prevalence of multimorbidity and complex multimorbidity in Japan, as well as their associated factors. Additionally, no studies regarding multimorbidity and complex multimorbidity in Japan have used patient data obtained directly from medical records. The primary objective was to clarify the prevalence of multimorbidity and complex multimorbidity using patient data obtained directly from medical records. The secondary objective was to elucidate factors associated with multimorbidity and complex multimorbidity.

METHODS

We conducted a cross-sectional study at Tarama Clinic on Tarama Island, a remote island in Okinawa, Japan. Among patients who visited Tarama Clinic from April 1 to June 30, 2018, those who were ≥ 20 years of age, lived on Tarama Island, and had capacity to give consent were eligible for study inclusion. We collected the following data using medical records, medical expense receipts, and self-administered questionnaires: multimorbidity and complex multimorbidity, participants' characteristics, and potentially associated factors. Multimorbidity was defined as having ≥ 2 among 17 chronic health conditions, in accordance with previous studies conducted in Japan, and having ≥ 2 among 16 chapters of the International Classification of Primary Care, 2nd edition (ICPC-2). Complex multimorbidity was defined as having ≥ 3 among 16 chapters of the ICPC-2.

RESULTS

We included 355 study participants. Descriptive analysis showed multimorbidity prevalence measured using the 17 chronic health conditions in this area was 30.0% (age ≥ 20 years) and 57.5% (age ≥ 65 years). Multimorbidity prevalence measured using the ICPC-2 was 32.9% (age ≥ 20 years) and 60.3% (age ≥ 65 years). We also found a 20.9% (age ≥ 20 years) and 45.1% (age ≥ 65 years) prevalence of complex multimorbidity, respectively. Poisson regression with robust error variance showed that age ≥ 60 years was associated with multimorbidity. Age ≥ 60 years (adjusted prevalence ratio [aPR] 1.887 and 1.831 for ages 60-79 and ≥ 80 years, respectively) and being unemployed (aPR 1.251) were associated with complex multimorbidity. However, having hazardous drinking or more was inversely associated with complex multimorbidity (aPR 0.745).

CONCLUSIONS

The population-based prevalence of multimorbidity and its upward trend with increasing age on a remote island in Japan was consistent with previous reports in the country. Multimorbidity was associated with age 60 years or older, and complex multimorbidity was associated with age 60 years or older, being unemployed, and not having hazardous drinking or more. Our study findings indicated a possible association between the coexistence of diseases and social determinants of health (SDH) in Japan. To improve care for patients with multimorbidity and complex multimorbidity, more research that takes SDH into account is warranted, and evidence-based policymaking is essential for Japan. The present study can provide a foundation for accumulating such evidence.

Alcohol Use Behaviors and Reasons to Abstain From or Limit Drinking Among Medically Vulnerable Youth

BACKGROUND

Youth with chronic medical conditions (YCMC) use alcohol at levels similar to their healthy peers but face elevated risk for adverse health consequences. As salient reasons to abstain from or limit drinking (RALD) among YCMC are unknown, we sought to identify clusters of RALD and test associations with use behaviors.

METHODS

Eligible YCMC (ages 9-18) recruited from outpatient clinics reported their use behaviors and importance of potential RALD. Cluster analysis was used to discern RALD patterns, which were examined as predictors of alcohol use using multivariate regression.

RESULTS

Among 398 participants, 30.9% reported past year alcohol use. Concerns about impacts on medications, school, and disease status were the most frequently endorsed RALD; prior negative experiences with alcohol and family history were the least frequently endorsed. Five RALD clusters were identified for all YCMC and 2 for recent drinkers. Compared to the cluster with high endorsement of multiple general and health-related RALD, those predominantly citing concerns about addiction and those not strongly endorsing any RALD consistently reported greater alcohol use. Among recent drinkers, the cluster characterized by low concern across multiple RALD also consistently reported greater alcohol use compared to their counterparts expressing moderate concern.

CONCLUSIONS

For YCMC, RALD are complex but endorsement of multiple general and health-related RALD is associated with less use, and health concerns are especially prevalent. More research is needed to understand how salient RALD can inform tailored interventions that aim to delay and reduce substance use and improve health outcomes for YCMC.

Understanding Alcohol and Tobacco Consumption in Asexual Samples: A Mixed-Methods Approach

Existing research suggests significant differences in alcohol and tobacco consumption trends according to one's sexual orientation. However, asexual people have not yet been included in these comparisons. In this mixed-methods, two-part study, we sought to compare group differences in alcohol and tobacco consumption among sexual orientations, focusing on asexual people, sexual people, and those in the "gray" area between asexual and sexual (i.e., "gray-asexual"). Data for Study 1 came from four British studies: National Surveys of Sexual Attitude and Lifestyles I, II, and III in 1990, 2000, and 2010 (NATSAL I, II, III) and Towards Better Sexual Health (TBSH) in 2000. Sample sizes for each study by gender are: NATSAL I-M: 1923 F: 3511; NATSAL II-M: 4604 F: 6031; NATSAL III-M: 6122 F: 7966; TBSH-M: 347 F: 552. Notably, asexual and gray-asexual respondents were found to consume significantly less alcohol and were more likely to abstain from drinking alcohol altogether, compared to allosexual respondents. Differences in tobacco consumption were only statistically significant for asexual respondents in two of three studies that included tobacco consumption. Each of the four studies also found that asexual and gray-asexual respondents were more likely to be non-drinkers (40.0-77.8%, asexual and 28.1-50.1% gray-asexual, non-drinkers, respectively) than allosexual respondents (10.2-27.2%, non-drinkers). Interviews conducted in Study 2 identified somatic, social, and psychological experiences and motivations that may shed light on the reasons for lower drinking frequencies among asexual individuals. Variability in alcohol consumption levels among asexual, lesbian, gay, and bisexual respondents, and the general population raises new questions about the motivations for why people consume alcohol.

Attachment Orientations and Adult Alcohol Use Among Those With Childhood Adversities

Abstract. Adverse psychological consequences have been associated with both alcohol abstinence and alcohol disorders. The current study considers those who have experienced childhood adversities and examines whether secure attachment orientation represents a protective factor against an increased likelihood of either abstinence/rare alcohol consumption or alcohol disorder diagnosis. Data were used from the National Comorbidity Survey-Revised (NCS-R) ( N = 5,692), a random sample representative of the American population. Adult personal alcohol use was considered in terms of abstinence/rare alcohol use, regular alcohol use, and alcohol disorder diagnosis. Analyses focused on those who had experienced childhood adversities ( N = 2,182) and assessed attachment orientation as a predictor of alcohol use. Within those who had experienced childhood adversities, in comparison with securely attached individuals, both anxiously attached individuals and avoidant attached individuals had a significantly increased likelihood of being in the alcohol disorder diagnosis group as opposed to the regular alcohol consumption group. Avoidant individuals also had a significantly increased likelihood of being in the abstinence/rare alcohol use group. Results are discussed in terms of subgroups (vulnerable individuals and families) that may benefit from supportive interventions, and what format these interventions might take.

Clusters of alcohol abstainers and drinkers incorporating motives against drinking: a random survey of 18 to 30 year olds in four cities in four different continents

Objective

The aim of this analysis was to identify alcohol consumption clusters for adolescents and early adults according to attitudes to drinking, motivations against drinking and perceptions associated with alcohol.

Method

Interviews were undertaken with people aged 18–34 years old living in four cities in different regions of the world. Multistage random sampling was consistent across the four cities (Ilorin (Nigeria), Wuhan (China), Montevideo (Uruguay) and Moscow (Russia)). The questionnaire was forward and back translated into relevant languages and face-to-face interviewing undertaken. The data were weighted to the population of each city. In total 6235 structured interviews were undertaken (1391 in Ilorin, 1600 in Montevideo, 1604 in Moscow and 1640 in Wuhan). Questions regarding motivation against alcohol consumption (14 items), assessing perceptions (3 items) and attitudes to drinking in certain situations (8 items) were asked of all respondents including abstainers. Factor analysis was initially undertaken to identify highly related correlated variables.

Results

Cluster analysis provided a variety of clusters (Ilorin (3 clusters), Montevideo (5), Moscow (4) and Wuhan (4)). At least one cluster in each city was dominated by abstainers and another by heavy episodic drinkers. Variations by city and alcohol consumption patterns existed in regards to variables included.

Conclusion

This analysis detailed the city specific motivations against drinking alcohol, and the attitudes towards alcohol consumption. Differences highlight the influence of country/city specific culture, customs, laws, societal norms and traditions.

Correlates of Reduced Alcohol Consumption among a Sample of Young Australians

AIMS

Population data suggest that a significant proportion of young drinkers are reducing or ceasing their alcohol use; however, there is a lack of information about the characteristics of young people who do so. Our study aimed to determine characteristics associated with self-reported attempted and successful alcohol reduction and cessation among young people in Victoria, Australia.

METHODS

Data are from a cross-sectional online survey with young people aged 15-29 years living in Victoria, Australia. Participants who reported consuming alcohol in the past 12 months were included in the analysis (N = 1,162).

RESULTS

Alcohol drinking cessation in the past 12 months was reported by 3.8% (n = 44) and reduced alcohol consumption was reported by 32.1% (n = 371) of participants. Characteristics associated with trying to reduce or cease alcohol consumption were older age, being born overseas, drinking at hazardous levels, experiencing alcohol-related harms and interest in health content on social media. Characteristics associated with successful alcohol reduction or cessation were being born overseas and experiencing alcohol-related harm, while being a member of a religious group was negatively associated.

CONCLUSIONS

Recent reduction in alcohol consumption was common among young people in this study. Recent reduction in alcohol consumption was common among young people in this study. A combination of factors appear to be correlated with recent attempts to reduce drinking young people including socio-demographic characteristics, religiosity, drinking practices and experience of harm, and interest in health.

Self-Reported Reasons for Abstinence from Illicit Drugs

OBJECTIVE

To provide a more balanced understanding of the initiation and restraint of substance use, educators, clinicians, and researchers would benefit from a review of research assessing the reasons nonusers report for having abstained from drugs.

METHOD

Based on searches of computerized databases and the reference sections of relevant articles, we identified 15 relevant studies that assessed and quantified participants' expressed reasons for having abstained from (a) one or more named substances or (b) drugs (or alcohol and drugs) with little or no further specification. We defined as more salient those 25% of reasons in each study that were endorsed most frequently, ranked highest, or rated most influential.

RESULTS

Five reasons - concerns about physical health, lack of interest, harmful psychological consequences, personal beliefs/morals, and peer/family disapproval - were most frequently identified as salient across studies and substances.

CONCLUSION

These salient reasons are consistent with outcome expectancy and social learning models that have been proposed to explain drug initiation. To enhance the value of future research, we recommend testing whether importance ratings differ across contexts; repeatedly assessing within-subject variability of reasons across time; evaluating the association of psychological characteristics with reasons for abstaining; and continuing to evaluate which reasons for abstaining vary by type of drug, gender, ethnicity, and religiosity. We also recommend additional research comparing which reasons predict continued abstinence and which predict initiation of use during follow-up.

Patterns in Reduction or Cessation of Drinking in Australia (2001-2013) and Motivation for Change

AIMS

This paper examines: (a) change over time (2001-2013) in recently reducing or ceasing drinking in the Australian population and (b) the reasons given for reducing or ceasing drinking in the most recent survey (2013); stratified by sex and age group.

SHORT SUMMARY

Rates of reducing and ceasing drinking increased between 2001 and 2013 in Australia. Young people were more likely to modify drinking due to lifestyle and enjoyment reasons; older groups were more likely to report health reasons. These trends contribute to the broader context of declining alcohol consumption in Australia.

METHODS

Data are from five waves of the National Drug Strategy Household Survey (N = 119,397). Logistic regression models with interaction terms were used to identify a shift in sex or age over time in predicting reduction or cessation of drinking and to predict motivations for reducing or ceasing drinking by sex and age.

RESULTS

Reports of recently reducing the quantity or frequency of drinking increased from 2001 to 2007 and remained stable between 2007 and 2013. There was a steady increase in the number of Australians reporting recently ceasing drinking from 2001 to 2013, with a significant effect for age (younger groups more likely than older groups to cease drinking in the past two waves). Reasons for reducing or ceasing drinking varied by age, with older people more likely to report health reasons and younger people more likely to report lifestyle reasons or enjoyment.

CONCLUSION

Increases over time in reports of reduction or cessation of drinking due to health, lifestyle, social and enjoyment reasons suggest that the social position of alcohol in Australia may be shifting, particularly among young people.

Medical Reasons for Limiting Drinking: Data from a Sexual Health Clinic

BACKGROUND

Heavy drinking poses health risks for individuals with HIV, and some individuals with HIV attempt to reduce drinking. Little is known about whether medical reasons motivate HIV-infected individuals to reduce drinking.

OBJECTIVES

We evaluated medical reasons for limiting drinking among patients in a sexual health clinic, and explored whether these reasons could be operationalized as a new scale for research and clinical use in sexual health clinics.

METHODS

A sample of 70 patients in a sexual health clinic who reported efforts to limit drinking in the past month (84% with self-reported HIV; 81% male; 50% Black) completed a nine-item medical reasons for limiting drinking scale on a tablet while waiting for their appointment. Exploratory factor analysis was performed to evaluate psychometric properties of the scale.

RESULTS

Patients most commonly endorsed general concerns about health, and concerns about alcohol's effect on the liver. Support was found for a unidimensional (one-factor) eight-item scale, which evidenced good internal consistency (α = 0.84). Results were identical when analyses were restricted to the subset of 59 individuals who self-reported HIV infection. Conclusions/Importance: This study suggests that individuals in a sexual health clinic most commonly endorse broad nonspecific concerns about drinking and health, as well as concerns about their liver. This study yields an 8-item scale to measure medical reasons for limiting drinking in sexual health clinics and among individuals with HIV. This scale should enhance researchers' ability to study this important construct and may facilitate discussion of drinking reduction with HIV-infected heavy drinkers, requiring future study.

Differences in alcohol consumption and drinking patterns in Ghanaians in Europe and Africa: The RODAM Study

BACKGROUND

Little is known about alcohol consumption among Africans living in rural and urban Africa compared to African migrants in Europe. We compared the patterns of alcohol consumption in a group of Ghanaians living in different locations in Ghana and in Europe and examined the factors associated with drinking alcohol.

METHODS

Data were from a cross-sectional study (RODAM) of Ghanaians aged 25-70 years living in rural and urban Ghana and in Amsterdam, Berlin and London. Information on how often participants consumed at least one standard alcoholic drink in the preceding 12 months, the type of alcoholic beverage and the average serving size was obtained using a food propensity questionnaire. The associations between drinking alcohol and socio-demographic variables, and frequency of attending religious services were investigated using logistic regression models stratified by site and sex. For Ghanaians living in Europe, the number of years since migration and acculturation were also included in the model as covariates.

RESULTS

4280 participants (62.2% women) were included in the analyses. In both men and women, the prevalence of drinking and amount of alcohol consumed per day was highest in Berlin (prevalence of drinking 71.0% and 61.7%) and lowest in urban Ghana (41.4% and 26.8%). After adjustment for age and education in both men and women in Europe, those attending religious services less frequently reported higher levels of drinking alcohol than non-attendants (never attend/no religion compared to attending service at least once a week men OR 4.60 95% CI 2.85, 7.44; women OR 1.80 95% CI 1.12, 2.90) p-trend with frequency <0.001 in men; 0.002 in women); this association was seen also in men in rural Ghana (p-trend = 0.001) and women in urban Ghana (p-trend = 0.02). The prevalence of drinking was positively associated with years since migration in both men and women in Europe ((OR per years increase in time lived in Europe 1.25 (95% CI 1.02,1.53) test for trend p = 0.03 in women; OR 1.29 (95% CI 1.03, 1.62 p = 0.03 in men) but no association was found with self-reported measures of acculturation (ethnic identity, cultural orientation or social networks).

CONCLUSION

There are marked differences in alcohol consumption between Ghanaians living in Europe and in Ghana suggesting migration has an important influence of drinking patterns and also suggesting the possibility of requiring different strategies in alcohol reduction campaigns among Ghanaians in different locations.

An exploration of adolescents' decisions to abstain or refrain from alcohol consumption in Australian social settings: a qualitative systematic review

BACKGROUND

A significant number of Australian adolescents consume alcohol, with almost two thirds of them doing so at risky levels. This is continuing to increase despite recent National Health and Medical Research Council (NHMRC) guidelines stipulating that no alcohol is the safest option. Measures initiated to reduce and prevent alcohol consumption by adolescents have limited effectiveness. Consumption of alcohol by Australian adolescents is a national concern because of the deleterious effects of alcohol consumption on adolescents' social, physical and neurological development, as well as other short- and long-term health risks, and the negative impact of alcohol-related violence and injury on the community. Understanding adolescents' decisions to abstain or refrain from alcohol consumption may provide valuable insights to assist in dealing with this significant social and health issue, more particularly about the mechanisms used by adolescents or their ability to make decisions about resisting or abstaining from alcohol consumption when exposed to alcohol in their social setting(s).

OBJECTIVES

The review aimed to synthesize the best available qualitative evidence on the decisions made or mechanisms used by adolescents who abstain or refrain from consuming alcohol in any social setting where alcohol is available.

INCLUSION CRITERIA

Adolescents aged between 14 and 19 years who reside in Australia.The phenomenon of interest was abstinence from or resistance to alcohol consumption when exposed to alcohol in social situations.This review considered studies that focused on qualitative data, including, but not limited to,designs such as phenomenology, grounded theory, action research and exploratory studies.

SEARCH STRATEGY

A three-step search strategy was used. An initial search to identify keywords only was undertaken in Medline and CINAHL. This was followed by an expanded search using all identified keywords and index terms specific to each included database. The reference lists of included papers were then searched for any other relevant studies.

METHODOLOGICAL QUALITY

No studies met the inclusion criteria sufficiently to progress to critical appraisal.

DATA EXTRACTION

No studies progressed to data extraction.

DATA SYNTHESIS

Data synthesis was not undertaken as no study met the inclusion criteria.

RESULTS

Although a number of studies retrieved indicated they had qualitative elements to their studies, the qualitative data was not reported.

CONCLUSIONS

Although a number of studies met some aspects of the inclusion criteria there was insufficient reporting of the phenomenon of interest. Due to the lack of studies meeting the inclusion criteria, no conclusions can be drawn for clinical practice. A lack of qualitative data on this topic has been identified. Thus there is a great need for qualitative research to understand and know more about what enables an adolescent to abstain or refrain from consumption in order to inform or formulate effective interventions, policies or plans to prevent or reduce the volume of alcohol consumed by Australian adolescents.

Life course socioeconomic position, alcohol drinking patterns in midlife, and cardiovascular mortality: Analysis of Norwegian population-based health surveys

BACKGROUND

Socioeconomically disadvantaged groups tend to experience more harm from the same level of exposure to alcohol as advantaged groups. Alcohol has multiple biological effects on the cardiovascular system, both potentially harmful and protective. We investigated whether the diverging relationships between alcohol drinking patterns and cardiovascular disease (CVD) mortality differed by life course socioeconomic position (SEP).

METHODS AND FINDINGS

From 3 cohorts (the Counties Studies, the Cohort of Norway, and the Age 40 Program, 1987-2003) containing data from population-based cardiovascular health surveys in Norway, we included participants with self-reported information on alcohol consumption frequency (n = 207,394) and binge drinking episodes (≥5 units per occasion, n = 32,616). We also used data from national registries obtained by linkage. Hazard ratio (HR) with 95% confidence intervals (CIs) for CVD mortality was estimated using Cox models, including alcohol, life course SEP, age, gender, smoking, physical activity, body mass index (BMI), systolic blood pressure, heart rate, triglycerides, diabetes, history of CVD, and family history of coronary heart disease (CHD). Analyses were performed in the overall sample and stratified by high, middle, and low strata of life course SEP. A total of 8,435 CVD deaths occurred during the mean 17 years of follow-up. Compared to infrequent consumption (

CONCLUSIONS

Moderately frequent consumers had a lower risk of CVD mortality compared with infrequent consumers, and we observed that this association was more pronounced among participants with higher SEP throughout their life course. Frequent binge drinking was associated with a higher risk of CVD mortality, but it was more uncertain whether the risk differed by life course SEP. It is unclear if these findings reflect differential confounding of alcohol consumption with health-protective or damaging exposures, or differing effects of alcohol on health across socioeconomic groups.

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Key Words Collapse

MESH Headings

• Adult
• Alcohol Drinking/epidemiology
• Cardiovascular Diseases/epidemiology
• Cardiovascular Diseases/etiology
• Cardiovascular Diseases/mortality
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Norway/epidemiology
• Proportional Hazards Models
• Prospective Studies
• Risk Factors
• Socioeconomic Factors

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Grants

• MC_UU_00011/1 Medical Research Council
• Norges Forskningsråd

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Affiliation(s)

Eirik Degerud Norwegian Institute of Public Health, Oslo, Norway
Inger Ariansen Norwegian Institute of Public Health, Oslo, Norway
Eivind Ystrom Norwegian Institute of Public Health, Oslo, Norway Department of Psychology, University of Oslo, Oslo, Norway School of Pharmacy, University of Oslo, Oslo, Norway
Sidsel Graff-Iversen Norwegian Institute of Public Health, Oslo, Norway
Gudrun Høiseth Norwegian Institute of Public Health, Oslo, Norway Diakonhjemmet Hospital, Center for Psychopharmacology, Oslo, Norway
Jørg Mørland Norwegian Institute of Public Health, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
George Davey Smith MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
Øyvind Næss Norwegian Institute of Public Health, Oslo, Norway Institute of Health and Society, University of Oslo, Oslo, Norway

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Religion, Alcohol Use and Risk Drinking Among Canadian Adults Living in Ontario

This research examines (1) the association between risk drinking and religious affiliation and (2) differences between religions for risk drinking among adults living in Ontario, Canada, for Christians, Buddhists, Sikhs, Muslims, Hindus, Jews, other religious groups and the non-religious. Data are based on telephone interviews with 16,596 respondents and are derived from multiple cycles (2005-2011) of the Centre for Addiction and Mental Health's (CAMH) Monitor survey, an ongoing cross-sectional survey of adults in Ontario, Canada, aged 18 years and older. Data were analysed using bivariate cross-tabulations, Mann-Whitney U nonparametric test and logistic regression. Alcohol use and risk drinking occur among members of all religious groups; however, the rate of drinking ranges widely. Risk drinking is significantly associated with religion. When compared to the No religion/Atheist group, several religious groups (Baptist, Christian, Hindu, Jehovah's Witness, Jewish, Muslim/Islam, Non-denominational, Pentecostal, Sikh and Other religion) in our sample have significantly lower odds of risk drinking. Risk drinkers also attended significantly fewer services among several religions. Results suggest that there are differences in the risk drinking rates among Canadian adults, living in Ontario, by religion. It appears that religious traditions of prohibition and abstention do hold sway among Canadian adults for some religious groups.

Changes in drinking habits and psychological distress in Japanese non- or occasional drinking workers: a one-year prospective cohort study

This study investigated whether non- or occasional drinkers' changes in drinking habits during a one-year period were related to psychological distress. Overall, 2,495 non- or occasional drinking employees (2,109 men and 386 women) completed a self-administered questionnaire measuring alcohol intake, psychological distress (12-item General Health Questionnaire), and demographic characteristics at baseline and one-year follow-up. They also completed a Web-based version of the Brief Job Stress Questionnaire to assess job stressors at baseline. Participants were categorized into three groups (stable non- or occasional drinkers; new light drinkers; new moderate drinkers) according to weekly alcohol consumption at follow-up (males 0 g/wk, 1-79 g/wk, and ≥80 g/wk; females 0 g/wk, 1-39 g/wk, and ≥40 g/wk, respectively); multiple logistic regression analyses were conducted by sex. Among only male participants, both stable non- or occasional drinkers and new moderate drinkers showed significantly higher odds ratios for psychological distress at follow-up than new light drinkers after adjusting for demographic characteristics, job stressors, and psychological distress at baseline (adjusted odds ratios of 1.72 and 1.99, respectively). These findings suggest that men who started to drink 80 g or more alcohol per week during the one-year follow-up period should have been monitored for psychological distress.

Experiences and explanations of mental ill health in a group of devout Christians from the ethnic majority population in secular Sweden: a qualitative study

OBJECTIVE

To explore existential meaning-making in an ethnic-majority subgroup with mental ill health and to increase knowledge about the importance of gaining access to such information in mental healthcare.

DESIGN

Qualitative study using in-depth interviews and systematic text condensation analysis.

PARTICIPANTS

17 devote Christians with an ethnic-Swedish background, 12 women and 5 men, 30-73 years old, from different congregations across Sweden, having sought medical care for mental ill health of any kind.

SETTING

The secular Swedish society.

RESULTS

A living, although asymmetric, relationship with God often was seen as the most important relationship, giving hope and support when ill, but creating feelings of abandonment and fear if perceived as threatened. Symptoms were interpreted through an existential framework influenced by their view of God. A perceived judging God increased feelings of guilt, sinfulness and shame. A perceived merciful God soothed symptoms and promoted recovery. Existential consequences, such as being unable to pray or participate in congregational rituals, caused feelings of 'spiritual homelessness'. Participants gave biopsychosocial explanations of their mental ill health, consonant with and sometimes painfully conflicting with existential explanations, such as being attacked by demons. Three different patterns of interaction among biopsychosocial and existential dimensions in their explanatory systems of illness causation were identified: (a) comprehensive thinking and consensus; (b) division and parallel functions and (c) division and competitive functions.

CONCLUSIONS

Prevailing medical models for understanding mental ill health do not include the individual's existential experiences, which are important for identifying risk and protective factors as well as possible resources for recovery. The various expressions of existential meaning-making identified in this devout religious subgroup illustrate that existential information cannot be generalised, even within a small, seemingly homogenous group. The three identified patterns of interactions formed a typology that may be of use in clinical settings.

Gender and Alcohol Use Disorders Diagnostic Criteria in Emergency Department Patients of Argentina

BACKGROUND

Alcohol consumption and its related consequences are not equal for women and men, although related studies do not frequently include gender analysis.

OBJECTIVE

Our aim was to characterize differences in endorsement of ICD-10 and DSM 5 alcohol use disorder (AUD) criteria by gender in an Argentinean emergency department population.

METHODS

A probability sample of patients (N = 923) from the largest emergency department in the city of Mar del Plata, Argentina (44% were females, aged 16 to 86, M (SD) = 37.31(15.20) was collected. Using a structured questionnaire, diagnostic criteria for alcohol use disorders, alcohol consumption, and socio-demographic variables were obtained. Bivariate and multivariate analyses were used to assess differences in the endorsement of each diagnostic criterion by gender.

RESULTS

Women were less likely to endorse each of the criteria for each of the diagnostic schemes. Even after controlling alcohol consumption, socio-demographic variables, severity of alcohol use disorders and adjusting for multiple comparisons females had a lower probability than males of endorsing withdrawal and impaired control.

CONCLUSIONS

gender differences in the endorsement of diagnostic criteria for both the DSM 5 and ICD-10 were found. Some differences in endorsement but not all, might be partially explained by alcohol consumption patterns and socio-demographic factors, and same remained after controlling severity of the AUD. Results also suggest a differential functioning of DSM 5 and ICD-10 AUD criteria for women and men.

Sociodemographic Characteristics and Health Status of Lifetime Abstainers, Ex-Drinkers, Bingers, and Nonbingers Among Baby Boomers and Older Adults

BACKGROUND

Health risks associated with abstention from alcohol drinking in previous studies may have been exaggerated because the pool of abstainers in many studies included both lifetime abstainers and ex-drinkers, including sick-quitters.

OBJECTIVES

This study compared sociodemographic and health statuses among lifetime abstainers, exdrinkers, bingers, and nonbingers in the 50-64 age group (baby boomers) and the 65+ age group.

METHODS

Data are from the 2008 to 2012 National Survey on Drug Use and Health (N = 18,443 for the 50-64 age group and N = 11,191 for the 65+ age group). Descriptive statistics and multinomial and binary logistic regression analyses were used to examine the study questions.

RESULTS

10% of the 50-64 age group and 20% of the 65+ age group reported lifetime abstention, and 21% and 28% of each group, respectively, reported being ex-drinkers (i.e., last used alcohol more than 12 months ago). In both age groups, lifetime abstainers, exdrinkers, and bingers had lower socioeconomic status than nonbingers. In the 50-64 age group, lifetime abstainers did not differ from or were less likely than nonbingers to have vascular and hepatic/gastrointestinal (HGI) disorders, but exdrinkers were more likely to have these diseases, and both lifetime abstainers and exdrinkers were more likely to have diabetes. In the 65+ age group, lifetime abstainers did not differ from nonbingers on high blood pressure, heart disease, and HGI, but both they and the exdrinkers were more likely to have stroke and diabetes.

CONCLUSIONS/IMPORTANCE

Diabetes screening/monitoring and stroke prevention/care are recommended for both age groups of abstainers and exdrinkers.

Trajectories and correlates of reasons for abstaining or limiting drinking during adolescence

INTRODUCTION

Our aim was to enhance understanding of the trajectory of reasons for abstaining and limiting drinking (RALD) over the course of adolescence and how RALD levels or trajectories may differ based on lifetime experience with alcohol and/or gender.

METHODS

Participants were 1023 middle school students (52% female) who completed online surveys at baseline and five follow-ups over a 3-year period, assessing lifetime sip and full drink of alcohol and RALD. Hierarchical linear models were used to estimate change over time in total RALD and RALD subscales (upbringing, performance/control). Between-person (gender and drinking status) correlates of average RALD and change in RALD over time were considered.

RESULTS

RALD total and subscale scores significantly decreased over time (ages 10.5-16.5). Drinking experience in both milestones (sip, full drink) was found to be a significant moderator of change in RALD over time; decline was fastest among adolescents reporting lifetime experience with drinking. Boys reported lower RALD, though the pace of change in RALD across time did not differ by gender.

CONCLUSIONS

This was the first study to report prospective changes in the cognitive domain of RALD among young adolescents. That change over time in RALD is moderated by drinking experience suggests an increased risk among those with earlier drinking experience. Findings highlight the importance of considering sipping, not just consumption of a full drink, as a pivotal developmental milestone. Prevention efforts that target RALD are implicated and parent-based intervention strategies may be beneficial.

Alcohol Use as Risk Factors for Older Adults' Emergency Department Visits: A Latent Class Analysis

INTRODUCTION

Late middle-aged and older adults' share of emergency department (ED) visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns.

METHODS

Data came from the 2013 National Health Interview Survey's Sample Adult file (n=15,713). Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA) modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/moderate drinkers, and current heavy drinkers), chronic health and mental health status, and past-year ED visits as indicators.

RESULTS

LCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group) were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/mental health problems; Class 2 (21%; low-risk group) consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group) was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group) included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors.

CONCLUSION

Alcohol nonuse/use (and quantity of use) and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex-drinkers improve chronic illnesses self-management.

Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations

AIMS

To review the contemporary evidence reflecting male/female differences in alcohol use and its consequences along with the biological (sex-related) and psycho-socio-cultural (gender-related) factors associated with those differences.

METHODS

MEDLINE, PubMed, Web of Science, SCOPUS, PsycINFO, and CINAHL databases were searched for relevant publications, which were subsequently screened for the presence/absence of pre-specified criteria for high quality evidence.

RESULTS

Compared to men, more women are lifetime abstainers, drink less, and are less likely to engage in problem drinking, develop alcohol-related disorders or alcohol withdrawal symptoms. However, women drinking excessively develop more medical problems. Biological (sex-related) factors, including differences in alcohol pharmacokinetics as well as its effect on brain function and the levels of sex hormones may contribute to some of those differences. In addition, differences in alcohol effects on behavior may also be driven by psycho-socio-cultural (gender-related) factors. This is evident by variation in the magnitude of differences in alcohol use between countries, decreasing difference in the rates of alcohol consumption in recent generations and other findings. Evidence indicates that both sex and gender-related factors are interacting with alcohol use in complex manner, which differentially impacts the risk for development of the behavioral or medical problems and alcohol use disorders in men and women.

CONCLUSIONS

Discovery of the mechanisms underlying biological (sex-related) as well as psycho-socio-cultural (gender-related) differences in alcohol use and related disorders is needed for development of personalized recommendations for prevention and treatment of alcohol use disorders and related problems in men and women.

Associations of lifetime abstention and past and current alcohol use with late-life mental health: a propensity score analysis

BACKGROUND

Compared to the extensive research on the effects of alcohol intake on physical health, little research has been done on the effects of alcohol use/nonuse patterns on mental disorders in late life. This study examined associations between mental disorders and alcohol use/nonuse patterns among individuals aged 65+ years.

METHODS

Data came from the public use files of the 2008 to 2012 National Survey on Drug Use and Health. Alcohol use/nonuse groups were lifetime abstainers, ex-drinkers, bingers, and nonbingers. Mental health problems were lifetime major depressive episode (MDE) and anxiety disorder, past-year MDE and anxiety disorder, and past-year serious suicidal ideation. To minimize selection biases resulting from a complex array of covariates, we implemented a generalized boosted model to generate propensity score weights on covariates. Then we employed logistic regression models with mental health outcomes as the dependent variables.

RESULTS

The four alcohol use/nonuse groups did not differ in past-year MDE. However, odds ratios show that, relative to non-binge drinking, lifetime abstention decreased the odds of lifetime MDE by more than 60% (OR = 0.39, 95% CI = 0.23-0.68, p = .001) and the odds of lifetime anxiety disorder by almost half (OR = 0.55, 95% CI = 0.38-0.79, p = .002). Ex-drinkers were more likely than nonbingers to report past-year serious suicidal thoughts (OR = 2.29, 95% CI = 1.45-3.62, p < .001).

CONCLUSIONS

While lifetime abstainers had significantly better lifetime mental health histories than nonbingers, ex-drinkers had worse past-year mental health status. Since lifetime abstainers and ex-drinkers have significantly different characteristics, researchers should distinguish between these groups.

Reasons for limiting drinking in an HIV primary care sample

BACKGROUND

Heavy drinking among individuals with HIV is associated with major health concerns (liver disease, medication nonadherence, immune functioning), but little is known about cognitive-motivational factors involved in alcohol consumption in this population, particularly reasons for limiting drinking.

METHODS

Urban HIV primary care patients (N = 254; 78.0% male; 94.5% African American or Hispanic) in a randomized trial of brief drinking-reduction interventions reported on reasons for limiting drinking, alcohol consumption, and alcohol dependence symptoms prior to intervention.

RESULTS

Exploratory factor analysis indicated 3 main domains of reasons for limiting drinking: social reasons (e.g., responsibility to family), lifestyle reasons (e.g., religious/moral reasons), and impairment concerns (e.g., hangovers). These factors evidenced good internal consistency (αs = 0.76 to 0.86). Higher scores on social reasons for limiting drinking were associated with lower typical quantity, maximum quantity, and binge frequency (ps < 0.01), and higher scores on lifestyle reasons were associated with lower maximum quantity, binge frequency, and intoxication frequency (ps < 0.01). In contrast, higher scores on impairment concerns were associated with more frequent drinking and intoxication, and higher risk of alcohol dependence (ps < 0.05), likely because dependent drinkers are more familiar with alcohol-induced impairment.

CONCLUSIONS

The current study is the first to explore reasons for limiting drinking among individuals with HIV and how these reasons relate to alcohol involvement. This study yields a scale that can be used to assess reasons for limiting drinking among HIV-positive drinkers and provides information that can be used to enhance interventions with this population. Discussing social and lifestyle reasons for limiting drinking among less extreme drinkers may support and validate these patients' efforts to limit engagement in heavy drinking; discussion of impairment reasons for limiting drinking may be a way to engage dependent drinkers in efforts to decrease their alcohol consumption.

Associations between IQ and alcohol consumption in a population of young males: a large database analysis

PURPOSE

This study aimed at exploring the relationship between intelligence quotient (IQ) and alcohol consumption in a large sample of young males. This study explored whether IQ influences alcohol drinking and which pathways might be involved. We further hypothesized that IQ differences between lifetime abstainers and former drinkers exist, and that they primarily result from different group characteristics.

METHOD

Within a psychiatric-epidemiological survey using a cross-sectional design IQ-tests were administered to approximately 50,000 Swiss conscripts at age of about 20 years. The sample was divided into four alcohol consumption categories (rare, occasional, moderate and daily drinking) and two non-drinker categories (former drinking and lifetime abstinence). Probabilities for different levels of consumption or former drinking against lifetime abstention in relation to IQ were estimated using multinomial logistic regression. Models were adjusted for education, disability pension, tobacco/cannabis use, migration, parental alcohol disorders, and mental health.

RESULTS

After adjusting for confounders full-scale IQ displayed positive associations with being a rare (OR 1.13; CI 95 % 1.07-1.19), occasional (OR 1.41; CI 95 % 1.33-1.48), and moderate drinker (OR 1.53; CI 95 % 1.45-1.62), and negative associations with being a former drinker (OR 0.85; CI 95 % 0.79-0.93). Daily drinking was positively associated only with the performance subscale IQ (OR 1.12; CI 95 % 1.02-1.22). Confounders contributed significantly to the IQ-alcohol association and, therefore, highlight the distinction of non-drinkers into lifetime abstainers and former drinkers.

CONCLUSIONS

Our data confirmed the positive link between IQ and moderate drinking. Lower IQ in non-drinkers, however, seems to be related to earlier consumption and the presence of other risk factors.

Prevalence and correlates of alcohol dependence disorder among TB and HIV infected patients in Zambia

Objectives

To determine the prevalence and correlates of alcohol dependence disorders in persons receiving treatment for HIV and Tuberculosis (TB) at 16 Primary Health Care centres (PHC) across Zambia.

Methods

649 adult patients receiving treatment for HIV and/or TB at PHCs in Zambia (363 males, 286 females) were recruited between 1st December 2009 and 31st January 2010. Data on socio-demographic variables, clinical disease features (TB and HIV), and psychopathological status were collected. The Mini International Neuropsychiatric Interview (MINI) was used to diagnose alcohol dependence disorder. Correlates of alcohol dependence were analyzed for men only, due to low prevalence in women. Univariable and multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using general estimating equations to allow for within-PHC clustering.

Results

The prevalence of alcohol dependence was 27.2% (95%CI: 17.7-39.5%) for men and 3.9% (95%CI: 1.4-0.1%) for women. Factors associated with alcohol dependence disorder in men included being single, divorced or widowed compared with married (adjusted OR = 1.47, 95%CI: 1.00-2.14) and being unemployed (adjusted OR=1.30, 95%CI: 1.01-1.67). The highest prevalence of alcohol dependence was among HIV-test unknown TB patients (34.7%), and lowest was among HIV positive patients on treatment but without TB (14.1%), although the difference was not statistically significant (p=0.38).

Conclusions

Male TB/HIV patients in this population have high prevalence of alcohol dependence disorder, and prevalence differs by HIV/TB status. Further work is needed to explore interventions to reduce harmful drinking in this population.

Use of and attitudes toward tobacco and alcohol among adults in southern Sri Lanka

The adverse health effects of tobacco and alcohol are well known. Alcohol consumption is increasing in Sri Lanka, but few population studies have been conducted. The objective of this study was to document tobacco and alcohol consumption levels among adults in southern Sri Lanka and to identify the main reasons for using or refraining from alcohol and tobacco products. Tobacco and alcohol use within Sri Lanka is relatively common, particularly among adult males. Reasons given for smoking and drinking frequently relate to social and image-based motivators. Women may be especially susceptible to the influence of peer pressure in social situations. Public health efforts should consider the use of demographic-specific anti-tobacco and anti-alcohol messages, as the motivators driving behavior appear to differ across gender and age groups.

Associations between self-reported illness and non-drinking in young adults

AIMS

This study investigated associations between self-reported illness, social factors and health behaviours and non-drinking among young people aged 18-34 years.

DESIGN

Logistic regression analysis of cross-sectional national survey data, collected from the Health Survey for England 2006 and 2008. Data were collected through face-to-face interviews and are self-reported.

PARTICIPANTS AND SETTINGS

A total of 2826 male and 3618 females aged 18-34 years drawn from a nationally representative multi-stage stratified probability sampling design across England.

MEASUREMENTS

Non-drinkers were based on those who reported 'no' to drinking alcohol currently. Exposure measures included self-reports of having a limiting long-standing illness, long-standing illness or self-reported poor health. We adjusted for ethnicity, income, education, general physical activity and other factors.

FINDINGS

Having a limiting long-standing illness during early adulthood increased the odds of being a non-drinker 1.74 times for men (P < 0.01) and 1.45 times for women (P < 0.01). In both men and women belonging to the lowest income quintile or having no qualifications was associated with increased odds of being a non-drinker (P < 0.001), indicating that the social gradient in non-drinking begins at an early age. Men and women aged 18-34 years with the lowest activity levels were also more likely to be non-drinkers (P < 0.01).

CONCLUSION

Young adults who have a limiting long-standing illness are more likely not to drink alcohol even after adjusting for a range of social and demographic measures. Studies on the putative health benefits of moderate alcohol consumption later in life need to take account of early life history.

To drink or not to drink: motives and expectancies for use and nonuse in adolescence

Drinking motives have a prominent role in cognitive models of adolescent and adult alcohol decision-making (Cooper, Russell, Skinner, & Windle, 1992; Cooper, 1994). The complementary construct of motivation not to drink has received less attention (Epler, Sher & Piasecki, 2009). We examined how abstinence motives interacted with drinking motives and alcohol expectancies to predict alcohol consumption in samples of US high school students (N>2500). Nondrinking motives predicted lower rates of lifetime and current alcohol use. Motives not to drink interacted with specific drinking motives, like social and coping motives, and alcohol expectancies to predict certain aspects of drinking behavior. For example, motives not to drink had the greatest impact on youth with weaker social motivations. Findings highlight the distinction between motives not to drink and other alcohol-related cognitions in predicting adolescent alcohol consumption. This work not only supports the utility of this construct in developing models of youth alcohol-related decision-making but also has implications for prevention programming.