The Design and Optimality of Survey Counts: A Unified Framework Via the Fisher Information Maximizer

Grouped and right-censored (GRC) counts have been used in a wide range of attitudinal and behavioural surveys yet they cannot be readily analyzed or assessed by conventional statistical models. This study develops a unified regression framework for the design and optimality of GRC counts in surveys. To process infinitely many grouping schemes for the optimum design, we propose a new two-stage algorithm, the Fisher Information Maximizer (FIM), which utilizes estimates from generalized linear models to find a global optimal grouping scheme among all possible N -group schemes. After we define, decompose, and calculate different types of regressor-specific design errors, our analyses from both simulation and empirical examples suggest that: 1) the optimum design of GRC counts is able to reduce the grouping error to zero, 2) the performance of modified Poisson estimators using GRC counts can be comparable to that of Poisson regression, and 3) the optimum design is usually able to achieve the same estimation efficiency with a smaller sample size.

Exploring the Protective Effects of Judaism on Risky Behaviors in College Students: A Pilot Study

BACKGROUND

Common risky behaviors among college-aged young adults include risky sexual behaviors and substance use.

PURPOSE

This study examines the protective effects of Judaism on students' engagement in risky behaviors, building on a body of research on the protective effects of religious beliefs on risky health behaviors.

METHODS

Validated and reliable measures were used to assess religiosity and risky behaviors through anonymous surveys. Data was collected in Fall 2018 from a small cohort (N = 15) of Jewish day school students.

RESULTS

Females had overall higher rates of risky behaviors such as drinking or using drugs before sex (27% compared to 13% for males), not using condoms (62% to 0% for males), and higher rates of binge drinking (62% to 20% for males).

CONCLUSION

Higher religiosity was more associated with delayed sexual activity than substance use behaviors. Judaism and religiosity were more strongly associated with the male participants than the female.

PRACTICE IMPLICATIONS

Since the participants still had low rates of condom use and other high risk behaviors despite speaking with their healthcare providers, the health care community must better educate adolescents and young adults on the health and social consequences of such risky activities, both in formal education programs during middle and high school, and in office visits.

Examining differences in drinking patterns among Jewish and Arab university students in Israel

OBJECTIVES

Worldwide there is a dearth of studies examining drinking patterns in Arabs and how these compare to other populations. The few studies that exist have suggested distinct drinking patterns in Arabs, with not only high rates of abstinence but also high rates of heavy drinking among current drinkers. No studies have yet examined potential socio-cognitive mechanisms that may contribute to this distinct drinking pattern. Israel represents a unique and valuable resource for studying Arab population drinking patterns because Israeli Arabs are nonimmigrants living in areas where exposure to Western lifestyles, including alcohol consumption, is prevalent. The current study was set out to examine differences in alcohol consumption in a convenience sample of 1310 Jewish and Arab students from Israeli universities and colleges and to explore alcohol expectancies as potential mediators of ethno-religious differences.

DESIGN

Logistic regressions were used to produce odds ratios and 95% confidence intervals to test differences between Jewish and Arab students on binary outcomes (lifetime, last month, and heavy drinking). Mediation of ethno-religious differences by alcohol expectancies was tested with bootstrapping procedures.

RESULTS

Results show that while Israeli Arab students tend to be more likely to abstain from alcohol than Israeli Jewish students, among current drinkers, Israeli Arab students are at a particular high risk of heavy drinking. Results also show that this is partly mediated by the expectancy that alcohol only influences the drinker at high levels of intake.

CONCLUSION

The current study confirms distinct Arab drinking patterns found in previous studies. The present study is the first demonstration that drinking expectations mediate ethno-religious differences in heavy drinking among Israeli Arabs and Jews. This work contributes to the understanding of ethno-religious group differences in harmful drinking, potentially informing future etiologic research and public health interventions aimed at reducing alcohol-related harm.

Evaluation of the influence of alcohol dehydrogenase polymorphisms on alcohol elimination rates in African Americans

INTRODUCTION

The relationship between alcohol dehydrogenase (ADH) polymorphisms and alcohol use disorders in populations of African descent has not been clearly established. This study examined the effect of ADH1B polymorphisms on alcohol metabolism and subjective response, following intravenous (IV) alcohol administration, and the influence of gender, recent drinking history, and family history of alcoholism (FHA), in nondependent African American drinkers.

MATERIALS

The sample included eighty-seven 21- to 35-year-old, light social drinkers of African descent. Participants included 39 sib pairs, 2 sibships with 3 siblings each, and 3 individuals who were not part of a sibship. Participants received infusions via the use of the clamp method that refers to the goal of controlling breath alcohol concentration in 2 randomized sessions at 0.06 g% ethanol and 0 mg% (placebo), and a battery of subjective scales at predefined time points. Dependent measures included alcohol elimination rates (AERs), alcohol disappearance rates (ADRs), subjective measures peak scores, and area under the curve. General linear model and mixed models were performed to examine the relationship between ADH1B genotype, dependent measures, and influence of covariates.

RESULTS

Participants with ADH1B1/1 genotypes showed higher number of drinks (p = 0.023) and drinks per drinking day (p = 0.009) compared with the persons with ADH1B1/3 genotype. AER (adjusted for body weight) was higher in ADH1B*1 homozygotes (p = 0.045) compared with ADH1B1/3 heterozygotes. ADR differed significantly between males and females (p = 0.002), regardless of body weight (p = 0.004) and lean body mass (p < 0.001) adjustments. Although a few subjective measures differed across genotype, all measures were higher in alcohol sessions compared with placebo sessions (p < 0.001). These observations were mediated by drinks per drinking day, gender, and FHA.

CONCLUSIONS

ADH1B polymorphism had a marginal effect on alcohol pharmacokinetics following IV alcohol administration in nondependent drinkers of African descent. Session (alcohol vs. placebo) and ADH1B genotype did, however, influence subjective response to alcohol with some variation by gender, FHA, and drinks per drinking day.

Respondent-driven sampling of Muslim undergraduate U.S. college students and alcohol use: pilot study

PURPOSE

Prevention of alcohol abuse requires information about all demographic groups. However, little is known about drinking among people affiliated with proscriptive religions due to omission of religious affiliation in many surveys and challenges sampling them. Our objective was to pilot a sampling technique frequently used in the HIV literature, respondent-driven sampling, to assess potential association of alcohol use with religiosity, personal proscriptive belief, and social influences among Muslim U.S. college students.

METHODS

Self-identified Muslim undergraduate students (N = 156) at one urban commuter university completed a web-based survey.

RESULTS

Prevalence adjusted for sampling was 9.1 % (95 % CI: 0.2-17.1 %) with in-group recruitment of 0.36 for drinkers and 0.43 for abstainers. In unadjusted analyses, students who were lifetime abstainers were more likely than drinkers to hold personal proscriptive belief and strongly agree with a measure of private religiosity. There was no difference on public religiosity measures between groups. Lifelong abstainers were more likely to report fewer students, fewer Muslim students, and fewer of their friends drank alcohol. They also were more likely to report that they attended high school with more Muslims and currently live in neighborhoods with more Muslims.

CONCLUSIONS

In this pilot study, lifetime abstinence was associated with high private religiosity, personal proscriptive religious beliefs, and more proscriptive social influences. The findings suggest that respondent-driven sampling may be feasible in recruiting Muslim students. However, validation against other sampling techniques is needed.

Alcohol use and abuse among rural Zimbabwean adults: a test of a community-level intervention

BACKGROUND

Understanding what factors contribute to alcohol abuse in resource-poor countries is important given its adverse health consequences. Past research shows that social peers influence substance abuse, suggesting that the social environment may be an effective target for reducing alcohol abuse across a population. This study investigates the determinants of alcohol use and abuse in rural Zimbabwe and tests a community popular opinion leader (CPOL) community-based intervention partly directed at reducing alcohol abuse.

METHODS

Tests were conducted on the impact of the CPOL intervention on alcohol use patterns across communities in rural Zimbabwe over three waves from 2003 to 2007, including community- and individual-level tests using data based on in-person interviews of adult men and women (ages 18-30; N=5543). Data were analyzed using paired-sample t-tests, as well as logistic and ordinary least-squares regression with random effects.

RESULTS

Higher drinking (any use, more frequent use, greater quantity, and/or frequent drunkenness) was generally associated with being male, older, not married, more highly educated, of Shona ethnicity, away from home frequently, employed, having no religious affiliation, or living in areas with a higher crude death rate or lower population density. Over the study period, significant declines in alcohol use and abuse were found in intervention and control sites at relatively equal levels.

CONCLUSIONS

Although no support was found for the effectiveness of the CPOL study in reducing alcohol abuse, Zimbabwe is similar to other countries in the impact of socio-demographic and cultural factors on alcohol use and abuse.

Religion and healthy lifestyle behaviors among postmenopausal women: the women's health initiative

Worship attendance has been associated with longer survival in prospective cohort studies. A possible explanation is that religious involvement may promote healthier lifestyle choices. Therefore, we examined whether attendance is associated with healthy behaviors, i.e. use of preventive medicine services, non-smoking, moderate drinking, exercising regularly, and with healthy dietary habits. The population included 71,689 post-menopausal women enrolled in the Women's Health Initiative observational study free of chronic diseases at baseline. Attendance and lifestyle behaviors information was collected at baseline using self-administered questionnaires. Healthy behaviors were modeled as a function of attendance using logistic regression. After adjustment for confounders, worship attendance (less than weekly, weekly, and more than weekly vs. never) was positively associated with use of preventive services [OR for mammograms: 1.34 (1.19, 1.51), 1.41 (1.26, 1.57), 1.33 (1.17, 1.52); breast self exams: 1.14 (1.02, 1.27), 1.33 (1.21, 1.48), 1.25 (1.1, 1.43); PAP smears: 1.22 (1.01, 1.47-weekly vs. none)]; non-smoking: [1.41 (1.35, 1.48), 1.76 (1.69, 1.84), 2.27 (2.15, 2.39)]; moderate drinking [1.35 (1.27, 1.45), 1.60 (1.52, 1.7), 2.19 (2.0, 2.4)]; and fiber intake [1.08 (1.03, 1.14), 1.16 (1.11, 1.22), 1.31 (1.23, 1.39), respectively], but not with regular exercise or with lower saturated fat and caloric intake. These findings suggest that worship attendance is associated with certain, but not all, healthy behaviors. Further research is needed to get a deeper understanding of the relationship between religious involvement and healthy lifestyle behaviors and of the inconsistent patterns in this association.

Haplotype-based study of the association of alcohol-metabolizing genes with alcohol dependence in four independent populations

BACKGROUND

Ethanol is metabolized by 2 rate-limiting reactions: alcohol dehydrogenases (ADH) convert ethanol to acetaldehyde that is subsequently metabolized to acetate by aldehyde dehydrogenases (ALDH). Approximately 50% of East Asians have genetic variants that significantly impair this pathway and influence alcohol dependence (AD) vulnerability. We investigated whether variation in alcohol metabolism genes might alter the AD risk in four non-East Asian populations by performing systematic haplotype association analyses to maximize the chances of capturing functional variation.

METHODS

Haplotype-tagging SNPs were genotyped using the Illumina GoldenGate platform. Genotypes were available for 40 SNPs across the ADH genes cluster and 24 SNPs across the two ALDH genes in four diverse samples that included cases (lifetime AD) and controls (no Axis 1 disorders). The case control sample sizes were the following: Finnish Caucasians: 232, 194; African Americans: 267, 422; Plains American Indians: 226, 110; and Southwestern American (SW) Indians: 317, 72.

RESULTS

In all four populations, as well as HapMap populations, 5 haplotype blocks were identified across the ADH gene cluster: (i) ADH5-ADH4; (ii) ADH6-ADH1A-ADH1B; (iii) ADH1C; (iv) intergenic; (v) ADH7. The ALDH1A1 gene was defined by 4 blocks and ALDH2 by 1 block. No haplotype or SNP association results were significant after correction for multiple comparisons; however, several results, particularly for ALDH1A1 and ADH4, replicated earlier findings. There was an ALDH1A1 block 1 and 2 (extending from intron 5 to the 3' UTR) yin yang haplotype (haplotypes that have opposite allelic configuration) association with AD in the Finns driven by SNPs rs3764435 and rs2303317, respectively, and an ALDH1A1 block 3 (including the promoter region) yin yang haplotype association in SW Indians driven by 5 SNPs, all in allelic identity. The ADH4 SNP rs3762894 was associated with AD in Plains Indians.

CONCLUSIONS

The systematic evaluation of alcohol-metabolizing genes in four non-East Asian populations has shown only modest associations with AD, largely for ALDH1A1 and ADH4. A concentration of signals for AD with ALDH1A1 yin yang haplotypes in several populations warrants further study.

Subjective responses to alcohol consumption as endophenotypes: advancing behavioral genetics in etiological and treatment models of alcoholism

Individual differences in subjective responses to alcohol consumption represent genetically mediated biobehavioral mechanisms of alcoholism risk (i.e., endophenotype). The objective of this review is three-fold: (1) to provide a critical review the literature on subjective response to alcohol and to discuss the rationale for its conceptualization as an endophenotype for alcoholism; (2) to examine the literature on the neurobiological substrates and associated genetic factors subserving individual differences in subjective response to alcohol; and (3) to discuss the treatment implications of this approach and to propose a framework for conceptualizing, and systematically integrating, endophenotypes into alcoholism treatment.

Clergy knowledge and attitudes concerning faith community nursing: toward a three-dimensional scale

OBJECTIVE

Research has described faith community nursing practice, including positive aspects and barriers to practice. Barriers to faith community nursing practice must be identified and addressed to facilitate faith community nursing programs. The primary purpose of this study was to pilot test a newly developed instrument to measure knowledge and attitudes concerning faith community nursing.

DESIGN AND SAMPLE

A survey design was used. The sample included clergy in the United Church of Christ (n=34).

MEASURES

An investigator developed survey entitled Knowledge, Attitudes, and Opinions Concerning Faith Community Nursing was administered.

RESULTS

Psychometric evaluation of the survey included content validity and internal consistency reliability for each of 3 scales. Coefficient alpha was high, ranging from .88 to .95. The results of the survey indicate that clergy, within the selected Christian denomination, generally have adequate knowledge and positive attitudes about faith community nursing. Knowledge scores on one item indicated some uncertainty among clergy about spiritual counseling as a nursing intervention. A major limitation to this study was the small, homogeneous sample. Future research should include further psychometric evaluation of validity and reliability in a larger, diverse sample.

CONCLUSION

The results of this study indicate that, with further testing, the Knowledge, Attitudes, and Opinions Concerning Faith Community Nursing Survey has the potential to expand assessment of barriers to faith community nursing.

Ethnic Origin of Alcoholics Admitted to an Israeli Treatment Center

Jews have a low rate of alcohol use and abuse as reported in several different countries. In Israel over the last 10 years there has been a rising rate of alcoholism. We studied consecutive new admissions to our inpatient alcohol center, and an age and sex matched comparison group of patients consecutively admitted with schizophrenia for whether each of their four grandparents was Jewish, or non-Jewish. A significantly higher percentage of alcohol-related admissions were immigrants from the Former Soviet Union (FSU) than among schizophrenics. Among the alcohol-related admissions from the FSU, there were significantly fewer Jewish grandparents than among schizophrenia patients from the FSU. These data could support the concept that biological Jewish ethnicity has a protective effect against alcohol abuse, but are also consistent with cultural transmission of Jewish attitudes toward alcohol use.

The alcohol clamp: applications, challenges, and new directions--an RSA 2004 symposium summary

This article summarizes the proceedings of a symposium organized and cochaired by Vijay Ramchandani and Sean O'Connor and presented at the 2004 Research Society on Alcoholism meeting in Vancouver, BC, Canada. The objectives of this symposium were: (1) to provide a rationale for the development and use of the alcohol clamp and the requirements for its use in alcohol challenge studies; (2) to highlight recent studies conducted using the alcohol clamp to identify sources of variation in the pharmacokinetics and pharmacodynamics of alcohol, as well as to address important research questions related to the relationship between the response to alcohol and the risk for alcoholism; and (3) to provide a perspective on progress, address limitations of the clamp, and identify new directions for alcohol challenge research. The symposium began with an introduction and overview of the alcohol clamp, by Vijay Ramchandani. This was followed by 4 presentations that highlighted recent studies conducted using the clamp including: (1) determination of the influence of alcohol dehydrogenase polymorphisms on alcohol elimination rates in a male Jewish population, by Yehuda Neumark; (2) examination of family history of alcoholism, recent drinking history, and levels and rates of administration as determinants of the response to alcohol and risk for alcoholism, by Sean O'Connor; (3) evaluation of the time course of ethanol intoxication on neuroendocrine function in humans, by Ulrich Zimmermann; and (4) a study of the effects of steady-state blood alcohol levels on auditory event-related potentials in rats, by Sandra Morzorati. Harriet de Wit summarized and discussed the research presented at the symposium and provided her perspective on future directions for research using the alcohol clamp.

Polymorphisms in the mitochondrial aldehyde dehydrogenase gene (Aldh2) determine peak blood acetaldehyde levels and voluntary ethanol consumption in rats

Dependence on alcohol, a most widely used drug, has a heritability of 50-60%. Wistar-derived rats selectively bred as low-alcohol consumers for many generations present an allele (Aldh2(2)) of mitochondrial aldehyde dehydrogenase that does not exist in high-alcohol consumers, which mostly carry the Aldh2(1) allele. The enzyme coded by Aldh2(2) has a four- to five-fold lower affinity for NAD than that coded by Aldh2(1). The present study was designed to determine whether these polymorphisms account for differences in voluntary ethanol intake and to investigate the biological mechanisms involved. Low-drinker F0 Aldh2(2)/Aldh2(2) rats were crossed with high-drinker F0 Aldh2(1)/Aldh2(1) rats to obtain an F1 generation, which was intercrossed to obtain an F2 generation that segregates the Aldh2 alleles from other genes that may have been coselected in the breeding for each phenotype. Data show that, with a mixed genetic background, F2 Aldh2(1)/Aldh2(1) rats voluntarily consume 65% more alcohol (P<0.01) than F2 Aldh2(2)/Aldh2(2) rats. A major phenotypic difference was a five-fold higher (P<0.0025) peak blood acetaldehyde level following ethanol administration in the lower drinker F2 Aldh2(2)/Aldh2(2) compared to the higher drinker F2 Aldh2(1)/Aldh2(1) animals, despite the existence of identical steady-state levels of blood acetaldehyde in animals of both genotypes. Polymorphisms in Aldh2 play an important role in: (i) determining peak blood acetaldehyde levels and (ii) modulating voluntary ethanol consumption. We postulate that the markedly higher peak of blood acetaldehyde generated in Aldh2(2)/Aldh2(2)(2) animals is aversive, leading to a reduced alcohol intake in Aldh2(2)/Aldh2(2) versus that in Aldh2(1)/Aldh2(1) animals.

Issues in the psychopharmacologic assessment and treatment of the orthodox Jewish patient

As with members of other cultural and religious groups, patients within the Orthodox Jewish community present with their own distinct clinical psychiatric issues related to their unique beliefs and practices. This article reviews the existing literature and anecdotal experience on the psychopharmacologic assessment and treatment of Orthodox Jewish patients. Specific aspects examined include this group's perceived intense stigma in receiving treatment, the priority this community places on cognitive functioning, and how the influence of Jewish laws on marriage and sexual practices impacts one's treatment decisions. The relevance of Jewish dietary laws, the Sabbath, and the community's interest in alternative treatments are also discussed. The limited ethno-psychopharmacology research related to Orthodox Jewish psychiatric patients is reviewed. We conclude that understanding issues such as these is critical if one is going to work within this cultural system in order to successfully address their mental health issues. However, the dearth of controlled research in this community needs to be addressed to provide more effective treatment.

Characteristics of binge drinkers in Europe

Binge drinking has been shown to be associated with considerable social harm and disease burden. This review aims to give an overview from a European perspective of the socio-demographical, individual, and social factors that affect binge drinking and to identify effective interventions to reduce binge drinking. To this end, a computer-assisted search of relevant articles was conducted. Results showed that males tended to binge drinking more frequently than females. Binge drinking was most prevalent among adolescents and young adults, and prevalence levelled off later in life. Socio-economic conditions seemed to have an effect on binge drinking, independent of their effects on the volume of alcohol consumed. The early onset of binge drinking was associated with a history of drinking in the family, but pathways into adulthood are less clear. Binge drinking often co-occurred with other substance use. Motives for binge drinking included both social camaraderie and tension reduction. Which aspect prevails may vary according to the type of binge drinker, but to date has not been satisfactorily explained. Binge drinkers were not likely to know enough about or be aware of the potential risks of bingeing. Pressure from peers was one of the strongest influencing factors for binge drinking and seemed to outweigh parental influences, especially from late adolescence onwards. Binge drinking also varied according to both the predominant adult and adolescent drinking culture with more binge drinking in the northern and middle parts of Europe compared to the southern parts. Thus, a variety of socio-demographical, individual, and social characteristics associated with binge drinking have been identified. However, knowledge in this area is limited, as most research has been conducted among particular groups in specific situations, in particular North American college students. More research in Europe is urgently needed, as results from other cultural backgrounds are difficult to generalize.

Twenty-year trends in illicit drug use among young Israelis completing military duty

AIM

This study examines patterns of illicit drug use in a national sample of young men and women in Israel over a 20-year period.

DESIGN

Annual cross-sectional data are analysed from an ongoing systematic sample of soldiers being discharged from active military service during the years 1982-2001.

SETTING

An anonymous questionnaire is self-administered to soldiers on the day of discharge in an unsupervised setting.

PARTICIPANTS

Between 1200 and 2800 individuals participated in the survey annually. A total of 40 518 people were included in the analysis. This sample frame is reflective of all Israel Defense Forces (IDF) releasees below the rank of Captain. Military recruits in Israel comprised about 80% of the country's 18-year-old Jewish male cohort in any given year, and about two-thirds of the female population of this age.

FINDINGS

Time-trends of drug use in Israel parallel those in the United States and European countries, although at much lower rates. Several indicators suggest a recent increase, particularly among women. Drug use is strongly inversely related to education level. Marijuana accounts for 65-75% of drug use in this young adult population.

CONCLUSION

Jewish cultural background and the military policy of zero tolerance are assumed contributors to the low drug use levels. Recent upward trends suggest that intensified prevention, surveillance and research efforts are in order.