Rural and Urban Differences in Adolescent Alcohol Use, Alcohol Supply, and Parental Drinking

Assessing how alcohol use patterns relate to obesity among American adolescents from rural and urban areas: Five years of pooled data

BACKGROUND

Obesity is associated with locality and alcohol use; however, less is known about how the interaction of these two factors may compound the risk of obesity among adolescents.

OBJECTIVES

This study examines the relationship between alcohol use and obesity among adolescents from rural and urban areas in the United States.

METHODS

Data came from a sample of American adolescents aged 12-17 years from the National Survey on Drug Use and Health (2015-2019; n = 39,489). Obesity was regressed on age, sex, race/ethnicity, income, cigarette smoking, locality, and alcohol use, with an interaction term to examine locality x alcohol use. Predicted probabilities were plotted to assess the interaction.

RESULTS

Compared to adolescents from urban areas, those from rural areas had 1.35 times higher odds of being obese (95% CI 1.25, 1.47). Predicted probabilities indicated that the probability of being obese was higher for rural adolescents at lower levels of drinking, up to about 40 drinks in the past 12 months.

CONCLUSIONS

Findings suggest rural-urban differences at the intersection of alcohol use and obesity could depend on the frequency of use, but overall adolescents from rural areas may be more at risk.

Rural Appalachian Adolescent Alcohol Misuse and the Triple Threat for Marginalization

Rural Appalachian adolescents are disproportionately affected by alcohol misuse, depression, and mortality rates. Disparities in Appalachia influence national health indicators and the social determinants of health, which may lead to marginalization and vulnerability to poorer health outcomes. Geographic and social isolation often results in missed opportunities for preventative and mental health care. There are an estimated 35% fewer mental health providers in rural areas to deal with these issues. This article examines the influence of marginalization on rural Appalachian adolescents. A case example was used to describe rural Appalachian adolescent alcohol misuse within the context of the Triple Threat for Marginalization, utilizing conversation within a natural setting. Marginalization contributes to alcohol misuse and adverse health outcomes. Nurses must advocate for marginalized rural adolescent patients to decrease alcohol misuse, depression, and mortality rates in this vulnerable population.

Adolescent predictors of psychiatric disorders in adulthood: The role of emotional distress and problem drinking in emerging adulthood

The current study evaluated risk factors in adolescence on problem drinking and emotional distress in late adolescence and emerging adulthood, and meeting criteria for diagnosed disorders in adulthood. The study included 501 parents and their adolescent who participated from middle adolescence to adulthood. Risk factors in middle adolescence (age 18) included parent alcohol use, adolescent alcohol use, and parent and adolescent emotional distress. In late adolescence (age 18), binge drinking and emotional distress were assessed, and in emerging adulthood (age 25), alcohol problems and emotional distress were examined. Meeting criteria for substance use, behavioral, affective, or anxiety disorders were examined between the ages of 26 and 31. Results showed parent alcohol use predicted substance use disorder through late adolescent binge drinking and emerging adulthood alcohol problems. Behavioral disorders were indirectly predicted by adolescent and emerging adult emotional distress. Affective disorders were indirectly predicted by parent emotional distress through adolescent emotional distress. Finally, anxiety disorders were predicted by parent alcohol use via adolescent drinking; parent emotional distress via adolescent emotional distress, and through adolescent alcohol use and emotional distress. Results provided support for the intergenerational transmission of problem drinking and emotional distress on meeting criteria for diagnosed psychiatric disorders in adulthood.

Alcohol Use Amongst Rural Adolescents and Young Adults: A Brief Review of the Literature

The sociodevelopmental periods of adolescence and young adulthood are rife with alcohol use. However, much of the literature demonstrating this comes from 'traditional' settings and college campuses (i.e., large suburban/urban campuses, or those containing their own infrastructure). Alcohol culture in rural areas has largely been understudied, which may be problematic given the unique stressors they face (e.g., economic hardship, lack of social activities, healthcare inequality). There has also been difficulty both within and across fields classifying rural versus urban geographical locations; no distinct system used broadly, making ittrea difficult to generalize and accurately collect data. The geographic categorizations are often viewed as homogenous identifiers; however, diversity occurs both within and outside of these classification systems. It appears that rurality may be a risk factor for increased drinking both earlier and later in life, but the research has failed to extend to the formative college years. This short review has two main focuses: attempting to disentangle the definition of rurality and reviewing the literature regarding alcohol use in rural areas, with a specific focus on adolescents and young adults. Identifying the mechanisms responsible for substance use in rural areas is a crucial component of prevention and treatment programs.

A scoping review of health inequities in alcohol use disorder

Background: Alcohol Use Disorder (AUD) poses a significant health burden on individuals. The burden occurs more frequently in the medically underserved, as well as racial and sexual minority populations. Ameliorating health inequities is vital to improving patient-centered care.Objectives: The objective of this scoping review is to chart the existing evidence on health inequities related to AUD and identify existing knowledge gaps to guide future equity-centered research.Methods: We performed a literature search using the Ovid (Embase) and MEDLINE (PubMed) databases for articles on AUD that were published in the 5-year period spanning from 2017 to 2021 and written in English. The frequencies of each health inequity examined were analyzed, and findings from each included study were summarized.Results: Our sample consisted of 55 studies for analysis. The most common inequity examined was by race/ethnicity followed by sex or gender. The least reported inequities examined were rural under-resourced areas and occupational status. Our findings indicate that significant research gaps exist in education, rural under-resourced populations, and LGBTQ+ communities with AUD.Conclusions: This scoping review highlights the gaps in research on inequities in AUD. To bridge the current gaps, we recommend research on the following: 1) triage screening tools and the use of telemedicine for rural, under-resourced populations; 2) interventions to increase treatment engagement and retention for women; and 3) community-based participatory methodologies for the LGBTQ+ communities.

The impact of the peer effect on adolescent drinking behavior: instrumental-variable evidence from China

Background

Governments around the world have taken measures to limit adolescent drinking, however, rates are still alarmingly high. However, most of these measures ignore the peer effect of drinking among adolescents. Previous studies have not sufficiently considered the reciprocal relationship between adolescent alcohol consumption and peer alcohol consumption, which may lead to an overestimation of the peer effect and mask underlying issues. Good instrumental variables are powerful but rare tools to address these issues.

Objective

This paper aims to correctly estimate the peer effect of drinking on adolescent drinking behavior in China.

Methods

Owing to the detailed information of household background in the dataset of our survey, we were able to use the drinking behaviors of peers' fathers and their beliefs about the health risks of alcohol as instrumental variables, which are more powerful than school-average instrumental variables. We collected data from the 2017 Health and Nutrition Panel survey, which surveyed 10,772 primary school students from 59 urban migrant and 60 rural public schools.

Results

The instrumental variable method estimation revealed that peer drinking significantly influences adolescent drinking behavior, with adolescents who have peers who drink alcohol being 10.5% points (2 stage least square, i.e., 2SLS, full sample estimation) more likely to engage in drinking compared to those without such peers. Furthermore, the effect differs significantly between migrant and rural adolescents.

Conclusion

The study found that parental care plays a significant role in the degree of peer effect, with the absence of parental care being a key factor in the presence of the peer effect.

Health inequalities in Brazilian adolescents: Measuring and mapping gaps in a cross-sectional school-based survey

Background and Aims

This study aims to describe inequalities in health indicators according to gender, area of residence, and socioeconomic position among Brazilian adolescents.

Methods

Cross-sectional study using data from a school-based survey carried out in Brazil in 2019. Twelve health outcomes were evaluated. Dimensions of inequality assessed were gender, area of residence, wealth and subnational region.

Results

This study comprises a sample of 124,898 adolescents. The most prevalent outcome was physical inactivity (71.9%) followed by thinking life is worthless (52.6%) and bullying (51.8%). Gender inequalities were more marked for physical inactivity and thinking life is worthless with girls presenting a prevalence more than 20 p.p. higher than boys. In zero-dose HPV, however, the prevalence in girls was 17.7 p.p. lower than in boys. Area of residence and wealth inequalities were smaller than gender disparities. Context presented a relevant role in inequality with analysis stratified by states of the country, revealing high variability in estimates.

Conclusions

We highlight the need for attention to disparities between subgroups of the adolescent population, especially for gender inequalities that were the most marked for this age group.

Magnitude of risk factors for chronic noncommunicable diseases in adolescents and young adults in Brazil: A population-based study

AIM OF THE STUDY

Estimate the magnitude and factors associated with risk factors for chronic noncommunicable diseases in adolescents and young adults in Brazil.

METHODS

Cross-sectional study that analyzed data from the 2019 National Health Survey. The population of interest was adolescents and young adults aged 15 to 24 years. Data were collected through individual interviews during home visits. Dependent variables included major risk factors for chronic noncommunicable diseases. Demographic and socioeconomic characteristics were used as independent variables. Multiple Poisson regression models were used to assess the relationship between independent variables and risk factors.

RESULTS

A total of 10,460 individuals (5,001 men and 5,459 women) were included. Regardless of sex, the most prevalent risk factors were insufficient fruit and vegetable consumption (92.6%) and leisure-time physical inactivity (43.3%). The prevalence rates of tobacco smokers, alcohol consumption once a month or more, and alcohol abuse were 8.9%, 28.7%, and 18.5%, respectively. Regular consumption of soft drinks and/or artificial juices was described by 17.2%. The prevalence of overweight was 32.5%. Young adults, males, and individuals with lower educational levels, of black race/skin color, with lower household income, and residents of urban areas had a higher prevalence for most risk factors. Differences in the determinants were found for some factors. Inequalities between Brazilian regions were recorded for seven of the nine factors analyzed. The most socioeconomically developed regions had the highest prevalence of most risk factors. The high magnitude of risk factors indicates a potential increase in the burden of chronic noncommunicable diseases in a future scenario for Brazil.

Effectiveness of strategies to reduce risky alcohol consumption among youth living in rural or remote areas: a systematic review

OBJECTIVE

This review aimed to evaluate the effectiveness of strategies to reduce risky alcohol consumption among youth living in rural and remote areas.

INTRODUCTION

Youth living in rural and remote areas are more likely to drink alcohol and experience alcohol-related harm than youth living in urban locations. This review assessed the effectiveness of strategies to reduce young people's risky alcohol consumption in rural and remote areas.

INCLUSION CRITERIA

We considered papers that included youth (aged 12 to 24 years; also referred to in this review as young people ) who were identified as living in rural or remote locations. Any intervention or strategy designed to reduce or prevent alcohol consumption among this population was included. The primary outcome was frequency of short-term risky alcohol consumption as measured by self-reported incidents of drinking 5 or more standard drinks in 1 session.

METHODS

We conducted this systematic review in accordance with the JBI methodology for systematic reviews of effectiveness. We searched for published and unpublished English-language studies and gray literature from 1999 to December 2021. Two authors screened titles and abstracts before full-text screening and data extraction. Two authors reviewed the extracted data to identify studies that reported duplicate data (eg, due to progressive publication of longitudinal data sets) and, where multiple studies reported the same data set, the study with the measure most proximal to the primary outcome measure and/or with the longest follow-up was selected. Two authors then critically appraised the studies. There were no interventions that were assessed for impact on the primary outcome in more than 1 study; in turn, the feasibility and utility of statistical pooling and the Summary of Findings were limited. Instead, results and certainty of evidence is provided in narrative format.

RESULTS

Twenty-eight articles reporting on 16 studies were included in the review: 10 randomized controlled trials, 4 quasi-experimental studies, and 2 cohort studies. All studies except 1 were conducted in the United States. Only 3 studies measured the primary outcome of short-term risky alcohol consumption and included a comparison group. A meta-analysis of 2 of these studies showed that interventions that included motivational interviewing had a small and non-significant effect on short-term risky alcohol consumption among Indigenous youth in the United States. Meta-analyses of the effect of a variety of interventions on secondary outcomes demonstrated that intervention was not more effective than control for reducing past month drunkenness; however, intervention was more effective for reducing past month alcohol use (odds radio 0.3; 95% CI 0.13 to 0.67; P =0.003). The heterogeneity of effects was evident within these meta-analyses as well as in the studies unable to be meta-analyzed.

CONCLUSION

Based on this review, no interventions can be broadly recommended for reducing short-term risky alcohol consumption among youth in rural and remote areas. Further research to increase the robustness of available evidence in relation to the effectiveness of strategies to reduce short-term risky alcohol consumption among youth in rural and remote areas is urgently required.

REVIEW REGISTRATION

PROSPERO CRD42020167834.

Prevalence of parental supply of alcohol to minors: a systematic review

Parental supply of alcohol to minors (i.e. those under the legal drinking age) is often perceived by parents as protective against harms from drinking, despite evidence linking it with adverse alcohol-related outcomes. This systematic review describes the prevalence of parental supply of alcohol, as reported in the international literature. The review was registered with PROSPERO (CRD42020218754). We searched seven online databases (Medline, Embase, PsycINFO, CINAHL, Scopus, Web of Science and Public Health Database) and grey literature from January 2011 to December 2022 and assessed the risk of bias with the JBI Critical Appraisal Checklist. Among 58 articles included in narrative synthesis from 29 unique datasets, there was substantial variation in the definition and measurement of parental supply of alcohol. Overall prevalence rates ranged from 7.0 to 60.0% for minor-report samples, and from 24.0 to 48.0% for parent-report samples. Data indicate that parental supply prevalence is generally proportionately higher for older minors or later-stage students, for girls, and has increased over time among minors who report drinking. Literature on the prevalence of parental supply of alcohol is robust in quantity but inconsistent in quality and reported prevalence. Greater consistency in defining and measuring parental supply is needed to better inform health promotion initiatives aimed at increasing parents' awareness.

Urban-Rural Differences in Mental and Physical Health among Primary Care Patients with Multiple Chronic Conditions: A Secondary Analysis from a Randomized Clinical Trial

PURPOSE

Rural health disparities are largely attributable to access to healthcare, socioeconomic status, and health behaviors. Little is known about the persistence of these disparities when differences in access to care are eliminated. We sought to investigate urban-rural differences in physical and mental health in primary care patients with demonstrated access to primary care.

METHODS

We obtained cross-sectional survey responses from a multicenter randomized controlled trial on 2726 adult primary care patients with multiple chronic medical or behavioral conditions from 42 primary care practices in 13 states. Study outcomes include measures of mental health including: The Patient-Reported Outcomes Measurement Information System (PROMIS-29®), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), as well as physical health including: the PROMIS-29® and the Duke Activity Status Index (DASI). Urban-rural residence was indicated by census-tract Rural Urban Commuting Areas of the participant's home address. Differences in mental and physical health outcomes attributable to rurality were assessed using multilevel models with a random intercept for census-tract.

RESULTS

After adjustment for demographic and neighborhood characteristics, urban residents had significantly worse generalized anxiety disorder (GAD-7) (ß = 0.7; 95% CI = 0.1, 1.3; p = 0.027), depression (PHQ-9) (ß = 0.7; 95% CI = 0.1, 1.4; p = 0.024), and functional capacity (DASI) (ß = -0.4; 95% CI = -0.5, -0.2; p < 0.001) compared to rural residents. Urban residents also had significantly worse anxiety and depression as measured by the PROMIS-29® compared to their rural counterparts. There were no urban-rural differences in the other PROMIS-29® subdomains.

CONCLUSIONS

Among adults with demonstrated access to care and multiple diagnosed chronic conditions, rural residents had better mental health and functional capacity than their urban counterparts. This finding is not consistent with prior research documenting rural health disparities and should be confirmed.

Health Needs for Suicide Prevention and Acceptance of e-Mental Health Interventions in Adolescents and Young Adults: Qualitative Study

BACKGROUND

Adolescence is a phase of higher vulnerability for suicidal behavior. In Germany, almost 500 adolescents and young adults aged 15-25 years commit suicide each year. Youths in rural areas are characterized by a higher likelihood of poorer mental health. In rural areas, appropriate support for adolescents and young adults in mental health crises is difficult to access. The general acceptability of digital communication in youths can make the provision of an eHealth tool a promising strategy.

OBJECTIVE

The aim of this study was to explore the health needs regarding suicide prevention for adolescents and young adults in rural areas of Germany and Switzerland and to identify characteristics of suitable e-mental health interventions.

METHODS

This study reports on a qualitative secondary analysis of archived data, which had been collected through formative participatory research. Using 32 semistructured interviews (individually or in groups of 2) with 13 adolescents and young adults (aged 18-25 years) and 23 experts from relevant fields, we applied a deductive-inductive methodological approach and used qualitative content analyses according to Kuckartz (2016).

RESULTS

Experts as well as adolescents and young adults have reported health needs in digital suicide prevention. The health needs for rural adolescents and young adults in crises were characterized by several categories. First, the need for suicide prevention in general was highlighted. Additionally, the need for a peer concept and web-based suicide prevention were stressed. The factors influencing the acceptability of a peer-driven, web-based support were related to low-threshold access, lifelike intervention, anonymity, and trustworthiness.

CONCLUSIONS

The results suggest a need for suicide prevention services for adolescents and young adults in this rural setting. Peer-driven and web-based suicide prevention services may add an important element of support during crises. By establishing such a service, an improvement in mental health support and well-being could be enabled. These services should be developed with the participation of the target group, taking anonymity, trustworthiness, and low-threshold access into account.

Age at first alcohol-related hospital separation or emergency department presentation and rate of re-admission: A retrospective data linkage cohort of young Australians

INTRODUCTION

Alcohol is a leading risk factor for death and disease in young people. We compare age-specific characteristics of young people who experience their first ('index') alcohol-related hospitalisation or emergency department (ED) presentation, and whether age at index predicts 12-month rates of readmission.

METHODS

We used a retrospective linked-data cohort of 10,300 people aged 12-20 years with an index alcohol-related hospital and/or ED record in New South Wales, Australia from 2005 to 2013. Age group (early adolescent [12-14 years], late adolescent [15-17 years], young adult [18-20 years]) and diagnosis fields were used in logistic regression analyses and to calculate incidence rates with adjustment for year of index event, sex, socioeconomic disadvantage and residence remoteness.

RESULTS

People who experienced their index event in early adolescence (adjusted relative risk ratio [ARRR] 0.45 [95% confidence interval 0.39, 0.52]) or late adolescence (ARRR 0.82 [0.74, 0.90]) were less likely to be male compared to young adults. Early adolescents (ARRR 0.60 [0.51, 0.70]) and late adolescents (ARRR 0.84 [0.76, 0.93]) were less likely to have a hospitalisation index event. Early adolescents (adjusted incidence rate ratio 1.40 [1.15, 1.71]) and late adolescents (adjusted incidence rate ratio 1.16 [1.01, 1.34]) were more likely than young adults to have a subsequent 12-month non-poisoning injury ED presentation.

DISCUSSION AND CONCLUSIONS

We identified preventable hospital events in young people who have previously experienced an alcohol-related ED presentation or hospitalisation, with age-specific characteristics and outcomes that can be used to inform future health policy and service planning.

A community‐wide approach to reducing risky drinking cultures in young people in rural Australia

OBJECTIVE

This study evaluated the impact of a multi-faceted, harm minimisation program addressing youth alcohol change and risky drinking behaviours in rural Australia. The role and influence of a multi-tiered community approach to changing alcohol cultures is examined.

SETTING

An alcohol culture change project for young people (12-18 years) was implemented in rural Victoria. It was informed by the Alcohol Cultures Framework, comprising community-wide events and youth-focused activities, co-designed with young people. The approach aimed at maximising engagement and reducing alcohol-related harm by targeting the shared activities and drinking practices of young people, parents and the community.

PARTICIPANTS

Participants (n = 446) provided feedback specific to three key program activities for promoting alcohol change.

DESIGN

Mixed methods: Feedback sheets were collected, and interviews and focus groups were conducted with program participants.

RESULTS

Participants indicated that the program had informed their understanding of the way people in their region drink, and the social norms and practices around alcohol that encourage risky drinking. It influenced their short- and medium-term reactions, learnings and activities relating to alcohol consumption. The impact of the program was greatest in adults than young people although reflective learning and some behaviour change were evident across all age groups and community clusters.

CONCLUSION

Community-wide health promotion events offer participants a deeper understanding of the ways in which dominant alcohol cultures inform the practices and activities of young people within a broader community context. Ensuring health promotion programs within a whole-of-community approach are established longer term, is recommended.

Risk and Resilience Pathways, Community Adversity, Decision-making, and Alcohol Use Among Appalachian Adolescents: Protocol for the Longitudinal Young Mountaineer Health Study Cohort

BACKGROUND

Alcohol use impairs psychosocial and neurocognitive development and increases the vulnerability of youth to academic failure, substance use disorders, and other mental health problems. The early onset of alcohol use in adolescents is of particular concern, forecasting substance abuse in later adolescence and adulthood. To date, evidence suggests that youth in rural areas are especially vulnerable to contextual and community factors that contribute to the early onset of alcohol use.

OBJECTIVE

The objective of the Young Mountaineer Health Study is to investigate the influence of contextual and health behavior variables on the early onset of alcohol use among middle school-aged youth in resource-poor Appalachian rural communities.

METHODS

This is a program of prospective cohort studies of approximately 2200 middle school youth from a range of 20 rural, small town, and small city (population <30,000) public schools in West Virginia. Students are participating in 6 waves of data collection (2 per year) over the course of middle school (sixth to eighth grades; fall and spring) from 2020 to 2023. On the basis of an organizational arrangement, which includes a team of local data collection leaders, supervising contact agents in schools, and an honest broker system to deidentify data linked via school IDs, we are able to collect novel forms of data (self-reported data, teacher-reported data, census-linked area data, and archival school records) while ensuring high rates of participation by a large majority of youth in each participating school.

RESULTS

In the spring of 2021, 3 waves of student survey data, 2 waves of data from teachers, and a selection of archival school records were collected. Student survey wave 1 comprised 1349 (response rate 80.7%) participants, wave 2 comprised 1649 (response rate 87%) participants, and wave 3 comprised 1909 (response rate 83.1%) participants. The COVID-19 pandemic has had a negative impact on the sampling frame size, resulting in a reduced number of eligible students, particularly during the fall of 2020. Nevertheless, our team structure and incentive system have proven vitally important in mitigating the potentially far greater negative impact of the pandemic on our data collection processes.

CONCLUSIONS

The Young Mountaineer Health Study will use a large data set to test pathways linking rural community disadvantage to alcohol misuse among early adolescents. Furthermore, the program will test hypotheses regarding contextual factors (eg, parenting practices and neighborhood collective efficacy) that protect youth from community disadvantage and explore alcohol antecedents in the onset of nicotine, marijuana, and other drug use. Data collection efforts have been successful despite interruptions caused by the COVID-19 pandemic in 2020 and 2021.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40451.

Characteristics and reasons for use associated with solitary alcohol and marijuana use among U.S. 12th Grade Students, 2015-2021

BACKGROUND

Little is known regarding what sociodemographic characteristics and reasons for use are associated with adolescent solitary alcohol and marijuana use.

METHODS

Data from 7845 12th grade students participating in the nationally-representative Monitoring the Future study from 2015 to 2021 were used to examine cross-sectional associations between sociodemographics, heavy drinking/marijuana use, reasons for use, and past 12-month solitary alcohol or marijuana use among past 12-month users. Historical trends and possible differences related to the COVID-19 pandemic also were examined.

RESULTS

Solitary use prevalence increased from 2015 to 2021 with no evidence of significant COVID-19 deviations. In 2021, solitary alcohol use was reported by 32.1% (SE 3.01) and solitary marijuana use by 55.8% (4.72) of those reporting past 12-month use. Common and substance-specific sociodemographic risk factors were observed. Binge drinking was associated with solitary alcohol use; frequent marijuana use was associated with solitary marijuana use. Reasons for use related to coping with negative affect were associated with solitary use. Compulsive use reasons were more strongly associated with solitary alcohol than marijuana use. Drinking to have a good time with friends was negatively associated with solitary alcohol use but this association was not seen for solitary marijuana use.

CONCLUSIONS

The percentage of adolescents who use alcohol or marijuana when they were alone has increased among those who report using each substance. Associations between solitary use and (a) higher levels of consumption and (b) coping with negative affect highlight the importance of solitary use as a risk indicator.

Are we overlooking alcohol use by younger children?

Alcohol use is a leading contributor to the burden of disease among youth. Early-onset use is associated with later life dependency, ill health and poor social functioning. Yet, research on and treatment opportunities for alcohol use among younger children are scarce. Despite knowledge that alcohol intake occurs in childhood, and the fact that children understand alcohol related norms and develop alcohol expectancies from age 4, younger children are rarely included in studies on alcohol use.Patterns of early alcohol use vary greatly across the globe and are part of complex interplays between sociocultural, economic and health-related factors. Family influence has proven important, but genetic factors do not seem to play a crucial role at this age. Stressful circumstances, including mental health problems and sociocultural factors can entice alcohol use to cope with difficult situations. The World Health Organization has developed guidelines for effective strategies to reduce the harmful use of alcohol, including preventative and treatment interventions, but important gaps in implementation remain. An increased focus on research, policy and implementation strategies related to early alcohol use is warranted, granted its wide-ranging implications for public health and social functioning. In this summary of literature on alcohol use among younger children and adolescents, we show that younger children (aged 10 and younger) tend to be systematically overlooked. However, research, interventions and policy implementation strategies need to include younger children to mitigate the global burden of harmful alcohol use more effectively.

Mortality and Alcohol as Its Cause-Comparative Characteristics of the Two Neighboring Countries: Ukraine and Poland

This paper presents a comparative assessment of mortality in Poland and Ukraine, including due to alcohol consumption, by sex, place of residence, and age groups. Mortality from alcohol consumption is and remains one of the health problems of the state’s population. The aim of this study was to establish the difference in mortality, including due to alcohol consumption, in the two neighboring countries. The analysis was conducted in 2008 and 2018 according to statistical institutions in Poland and Ukraine. Data from the codes of the International Statistical Classification of Diseases of the 10th edition: F10, G31.2, G62.1, I42.6, K70, K86.0, and X45 were used to calculate mortality due to alcohol consumption. The share of mortality caused by alcohol consumption in Ukraine in 2008 was 3.52%, and 1.83% in 2018. At the same time, in Poland, there is an increase in this cause of death from 1.72% to 2.36%. Mortality caused by alcohol consumption is the main share of mortality in the section “Mental and behavioral disorders” in both Ukraine, at 73–74%, and Poland, at 82–92%. Changes in the mortality rate in the cities and villages of Ukraine and Poland showed different trends: Poland nated, a significant increase in mortality, while in Ukraine it has halved on average. Overall and alcohol mortality rates in both countries were higher among the male population. The analysis of mortality among people of working age showed that the highest proportion of deaths from alcohol consumption in both countries was among people aged 25–44. Despite the geographical proximity, and similarity of natural and climatic characteristics and population, mortality rates in each country reflect the difference in the medical and demographic situation, and the effectiveness of state social approaches to public health.

Adolescent income and binge drinking initiation: prospective evidence from the MyLife study

BACKGROUND AND AIMS

No previous studies have examined the prospective association between disposable income and binge-drinking initiation among adolescents. We aimed to examine whether there is such an association and, if so, whether it is robust to confounders, uniform across individual characteristics and linear versus non-linear.

DESIGN

Prospective study of adolescents from 32 middle schools, stratified according to geographic location, urban and rural locations and standard of living. Adolescents were assessed in 2017 (T1) and 1 year later (T2).

SETTING

Norway.

PARTICIPANTS

A nation-wide sample of 1845 adolescents (mean age 13.5 years, 44% boys) with no binge-drinking experience at T1.

MEASUREMENTS

Data were collected on binge drinking at T1 and T2. Data on disposable income and on a range of demographic, individual and family factors were collected at T1.

FINDINGS

Overall, 7.2% initiated binge drinking between T1 and T2. Logistic regression showed that the crude linear effect of disposable income on binge drinking initiation was substantial, and only slightly attenuated in the fully adjusted model including all putative confounders [odds ratio (OR) = 1.19, 95% confidence interval (CI) = 1.08, 1.31, P < 0.001]. However, interaction analyses showed disposable income to be negatively related to binge drinking initiation for adolescents who had experienced light drinking at T1 (OR = 0.66, 95% CI = 0.49, 0.89, P = 0.006) or who had seen their mothers intoxicated [OR = 0.62, 95% CI = 0.39, 0.99, P = 0.043).

CONCLUSION

Norwegian adolescents with higher disposable income have a greater risk of subsequent binge drinking initiation than those with lower disposable income. Each additional 100 NOK (≈ €10) of weekly income increased the risk of binge drinking initiation in the following year by approximately 20%.

Youth access clinics in Gippsland: Barriers and enablers to service accessibility in rural settings

AIM

Approximately 15 years ago, four youth access clinics (YACs) were established in the Gippsland region to improve mental and general healthcare for young people living in the region. The aim of the study was to examine the barriers and enablers for young people accessing the YACs in Gippsland.

METHODS

Using qualitative methodology, nine female YAC staff members and seven youth YAC consumers were interviewed. Thematic analysis was utilized to identify important and consistent themes in the data derived through the consultation process.

RESULTS

Barriers under four themes were identified: environmental (eg, limited transport); service (ie, limited opening hours); client (eg, parent permission) and staff (ie, retention of staff). Enablers were identified as environmental (ie, high social proximity), service (eg, funding), client (ie, awareness of service) and staff (eg, champion staff).

CONCLUSION

The success of new rural service models will likely depend on learning from what has already worked in some of the many small communities in this region. Beyond learning, further success and uptake of new service offerings will be enhanced through understanding community needs, obtaining community support and enhancing high social proximity.

Clergy as a frontline mental health service: a UK survey of medical practitioners and clergy

Background

Christian clergy have often been identified as ‘frontline mental health workers’ and gatekeepers to mental health services. However, despite this, collaboration between clergy and mental health services remains poor, with some US clergy referring on as little as 10% of cases.

Aims

In this study, we aimed to evaluate the collaborative relationship between UK clergy and medical practitioners, with the purpose of identifying key issues that should be addressed to improve such collaboration between the two services.

Methods

We surveyed 124 clergy, 48 general practitioners and 13 psychiatrists in Wales. Part 1 of the survey covered four main themes: demographics; types of mental health cases seen by clergy and practitioners; referral rates between clergy and mental health services; attitude and relationship between clergy and mental health services. Part 2 was directed at clergy only and assessed how sensitive clergy were in identifying and referring on mental health disorders by using seven virtual case vignettes.

Results

Clergy frequently encountered mental health cases and around 60%–80% regularly referred on to a healthcare professional. Clergy appeared very effective at identifying and referring on high risk scenarios, such as psychosis, suicidal ideation and substance misuse, however were less effective at identifying and referring on clinical depression and anxiety. Clergy rarely received referrals from medical professionals. Both medical professionals and clergy felt they needed to engage in a more collaborative relationship, and around of one-third of practitioners were prepared to offer training to clergy.

Conclusion

Most clergy in Wales regularly encounter mental health cases and appear effective at recognising and referring on mental health disorders; however, a large minority do not (20%–40%). Clergy generally do not receive referrals from mental health professionals, despite the proven benefits. Therefore, improving collaboration, developing spiritual training for mental health professionals, and mental health training for clergy is likely useful, a notion that many clergy and medical professionals deem important and are prepared to support.

Effectiveness of strategies for reducing risky alcohol consumption among youth living in rural or remote areas: a systematic review protocol

OBJECTIVE

The aim of this review is to evaluate the effectiveness of strategies for reducing risky alcohol consumption among youth living in rural and remote areas.

INTRODUCTION

Youth living in rural and remote areas are more likely to drink alcohol and are at higher risk of experiencing alcohol-related harm than youth living in urban locations. However, a review has not yet been conducted evaluating the effectiveness of strategies for reducing young people's risky alcohol consumption in rural and remote locations.

INCLUSION CRITERIA

This systematic review will consider papers that include youth (aged 12 to 24 years) who are identified as living in rural, remote, regional, non-urban or non-metropolitan locations. Any intervention or strategy with the purpose of reducing or preventing alcohol consumption or alcohol-related harms among this population will be considered. The primary outcome is frequency of short-term risky alcohol consumption, as measured by self-reported incidents of drinking five or more standard drinks. Secondary outcomes will also be included.

METHODS

Sources of published studies, unpublished studies and gray literature will be searched. Only studies in English published from 1999 will be included. Titles and abstracts of all search results will be screened. The full text of potentially relevant studies will then be assessed in detail. Studies will be stratified by methodological quality. The data extracted will include specific details about the populations, study methods, interventions and outcomes. Studies will be pooled in statistical meta-analysis, where possible, and where statistical pooling is not possible, the findings will be presented in narrative form.

Sources of Social Influence on Adolescents' Alcohol Use

The present research examines social influences on self-reported frequency of drunkenness in a longitudinal sample of 1,439 adolescents (46% female, 90% White, mean age = 14 at baseline) with social network measures from friends, romantic partners, and romantic partners' friends. We build on past research by addressing multiple mechanisms of social influence-peers' frequency of drunkenness, alcohol-related attitudes, and unstructured socializing-across relationship types. Adolescents' drunkenness frequency increased when their friends' and partners' friends' drunkenness frequency increased and when their romantic partners' positive alcohol-related attitudes increased. Furthermore, the association between unstructured socializing and frequency of drunkenness was stronger for older than younger adolescents. Results advance understanding of the social transmission of alcohol use in adolescence and inform intervention efforts.

The impact of gender, socioeconomic status and locality on the development of student patterns of alcohol consumption and harm

Purpose

The consequences of problematic alcohol consumption fall heavily on Australian adolescents, with this population at increased risk of death, serious injury and other harm. Research regarding whether gender, socioeconomic status (SES) or locality play a role in young people’s alcohol consumption and related harm is limited in Australia. The purpose of this paper is to determine whether Victorian students’ patterns of alcohol uptake, consumption and related harm differed between gender, SES and locality.

Design/methodology/approach

The study involved secondary analysis of student data from the Drug Education in Victorian Schools harm minimisation drug education programme, undertaken in 21 Victorian government schools over three years The initial cohort of 1,752 students was followed during Years 8, 9 and 10, when their average age would have, respectively, been 13, 14 and 15 years.

Findings

There were no gender differences in drinking uptake, consumption or harm. Students with low SES were more likely to have consumed a full drink of alcohol and also experienced more alcohol-related harm. Students living in a regional/rural area were more likely to have engaged in high alcohol consumption.

Originality/value

The findings of this study highlighted that different student demographics have an impact on patterns of alcohol consumption, vulnerability and harm. Students with low SES, living in a regional/rural area, are more at risk than students with higher SES living in a fringe metro/major regional or metro area. Future school harm minimisation drug education programmes should consider the needs of students with demographics that make them more susceptible to higher consumption and harm.

Selection and Socialization Influences on Adolescent Alcohol Use: The Individual and Joint Contexts of Neighborhood Disadvantage and Population Density

Background: Neighborhood disadvantage (ND) and population density (PD) are two community characteristics contextualizing friends' influence on adolescent alcohol use. However, these community characteristics are rarely examined for potential joint contributions, although it is possible that the way friends are selected or influence alcohol use are shaped by both ND and PD. In addition, prior studies examining ND or PD contexts on friend influence rarely discern between socialization and selection. Objectives: The current study examined how selection and socialization influences on adolescent alcohol use are shaped by unique and joint contexts of ND and PD. Methods: Adolescents from Waves I and II of the National Longitudinal Study of Adolescent and Adult Health (Add Health) were included in three models assessing friends' socialization of alcohol us initiation and binge drinking, and selection of drinking friends. ND and PD were tested for mediation and moderation individually and jointly. Results: Results indicated that socialization of drinking initiation was stronger in high ND contexts, and that continued binge drinking was stronger in low ND contexts. PD indirectly influenced socialization of initiation and binge drinking maintenance via a negative association with number of drinking friends. PD and ND jointly influenced the association between initial binge drinking and next-year selection of drinking friends, such that selection was stronger within areas related to lower levels of drinking friends. Conclusions/Importance: Current results indicate that PD and ND shape friends' influence on alcohol use in unique ways. These must be accounted for to better understand bidirectional effects of friend influence.

Population Health Outcomes of a Student-Led Free Health Clinic for an Underserved Population: A Naturalistic Study

There are a number of hard to reach and underserved communities who experience inadequate health care. In Australia, the Aboriginal and Torres Strait Islanders peoples experience low life expectancy, higher levels for chronic disease and elevated smoking and drinking. These problems are further exacerbated when living in regional and rural Australia and poverty. There are growing concerns over helping such groups in order to close the health disparity gap. A student-led clinic (SLC) was developed to address clinical placement shortages while providing free health and social services in an underserved community in regional Australia. Health data was collected from 2086 attendees enrolled in the SLC to determine health changes and outcomes of student-delivered services. A series of health data was routinely collected at all contact points. This included physical health care, behavioural health risk, and chronic disease measures. All data was recorded in an electronic monitoring system. Population data identified some significant and positive changes to health patterns-smoking, waist size, and body mass index. Unfortunately, gaps in data entry precluded more robust findings. It was clear that this community suffered from experiences commonly associated with health disparity and poverty. There were higher risks of drinking alcohol and smoking with raised levels of lifestyle disease including diabetes. Some of these issues were mitigated by the community being able to attend a locally situated community driven clinic.

The Influence of Economic Pressure on Emerging Adult Binge Drinking: Testing the Family Stress Model over Time

The Family Stress Model proposes that disrupted family processes may help explain the association between economic adversity and poor child developmental outcomes. In this study, the Family Stress Model was tested across adolescence to emerging adulthood. Participants included 451 rural White youth who participated with their parents from age 13-23 (52% female). The data were analyzed at five developmental time periods with separate pathways for mothers and fathers. The findings reveal for both parents that economic pressure at time 1 (age 13) led to parental emotional distress which was related to harsh couple interaction at time 2 (ages 14 and 15). This marital conflict was related to harsh parenting toward the adolescent (time 2), which was then directly associated with higher levels of offspring drinking when youth were in middle adolescence (age 16) at time 3. Alcohol use in middle adolescence was associated with binge drinking in late adolescence (age 18, time 4) into emerging adulthood (age 23, time 5). Drinking behaviors did not differ for boys and girls. The current results show that economic adversity has an effect on family processes which influence offspring binge drinking patterns in later adolescence that continue into emerging adulthood.

Community-Level Exposure to the Rural Mining Industry: The Potential Influence on Early Adolescent Alcohol and Tobacco Use

PURPOSE

Rural youth have higher rates of alcohol and tobacco use compared to their urban counterparts. However, the economic dependence of rural communities may differentially influence risk behaviors. While research has shown that adults working in mining have elevated rates of alcohol and tobacco use, the influence of living in a mining community on early adolescent substance use is unknown.

METHODS

Using data from a representative sample of 4,535 middle school students in a state with heavy reliance on mining, we conducted weighted logistic regression to investigate whether community-level mining economic dependence influences rural-urban differences in adolescent alcohol and tobacco use. All models adjusted for sociodemographics, military family involvement, parental monitoring, and length of residence.

FINDINGS

Over one quarter of the sampled students lived in rural counties and approximately half of these counties met the USDA mining economic typology. After stratifying rural counties by mining and nonmining economic dependence, students in rural mining counties had significantly higher odds of all measures of alcohol use (AORs ranged from 1.83 to 3.99) and tobacco use (AORs ranged from 1.61 to 5.05) compared to students in urban counties. Only use of smokeless tobacco was higher among students in rural nonmining counties.

CONCLUSIONS

Our findings demonstrate rural-urban disparities in adolescent substance use that are particularly pronounced among youth living in counties with economic dependence on mining. Future research on this subject should include a wider range of community-level factors that may have specific relevance in rural settings to inform the development of population-level interventions.

Trend in alcohol use in Australia over 13 years: has there been a trend reversal?

BACKGROUND

Skog's collectivity theory of alcohol consumption predicted that changes in alcohol consumption would synchronize across all types of drinkers in a population. The aim of this paper is examine this theory in the Australian context. We examined whether there was a collective change in alcohol use in Australia from 2001 to 2013, estimated alcohol consumption in non-high risk and high risk drinkers, and examined the trends in alcohol treatment episodes.

METHODS

Data from the 2001-2013 National Drug Strategy Household Surveys (N = 127,916) was used to estimate the prevalence and alcohol consumption of abstainers, high risk drinkers and frequent heavy episodic drinkers. Closed treatment episodes recorded in the Alcohol and Other Drug Treatment Services National Minimum Dataset (N = 608,367) from 2001 to 2013 were used to examine the trends of closed alcohol treatment episodes.

RESULTS

The prevalence of non-drinkers (abstainers) decreased to the lowest level in 2004 (15.3 %) and rebounded steadily thereafter (20.4 % in 2013; p < .001). Correspondingly, the per capita consumption of high risk drinkers (2 standard drinks or more on average per day) increased from 20.7 L in 2001 to peak in 2010 (21.5 L; p = .020). Non-high risk drinkers' consumption peaked in 2004 (2.9 L) and decreased to 2.8 L in 2013 (p < .05). There were decreases in alcohol treatment episodes across nearly all birth cohorts in recent years.

CONCLUSION

These findings are partially consistent with and support Skog's collectivity theory. There has been a turnaround in alcohol consumption after a decade-long uptrend, as evident in the collective decreases in alcohol consumption among nearly all types of drinkers. There was also a turnaround in rate of treatment seeking, which peaked at 2007 and then decreased steadily. The timing of this turnaround differs with level of drinking, with non-high risk drinkers reaching its peak consumption in 2004 and high risk drinkers reaching its peak consumption in 2010.

Epidemiology of substance-exposed pregnancies at one Great Lakes hospital that serves a large number of American Indians

OBJECTIVE

The purpose of this research was to determine the prevalence of substance-exposed pregnancies at a hospital in the Great Lakes region of the U.S.

METHOD

Data were collected via retrospective chart abstractions of patients who were seen for delivery at one Great Lakes region hospital during a 1-year period who were given at least one of the International Classification of Diseases codes related to substance use.

RESULTS

A total of 342 medical records were included in the analysis, and, while much race/ethnicity data were missing, a large percentage of those in our analysis identified as American Indian. The prevalence of substance-exposed pregnancies at this hospital during a 1-year period was 34.5%. The majority (84.8%) were tobacco users, and many were found to have multiple substance exposures. Also, 48.5% were found to have a mental health diagnosis in addition to substance use.

CONCLUSIONS

Data from this project can be used in prevention efforts, including preconception care for women at risk for substance use and mental health issues.