Assessing alcohol use in situ: Correlates of self-report vs. objective alcohol consumption

Associations between self-report and objective measurement of young adult alcohol use are weakened by excessive consumption levels; therefore, associations between correlates of alcohol use and consumption likely also differ by alcohol measurement. This study examined the extent to which correlates of heavy drinking measured via self-report are also indicators of heavy drinking measured objectively. Data were collected from 164 bar patrons (54% male; 73% White, 12% Black, 15% Other; 15% Hispanic) as they exited the bar. Participants completed an intercept survey including self-reported measures of drinking, demographics, and social-environmental factors. A breath alcohol concentration (BrAC) reading was also obtained using a handheld breathalyzer device. Correlations between two self-reported outcomes, number of drinks consumed prior to and at the bar, and BrAC were significant among those in the lowest quartile of BrAC readings, but largely non-significant at moderate and high BrAC levels. Intention to get drunk that night was a robust predictor of alcohol consumption across self-reported outcomes and BrAC. Social factors (presence of drinking peers, witnessing drunk others) were predictive of self-reported alcohol use but not BrAC. AUDIT-C score was the only additional alcohol behavior predictive of objectively measured alcohol use. Self-reported outcomes and BrAC, as well as their association with key correlates, diverge at high levels of intoxication, when preventive intervention is most needed. Implications for further research and alcohol prevention practice are discussed.

Natural Observation of Alcohol Price and Promotions at Bars: Implications for Alcohol Misuse Prevention

Alcohol misuse among young adults remains a primary public health concern given the wide range of short- and long-term physical, social, and societal consequences of the behavior. On-premise drinking establishments, which allow alcohol consumption on site (i.e., bars), are frequent locations for young adult alcohol use. Risks for alcohol misuse within the bar setting are key factors to identify for prevention. Notably, alcohol price and promotions are associated with alcohol consumption among young adults. This study sought to develop and pilot test an observational protocol to assess the alcohol environment at on-premise drinking establishments. Following qualitative exploration of salient risk factors in these settings through focus groups with young adults, an observational tool was adapted and tested in a feasibility study. The refined tool was then pilot tested with two independent data collectors conducting natural observation at 13 establishments in the downtown nightlife district of a small, southeastern city. High interrater reliability was noted. Descriptive summary statistics of bar characteristics demonstrate low alcohol prices with variability across types of alcohol (e.g., beer, wine, and liquor), greater numbers of alcohol promotions inside rather than outside the building, and higher rates of manual versus electronic age verification procedures. Observational assessment of alcohol price and marketing at on-premise drinking establishments as described in this study is needed to inform prevention policy and programs to reduce harms associated with young adult alcohol misuse.

Social and Situational Party Characteristics Associated With High-Intensity Alcohol Use Among Youth and Young Adults

BACKGROUND

Rates of high-intensity drinking, which is alcohol consumption that exceeds standard heavy drinking levels, have increased in recent years and peak in young adulthood. To identify modifiable environmental targets for prevention of high-intensity drinking, we identified characteristics of parties attended by youth and young adults that were associated with high-intensity drinking and the consequences of this excessive form of drinking.

METHODS

Data are from 15- to 20-year-old participants in an online survey (n = 2,442; 55.4% female, 74.8% White) who resided in 24 communities across 7 states that were a part of a community randomized intervention trial to reduce the incidence and consequences of underage drinking parties. We used multinomial logistic regression to predict level of drinking by 6 party characteristics (size, location, age and gender composition, supervision, others' drinking behavior), and to predict 6 consequences (hangover, not remember event, passed out, punished by parents, broke something/got in fight, and sex against will) from level of drinking. We tested study hypotheses in 2 models, one that used a single binge drinking threshold (below binge vs. at or above binge level) and one that additionally used a high-intensity drinking level (below binge, 1 to 2 times binge, 2+ times binge level).

RESULTS

We found that larger party size and a mostly male composition were unique predictors of high-intensity drinking when compared to those who consumed 1 to 2 times the binge drinking level. Odds of passing out, not remembering the drinking event, breaking/damaging property, or getting in a fight were more than double for high-intensity drinkers compared to standard binge level drinkers.

CONCLUSIONS

Results from this study indicate there are unique precursors and consequences of high-intensity alcohol consumption among youth and young adults. These environmental factors associated with high-risk drinking contexts can be used to develop prevention strategies to mitigate the harms associated with excessive alcohol consumption.

Characteristics of drinking events associated with heavy episodic drinking among adolescents in the United States

PURPOSE

To examine associations between characteristics of drinking events and the quantity of alcohol consumed by adolescents in the United States.

METHODS

Analyses relied on 2011-2015 data from the National Survey on Drug Use and Health (NSDUH). The study sample included 8110 adolescents, ages 12-17years old, who drank alcohol in the past 30days. A logistic regression model, weighted for national estimation, was constructed to examine factors associated with heavy episodic drinking (HED; 5+ drinks for males, 4+ drinks for females) during the underage drinker's most recent drinking event. These models were adjusted for study year and individual characteristics, including past year drinking frequency, age of drinking onset, and demographic variables.

RESULTS

Buying alcohol off-premise or from another person and being given alcohol from non-parent social sources were associated with greater odds of HED compared to being given alcohol by one of their parents. Drinking alcohol at someone else's house or multiple locations were associated with heavier alcohol consumption compared to drinking at one's own home. Being older and an earlier age of alcohol onset were associated with greater odds of HED.

CONCLUSIONS

This study identifies contextual factors associated with HED by adolescents. Compared to global association studies, the findings from these event-specific analyses provide strong evidence of the environmental conditions that contribute to HED in American adolescents. Although no level of alcohol consumption is safe for adolescents, knowledge of event-level risk factors can inform targeted interventions.

Predictors of alcohol-related negative consequences in adolescents: A systematic review of the literature and implications for future research

OBJECTIVE

To conduct a systematic review of the literature examining risk and protective factors of alcohol related negative consequences (ARNCs) among adolescents.

METHODS

We conducted a systematic search of original empirical articles published between January 1, 1990 and June 1, 2015. The qualitative synthesis was performed using the Theory of Triadic Influence as a framework.

RESULTS

Fifty-two studies were reviewed. Intrapersonal (e.g., personality traits, drinking motives and expectancies, depression), interpersonal (e.g., parental and peer alcohol use, violence exposure) and attitudinal factors (e.g., media exposure to alcohol, religiosity) influence ARNCs. Emerging evidence of new trends contributing to ARNCs include ready mixed alcohol drinks and childhood trauma and abuse.

CONCLUSIONS

Risk factors from all domains of influence were observed. More research is needed on protective factors and how alcohol use interacts with preventive factors in predicting ARNCs. The conceptualization of negative consequences varies significantly between studies and may impact the external validity of previous research.

A critical systematic review of alcohol-related outcome expectancies

To assess the validity of the research into alcohol-related outcome expectancies a systematic review of 80 articles published between 1970 and 2013 was conducted. Participant gender, age, and contextual influences are highlighted as possible causes of the observed variations in research findings. There is a need for fuller consideration of the influences of demographics and environmental and social contexts on research findings. It is recommended that alcohol intake measures should be standardized to a greater degree in future research. Contextual influences on expectancies also require extensive future investigation to increase the validity of research and improve alcohol-related interventions.

Person and environment predictors of blood alcohol concentrations: a multi-level study of college parties

AIMS

This study builds upon previous research by assessing the relationship of breath blood alcohol concentrations (BrAC) to environmental and individual characteristics.

DESIGN

We conducted a multi-level study of college parties. Our design included observational measures of party environments, a brief self-administered questionnaire, and the collection of breath samples from partygoers.

SETTING

Data were collected in private residences of students living in a neighborhood adjacent to a large public university located in the Southwestern United States.

PARTICIPANTS

A total of 1,304 individuals attending 66 parties participated in the study.

MEASURES

Observational measures of party characteristics were made by 2 trained research assistants at each party. Four to 5 trained interviewers administered a brief field survey to partygoers at each party. In addition, the trained interviewers collected breath samples using handheld breathalyzer devices.

FINDINGS

Hierarchical linear modeling analyses revealed significant variation at the party and individual levels. At the individual level, motivations to socialize were significantly associated with lower BrAC, while drinking games and providing the sample after 11:00 pm were associated with higher BrACs. At the party level, large parties were significantly associated with lower BrACs while reports of many intoxicated partygoers were associated with higher BrACs. Finally, we identified a significant gender by theme party interaction, indicating women had higher BrACs at theme parties relative to nontheme parties; however, BrACs for men were similar regardless of the type of party attended.

CONCLUSIONS

Alcohol consumption among young adults in natural settings is a function of both person and environmental factors.

Perceived family support, negative mood regulation expectancies, coping, and adolescent alcohol use: evidence of mediation and moderation effects

The stressor vulnerability model of alcohol use posits that individuals learn to use drinking as a coping response when they believe healthier means of coping are unavailable. The present study evaluated hypotheses derived from the model adding two potential coping resources that may be important for adolescents--perceived family support and expectancies for negative mood regulation. Students in Grades 9-12 (N=210, 50% female) completed self-report measures of family environment, alcohol expectancies, coping preferences, negative mood regulation, motives for drinking, and drinking behavior. Recent drinking, lifetime drinking, and drunkenness were positively associated with stronger tension reduction alcohol expectancies, and drinking to cope (DTC) completely mediated these relations. DTC also was associated with avoidant coping dispositions and with the interaction between tension reduction alcohol expectancies and avoidant coping dispositions. Family support and NMR expectancies were only modestly correlated with DTC and not correlated with drinking measures. In regression analyses, family support and NMR expectancies were not associated with DTC independent of tension reduction expectancies and avoidant coping disposition. However, these two coping resource variables moderated the relations of other predictors with DTC and with drunkenness. The present study supports the stressor vulnerability model and highlights the importance of family support and NMR expectancies as coping resources related to drinking processes. Because many of the tenets of the model appear to extend to adolescents, it may have considerable utility as a conceptual framework for the design and implementation of prevention programs.

Laying the foundation for quantifying regional exposure to social phenomena: considering the case of legalized gambling as a public health toxin

Exposure and adaptation models provide competing perspectives of the environmental influence on the development of addictive disorders. Exposure theory suggests that the presence of environmental toxins (e.g., casinos) increases the likelihood of related disease (e.g., gambling-related disorders). Adaptation theory proposes that new environmental toxins initially increase adverse reactions; subsequently, symptoms diminish as individuals adapt to such toxins and acquire resistance. The authors describe a new public health regional exposure model (REM) that provides a tool to gather empirical evidence in support of either model. This article demonstrates how the strategic REM, modified to examine gambling exposure, uses standardized indices of exposure to social phenomena at the regional level to quantify social constructs.