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Age of drinking onset and unintentional injury involvement after drinking.

CONTEXT: In 1997, unintentional injury was the leading cause of death for persons aged 1 to 34 years. Approximately one third of deaths due to unintentional injury in the United States are estimated to be alcohol related. Onset of drinking at an early age has been found to be associated with alcohol dependence, but whether early-onset drinking increases risk for unintentional injury while drinking is unknown. OBJECTIVE: To explore whether persons who started drinking at an early age are more likely to have experienced unintentional injuries while under the influence of alcohol. DESIGN AND SETTING: The National Longitudinal Alcohol Epidemiology Survey, a cross-sectional survey conducted in 1992 of a representative sample of the US population. PARTICIPANTS: A total of 42,862 randomly selected adults (response rate, 90%; mean age, 44 years). MAIN OUTCOME MEASURES: Unintentional injury involvement while under the influence of alcohol by age of drinking onset (categorized as <14 years, each age from 14-20 years, or >/=21 years). RESULTS: Relative to respondents who began drinking at age 21 years or older, those who started before age 14 years as well as those who started at each intervening age up to 21 years were significantly more likely to have been injured while under the influence of alcohol, even after controlling for history of alcohol dependence, heavy drinking frequency during the period that they drank most, family history of alcoholism, and other characteristics associated with earlier onset of drinking. After adjusting for these variables, odds ratios for having been injured while under the influence of alcohol were as follows: for younger than 14 years, 2.98 (95% confidence interval [CI], 2.29-3.89); age 14 years, 2.96 (95% CI, 2.26-3.88); age 15 years, 3.14 (95% CI, 2.48-3.97); age 16 years, 2.38 (95% CI, 1.90-2.98); age 17 years, 2.12 (95% CI, 1.66-2.71); age 18 years, 1. 33 (95% CI, 1.08-1.64); age 19 years, 1.42 (95% CI, 1.07-1.89); and age 20 years, 1.39 (95% CI, 1.01-1.91). CONCLUSION: Drinking onset at ages younger than 21 years is associated with having experienced alcohol-related injuries. JAMA. 2000;284:1527-1533

Accidents↗

Alcohol consumption and expenditures for underage drinking and adult excessive drinking.

CONTEXT: Although estimates of the amount and proportion of alcohol consumed by underage and adult drinkers have been reported, more accurate estimates are possible and the economic impact has not been explored. OBJECTIVES: To provide accurate estimates of underage and adult excessive drinking and to describe consumer expenditures linked to underage and adult excessive drinking. DESIGN AND SETTING: Information was obtained from national data sets, including 1999 versions of the National Household Survey of Drug Abuse, the Youth Risk Behavior Survey (YRBS), the Behavior Risk Factor Surveillance System (BRFSS), 2000 US Census, and national data on consumption and consumer expenditures for alcohol, published by Adams Business Research. PARTICIPANTS: A total of 217 192 persons aged 12 years or older across 3 data sources. MAIN OUTCOME MEASURES: Amount as a proportion of total alcohol consumed and proportion of consumer expenditures on alcohol among underage (12-20 years) and adult excessive (> or =21 years) drinkers. RESULTS: The proportion of 12- to 20-year-olds who drink was estimated to be 50.0% using data from the YRBS; the proportion of adults aged 21 or older who drink was estimated to be 52.8% using data from the BRFSS. The estimated total number of drinks consumed per month was 4.21 billion; underage drinkers consumed 19.7% of this total. The amount of adult drinking that was excessive (>2 drinks per day) was 30.4%. Consumer expenditure on alcohol in the United States in 1999 was $116.2 billion; of that, $22.5 billion was attributed to underage drinking and $34.4 billion was attributed to adult excessive drinking. CONCLUSION: These data suggest that underage drinkers and adult excessive drinkers are responsible for 50.1% of alcohol consumption and 48.9% of consumer expenditure.

Adolescent↗

Effects of drinking pattern on the peak/trough blood concentrations in drinking water studies.

The effects of changes in drinking patterns on the expected peak/trough blood concentrations of test compounds were examined during rodent dosed drinking water studies. They were based on the assumption that the kinetics of the test compound is linear and time-invariant. Results indicate that drinking patterns have minor effects on the expected peak/trough concentrations and the time to reach these concentrations. If a 12-hr light/dark cycle starting at 7.00 is used for all the drinking patterns studied, the peak and trough concentrations will occur in the early morning and late afternoon, respectively. A comparison of the predicted versus experimentally determined pentachlorophenol (PCP) plasma concentrations in a 1-wk rat drinking water study revealed that using a circadian rhythm drinking pattern in the model generated the most satisfactory prediction. Predictions based on a square wave drinking pattern with 90% drinking activities in the night phase were also excellent. Triangular or sinusoidal drinking patterns were least accurate in predictions.

Animals↗

Influence of age at drinking onset on the alcohol deprivation effect and stress-induced drinking in female rats.

We have recently observed increased stress responsiveness with regard to alcohol consumption in male rats that consumed alcohol since their adolescent period. Thus, early age at drinking onset can induce enhanced stress-induced alcohol drinking in male rats. However, it is not known whether female rats respond in a similar way. Therefore, we compared the drinking behavior of two female Wistar rat groups--one that acquired alcohol consumption during adolescence (adolescent group) and the other that acquired their drinking during adulthood (adult group) in a model of long-term voluntary alcohol drinking with repeated deprivation and stress phases. Furthermore, we studied the influence of age at drinking onset on the efficacy of acamprosate treatment. Thirty-nine female Wistar rats aged 31 days (adolescents) and 71 days (adults) were given ad libitum access to water, as well as to 5% and 20% ethanol solutions during an observation period of 29 weeks. A deprivation phase of 14 days was introduced following 8 weeks of access to alcohol in order to measure the alcohol deprivation effect (ADE). After 15 and 25 weeks of alcohol access, all animals were subjected for 3 consecutive days of forced swim and electric foot-shock stress, respectively. After 29 weeks of access to alcohol all animals underwent a second deprivation phase and the subsequent ADE was measured either under acamprosate (200 mg/kg) or vehicle treatment. Drinking before the first deprivation phase was not different between animal groups. However, the expression of the first ADE was more pronounced in adult female rats and alcohol intake stayed increased for the remainder of the experiment in the adult group. Both repeated swim stress and foot-shock stress produced a more pronounced increase in ethanol consumption in the adolescent group compared to the adult group. Acamprosate reduced relapse-like drinking in the adult female rat group. However, it had no effect on the ADE in the adolescent group. In conclusion, female rats that initiate alcohol consumption during adolescence might be more susceptible to stress-induced alcohol consumption. Adolescent alcohol drinking might also result in a reduced response to acamprosate.

Acamprosate↗

Oral pH and drinking habit during ingestion of a carbonated drink in a group of adolescents with dental erosion.

OBJECTIVES: To investigate the relationship between dental erosion, oral pH and drinking habit in a group of adolescents. METHODS: Oral pH was measured simultaneously at the surface of four teeth in 11 patients, aged 10-16 years, with erosion and in 10 controls subjects without erosion using antimony electrodes. Measurements were made before, during and after drinking 330 ml of a carbonated drink. The method and timing of drinking the beverage, reported dietary intake of acidic foods and flow rate and buffering capacity of saliva were recorded. RESULTS: The erosion patients reported drinking more carbonated drinks (p<0.01) and drinking directly from a can more frequently than the controls (p<0.05). They also drank twice as quickly (p<0.05). The pH at the buccal surface of a molar remained lower for longer in the erosion patients than in the patients without erosion (p<0.01), whilst the labial surface of the upper central incisor had a longer exposure to low pH in the controls subjects (p<0.05). CONCLUSION: The pattern of oral pH differed between subjects with and without erosion after drinking an acidic beverage. This may be related to observed differences in drinking habit, which could have influenced the pattern of erosion in these subjects.

Adolescent↗

Patterns of drinking and drinking outcomes among drug misusers. 1-year follow-up results.

This article investigates patterns of drinking and drinking outcomes among 753 drug-misusing clients recruited to the National Treatment Outcome Research Study (NTORS). More than one third of those who were drinking at intake reported problematic or highly problematic patterns of alcohol consumption. About one third of the sample were abstinent from alcohol at intake and at follow-up. Some improvements in drinking behavior were found at 1-year follow-up, especially among the heaviest and most problematic drinkers. Improvements were specifically related to patterns of preintake drinking behavior. The majority of clients made little change to their pattern of pretreatment drinking behavior and the continued heavy drinking of many drinkers at follow-up is a disappointing finding. Drinking problems have been given insufficient attention in the treatment of illicit substance misuse problems, and efforts should be made to develop and strengthen the assessment and treatment of drinking problems among drug misusers.

Alcohol Drinking↗

Water-intake volume regulation in the rat: schedule-induced drinking compared with water-deprivation-induced drinking.

Hungry rats drink extremely large amounts of water when they are intermittently fed small amount of food (schedule-induced polydipsia). Are such animals motivated to drink for long durations, to ingest large amounts of fluid, or to do both? When drinking-tube apertures were decreased to slow the rate of water ingestion, each of eight rats spent more time drinking (M = 11.5 min) than when larger apertures were used (M = 7.8 min). The mean volumes ingested were not different. These equal volumes were generated by adjustment of each drink duration in accordance with ingestion rate even during the first few drinks of the sessioons, even when the drinking tubes were frequently switched (every 1-3 min) during the sessions. During drinking induced by water deprivation when food was concurrently available, restriction of the driking-tube apertures reduced intake volumes by 18%-19%. However, when food was not concurrently available during water-deprivation-induced driking, regulation of intake volumes was comparable with that found during schedule-induced polydipsia. These data pose difficulties for theories that ascribe a crucial role to the motor aspects of schedule-induced drinking.

Animals↗

Relationships of drinking behaviour, gender and age with reported negative and positive experiences related to drinking.

AIMS: To assess associations between drinking behaviour, gender and age with reported experiences related to drinking. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: Interviews were performed in 1992 with a representative sample of the Finnish population between 15 and 69 years of age (N = 3446). MEASUREMENTS: Annual intake of alcohol, frequency of drunkenness, and 14 negative and eight positive reported experiences related to drinking. FINDINGS: Logistic regression models showed that overall intake and frequency of drunkenness were independently associated with almost all reported positive and negative consequences of drinking. Women more commonly reported that drinking had helped them to sort out interpersonal problems at home or in the work-place, to feel more optimistic about life, and to express their feelings. Men more commonly reported that drinking had helped them to be funnier and wittier and to get closer to the opposite sex. Drunken driving was markedly male behaviour, but women more commonly reported other types of reckless behaviour and adverse consequences of drinking. However, men more commonly said they were criticized by family for their drinking. With the exception of health problems, both positive and negative consequences of alcohol were more common among younger drinkers. CONCLUSIONS: Once overall intake and frequency of drunkenness were controlled for, significant differences between men's and women's perceptions of the costs and benefits of alcohol consumption emerged. Men tended to perceive more hedonic benefits while women perceived more functional benefits. Women reported behaving more recklessly in drinking situations. In light of the results, women were not under selective social control.

Adolescent↗

Reasons for drinking less and their relationship to sustained remission from problem drinking.

AIMS: To compare representative general population and treated samples on their reasons for drinking less and whether particular reasons were related to sustained remission from problem drinking for either group. PARTICIPANTS AND DESIGN: A total of 659 problem drinking adults in a Northern California county identified through a probability survey in the general population (n = 239) and a survey of consecutive admissions to public and private alcohol and drug programs (n = 420), who reported drinking less at the one-year follow-up and provided reasons for reducing their drinking, were assessed 1-, 3-, and 5-years post-baseline regarding their problem drinking status. MEASUREMENTS: Logistic regression models were used to predict sustained remission from problem drinking. RESULTS: While the treated sample endorsed a majority of reasons in significantly higher proportions than the general population sample, the same three reasons were significant for both groups in predicting sustained remission from problem drinking: hitting rock bottom, experiencing a traumatic event and undergoing a spiritual awakening. Interventions by medical personnel and family members were either non-significant predictors or significantly negatively related to sustained improvement for both general population and treated problem drinkers. CONCLUSIONS: General population and treatment samples have similar reasons for cutting down as they relate to sustained remission from problem drinking.

Adolescent↗

The effect of 'standard drink' labelling on the ability of drinkers to pour a 'standard drink'.

Australia's National Health Policy on Alcohol has recommended that beverage containers be labelled so that alcohol content is 'readily understandable by the public'. Health promotion to increase the responsible use of alcohol now relies extensively on the concept of a standard drink--usually defined as 10 g of ethyl alcohol. Numerous difficulties confront a drinker who wishes to apply the standard drink system to monitor alcohol intake. This report describes a series of experimental tests of the proposal that these difficulties are minimised if alcohol containers have their alcohol content indicated in terms of standard drinks in addition to the usual percentage alcohol by volume method. Subjects were drinkers recruited from a Perth shopping mall and were tested only on beverage types they had consumed within the previous week. They were required to pour what they judged to be a single standard drink from a 750 ml bottle of either wine or beer. Beer drinkers achieved greater accuracy in this task when the bottles had standard drink labels, even when the glass size and beverage strength were varied. Wine drinkers had equal difficulty with this task whether standard drink or percentage labels were used. The addition of a 'ladder' up the side of a wine bottle with graduations in standard drinks would be necessary for wine drinkers to achieve a high level of accuracy. We conclude that labelling drink containers with their alcohol content in terms of standard drinks would better equip all drinkers to follow the advice of health educators.

Adolescent↗

Drinking, problem drinking and life stressors in the elderly general population.

OBJECTIVE: Research shows that although heavy drinking in the United States is less prevalent among older persons, some maintain or increase heavy drinking. Late-onset heavy drinking is believed to be related to stressors of aging such as retirement or bereavement, particularly when coping resources or social supports are inadequate. This study investigated that relationship. METHOD: In 1990-91, a random-digit-dial telephone survey was conducted with 2,325 Erie County, New York, residents aged 60 or older. Heavy drinkers were oversampled. Questions included demographics, drinking quantity-frequency, alcohol dependence/problems, stressful life events, chronic stresses, coping resources and social supports. Analyses were conducted to examine the relationship between drinking and stress. RESULTS: There was no bivariate correlation between average alcohol consumption and acute or chronic stress. Logistic regressions with interaction terms show that stress has no relationship to heavy drinking (average alcohol consumption of 2+ drinks/day) regardless of coping style or social supports. Logistic regressions predicting late-onset heavy drinking also produced negative results. Chronic stress was, however, positively related to alcohol dependence and problems. CONCLUSIONS: Treatment and prevention programs for the elderly should not be based on the assumption that life stresses are a direct cause of drinking, although they may exacerbate consequences of drinking.

Adaptation, Psychological↗

Beverage sales and drinking and driving: the role of on-premise drinking places.

OBJECTIVE: The relationships between on-premise drinking places, beverage specific alcohol sales and drinking and driving were examined in a time series cross-sectional study of place-of-last-drink data from Perth, Western Australia. METHOD: At arrest, 2,411 drinking drivers reported their last location of consumption. Tabulated by 57 premises over 4 years, the rates at which individual premises were referenced as the place-of-last-drink were taken to reflect the relative distributions of numbers of drinking drivers coming from different premise types (hotels, taverns and nightclubs). The data were then statistically related to measures of premise types and characteristics and beverage specific alcohol sales. RESULTS: Significant cross-sectional relationships were obtained between measures of premise types, alcohol sales and drinking and driving. Greatest numbers of drinking drivers came from taverns and from places selling greater amounts of beer and spirits. Significant longitudinal effects were obtained for sales of beer, proportions of high alcohol beer sold and sales of spirits. CONCLUSIONS: As a whole, the results suggest that, at least for Western Australia, outlets selling greater amounts of beer and spirits, and greater amounts of high alcohol beer, will produce larger numbers of drinking drivers.

Accidents, Traffic↗

Personal drinking and sociocultural drinking norms: a representative population study.

OBJECTIVE: This study examined relationships between personal drinking and perceived social norms for alcohol use. It was hypothesized that frequent heavy drinkers (i.e., those consuming five or more drinks at least once a week or greater in the last 12 months) would exhibit biases in sociocultural expectations for alcohol use. METHOD: A representative sample of Ontario residents who had consumed alcohol in the previous 12 months (N = 937, 51.8% women, mean [SD] age = 42.7 [15.2] years) compared their own alcohol use with the drinking habits of friends, coworkers and the general public. Respondents rated the importance of seven psychosocial factors that might define "problem drinking" and estimated the number of drinks social and problem drinkers are likely to have in different contexts. RESULTS: Compared with lighter drinkers, frequent heavy drinkers (1) believed that heavy alcohol use is more normative in social reference groups, (2) overestimated the amount of alcohol that social and problem drinkers consume in different contexts, (3) rated several criteria (e.g., frequency of intoxication) as less definitive of problem drinking and (4) did not exhibit pluralistic ignorance (i.e., they shifted private approval of the drinking habits of others to match [mistaken] social norms of reference groups). CONCLUSIONS: Frequent heavy drinkers calibrate their beliefs about drinking in reference groups in order to view their drinking as normative. Results are discussed in relation to the development of brief public health interventions.

Adolescent↗

Age of first intoxication, heavy drinking, driving after drinking and risk of unintentional injury among U.S. college students.

OBJECTIVES: This study explored whether college students who were first intoxicated by alcohol at ages younger than 19 are more likely to become alcohol dependent and frequent heavy drinkers, drive after drinking, ride with intoxicated drivers and be injured after drinking. It also investigated whether these results occur because these students believe they can drink more and still drive legally and safely. METHOD: In 1999, 14,138 of 23,751 full-time 4-year students from a random sample of 119 college and universities nationwide completed self-administered questionnaires (response rate: 60%). This analysis focused on 12,550 who were aged 19 or older. Respondents were asked the age at which they first got drunk, as well as questions about recent alcohol-related behaviors and consequences. RESULTS: Compared with respondents first drunk at age 19 or older, those first drunk prior to age 19 were significantly more likely to be alcohol dependent and frequent heavy drinkers, to report driving after any drinking, driving after five or more drinks, riding with a driver who was high or drunk and, after drinking, sustaining injuries that required medical attention. Respondents first intoxicated at younger ages believed they could consume more drinks and still drive safely and legally; this contributed to their greater likelihood of driving after drinking and riding with high or drunk drivers. CONCLUSIONS: Educational, clinical, environmental and legal interventions are needed to delay age of first intoxication and to correct misperceptions among adolescents first drunk at an early age about how much they can drink and still drive safely and legally.

Adolescent↗

The state sets the rate: the relationship among state-specific college binge drinking, state binge drinking rates, and selected state alcohol control policies.

OBJECTIVES: We assessed the relationship between college binge drinking, binge drinking in the general population, and selected alcohol control policies. METHODS: We analyzed binge drinking rates from 2 national surveys, the Harvard School of Public Health College Alcohol Study and the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Binge drinking data were linked to a summary measure of 7 salient alcohol control policies and a rating of resources devoted to law enforcement. RESULTS: State-level college and adult binge drinking rates were strongly correlated (Pearson correlation coefficient=0.43; P<.01). Attending college in states with the lowest binge drinking rates (adjusted odds ratio [OR]=0.63; 95% confidence interval [CI]=0.41, 0.97) and presence of more stringent alcohol control policies (adjusted OR=0.57; 95% CI=0.33, 0.97) were independent predictors of student binge drinking, after adjusting for state law enforcement and individual-, college-, and state-level covariates. CONCLUSIONS: State of residence is a predictor of binge drinking by college students. State-level alcohol control policies may help reduce binge drinking among college students and in the general population.

Adolescent↗

Validity of the Obsessive Compulsive Drinking Scale (OCDS): does craving predict drinking behavior?

OBJECTIVE: The Obsessive Compulsive Drinking Scale (OCDS), a 14-item, self-report questionnaire, was developed to measure alcohol-related craving. The OCDS may provide a measure of the state of illness among alcohol-dependent individuals and may have value in predicting subsequent drinking behavior. The present study was conducted to evaluate the factor structure and the concurrent, construct, and predictive validity of the OCDS. METHODS: Data on desire to drink and on drinking behavior were obtained from 127 alcohol-dependent subjects who participated in a 12-week outpatient pharmacotherapy trial and a 3-month posttreatment follow-up. RESULTS: Principal components analysis of the OCDS indicated that three factors best described its structure: obsessions, drinking control and consequences, and alcohol consumption. Data also supported the concurrent and discriminant validity of the OCDS. However, the OCDS total score showed limited validity in predicting drinking during a posttreatment follow-up period. Furthermore, the only empirically derived factor that predicted drinking during this period was the alcohol consumption factor. CONCLUSIONS: As might be expected, the OCDS questions on drinking behavior predict subsequent drinking behavior. However, the instrument does not appear to provide a general measure of alcohol-related illness. The utility of the OCDS in studies of alcoholism treatment outcome requires clearer definition.

Adolescent↗

[Drinking alcohol among junior high school students: reflecting drinking culture].

Using a data obtained from a junior high school students survey on drug use, perception of alcohol drinking for junior high school students and role of adults in drinking were examined. 78% of the junior high school students had ever drunk alcohol at least once. The results revealed that experience of drinking alcohol accompanied by family did not have a close relationship with regularity of daily life routine, school lives and family lives for the students. It was, however, strongly suggested that experience of drinking alcohol only with peers had a close relationship with undesirable daily life routine, school lives and family lives for the students. Furthermore, lifetime prevalence of cigarette smoking and that of solvent inhalation for the male students with experience of drinking only with friends were 11 to 13 times and 5 to 8 times higher, respectively, than the male students without experience of drinking only with friends. These were 22 times and 3 to 5 times, respectively, for female students. As for observance of the law which prohibits drinking alcohol for those under 20 years old, over a half of the students consider that alcohol drinking for minors was acceptable depending on the time and circumstances. This was greatly different from the observance of the laws against cigarette smoking and solvent inhalation. The author considers that this may reflect adult alcohol drinking culture in Japan.

Adolescent↗