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PubMed1999

Drinking patterns in the American Deep South.

OBJECTIVE: To determine whether the states of the Deep South are characterized by contradictory drinking norms: high abstinence paired with high consumption among drinkers. METHOD: Comparison of survey results of drinking patterns (N = 65,216) in four states of the Deep South (Alabama, Georgia, Louisiana and Mississippi) to those in leading states in the East (New York), Midwest (Illinois), Rocky Mountains (Colorado) and West (California) for the years 1990-93. Respondents were selected by random-digit dialing and interviewed by telephone as part of a larger study conducted by the Behavioral Risk Factor Surveillance System (BRFSS) of the Centers for Disease Control and Prevention (CDC). RESULTS: A higher proportion of persons drank alcohol in 1993 than in any of the previous 3 years. Persons with higher education, with higher income, of younger age, male, white and not living in the Deep South were more likely to drink. Among drinkers, the likelihood of episodic heavy drinking decreased with higher education, income and age. In addition, women, blacks and married respondents were less likely to report heavy drinking. Region of residence is not significantly associated with episodic heavy drinking. CONCLUSIONS: The Deep South has a significantly higher proportion of abstainers from alcohol use than other regions. Among drinkers, Southerners are not more likely to engage in occasions of heavy drinking. The results are discussed in relation to Southern culture and drinking norms.

Adolescent↗
PubMed1999

Children's perceptions of parental drinking: the eye of the beholder.

OBJECTIVE: Children learn about alcohol and about how to drink through modeling experience, in part. Modeling is typically studied by asking parents to describe their drinking behavior. However, children's perception of parents' drinking may differ from the way parents describe it. This study examined the degree to which children's perceptions and parents' reports agreed. METHOD: A sample of 177 grade-school children and their parents was drawn from a public school in Kentucky. Children completed questionnaires inquiring about their perceptions of the quantity, frequency and the positive and negative consequences of their parents' drinking. Their parents completed similar questionnaires describing their own drinking and its consequences. RESULTS: As hypothesized, first and second grade children's perceptions of parents' drinking were unrelated to parents' self-reports: Most of these children perceived their parents as nondrinkers even though parents reported drinking. Also as hypothesized, children's perceptions and parents' reports were significantly correlated for third through sixth grade students. However, there was a great deal of reliable, but unshared variance between these older children's perceptions and parents' reports. Children's perceptions and parents' reports were consistently quite different, even when both child and parent described the parent as a drinker. CONCLUSIONS: Studies of modeling influences on children regarding drinking should assess children's perceptions of their parents' behavior rather than parents' self-reports.

Age Factors↗
PubMed2000

Drinking patterns and problems of the "stably insured": a study of the membership of a health maintenance organization.

OBJECTIVE: This article describes drinking patterns and examines the prevalence of heavy drinking and alcohol problems, and their association with other behavioral and social problems within the membership of a health maintenance organization, a setting in which increasing numbers of Americans receive services. METHOD: The sample is representative of the stably insured membership of the Northern California Region of Kaiser Permanente Medical Care Program; i.e., those who have been insured continuously under that plan for 30 months or longer. A telephone survey of the adult membership (N = 10,292) was conducted between June 1994 and February 1996. RESULTS: As in other studies, health and mental health status and smoking were related to drinking levels, with symptoms higher for those in the heaviest drinking group. However, in contrast to studies of those using medical services, demographic characteristics (e.g., young age) were not associated with heavy drinking in this population. When controlling for drug use and drinking, however, women and those reporting any mental health symptom were more likely to report alcohol problems. CONCLUSIONS: Findings suggest that in private managed care populations, particular behavioral indicators may be more important than demographic characteristics in screening for problem drinkers. The identification of individuals who report a mental health symptom, who drink a large number of drinks occasionally or who report any drug use may be important in a health maintenance approach to prevention and case finding.

Adolescent↗
PubMed2000

Psychosocial and behavioral factors in early adolescence as predictors of heavy drinking among high school seniors.

OBJECTIVE: Most adolescents experiment with alcohol, and the use of alcohol typically escalates during the teenage years. The present study examined how several risk and protective factors measured during early adolescence were associated with heavy drinking in a sample of high school seniors. METHOD: As part of a school-based survey, seventh-grade students (N = 1,132) reported degrees of experimentation with alcohol and cigarettes. Several psychosocial factors deemed to be important in the etiology of drinking were also assessed. Students were followed-up in the twelfth grade, when 16% were categorized as heavy drinkers based on drinking and drunkenness frequency and quantity typically consumed. RESULTS: Logistic regression analyses revealed that heavy drinking was predicted by having had experimented with alcohol or cigarettes, having had a majority of one's friends drink and having had poor behavioral self-control in early adolescence. In addition, several effects were limited to either boys or girls. For example, positive alcohol expectancies predicted greater later heavy drinking in boys, while friends' smoking predicted later heavy drinking in girls. CONCLUSIONS: The findings suggest that early intervention programs aimed at preventing alcohol use by addressing the social and psychological determinants of alcohol use may have important preventive effects in terms of later heavy drinking.

Adolescent↗
PubMed2002

The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV Cost and Services Utilization Study.

OBJECTIVE: To establish population-based estimates of the prevalence of any alcohol consumption and heavy drinking among individuals who tested positive for human immunodeficiency virus (HIV) and to identify the factors associated with alcohol consumption and heavy drinking in this population. METHOD: Data from the HIV Cost and Services Utilization Study (HCSUS), a national probability survey of HIV-infected adults receiving medical care in the U.S. in early 1996 (N = 2,864: 2,017 men, 847 women), were used to estimate the prevalence of any alcohol consumption and heavy drinking. Logistic regression was used to identify independent influences of sociodemographic, health status, and substance use variables on alcohol consumption and heavy drinking. RESULTS: Approximately 53% of persons in care for HIV reported drinking alcohol in the preceding month and 8% were classified as heavy drinkers. Of those who drank, 15% were heavy drinkers. The odds of heavy drinking were significantly higher among users of cocaine or heroin and significantly lower among the better educated and those with an AIDS-defining illness. CONCLUSIONS: Alcohol consumption is common among people in care for HIV, with rates of heavy drinking almost twice those found in the general population. Heavy drinking is especially higher among individuals with lower educational levels and users of cocaine or heroin.

Adolescent↗
PubMed2002

The effects of low Km aldehyde dehydrogenase (ALDH2) phenotype on drinking behavior in Japanese university students.

OBJECTIVE: The present study investigated the relationship between a history of a flushing reaction and drinking behavior in Japanese university students, adjusting for the effects of alcohol-related psychosocial factors including academic year, school division, club membership and housing situation. METHOD: In 1995, 419 men and 321 women at Kyoto University were enrolled in a study using informed consent. Subjects were classified as nonflushers or flushers by using a self-reported measure, the ALST (Alcohol Sensitivity Screening Test). Alcohol drinking behavior during the last year, including drinking frequency, alcohol intake per occasion and problem drinking behavior, was investigated. RESULTS: Compared with male flushers, male nonflushers showed a 1.8 times higher frequency of drinking with family members (p < .01) and drank significantly larger amounts of alcohol with family members (p < .05). Male nonflushers drank significantly larger amounts of alcohol with friends than did male flushers (p < .0001) and showed significantly heavier mean alcohol consumption per month than male flushers did (p < .001). Compared with male flushers, male nonflushers showed a 1.7 times higher rate of high-problem drinking (p < .01). In contrast, none of these drinking behaviors differed between female nonflushers and female flushers. CONCLUSIONS: Even after adjusting for aspects of alcohol-related psychosocial factors, flushing reactions among Japanese university students were significantly related to drinking behavior in men but not in women.

Alcohol Drinking↗
PubMed2003

Alcohol craving predicts drinking during treatment: an analysis of three assessment instruments.

OBJECTIVE: The purpose of this investigation was to examine the utility of thee craving instruments to predict drinking during treatment. The three assessments used were the Penn Alcohol Craving Scale (PACS), the Alcohol Urge Questionnaire (AUQ) and Items 1-6 of the Obsessive subscale (OBS) of the Obsessive Compulsive Drinking Scale (OCDS). METHOD: The three instruments were administered during the course of a 9-month, double-blind, placebo-controlled trial of 100 mg/day of naltrexone, and a manual-based psychosocial intervention using the BRENDA manual conducted at the University of Pennsylvania's Treatment Research Center. Participants (133 men and 50 women at the initiation of the study) used these instruments to self-report craving on a weekly or biweekly basis. The weekly number of drinks was reported using the Timeline Followback interview. The data were analyzed with generalized estimating equations using craving scores at 1 week as the independent variable and number of drinks in the subsequent treatment week as the dependent variable. RESULTS: Each of the three scales predicted drinking during the subsequent treatment week. The PACS was the strongest predictor followed closely by the OBS and then the AUQ. Most important, craving as measured by the three scales was a stronger predictor of subsequent drinking than was drinking during the prior treatment week. CONCLUSIONS: Craving assessment provides a useful means of predicting drinking during treatment. Such information would be helpful in designing clinical trials and for many treatment modalities.

Adult↗
PubMed2004

Changes in alcohol involvement, cognitions and drinking and driving behavior for youth after they obtain a driver's license.

OBJECTIVE: This study tested whether obtaining a driver's license was associated with increases in alcohol and other drug involvement and changes in alcohol-related cognitions for youth, and whether drinking and driving behavior increased with driving experience. METHOD: Confidential, anonymous surveys were conducted at two time points (fall, spring) with students at four high schools in San Diego county (N = 2,865, 51% female). Data were collected on alcohol, cigarette and marijuana use, license status, alcohol use by peers, attitudes towards drinking and driving and drinking and driving behaviors. RESULTS: Nondrivers (60%), new drivers (obtained a license between Time 1 and Time 2) and experienced drivers (26%) were compared on study variables at both time points and over time. Initially obtaining a driver's license was associated with increased frequency of substance use. Results were not significant for quantity of alcohol use, frequency of heavy drinking or perceived alcohol use norms. Attitudes towards drinking and driving reflected an increase in the perceived dangerousness of this behavior for new drivers. Drinking and driving behavior during the last 30 days increased with increased driving experience. CONCLUSIONS: The results indicate a number of changes in substance involvement after obtaining a driver's license. However, initially this transition may also indicate a period of protection against drinking and driving. These results may have implications for the target and content of drinking and driving interventions.

Adolescent↗
PubMed2004

Documenting natural recovery in American-Indian drinking behavior: a coding scheme.

OBJECTIVE: This report describes a coding scheme developed to analyze how some American Indians changed their drinking behavior and explores the contributions of this approach to our understanding of natural recovery in American-Indian communities. METHOD: We analyzed the responses to two open-ended questions about drinking in an epidemiological survey. The first question asked what helped respondents to quit or cut down on their drinking; the second asked respondents what they did instead of drinking when they wanted to drink. Codes were developed using anthropological analyses of content and then refined through analyses of frequencies and attempts to establish reliability. The frequencies of these codes were then examined by gender, age and current drinking status. RESULTS: Reliability was attained for the coding of responses to both questions. Their content reflects salient themes in the literature on natural recovery. The distribution of these codes across gender, age and current drinking status reveals interesting insights into what prompts and supports quitting and change for different members of these American-Indian communities, especially for women, older respondents and those who abstain from alcohol. CONCLUSIONS: This approach points the way to a consideration of a broad set of factors related to changes in drinking behavior in American-Indian populations that can be applied in future studies, both in American-Indian communities and, potentially, in other populations as well.

Adolescent↗
PubMed2004

Mortality attributable to harmful drinking in the United States, 2000.

OBJECTIVE: Although alcohol has been associated with death from a variety of causes, there are no recent data on the number of deaths in the United States attributable to harmful alcohol use. This study provides updated information on the number of deaths in the United States attributable to harmful drinking. METHOD: We used the etiologic-fraction method to calculate alcohol-related mortality by cause of death, using U.S. mortality data for 2000, the most recent year available. Prevalence of alcohol use was estimated from the Behavioral Risk Factor Survey and from the National Household Survey on Drug Abuse. Medium and high levels of regular drinking or heavy episodic drinking were defined as harmful drinking. RESULTS: An estimated 63,718 deaths were attributable to harmful drinking in the U.S. in 2000. Of these, an estimated 45,988 were in men and 17,730 in women, accounting for 4% of all deaths among men and 1.5% among women. Among men, 47.6% were due to medium and high levels of regular drinking, and 52.4% due to heavy episodic drinking, whereas among women these proportions were 54.2% and 45.8%. CONCLUSIONS: Harmful drinking accounts for a substantial number of deaths each year in the United States. Prevention of this underlying cause of mortality must be a public health priority.

Alcohol Drinking↗
PubMed2004

Retirement, risky alcohol consumption and drinking problems among blue-collar workers.

OBJECTIVE: In this study, we assess the initial effects of employment status (not yet retired/continued employment, retirement with bridge employment and full retirement) on the alcohol consumption and drinking problems of retirement-eligible blue-collar workers. METHOD: Data were collected at two points from a random sample of members of nine unions within 6 months of retirement eligibility. Alcohol consumption and drinking problem data were collected from 1279 members 6 months prior to retirement-eligibility (T1) and from 1083 retained respondents 1 year later (T2). At T2 respondents were categorized as (1) not yet retired, (2) retired but engaging in bridge employment or (3) fully retired. RESULTS: Across all of the models tested, alcohol consumption and drinking behaviors at T1 were significant predictors of those same patterns of consumption or behavior at T2 and explained the greatest proportion of the variance in those same patterns at T2, suggesting that alcohol consumption and drinking behaviors remain largely stable over the period of time in which individuals become eligible to retire. Nevertheless, taking into account the effects of periodic heavy drinking prior to retirement and a variety of other factors, individuals opting to retire fully were twice as likely to engage in periodic heavy drinking (odds ratio = 2.01, p < .05) as those continuing to work. Bridge employment (as compared with continued employment) was also associated with significantly higher quantities of alcohol consumed on average drinking occasions (Beta = 0.14, p < .05). CONCLUSIONS: Retirement, at least in its early stages, is not associated with major shifts in alcohol consumption or problem drinking status. However, the particular retirement trajectory taken may have significant implications for individuals.

Adult↗
PubMed2004

Drinking on campus: self-reports and breath tests.

OBJECTIVE: Concern about excessive alcohol consumption by college students has been raised by surveys indicating that more than 40% of students are "heavy" drinkers. This definition is based on students' reports of consuming five or more drinks (four or more for women) on an occasion sometime during the past 2 weeks. The present survey examines the degree to which this 2-week 5+/4+ drink criterion characterizes a student's pattern of alcohol use, and whether a 5+/4+ criterion for a drinking occasion is a valid indicator of high blood alcohol concentration (BAC). METHOD: Students (N = 856, 70% male) were interviewed as they returned home between 10 PM and 3 AM. Students reported their drinking of the past 2 weeks and of the night they were interviewed, then provided breath samples to determine their BAC. RESULTS: Among the students in the sample classified as "heavy" drinkers on the basis of self-reports, 49% had zero BAC on the night they were interviewed. Those who reported consuming 5+/4+ drinks the evening of the interview had a mean BAC <0.08%. The distribution of BACs in the entire sample showed 74.4% of students had a BAC of zero and 11.8% had a BAC <0.05%. Very high BACs (i.e., > or =0.15%) were rare (1.3%). CONCLUSIONS: Self-reports of consuming 5+/4+ drinks on at least one occasion during the previous 2 weeks did not reliably identify a pattern of heavy drinking. Moreover, reports of 5+/4+ drinks on an occasion were not necessarily associated with high BACs.

Alcohol Drinking↗
PubMed2005

Use of heavier drinking contexts among heterosexuals, homosexuals and bisexuals: results from a National Household Probability Survey.

OBJECTIVE: Extensive use of specific social contexts (bars and parties, for instance) by homosexuals and bisexuals is thought to be a factor in the higher rates of drinking among these groups. However, much of the empirical evidence behind these assumptions has been based on studies with methodological or sampling shortcomings. This article examines the epidemiological patterns of alcohol contexts in relation to sexual identity, using a large, national, probability population survey. METHOD: We used the 2000 National Alcohol Survey for these analyses. The prevalence of spending leisure time in each of two social contexts (bars and parties) that are associated with heavier drinking is examined by sexual orientation (heterosexual, homosexual, bisexual and self-identified heterosexuals with same sex partners). In addition, we compare levels of drinking within these contexts by sexual orientation within these groups. RESULTS: Exclusively heterosexual women spent less time in these two contexts relative to all other groups of women. Gay men spent considerably more time in bars compared with the other groups of men. Heterosexual women who reported same sex partners drink more at bars, and bisexual women drink more alcohol at both bars and parties than exclusively heterosexual women. For men, there were no significant differences for average consumption in any of these contexts. Entry of background and demographic variables into logistic regression analyses did little to modify these associations. CONCLUSIONS: There is empirical evidence that some groups of homosexual and bisexual women and men spend more time than heterosexual individuals in heavier drinking contexts. The frequency of being in these two social contexts does not appear to be associated with heavier drinking within these contexts for men, but it may be related to heavier drinking in those places among some groups of women.

Adult↗
PubMed2005

It's all fun and games...or is it? Collegiate sporting events and celebratory drinking.

OBJECTIVE: Heavy drinking is prevalent on college campuses, and collegiate sporting events may precipitate heavy drinking. Despite this, relatively few studies have examined student drinking on the days of sporting events. In 2003, Syracuse University won the men's National College Athletic Association basketball championship; ongoing data collection allowed an investigation of alcohol consumption at Syracuse University during the two Final Four game days, when the semifinals and championship games are played. The goals of the study were to examine the level of alcohol use on these days and to examine factors related to game-day consumption. METHOD: As a part of an ongoing study, 206 undergraduate students completed several questionnaires, then returned daily drinking diaries at 1-week intervals for 4 consecutive weeks. RESULTS: Alcohol consumption levels on the two game days exceeded what is typical on campus. Further analyses conducted using zero-inflated negative binomial regression modeling demonstrated that heavier drinkers were more likely to drink alcohol, and drink alcohol heavily, on both game days. Furthermore, lack of impulse control was independently associated with an increased likelihood of drinking on both days. CONCLUSIONS: Although results from this study should be considered preliminary, these data document heavier drinking associated with high-profile athletic events. Sporting events may be a particularly opportune time and venue for collegiate risk-reduction programs.

Adolescent↗
PubMed2005

Adolescent-to-young adulthood heavy drinking trajectories and their prospective predictors.

OBJECTIVE: The purpose of this study was to investigate longitudinal trajectories of heavy drinking for males and females from adolescence to young adulthood, across the age span of 16-25 years, and to identify prospective predictors of the trajectory groups identified. METHOD: This study used semiparametric group-based mixture modeling to derive adolescent to young adult longitudinal trajectories of heavy drinking separately for 760 participants (430 females and 330 males) who have been participating in a long-term prospective study of risk factors for the development of heavy drinking and alcohol disorders. RESULTS: Four trajectory groups were identified for males and five for females; the trajectories indicated both continuity and change in heavy drinking across time for the trajectory groups identified. Major common prospective predictors for the high and very high heavy drinking trajectory groups supported the influences of values and beliefs (e.g., religious commitment), stressful life events and substance use. Additional predictors for males included lower academic functioning and task orientation, and for females, more frequent sexual behavior and general deviance. CONCLUSIONS: In this predominantly white, middle-class sample, we identified groups of frequent, heavy drinking teens during the middle-adolescent years. Our findings suggest that the frequency of heavy drinking behavior will further increase for some teens into their young adult years. The potential adverse consequences of heavy drinking among adolescents and young adults suggests that multitargeted, gender-specific, early interventions with these high-risk teens is important.

Adolescent↗
PubMed2005

Initial depression and subsequent drinking during alcoholism treatment.

OBJECTIVE: Individuals entering treatment for alcoholism have elevated depressive symptoms that in turn may affect response to treatment, including drinking outcomes. The purpose of the study is to examine the impact of depression at treatment entry on drinking over the course of treatment. METHOD: The Project MATCH (Matching Alcoholism Treatment to Client Heterogeneity) data set, a randomized, multisite psychosocial treatment trial for alcoholism, was analyzed. The sample consisted of 1,450 subjects, of whom 1,102 (76.0%) were male and 348 (24.0%) were female. Cross-lagged analyses of (1) depression and drinking intensity and (2) depression and drinking frequency were conducted using path analysis. Covariates were age, gender, race, and treatment assignment. Analyses focused on the 3-month active treatment phase of the trial. RESULTS: Depression at treatment entry predicted more intense drinking and more frequent drinking, respectively, in the first month of treatment but showed little association with drinking in Months 2 and 3. CONCLUSIONS: Individuals entering treatment for alcoholism with elevated levels of depression may be slower to benefit from treatment. Because the initial phase of treatment may be crucial to successful engagement and retention, the development of interventions to improve early success in treatment among individuals with elevated levels of depression may be beneficial. Future studies should examine the long-term, bidirectional relationship of depression and drinking following treatment.

Adolescent↗
PubMed2006

Are U.S. women drinking less (or more)? Historical and aging trends, 1981-2001.

OBJECTIVE: Women's alcohol consumption in the United States has aroused increased public concern, despite a scarcity of evidence of any major increases in women's drinking. To help resolve this apparent inconsistency, we examined patterns of historical and age-related changes in U.S. women's drinking from 1981 to 2001. METHOD: In national surveys of women in 1981, 1991, and 2001, we measured the prevalence of 12-month and 30-day drinking, heavy episodic drinking (HED; six or more drinks per day), and subjective intoxication. Using these data, we analyzed time and age trends for six 10-year age groups in each survey, taking into account effects of repeated observations and possible covariates (ethnicity, marital status, and education). RESULTS: Women's 12-month drinking did not change significantly between 1981 and 1991, but it became more prevalent in the total samples between 1991 and 2001. Among 12-month drinkers, however, 30-day abstinence increased from 1981 to 2001 (particularly among women drinkers ages 21-30). From 1981 to 2001, HED declined (particularly among women drinkers ages 21-30), but intoxication became more prevalent (particularly among women drinkers ages 21-50). Drinking, HED, and intoxication became consistently less prevalent with increasing age. CONCLUSIONS: Among drinkers, increases in 30-day abstinence and declines in HED suggest that recent alarms about women's drinking may have been overstated. The contrast of lower rates of HED but increased reports of intoxication may indicate that women are more alert to alcohol's effects now than in earlier decades.

Adult↗
PubMed2006

A multisite randomized trial of social norms marketing campaigns to reduce college student drinking.

OBJECTIVE: An 18-site randomized trial was conducted to determine the effectiveness of social norms marketing (SNM) campaigns in reducing college student drinking. The SNM campaigns are intended to correct misperceptions of subjective drinking norms and thereby drive down alcohol consumption. METHOD: Institutions of higher education were randomly assigned to treatment and control groups. At the treatment group institutions, SNM campaigns delivered school-specific, data-driven messages through a mix of campus media venues. Cross-sectional student surveys were conducted by mail at baseline (n = 2,771) and at posttest 3 years later (n = 2,939). Hierarchical linear modeling was applied to examine multiple drinking outcomes, taking intraclass correlation into account. RESULTS: Controlling for other predictors, having an SNM campaign was significantly associated with lower perceptions of student drinking levels and lower alcohol consumption, as measured by a composite drinking scale, recent maximum consumption, blood alcohol concentration for recent maximum consumption, drinks consumed when partying, and drinks consumed per week. A moderate mediating effect of normative perceptions on student drinking was demonstrated by an attenuation of the Experimental Group x Time interaction, ranging from 16.4% to 39.5% across measures. Additional models that took into account the intensity of SNM campaign activity at the treatment institutions suggested that there was a dose-response relationship. CONCLUSIONS: This study is the most rigorous evaluation of SNM campaigns conducted to date. Analysis revealed that students attending institutions that implemented an SNM campaign had a lower relative risk of alcohol consumption than students attending control group institutions.

Adult↗