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1.  Drinking Settings, Alcohol Consumption, and Sexual Risk Behavior among Gay Men 
Addictive behaviors  2012;38(3):1824-1830.
We sought to 1) describe the settings or groups of settings where men who have sex with men (MSM) consume alcohol in 16 U.S. metropolitan statistical areas (MSA); and 2) investigate whether certain drinking settings or groups of settings are associated with higher levels of alcohol consumption, problem drinking, and sexual risk behavior. Latent class analysis was used to develop our measure of drinking settings. The final latent class model consisted of four distinct classes which captured the typical settings where MSM consumed alcohol: “home” “social,” “bar/social,” and “general” drinkers (i.e., drinks in all settings). Regression models showed that “general” drinkers were more likely than “social” drinkers to engage in frequent heavy drinking. Compared to `social' drinkers, general drinkers were also more likely to engage in unprotected anal intercourse (UAIMP) and UAIMP with men met in bars and other venues (e.g., private parties, bath houses) while intoxicated. Assessment of drinking settings may be a means of identifying MSM who are at greater risk for frequent, heavy drinking and related sexual risk behavior.
PMCID: PMC3569002  PMID: 23261495
alcohol consumption; sexual risk behavior; drinking settings; gay men
2.  Locally dependent latent class models with covariates: an application to under-age drinking in the USA 
Under-age drinking is a long-standing public health problem in the USA and the identification of underage drinkers suffering alcohol-related problems has been difficult by using diagnostic criteria that were developed in adult populations. For this reason, it is important to characterize patterns of drinking in adolescents that are associated with alcohol-related problems. Latent class analysis is a statistical technique for explaining heterogeneity in individual response patterns in terms of a smaller number of classes. However, the latent class analysis assumption of local independence may not be appropriate when examining behavioural profiles and could have implications for statistical inference. In addition, if covariates are included in the model, non-differential measurement is also assumed. We propose a flexible set of models for local dependence and differential measurement that use easily interpretable odds ratio parameterizations while simultaneously fitting a marginal regression model for the latent class prevalences. Estimation is based on solving a set of second-order estimating equations. This approach requires only specification of the first two moments and allows for the choice of simple ‘working’ covariance structures. The method is illustrated by using data from a large-scale survey of under-age drinking. This new approach indicates the effectiveness of introducing local dependence and differential measurement into latent class models for selecting substantively interpretable models over more complex models that are deemed empirically superior.
PMCID: PMC2600526  PMID: 19079793
Differential measurement; Latent class; Local dependence; Marginal regression; Odds ratio; Second-order estimating equations
3.  Parental alcohol misuse and hazardous drinking among offspring in a general teenage population: gender-specific findings from the Young-HUNT 3 study 
BMC Public Health  2013;13:1140.
Parental alcohol misuse may negatively affect drinking behaviours among offspring, but it is unclear to what extent influences are gender-specific and dependent upon the actual drinking behaviour measured. The aim of this study was to investigate whether hazardous drinking among Norwegian teenage boys (N = 2538) and girls (N = 2494) was associated with paternal and maternal alcohol misuse (CAGE).
Definitions of hazardous drinking among offspring were based on self-reported alcohol consumption (in litres a year), frequency of drinking, and frequency of drunkenness. Based on this information, two composite measures of hazardous drinking were also constructed. Cross-sectional data from the Norwegian Young-HUNT 3 survey (2006–2008) were linked to information from biological parents who participated in the adult part of the HUNT study.
Logistic regression analyses showed that both boys and girls with alcohol misusing fathers were more likely to report high levels of alcohol intake compared to others of the same age and gender. This was contrary to boys with misusing mothers, who reported less alcohol consumption than other boys. Among girls, but not boys, high frequency of drunkenness was associated with maternal as well as paternal misuse.
This study suggests that adolescent hazardous drinking is more prevalent among boys and girls with alcohol misusing parents versus those whose parents do not misuse alcohol. However, findings were gender specific and varied depending on the drinking outcomes under investigation. More evidence-based knowledge in this field is of great importance for better understanding the possible role paternal and maternal alcohol misuse may play in the development of hazardous alcohol drinking patterns among adolescent boys and girls.
PMCID: PMC3866523  PMID: 24314020
Adolescence; Parents; Alcohol consumption; Alcohol misuse; Gender; Generations; Family; Environment
4.  Growth and weight status in treatment-naïve 12-16 year old adolescents with Alcohol Use Disorders in Cape Town, South Africa 
Nutrition Journal  2011;10:87.
Heavy alcohol consumption during adolescence has many known harmful health and social consequences and is strongly associated with numerous health risk behaviours. The consequences of heavy alcohol use during adolescence on nutritional status, specifically growth and weight status are largely unknown at this time.
Substance use, anthropometric indices of growth and weight, dietary energy intake and physical activity in heavy drinking adolescents (meeting DSM-IV criteria for alcohol use disorders) and matched light/non-drinking control adolescents were assessed.
Lifetime alcohol dose, measured in standard drinks of alcohol, was orders of magnitude higher in adolescents with alcohol use disorders (AUDs) compared to controls. The AUDs group was selected to represent relatively 'pure' AUDs, with minimal other drug use and no psychiatric diagnoses. The growth and weight status of adolescents with AUDs were generally comparable to that of controls, and is in line with the growth and weight status of the South African adolescent population. A greater proportion of overweight/obese females was found in both groups, with this percentage tending to be greater, although not significantly so, in the AUDs group. Adolescent females with AUDs had increased odds of being overweight/obese compared to controls, after adjustment for smoking, physical activity and energy intake.
Anthropometric indices of growth and weight status of participants in the Control and AUD groups were generally comparable. Female adolescents with AUDs may have an increased risk of being overweight/obese compared to adolescent females without AUDs. The presence of an AUD in our adolescent sample was associated with higher energy intake. Longitudinal studies are needed to elucidate the effects of heavy alcohol use on energy balance, growth and weight status in adolescents as they age. Nonetheless, the current study contributes to our understanding of the impacts of heavy alcohol consumption on important aspects of adolescent development.
PMCID: PMC3173299  PMID: 21861902
adolescent; alcohol; growth; weight; anthropometry; energy intake
5.  Occupational level of the father and alcohol consumption during adolescence; patterns and predictors 
Study objective: This paper describes and attempts to explain the association between occupational level of the father and high alcohol consumption among a cohort of New Zealand adolescents from age 11 to 21.
Design: Data were obtained from the longitudinal Dunedin multidisciplinary health and development study. At each measurement wave, those who then belonged to the quartile that reported the highest usual amount of alcohol consumed on a typical drinking occasion were categorised as high alcohol consumers. Potential predictors of high alcohol consumption included environmental factors, individual factors, and educational achievement measured at age 9, 11, or 13. Longitudinal logistic GEE analyses described and explained the relation between father's occupation and adolescent alcohol consumption.
Setting: Dunedin, New Zealand.
Participants: About 1000 children were followed up from birth in 1972 until adulthood.
Main results: A significant association between fathers' occupation and adolescent alcohol consumption emerged at age 15. Overall adolescents from the lowest occupational group had almost twice the odds of being a large consumer than the highest occupational group. The association between father's occupation and high alcohol consumption during adolescence was explained by the higher prevalence of familial alcohol problems and friends approving of alcohol consumption, lower intelligence scores, and lower parental attachment among adolescents from lower occupational groups.
Conclusions: Socioeconomic background affects adolescent alcohol consumption substantially. This probably contributes to cumulation of disadvantage. Prevention programmes should focus on adolescents from lower socioeconomic groups and make healthier choices the easier choices by means of environmental change.
PMCID: PMC1732575  PMID: 12933777
6.  Developmental Alcohol-Specific Parenting Profiles in Adolescence and their Relationships with Adolescents’ Alcohol Use 
Journal of Youth and Adolescence  2012;41(11):1502-1511.
Previous studies on general parenting have demonstrated the relevance of strict parenting within a supportive social context for a variety of adolescent behaviors, such as alcohol use. Yet, alcohol-specific parenting practices are generally examined as separate predictors of adolescents’ drinking behavior. The present study examined different developmental profiles of alcohol-specific parenting (rule-setting, quality and frequency of communication about alcohol use) and how these patterns relate to the initiation and growth of adolescents’ drinking. A longitudinal sample of 883 adolescents (47 % female) including four measurements (between ages 12 and 16) was used. Latent class growth analysis revealed that five classes of parenting could be distinguished. Communication about alcohol appeared to be fairly stable over time in all parenting classes, whereas the level of rule-setting declined in all subgroups of parents as adolescents grow older. Strict rule-setting in combination with a high quality and frequency of communication was associated with the lowest amount of drinking; parents scoring low on all these behaviors show to be related to the highest amount of drinking. This study showed that alcohol-specific rule-setting is most effective when it coincides with a good quality and frequency of communication about alcohol use. This indicates that alcohol-specific parenting behaviors should be taken into account as an alcohol-specific parenting context, rather than single parenting practices. Therefore, parent-based alcohol interventions should not only encourage strict rule setting, the way parents communicate with their child about alcohol is also of major importance.
PMCID: PMC3473184  PMID: 22614696
Alcohol-specific parenting; Adolescents; Parenting profiles; Alcohol use; Longitudinal; Communication
7.  Lapses following Alcohol Treatment: Modeling the Falls From the Wagon* 
This study investigated transitions between drinking and nondrinking during the first 12 months following treatment and whether transitions in posttreatment drinking are related to alcohol-dependence symptoms.
Data from individuals in the outpatient (n = 952) and aftercare (n = 774) arms of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) were included in the analyses. Drinking consequences, percentage of drinking days, and drinks per drinking day were used as indicators of drinking behavior. Latent transition analysis was used to estimate a model of drinking patterns, defined by transition probabilities between drinking classes, from immediately following treatment to 6 and 12 months following treatment.
Across both aftercare and outpatient samples, three drinking classes were identified at each time point: frequent heavy drinking with high consequences, moderate infrequent drinking with low consequences, and nondrinking with low consequences. Many participants maintained nondrinking, and, of those who drank, there was a trend toward transitioning to less drinking over time. Transition probabilities were noninvariant across treatment arms: The probability of transitioning from moderate drinking to frequent drinking was more than six times more likely in the aftercare arm, as compared with the outpatient arm. In both samples the transition to heavy drinking and membership in the heavy-drinking class were significantly positively related to alcohol-dependence symptoms. There were no differences across MATCH treatment groups.
This study examined transitions in post-treatment drinking and the role of alcohol dependence in predicting posttreatment drinking. The results suggest a low probability of moderate drinking among individuals with greater alcohol dependence.
PMCID: PMC2721009  PMID: 18612576
8.  Genetic and Environmental Predictors of Latent Trajectories of Alcohol Use from Adolescence to Adulthood: A Male Twin Study 
Adolescence is characterized by higher levels of novelty-seeking and risk-taking behavior, including initiation of alcohol use. Also, there is considerable heterogeneity in the change and continuity of alcohol use over time, which emphasizes the need to examine factors predicting alcohol use and the patterns of use over time.
Retrospective data on average monthly alcohol use and risk and protective factors were obtained through interviews and questionnaires in 1,560 adult male twins. Latent class growth analysis in Mplus was performed on data of alcohol use over ages 15 to 36. Second, logistic regression analyses were used to associate risk and protective characteristics with membership in distinct latent trajectories of alcohol use.
Six trajectories of alcohol use were identified, varying in the level of alcohol use, the rate of change in use in early adolescence and the persistence of use into adulthood. Genetic risk of externalizing disorder and peer deviance showed the greatest risks for unfavorable alcohol trajectories with higher levels of use and higher rates of early increase in use. Parental monitoring and involvement in social activities showed protective effects. Involvement in religious activities was strongly associated with reduced persistence of high-level drinking in univariate but not multivariate regression analyses.
Risk and protective factors impacted differentially on level of alcohol use, rate of increase in use during adolescence, and persistence of heavy alcohol use over time. Insight into the different ways in which predictors impact on alcohol use is relevant for the development of new intervention strategies. For this purpose, causality of the associations should be further examined.
PMCID: PMC3644700  PMID: 23347157
Latent Class Growth Analysis; Adolescence; Alcohol Use; Genetic and Environmental Risk Factors
9.  Drinking Patterns and Myocardial Infarction: A Linear Dose-Response Model 
The relation of alcohol intake to cardiovascular health is complex, involving both protective and harmful effects, depending on the amount and pattern of consumption. Interpretation of data available on the nature of these relations is limited by lack of well-specified, mathematical models relating drinking patterns to alcohol-related consequences. Here we present such a model and apply it to data on myocardial infarction (MI).
The dose-response model derived assumes: 1) each instance of alcohol use has an effect that either increases or decreases the likelihood of an alcohol-related consequence, and 2) greater quantities of alcohol consumed on any drinking day add linearly to these increases or decreases in risk. Risk was reduced algebraically to a function of drinking frequency and dosage (volume minus frequency, a measure of the extent to which drinkers have more than one drink on days when they drink). In addition to estimating the joint impact of frequency and dosage, the model provides a method for calculating the point at which risk related to alcohol consumption is equal to background risk from other causes. A bootstrapped logistic regression based on the dose-response model was conducted using data from a case-control study to obtain the predicted probability of MI associated with current drinking patterns, controlling for covariates.
MI risk decreased with increasing frequency of drinking, but increased as drinking dosage increased. Rates of increasing MI risk associated with drinking dosage were twice as high among women as they were among men. Relative to controls, lower MI risk was associated with consuming less than 4.55 drinks per drinking day for men (95% CI: 2.77 to 7.18) and less than 3.08 drinks per drinking day for women (95% CI: 1.35 to 5.16), increasing after these cross-over points were exceeded.
Use of a well-specified mathematical dose-response model provided precise estimates for the first time of how drinking frequency and dosage each contribute linearly to the overall impact of a given drinking pattern on MI risk in men and women.
PMCID: PMC2679679  PMID: 19032575
dose-response model; alcohol drinking pattern; alcohol-related disorders; public health; myocardial infarction
10.  On-line Randomized Controlled Trial of an Internet Based Psychologically Enhanced Intervention for People with Hazardous Alcohol Consumption 
PLoS ONE  2011;6(3):e14740.
Interventions delivered via the Internet have the potential to address the problem of hazardous alcohol consumption at minimal incremental cost, with potentially major public health implications. It was hypothesised that providing access to a psychologically enhanced website would result in greater reductions in drinking and related problems than giving access to a typical alcohol website simply providing information on potential harms of alcohol. DYD-RCT Trial registration: ISRCTN 31070347.
Methodology/Principal Findings
A two-arm randomised controlled trial was conducted entirely on-line through the Down Your Drink (DYD) website. A total of 7935 individuals who screened positive for hazardous alcohol consumption were recruited and randomized. At entry to the trial, the geometric mean reported past week alcohol consumption was 46.0 (SD 31.2) units. Consumption levels reduced substantially in both groups at the principal 3 month assessment point to an average of 26.0 (SD 22.3) units. Similar changes were reported at 1 month and 12 months. There were no significant differences between the groups for either alcohol consumption at 3 months (intervention: control ratio of geometric means 1.03, 95% CI 0.97 to 1.10) or for this outcome and the main secondary outcomes at any of the assessments. The results were not materially changed following imputation of missing values, nor was there any evidence that the impact of the intervention varied with baseline measures or level of exposure to the intervention.
Findings did not provide support for the hypothesis that access to a psychologically enhanced website confers additional benefit over standard practice and indicate the need for further research to optimise the effectiveness of Internet-based behavioural interventions. The trial demonstrates a widespread and potentially sustainable demand for Internet based interventions for people with hazardous alcohol consumption, which could be delivered internationally.
Trial Registration ISRCTN31070347
PMCID: PMC3052303  PMID: 21408060
11.  Patterns of alcohol use and multiple risk behaviour by gender during early and late adolescence: the ALSPAC cohort 
Journal of Public Health (Oxford, England)  2012;34(Suppl 1):i20-i30.
Adolescent risk behaviours such as smoking, alcohol use and antisocial behaviour are associated with increased risk of morbidity and mortality. Patterns of risk behaviour may vary between genders during adolescence.
Analysis of data from a longitudinal birth cohort to assess the prevalence and distribution of multiple risk behaviours by gender at age 15–16 years with a focus on alcohol use at age 10, 13 and 15 years.
By age 15 years, over half of boys and girls had consumed alcohol and one-fifth had engaged in binge drinking with no clear difference by gender. At age 15–16 years, the most prevalent risk behaviours were physical inactivity (74%), antisocial and criminal behaviour (42%) and hazardous drinking (34%). Boys and girls engaged in a similar number of behaviours but antisocial and criminal behaviours, cannabis use and vehicle-related risk behaviours were more prevalent among boys, whilst tobacco smoking, self-harm and physical inactivity were more prevalent among girls.
Multiple risk behaviour is prevalent in both genders during adolescence but the pattern of individual risk behaviour varies between boys and girls. Effective interventions at the individual, family, school, community or population level are needed to address gender-specific patterns of risk behaviour during adolescence.
PMCID: PMC3284864  PMID: 22363027
Alcohol; risk behaviour; adolescence; cohort
12.  Prospective Changes in Alcohol Use Among Hazardous Drinkers in the Absence of Treatment 
Gaining a better understanding of the natural course of hazardous alcohol consumption could inform the development of brief interventions to encourage self-change. In the current study, hazardous drinkers (based on Alcohol Use Disorders Identification Test score) were recruited using advertisements to participate in a 2-year multi-wave prospective study. Participants (N = 206) provided self-reports every six months during the study, including reports of daily alcohol consumption. The current investigation focuses on self-initiated change in participants’ frequency of heavy drinking days (i.e., ≥ 5/4 drinks per day for men/women), as predicted by a number of demographic (e.g., age) and psychosocial (e.g., guilt-proneness) variables. Latent growth curve models of the change in percent heavy drinking days over the 2-year period provided an excellent fit to the observed data and indicated a significant decline in percent heavy drinking days over time. Reductions in heavy drinking frequency were predicted by younger age and higher guilt-proneness. The identification of these predictors of reductions in heavy drinking frequency provides information to guide future work investigating self-change among hazardous drinkers.
PMCID: PMC3427414  PMID: 22612252
self-change; hazardous alcohol consumption; heavy drinking; shame; guilt
13.  Alcohol Consumption and CD4 T-cell count response among persons initiating antiretroviral therapy 
We evaluated the longitudinal association of alcohol use with immunological response to combination antiretroviral therapy (ART) among HIV infected individuals.
This was a prospective cohort study of individuals initiating ART. Participants underwent an Audio Computer-Assisted Self Interview querying drug and alcohol use within 6 months of treatment. Immunological response to ART was defined by CD4 T-cell count (CD4). Primary independent variables were self-reported number of drinks consumed per drinking day (quantity) and days of alcohol consumption in a typical week (frequency). We used linear mixed effects models to quantify the association between CD4 T-cell count and alcohol quantity and frequency and Cox proportional hazards models to estimate the relative hazard of an increase 100, 150 and 200 CD4 cells/mm3 per additional drink per drinking day. Analyses were stratified by gender. Viral suppression was examined as a time-varying covariate.
Between 2000-2008, 1107 individuals were eligible for inclusion in this study. There was no statistically significant difference in CD4 T-cell count by average drinks per drinking day at any frequency of alcohol use irrespective of gender or viral suppression. Similarly, we found no difference in the hazard ratio for drinks per drinking day within the categories of drinking frequency for time to CD4 T-cell count increase of 100, 150 and 200 cells/mm3, respectively.
Among individuals initiating antiretroviral therapy (ART) the benefits of therapy and viral suppression on the immune system outweigh detrimental effects of alcohol, reinforcing the importance of initiating ART and ensuring adequate adherence to therapy.
PMCID: PMC3541505  PMID: 22955054
HIV; alcohol; Immune Response; CD4 T-CELL COUNT; antiretroviral therapy
14.  Alcohol and homicide in the United States – is the link dependent on wetness? 
Drug and alcohol review  2011;30(5):458-465.
Several aggregate-level studies have suggested that the relationship between alcohol and homicide is stronger in countries with an intoxication-oriented drinking pattern than in countries where drinking is more tempered. The present paper extends this research tradition by analysing the alcohol-homicide link in various regions in the U.S.
Design and Methods
I used annual time-series data for the U.S. states covering the period 1950-2002. Alcohol sales figures were used as proxy for alcohol consumption. Mortality data were used as indicators of homicide. The states were sorted into 3 groups labelled Dry, Moderate and Wet, where the last group has the highest prevalence of hazardous drinking according to survey data. Group-specific data were analysed using (i) ARIMA modelling and (ii) fixed-effects modelling. All modelling was based on differenced data, thus eliminating time trends and interstate correlations, both of which may bias estimates.
The ARIMA estimates displayed a statistically significant gradient in alcohol effects; the effect was strongest in Wet, and weakest and insignificant in Dry states. The fixed-effects estimates showed a corresponding pattern, although the gradient was less steep and insignificant. The gradient was also weakened if the effects were expressed in absolute rather than relative terms. The spatial pattern revealed no ecological correlation between alcohol and homicide.
Results provided mixed support for the hypothesis that the relationship between alcohol and homicide is stronger in wet than in dry states in the U.S. Future research should probe more specific indicators of homicide as well as alcohol consumption.
PMCID: PMC3177174  PMID: 21896067
alcohol; violence; homicide; drinking patterns; United States
15.  Alcohol Use in Adolescence and Risk of Disability Pension: A 39 Year Follow-up of a Population-Based Conscription Survey 
PLoS ONE  2012;7(8):e42083.
The role of alcohol consumption for disability pension (DP) is controversial and systematic reviews have not established causality. We aimed to assess the role of adolescent alcohol use for future DP. We wanted to find out whether an increased risk mainly would affect DP occurring early or late in life as well as whether the level of alcohol consumption and patterns of drinking contribute differently in DP receiving.
Methodology/Principal Findings
The study is a 39-year follow-up of 49 321 Swedish men born in 1949–1951 and conscripted for compulsory military service in 1969–1970. As study exposures (i) “risk use” of alcohol composed of measures related to pattern of drinking, and (ii) the level of consumption based on self-reported volume and frequency of drinking had been used. Information on DP was obtained from social insurance databases through 2008. “Risk use” of alcohol was associated with both “early DP” and “late DP”, i.e. granted below and above the approximate age of 40 years, with crude hazard ratio (HR) of 2.89 (95% confidence intervals (CI) 2.47–3.38) and HR of 1.87 (95%CI: 1.74–2.02), respectively. After adjustment for covariates, HR was reduced to 1.32 (95%CI: 1.09–1.59) and 1.14 (95%CI: 1.05–1.25), respectively. Similar patterns were seen for moderate (101–250 g 100% alcohol/week) and high (>250 g) consumption, though the risk disappeared when fully adjusted.
Alcohol use in adolescence, particularly measured as “risk use”, is associated with increased risk of future DP. The association is stronger for “early DP”, but remains significant even for DP granted in older ages. Therefore, pattern of drinking in adolescent should be considered an important marker for future reduced work capacity.
PMCID: PMC3411655  PMID: 22870284
16.  Alcohol consumption in tertiary education students 
BMC Public Health  2011;11:545.
Heavy alcohol consumption among adolescents and young adults is an issue of significant public concern. With approximately 50% of young people aged 18-24 attending tertiary education, there is an opportunity within these settings to implement programs that target risky drinking. The aim of the current study was to survey students and staff within a tertiary education institution to investigate patterns of alcohol use, alcohol-related problems, knowledge of current National Health and Medical Research Council (NHMRC) guidelines for alcohol consumption and intentions to seek help for alcohol problems.
Students of an Australian metropolitan university (with staff as a comparison group) participated in a telephone interview. Questions related to knowledge of NHMRC guidelines, drinking behaviour, alcohol-related problems and help-seeking intentions for alcohol problems. Level of psychological distress was also assessed.
Of the completed interviews, 774 (65%) were students and 422 (35%) were staff. While staff were more likely to drink regularly, students were more likely to drink heavily. Alcohol consumption was significantly higher in students, in males and in those with a history of earlier onset drinking. In most cases, alcohol-related problems were more likely to occur in students. The majority of students and staff had accurate knowledge of the current NHMRC guidelines, but this was not associated with lower levels of risky drinking. Psychological distress was associated with patterns of risky drinking in students.
Our findings are consistent with previous studies of tertiary student populations, and highlight the disconnect between knowledge of relevant guidelines and actual behaviour. There is a clear need for interventions within tertiary education institutions that promote more effective means of coping with psychological distress and improve help-seeking for alcohol problems, particularly among young men.
PMCID: PMC3223920  PMID: 21740593
17.  Interactive Effects of Cumulative Stress and Impulsivity on Alcohol Consumption 
Alcohol addiction may reflect adaptations to stress, reward, and regulatory brain systems. While extensive research has identified both stress and impulsivity as independent risk factors for drinking, few studies have assessed the interactive relationship between stress and impulsivity in terms of hazardous drinking within a community sample of regular drinkers.
One hundred and thirty regular drinkers (56M/74F) from the local community were assessed for hazardous and harmful patterns of alcohol consumption using the Alcohol Use Disorders Identification Test (AUDIT). All participants were also administered the Barratt Impulsiveness Scale (BIS-11) as a measure of trait impulsivity and the Cumulative Stress/Adversity Checklist (CSC) as a comprehensive measure of cumulative adverse life events. Standard multiple regression models were used to ascertain the independent and interactive nature of both overall stress and impulsivity as well as specific types of stress and impulsivity on hazardous and harmful drinking.
Recent life stress, cumulative traumatic stress, overall impulsivity, and nonplanning-related impulsivity as well as cognitive and motor-related impulsivity were all independently predictive of AUDIT scores. However, the interaction between cumulative stress and total impulsivity scores accounted for a significant amount of the variance, indicating that a high to moderate number of adverse events and a high trait impulsivity rating interacted to affect greater AUDIT scores. The subscale of cumulative life trauma accounted for the most variance in AUDIT scores among the stress and impulsivity subscales.
Findings highlight the interactive relationship between stress and impulsivity with regard to hazardous drinking. The specific importance of cumulative traumatic stress as a marker for problem drinking is also discussed.
PMCID: PMC3676668  PMID: 20491738
Impulsivity; Cumulative Stress; Alcohol Consumption; Trauma; Community Sample
18.  Teenage drinking, alcohol availability and pricing: a cross-sectional study of risk and protective factors for alcohol-related harms in school children 
BMC Public Health  2009;9:380.
There is a lack of empirical analyses examining how alcohol consumption patterns in children relate to harms. Such intelligence is required to inform parents, children and policy relating to the provision and use of alcohol during childhood. Here, we examine drinking habits and associated harms in 15-16 year olds and explore how this can inform public health advice on child drinking.
An opportunistic survey of 15-16 year olds (n = 9,833) in North West England was undertaken to determine alcohol consumption patterns, drink types consumed, drinking locations, methods of access and harms encountered. Cost per unit of alcohol was estimated based on a second survey of 29 retail outlets. Associations between demographics, drinking behaviours, alcohol pricing and negative outcomes (public drinking, forgetting things after drinking, violence when drunk and alcohol-related regretted sex) were examined.
Proportions of drinkers having experienced violence when drunk (28.8%), alcohol-related regretted sex (12.5%) and forgetting things (45.3%), or reporting drinking in public places (35.8%), increased with drinking frequency, binge frequency and units consumed per week. At similar levels of consumption, experiencing any negative alcohol-related outcome was lower in those whose parents provided alcohol. Drunken violence was disproportionately associated with being male and greater deprivation while regretted sex and forgetting things after drinking were associated with being female. Independent of drinking behaviours, consuming cheaper alcohol was related to experiencing violence when drunk, forgetting things after drinking and drinking in public places.
There is no safe level of alcohol consumption for 15-16 year olds. However, while abstinence removes risk of harms from personal alcohol consumption, its promotion may also push children into accessing drink outside family environments and contribute to higher risks of harm. Strategies to reduce alcohol-related harms in children should ensure bingeing is avoided entirely, address the excessively low cost of many alcohol products, and tackle the ease with which it can be accessed, especially outside of supervised environments.
PMCID: PMC2770487  PMID: 19818118
19.  Drinking Behavior from High School to Young Adulthood: Differences by College Education 
Background: Recent serious alcohol-related events have raised public awareness of the prevalence of at-risk alcohol use among college undergraduates, but heavy alcohol consumption during late adolescence and young adulthood is not limited to college students. Alcohol consumption typically peaks in young adulthood regardless of education level, and risks related to alcohol misuse are shared by young adults, regardless of their educational choices. Differences in alcohol risk between college-attending and non-college-attending young adults are generally small, and emphasize the need for research examining the drinking patterns of both of these groups.
Methods: To better understand patterns of at-risk alcohol use and its association with education, this study compared at-risk alcohol use from 12th grade to young adulthood (age 24) in a sample of never-married young adults. Three groups were formed based on completed education when the survey was administered in young adulthood: high school or less, postsecondary education without a four-year college degree, and completed college.
Results: Men who completed college experienced the greatest increase in at-risk drinking from grade 12 to young adulthood; however, their at-risk alcohol use did not differ markedly from men in the other education groups in young adulthood. Men who did not complete college had high levels of alcohol risk in 12th grade and maintained or increased those levels in young adulthood, demonstrating a pattern of prolonged risk. Women whose completed education was high school or less experienced the fewest increases in at-risk alcohol use. Education group differences were not explained by place of residence or employment status.
Conclusions: These results emphasize the need to intervene early to prevent at-risk alcohol use, and emphasize that at-risk alcohol use is neither unique, nor necessarily the highest among individuals who complete college.
PMCID: PMC1397708  PMID: 16385187
At-Risk Drinking; Education Level; High School Drinking; College Drinking; Longitudinal; Young Adulthood
20.  Cross-sectional measures and modelled estimates of blood alcohol levels in UK nightlife and their relationships with drinking behaviours and observed signs of inebriation 
Management of nightlife in UK cities focuses on creating safe places for individuals to drink. Little is known about intoxication levels as measuring total alcohol consumption on nights out is complicated by early evening interviews missing subsequent consumption and later interviews risking individuals being too drunk to recall consumption or participate at all. Here we assess mixed survey and modelling techniques as a methodological approach to examining these issues.
Interviews with a cross sectional sample of nightlife patrons (n = 214) recruited at different locations in three cities established alcohol consumption patterns up to the point of interview, self-assessed drunkenness and intended drinking patterns throughout the remaining night out. Researchers observed individuals' behaviours to independently assess drunkenness. Breath alcohol tests and general linear modelling were used to model blood alcohol levels at participants' expected time of leaving nightlife settings.
At interview 49.53% of individuals regarded themselves as drunk and 79.43% intended to consume more alcohol before returning home, with around one in ten individuals (15.38% males; 4.35% females) intending to consume >40 units (equal to 400 mls of pure alcohol). Self-assessed drunkenness, researcher observed measures of sobriety and blood alcohol levels all correlated well. Modelled estimates for blood alcohol at time of going home suggested that 71.68% of males would be over 0.15%BAC (gms alcohol/100 mls blood). Higher blood alcohol levels were related to drinking later into the night.
UK nightlife has used substantive health and judicial resources with the aim of creating safer and later drinking environments. Survey and modelling techniques together can help characterise the condition of drinkers when using and leaving these settings. Here such methods identified patrons as routinely getting drunk, with risks of drunkenness increasing over later nights. Without preventing drunkenness and sales to intoxicated individuals, extended drinking hours can simply act as havens for drunks. A public health approach to nightlife is needed to better understand and take into account the chronic effects of drunkenness, the damages arising after drunk individuals leave city centres and the costs of people avoiding drunken city centres at night.
PMCID: PMC2873259  PMID: 20406433
21.  Adolescent C57BL/6J mice show elevated alcohol intake, but reduced taste aversion, as compared to adult mice: a potential behavioral mechanism for binge drinking 
Binge alcohol drinking during adolescence is a serious health problem which may increase future risk of an alcohol use disorder. Although there are several different procedures by which to preclinically model binge-like alcohol intake, limited-access procedures offer the advantage of achieving high voluntary alcohol intake and pharmacologically relevant blood alcohol concentrations (BACs). Therefore, in the current study, developmental differences in binge-like alcohol drinking using a limited-access cycling procedure were examined. In addition, as alcohol drinking has been negatively correlated with sensitivity to the aversive properties of alcohol, we examined developmental differences in sensitivity to an alcohol-induced conditioned taste aversion (CTA).
Binge-like alcohol consumption was investigated in adolescent (4 wk) and adult (10 wk) male C57BL/6J mice for 2-4 h/day for 16 d. Developmental differences in sensitivity to an alcohol-induced CTA were examined in adolescent and adult mice, with saline or alcohol (3 or 4 g/kg) repeatedly paired with intake of a novel tastant (NaCl).
Adolescent mice showed a significant increase in alcohol intake as compared to adults, with adolescents achieving higher BACs and increasing alcohol consumption over successive cycles of the binge procedure. Conversely, adolescent mice exhibited a dose-dependent reduction in sensitivity to the aversive properties of alcohol, as compared to adult mice, with adolescent mice failing to develop a CTA to 3 g/kg alcohol. Finally, extinction of an alcohol CTA was observed following conditioning with a higher dose of alcohol in adolescent, versus adult, mice.
These results indicate that adolescent mice consume more alcohol, per kg body weight, than adults in a binge-like model of alcohol drinking, and demonstrate a blunted sensitivity to the conditioned aversive effects of alcohol. Overall, this supports a behavioral framework by which heightened binge alcohol intake during adolescence occurs, in part, via a reduced sensitivity to the aversive properties of alcohol.
PMCID: PMC3158303  PMID: 21575017
Development; ethanol; drinking; binge; correlated trait
22.  Trajectory classes of heavy episodic drinking among Asian American college students 
Addiction (Abingdon, England)  2010;105(11):1912-1920.
Heavy episodic drinking (HED) among Asian Americans is a growing concern. However, little is known about the etiology and developmental patterns of HED among Asian Americans, even though this group is one of the fastest-growing populations in the United States.
Three year longitudinal design.
Sample included 404 Asian American college students transitioning from high school, through the college years.
Measures included heavy episodic drinking, parental and peer relationships, alcohol expectancies, drinking values, and alcohol-related problems.
Results from growth-mixture models (GMM) identified two discrete latent classes of HED comprising 59% of our sample: these trajectory classes (high increasers and low increasers) corresponded to expected changes and stability in well-established correlates of drinking behaviour, including alcohol-related problems, personal drinking values and alcohol expectancies. Parental awareness and caring and quality of peer relationships during senior year of high school were associated directly and indirectly with HED class membership.
These findings advance the literature by providing information about the developmental course of HED among Asian American young adults. The significant within-group variability in problematic drinking in this sample highlights the fact that subgroups of high-risk drinkers can be identified even in relatively low-risk groups such as Asian Americans.
PMCID: PMC3047455  PMID: 21040058
Alcohol; Asian Americans; heavy episodic drinking; longitudinal
23.  The Role of Peers and Parents in Predicting Alcohol Consumption among Chilean Youth 
This study estimated marginal associations of parent- and peer-related measures to examine the different patterns of lifetime ever-use and frequency of alcohol consumption among adolescents in Santiago, Chile (N=918). Probit and negative binomial models were applied to predict the probability of ever-use and the average number of drinks consumed in the past 30 days. Results supported the profound role of peer-relationships in the development of youth drinking behavior. Particularly, peer pressure seemed more important in predicting alcohol ever-use than the frequency of drinking. Simultaneously, parents, especially fathers, played a crucial protective role. Policies aimed at preventing various drinking patterns may be more effective if they not only focus on the targeted adolescents, but also reach out to peers and parents.
PMCID: PMC3906685  PMID: 24489979
Adolescents; alcohol; Chile; parent; peer
24.  Parent attitudes, family dynamics and adolescent drinking: qualitative study of the Australian parenting guidelines for adolescent alcohol use 
BMC Public Health  2012;12:491.
Parents play a critical role in their children’s introduction to alcohol. A range of parenting factors have been associated with the progression to risky drinking among adolescents, and have recently formed the basis of the Australian ‘Parenting Guidelines for Adolescent Alcohol Use’ designed to help parents delay or reduce their adolescents’ alcohol use.
This study aimed to explore the experiences and attitudes of parents of adolescents to gain insight into: (1) the extent to which the behaviours of parents follow the recommendations made in the guidelines; and (2) approaches to reduce hazardous drinking among adolescents. Thirty-two telephone and face-to-face interviews were conducted with parents, and the content of discussions was examined using thematic analysis.
Parents used approaches they thought would minimise harm and promote healthy development in their children. The guidelines address key areas of concern for parents but their adherence to these approaches is low in certain areas. Many parents provided some alcohol to their adolescents and often cited the social norm of drinking among their adolescents’ peers as a source of pressure to supply.
Further dissemination of the guidelines may be the first step in a public health strategy, but it is likely that parents will require support to effectively adopt the recommendations. Understanding the influences on parents’ beliefs about their children’s drinking and the functions of social networks in the creation of behavioural norms relating to alcohol consumption and supply may be necessary to address adolescent risky drinking.
PMCID: PMC3461436  PMID: 22747699
Parent; Adolescent; Alcohol; Supply; Guidelines
25.  Clustering of health behaviours in adult survivors of childhood cancer and the general population 
British Journal of Cancer  2012;107(2):234-242.
Little is known about engagement in multiple health behaviours in childhood cancer survivors.
Using latent class analysis, we identified health behaviour patterns in 835 adult survivors of childhood cancer (age 20–35 years) and 1670 age- and sex-matched controls from the general population. Behaviour groups were determined from replies to questions on smoking, drinking, cannabis use, sporting activities, diet, sun protection and skin examination.
The model identified four health behaviour patterns: ‘risk-avoidance', with a generally healthy behaviour; ‘moderate drinking', with higher levels of sporting activities, but moderate alcohol-consumption; ‘risk-taking', engaging in several risk behaviours; and ‘smoking', smoking but not drinking. Similar proportions of survivors and controls fell into the ‘risk-avoiding' (42% vs 44%) and the ‘risk-taking' cluster (14% vs 12%), but more survivors were in the ‘moderate drinking' (39% vs 28%) and fewer in the ‘smoking' cluster (5% vs 16%). Determinants of health behaviour clusters were gender, migration background, income and therapy.
A comparable proportion of childhood cancer survivors as in the general population engage in multiple health-compromising behaviours. Because of increased vulnerability of survivors, multiple risk behaviours should be addressed in targeted health interventions.
PMCID: PMC3394979  PMID: 22722311
childhood cancer survivors; health behaviour; cluster analysis; smoking; alcohol consumption

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