Measuring alcohol consumption and alcohol-related problems: comparison of responses from self-administered questionnaires and telephone interviews

Aims. Compared with surveys using self-administered questionnaires, telephone interviews generally yield higher coverage rates, have a lower proportion of missing values and result in fewer inconsistencies. Meta-analyses, however, show that responses to sensitive questions by telephone tend to be biased by social expectations. The aim of the study is to examine whether responses on alcohol consumption and alcohol-related problems differ with respect to mode of administration (self-administered vs. telephone). Design and participants. Data were analysed from the 1995 self-administered survey among 6427 subjects and from telephone surveys conducted annually between 1994 and 1996 yielding a pooled sample of 6193 subjects. Measurements. Alcohol consumption within the last 30 days was measured using a beverage-specific quantity-frequency index. For a summary measure responses were converted into pure alcohol (ethanol) per day and categorized into no alcohol consumption (0 g), non-hazardous consumption (≤ 20 g for female and ≤ 40 g for males) and hazardous consumption (> 20 g for females and > 40 g for males). Alcohol-related problems were assessed using the CAGE questionnaire with a cut-off point of at least two positive responses. Findings. Using (cumulative) logistic regression, a significant mode effect was found for both alcohol consumption and alcohol-related problems. Lower beverage-specific prevalences in the telephone mode were found to be responsible for the difference in the distribution of the summary consumption measure. Conclusions. Results indicate that patterns of drinking and alcohol-related problems are more easily reported in self-administration questionnaires compared to telephone interviews.     

Relationships of measures of alcohol consumption with alcohol-related problems in multiple studies: a research synthesis from the collaborative alcohol-related longitudinal project

Two measures of alcohol consumption were used to predict groups of alcohol problems in 21 general population studies from 11 countries to determine (a) if quantity of drinking per occasion or frequency of drinking per month constituted significant “risk” for alcohol problems, having controlled for each as well as individual-level and aggregate-level variables winch might confound these relationships and (b) if these associations mere homogeneous across studies. A two-tiered analysis assessed these relationships within each study by modeling age, sex, quantity per occasion and frequency per month as predictors of alcohol problems. Mela-analysis combined test statistics to determine if they were homogeneous across studies. The meta-analysis was repealed, blocking for per capita consumption of alcohol (a trait of nations thought to measure drinking norms) and the female rate of suicide (a trail of nations thought to measure societal-level stress). When only individual-level variables were controlled (age and sex), both quantity and frequency were risk factors for each drinking problem. However, except in the case of the association of quantity with alcohol treatment, the magnitude of these risks were heterogeneous across studies. When blocking for the societal-level traits, each had more relevance for some, but not all, of the relationships between consumption and problems. Particularly striking was the welt-documented finding that per capita consumption of alcohol significantly distinguished the relationships of frequency of drinking and health problems (while the female suicide rate did not) and the previously undocumented finding that the female suicide rate significantly distinguished the relationships of both quantity and frequency with treatment (while the per capita consumption of alcohol did not). These findings suggest that the impact of norms and the impact of societal stress in groups have different but significant consequences for the relationships of consumption to problems.     

Alcohol consumption and problems: the relevance of drinking patterns

BACKGROUND: Data on risks and benefits associated with drinking patterns provide the scientific basis for moderate, low-risk drinking guidelines. Illustrated are methods to investigate and adjust for heterogeneity in relations between three-dimensional drinking patterns and 41 alcohol problems assessed among current regular drinkers in the 1988 National Health Interview Survey. METHODS: Three dimensions of mean drinking patterns, (i.e., usual quantities, heavy drinking rates (days of 5+ drinks/drinking days x 100), and drinking frequencies) were estimated in overlapping subsets of the population reporting each of the 41 problems, and mean usual quantities and heavy drinking rates were plotted against frequencies. Respondents were categorized into drinking problem groups associated with comparable mean drinking patterns; and main and interactive effects of age and sex on drinking patterns were examined by conducting three regression analyses within each group, with quantity, frequency, and heavy drinking rates as dependent variables, respectively. RESULTS: Analyses revealed substantial heterogeneity in relations between drinking patterns and alcohol problems. Respondents having only minor problems drank on average two days a week, usually had 2.6 drinks, and drank heavily 12-13 days a year. Whereas, those having minor and severe problems drank an average of 3.5 days a week, usually had 4.7 drinks, and drank heavily 58 days a year. Within each problem group, usual quantity and frequency were higher among males than females, but the greatest gender differences were seen in heavy-drinking rates. Age-related differences in drinking patterns were striking. Usual quantity and heavy-drinking rates associated with problems decreased with age, whereas drinking frequency increased. CONCLUSIONS: Findings demonstrated the importance of assessing and adjusting for heterogeneity in relations between drinking patterns and alcohol problems when aggregating and interpreting such data, (e.g., when assessing alcohol dependence criteria or evaluating guidelines for moderate drinking), and illustrated new methods for doing so.     

Negative affect, alcohol expectancies and alcohol-related problems

Using data from the first epidemiological study of mainland Puerto Rican drinking, the authors explore the relationships between negative affect, alcohol expectancies and drinking problems. Results revealed that the co-occurrence of depressed mood and drinking problems was strongly moderated by alcohol expectancies. More specifically, the co-occurrence was strongest among those Puerto Ricans who most expected alcohol to elevate their mood. Findings are discussed in terms of their explication of the co-morbidity of depressive symptomatology and alcohol abuse.     

Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men's Health Study

Aims . To measure the prevalence and independent associations of heavy and problematic use of alcohol and recreational drugs among a household-based sample of urban MSM (men who have sex with men).
Design . Cross-sectional survey.
Participants . Men who identified as being gay or bisexual or who reported sex with another man in the prior 5 years were included in this analysis ( n = 2172).
Setting . A probability telephone sample of MSM was taken within Zip Codes of four large American cities (Chicago, Los Angeles, New York and San Francisco) estimated to have total concentrations of at least 4% of all households with one resident MSM.
Measurements . Standard measures of alcohol use, problems associated with alcohol use, and recreational drug use were administered by trained telephone interviewers.
Findings . Both recreational drug (52%) and alcohol use (85%) were highly prevalent among urban MSM, while current levels of multiple drug use (18%), three or more alcohol-related problems (12%), frequent drug use (19%) and heavy-frequent alcohol use (8%) were not uncommon. The associations of heavy and/or problematic substance use are complex, with independent multivariate associations found at the levels of demographics, adverse early life circumstances, current mental health status, social and sexual practices and connection to gay male culture.
Conclusions . The complex pattern of associations with heavy and/or problematic substance use among urban MSM suggests that heavy and/or problematic substance use is grounded in multiple levels: the individual, the interpersonal and the socio-cultural.     

Alcohol consumption and antiretroviral adherence among HIV-infected persons with alcohol problems

BACKGROUND: Alcohol abuse has been associated with poor adherence to highly active antiretroviral therapy (HAART). We examined the relative importance of varying levels of alcohol consumption on adherence in HIV-infected patients with a history of alcohol problems. METHODS: We surveyed 349 HIV-infected persons with a history of alcohol problems at 6-month intervals. Of these subjects, 267 were taking HAART at one or more time periods during the 30-month follow-up period. Interviews assessed recent adherence to HAART and past month alcohol consumption, defined as "none", "moderate", and "at risk". We investigated the relationship between adherence to HAART and alcohol consumption at baseline and at each subsequent 6-month follow-up interval using multivariable longitudinal regression models, while controlling for potential confounders. RESULTS: Among the 267 HIV-infected persons with a history of alcohol problems who were receiving HAART, alcohol consumption was the most significant predictor of adherence (p < 0.0001), with better adherence being associated with recent abstinence from alcohol, compared with at-risk level usage (odds ratio = 3.6, 95% confidence interval = 2.1-6.2) or compared with moderate usage (odds ratio = 3.0, 95% confidence interval = 2.0-4.5). CONCLUSIONS: Any alcohol use among HIV-infected persons with a history of alcohol problems is associated with worse HAART adherence. Addressing alcohol use in HIV-infected persons may improve antiretroviral adherence and ultimately clinical outcomes.     

The importance of amount and location of drinking for the experience of alcohol-related problems

People's self report of a variety of alcohol-related problems was collected as part of a national survey carried out in New Zealand in 1988. These problems included self perception of adverse effects of drinking on a number of life areas such as health, friendships and financial position; items covering tangible consequences of alcohol use and items suggestive of alcohol dependence. The experience of these problems was predicted from a number of socio-demographic variables and respondent's reports of their typical drinking behaviour. Of the socio-demographic variables only age was found to relate strongly to experience of problems. The overall frequency of drinking relatively large amounts and the typical quantity drunk in certain licensed premises (hotels, taverns and clubs) and the typical quantity drunk in others' homes predicted the experience of problems. These findings are similar to research from other countries using different methodologies and support the likely effectiveness of prevention strategies which reduce the access of young people to alcohol and which aim to influence the amounts consumed in drinking sessions on licensed premises.     

Alcohol consumption: Risks and benefits

Alcohol has had a long and complicated role in human society and health. Excessive use of alcohol causes enormous morbidity and mortality worldwide, but the health effects of alcohol use within recommended guidelines are diverse and complex. Established effects include increased high-density lipoprotein cholesterol and antithrombotic activity, providing plausible mechanisms for the observed association of moderate drinking with lower risk of coronary heart disease but higher risk of hemorrhagic stroke. However, moderate drinking increases sex steroid hormone levels and may interfere with folate metabolism, both of which are potential mechanisms for the observed associations of moderate drinking with several forms of cancer, particularly breast and colorectal. Genetic susceptibility to the effects of alcohol on cancer and coronary heart disease also differs across the population. Recommendations regarding moderate drinking must be individualized to reflect the potentially competing effects of alcohol on several chronic diseases.     

Self-reported alcohol consumption and the risk of alcohol-related problems: a comparative risk-curve analysis of the 3 Baltic countries, Sweden, and Italy

Background: Previous research has suggested a positive risk‐relationship between volume of consumption and adverse behavioral and social consequences of drinking. However, because the risk‐relationship may be modified by factors such as pattern of drinking, attributes of social drinking contexts, and drunken comportment, the shape of the risk‐function appear to be contingent upon the larger cultural context of drinking. Methods: In this article, I use graphical risk‐curve analyses and model estimations to assess how the risk of experiencing alcohol‐related problems is associated with self‐reported volume of alcohol consumption in the 3 Baltic countries (Estonia, Latvia, and Lithuania) as well as Sweden and Italy. The analysis utilized data from 2 general population surveys (including Sweden plus Italy and the Baltic countries, respectively) with approximately 1,000 respondents from each country. Results: The risk‐curves for the 3 Baltic countries and Sweden were fairly parallel and clearly steeper than that for Italy. In the logistic regression models, the country‐specific Baltic estimates were not entirely homogenous; for Estonia and Latvia, the estimates were similar to that for Sweden and significantly larger than that for Italy, whereas the estimate for Lithuania did not differ significantly from that for Italy. However, the negative binominal regression models suggested that increasing volume of consumption is associated with the risk of experiencing a larger number of different problems in all 3 Baltic countries and Sweden than in Italy. Overall, the result thus suggests that there is a significant relationship between volume of consumption and risk of experiencing alcohol‐related problems in all countries but that the relationship generally is stronger in the Baltic countries and Sweden than in Italy. Conclusions: The results were largely in line with the hypothesis of a European north to south gradient in the strength of the risk‐relationship, but also add that most Baltic countries may be placed alongside the Nordic countries in this context. Because only volume of consumption is considered, the results cannot be used to specify which factors and mechanisms that actually modify the shape of the risk‐function in each culture.     

Alcohol use and alcohol-related consequences: associations with emotion regulation difficulties

Background: Understanding factors associated with alcohol-related consequences is an important area of research. Emotional functioning has been associated with alcohol-related consequences but there is less research examining a comprehensive underlying model of emotional regulation. The Difficulties in Emotion Regulation Scale (DERS) is a recent measure developed to assess six facets of emotion regulation difficulties that contribute to overall emotional functioning. Objectives: The current study examines associations between these six facets of emotion regulation difficulties and problematic alcohol use. Methods: Participants (n?=?1758 college students) were recruited as part of a larger study and were asked to complete online questionnaires assessing demographics, alcohol use and problems, and emotion regulation difficulties. Results: Negative binomial hurdle models for alcohol use and alcohol-related consequences were estimated. Impulse control difficulties were positively related to the number of drinks consumed during the week among active drinkers. Non-acceptance of emotional responses, impulse control difficulties, lack of emotional clarity, and difficulties engaging in goal-directed behavior were all positively associated with number of consequences endorsed. Difficulty engaging in goal-directed behavior was also positively associated with the likelihood of experiencing any alcohol-related consequences. Conclusions: The findings support previous research indicating that emotion-regulation difficulties are broadly associated with alcohol-related consequences. Results suggest exposure and/or mindfulness based prevention/interventions with emotion focused psychoeducation may offer one path to reducing alcohol-related consequences among college students.     

Prediction of alcohol-related harm from controlled drinking strategies and alcohol consumption trajectories

Aims To establish predictors of age 21 alcohol‐related harm from prior drinking patterns, current levels of alcohol consumption and use of controlled drinking strategies. Participants One thousand, five hundred and ninety‐six students recruited from an initial sample of 3300 during their final year of high school in 1993. Design Longitudinal follow‐up across five waves of data collection. Setting Post high school in Victoria, Australia. Measurements Self‐administered surveys examining a range of health behaviours, including alcohol consumption patterns and related behaviour. Findings Drinking behaviours at age 21 were found to be strongly predicted by drinking trajectories established through the transition from high school. Multivariate regression analysis revealed that alcohol‐related harms at age 21 were reduced where current levels of alcohol use fell within limits recommended in Australian national guidelines. After controlling for this effect it was found that the range of strategies employed by participants to control alcohol use maintained a small protective influence. Post‐high‐school drinking trajectories continued to demonstrate a significant effect after controlling for current behaviours. Findings revealed that over one quarter of males and females drank alcohol, but on a less‐than‐weekly basis. This pattern of alcohol use demonstrated considerable stability through the post‐school transition and was associated with a low level of subsequent harm at age 21. Conclusions Future research should investigate whether encouraging more Australian adolescents to drink alcohol on a less‐than‐weekly basis may be a practical intervention target for reducing alcohol‐related harms.     

Alcohol consumption and sickness absence: from the Whitehall II study

Previous studies suggest that problem drinkers have markedly increased sickness absence. However, it is not dear how more moderate alcohol consumption and abstinence relate to sickness absence. As part of the Whitehall II study the relationship between different drinking patterns and, sickness absence is examined. A total of 10314 male and female civil servants completed a baseline questionnaire about their drinking habits—the amount of alcohol consumed over the past 7 days and the frequency of drinking over the past 12 months. All sickness absence has been recorded prospectively. Drinking patterns and sickness absence are examined for short spells (7 days) and long spells (> 7 days) adjusting for other causes of sickness absence: age, grade of employment, smoking, work characteristics and baseline health. Alcohol consumption was strongly related to employment grade, the lower the grade the higher proportion of men and women reporting no alcohol consumption. For men the relation of alcohol intake to short spelts of sickness absence (> 7 days) appeared to be U-shaped, for long spells (> 7 days) increased rates of absence were found only in frequent drinkers. There was no clear relationship for women, however higher rates of sickness absence were found in non-drinkers.     

Alcohol consumption, alcohol dependence, and all-cause mortality

BACKGROUND: This study examined the effects of alcohol consumption and DSM-IV alcohol dependence on the risk of mortality. METHODS: Data from the 1988 National Health Interview Survey Alcohol Supplement were matched to the National Death Index for the years 1988 to 1995 (baseline n = 37,682 U.S. adults age > or =25 linked to 3,586 deaths). All mortality analyses were based on proportional hazards models that adjusted for age, sex, race/ethnicity, marital status, education, income, labor force status, body mass index, smoking status, and poor health indicators at baseline. RESULTS: When dependence was not considered and all past-year abstainers were used as the reference group, both light and moderate drinkers exhibited a reduced risk of mortality, with hazards ratios of 0.76 (0.68-0.84) and 0.84 (0.74-0.96). Heavy drinkers had about the same risk of dying as did past-year abstainers, and very heavy drinkers had an increased risk that was not significant (OR = 1.17, CI = 0.93-1.47). When lifetime abstainers were used as the reference category, the protective effect of moderate drinking fell short of significance, and there were nearly significant increased risks among former drinkers and very heavy drinkers. When dependence was considered, light and moderate drinkers without dependence had a reduced mortality risk regardless of reference group, and there was no significant effect among heavy or very heavy drinkers without dependence. Among dependent drinkers, there was no protective effect of light or moderate drinking, and very heavy drinkers had a significantly increased risk (OR = 1.56 relative to past-year abstainers and 1.65 relative to lifetime abstainers). CONCLUSIONS: Because alcohol dependence nullifies the protective effect of light and moderate drinking, it is important to understand its role as an independent risk factor for mortality. Differences between dependent and nondependent drinkers who drank comparable amounts suggest that this risk may result from longer and heavier drinking histories before baseline, more severe health problems at baseline, more heavy episodic drinking, and, possibly, differences in beverage preference.     

Alcohol consumption in high school adolescents: frequency of use and dimensional structure of associated problems

The goal of this paper is in present data regarding the occurrence of alcohol consumption and the relative prevalences and the factorial structure of DSM-IV symptoms of alcohol abuse/dependence in a sample of 1507 older (14–18 years) community adolescents. Participants were diagnostically assessed at two time points, approximately 1 year apart. Three-quarters of the sample had tried alcohol. Boys in general had greater usual frequency and quantity of alcohol consumption than girls and began drinking at an earlier age; girls with a diagnosis of alcohol abuse/dependence had a significantly earlier mean age of alcohol disorder onset and were more likely to have a relapse of alcohol disorder. However, gender differences in symptom prevalence were non-significant. Seventeen per cent of the sample had at least one alcohol abuse/dependence symptom. The most frequent symptoms included reduced activities because of alcohol use, consumed more than intended, and tolerance. Eight of the 11 symptoms made a unique contribution to the prediction of diagnosis in a multiple logistic regression analysis. Components analysis supported the general division of symptoms into the categories of abuse and dependence.     

Alcohol consumption among unemployed youths: results from a prospective study

A prospective study, including all 1083 pupils in the final year of compulsory schooling in a municipality in northern Sweden, was performed. Ninety-seven point nine per cent of the pupils were followed up after five years. They completed a comprehensive self-administered questionnaire including questions on alcohol consumption. Among men a positive correlation between long-standing unemployment (> 20 weeks) and alcohol consumption at the beginning and at the end of the study, as well as the change in consumption during the follow-up period was seen. This correlation was still present when earlier alcohol consumption and socio-economic variables were controlled for. In women there was a positive correlation between unemployment and the level of alcohol consumption, but a negative correlation between unemployment and change in consumption. When controlling for motherhood and alcohol intake at the start of the study the correlation turned positive. Unemployment among women did not seem to affect recruitment to the high consumption group. Our remits support the suggestion that unemployment may be a risk indicator for increasing alcohol consumption among young people, particularly in young men.     

Addiction sciences and its psychometrics: the measurement of alcohol-related problems

AIMS: The focus of this paper is on psychometric issues related to the measurement of alcohol problems. METHODS: Taking a broad perspective, this paper first examines several issues around the use of instruments to provide diagnostic categories in surveys, including dimensionality, severity and alcohol consumption. Secondly, a discussion of some of the political issues surrounding measurement of alcohol problems is presented, including some of the conflicts that arise when the psychometric properties of commonly used instruments are questioned. Finally, newer statistical techniques that can be applied to scale development in the alcohol field are examined, including non-linear multivariate analyses and confirmatory/hypothesis-based methods. RESULTS AND CONCLUSIONS: Continued scholarly discussion needs to be encouraged around these psychometric issues so that instrument development and maintenance in the addiction sciences becomes an ongoing academic pursuit as we strive to measure alcohol problems in the best way possible.     

Attitudes toward alcohol and drug-free experience among college students: relationships with alcohol consumption and problems

This study examined prospective relations between attitudes toward alcohol use and drug-free experience and alcohol consumption and problems in 231 undergraduate students (73% women). Attitude toward drug-free experience was hypothesized to moderate the alcohol attitude--behavior relationship. Participants were assessed twice, separated by a 30-day interval. Attitude toward alcohol use at Time 1 was associated with alcohol consumption at Time 2. Time 1 attitude toward alcohol use and the interaction between the attitude variables were associated with problems at Time 2, indicating that attitude toward alcohol use was less associated with alcohol problems among participants with more positive attitudes toward drug-free experience. Attitude toward drug-free experience acted as a protective factor, reducing the relationship between alcohol attitude and alcohol-related problems.