Confirmatory factor analysis of the Quitting Time for Alcohol Questionnaire

The Quitting Time for Alcohol Questionnaire (QTAQ) was developed by Oei et al. in 1999 to provide a tool that could assess the reasons why a person would cease drinking in a single episode. While this tool was observed to have good psychometric properties, including reliability and validity, the findings have not been replicated, in particular, confirmatory factor analysis has not been provided. This study, using 300 community drinkers, attempted to address this shortcoming. Confirmatory factor analysis supported Oei et al.'s research, indicating that the community sample had a three-factor underlying structure, leading to one total score. The findings show that the QTAQ is a valid and reliable instrument for assessing reasons why people cease drinking in a single session.     

Patterns of Betel Quid,Cigarette, and Alcohol Use,and Their Correlates With Betel Quid Cessation in a Male Inmate Population

Background: There are few published studies addressing multiple substance uses and their effects on subsequent cessation of betel quid (BQ) chewing in the Asia Pacific region. Objectives: This study aims to investigate the usage patterns of BQ chewing, cigarette smoking, and alcohol drinking, and their correlates with subsequent BQ cessation among a male inmate population. Methods: Data from 473 male inmates with a history of BQ use who were incarcerated in Taiwan Kaohsiung Prison was used for this analysis. Participants were asked to report their lifetime usage patterns of cigarette, alcohol, and BQ, and their cessation status of each substance. A stepwise logistic regression analysis was performed to identify predictors of voluntary BQ cessation. Results: Seventy-five percent of all participants reported habitual use of all three substances. A total of 185 (39%) participants reported voluntary cessation of BQ prior to incarceration, and 288 (61%) reported cessation because of incarceration. Inmates who quit smoking before incarceration were more likely to voluntarily quit BQ. Inmates who had drinking habits were less likely to quit BQ, but those who quit drinking before incarceration were more likely to quit BQ. Inmates who preferred the type of BQ known as lao-hwa quid were more likely to quit BQ, and a longer chewing history correlated with a lower likelihood of quitting BQ. Conclusions Importance: Our data suggest that coexisting habitual use of cigarette, alcohol, and BQ is very common in this inmate population. BQ cessation is significantly associated with not only inmates' usage patterns of cigarette and alcohol, but also their cessation status of these substances.     

For all these reasons,I do...drink: a multilevel analysis of contextual reasons for drinking among Canadian undergraduates

OBJECTIVE: Student drinking is largely related to the setting of the drinking occasion as well as to individual psychosocial characteristics. This article assesses the effect of the reasons for drinking on situational alcohol use above and beyond other environmental and individual factors. METHOD: The data were drawn from the Canadian Campus Survey, a national mail survey conducted in 1998 with a sample of 8,864 students in 18 universities. Each student provided information on up to five drinking occasions, resulting in 25,347 drinking occasions among 6,598 drinkers. At the individual level, this study focused on the university life experience. At the situational level, information about alcohol intake was recorded relative to why, when, where and with whom drinking occurred and the reasons for drinking. RESULTS: Our results show that the reasons for drinking explain 8.3% of the variance in individual alcohol intake per occasion at the individual level and 8.1% at the drinking occasion level. CONCLUSIONS: Reasons for drinking and the drinking setting together influence consumption. Moreover, reasons are context specific, because students drink for different reasons in different contexts. Thus, contextual motivational models may be more effective in helping one understand the various pathways to alcohol use and misuse.     

Social cognitive determinants of drinking in young adults: beyond the alcohol expectancies paradigm.

In prior investigations of the psychology of drinking behavior, drinkers' positive expectancies regarding the effects of alcohol have been studied extensively. From a social cognitive point of view, however, several additional psychological factors also deserve attention, namely negative expectancies, social influence, and self-efficacy expectations. In a representative sample of 161 university students, this study examined to what extent inclusion of these additional social cognitive factors enhanced the predictive power of the predominant alcohol-expectancies model of drinking behavior, and to what extent all four social cognitive factors were related to the uptake and cessation of drinking behavior. The three additional social cognitive factors contributed 17% to the explained variance in drinking behavior, in addition to the 18% accounted for by positive expectancies. The constructs with the greatest predictive strength all pertained to the social effects and social context of drinking. The most important predictors of drinking behavior were found to differ for male versus female students, and for students living with their parents versus those living on their own. The data on drinking acquisition and cessation suggest that in this sample little change in drinking behavior could be expected. The social cognitive factors were strongly related to acquisition stages but only weakly to cessation stages. Recommendations for interventions aimed at lowering alcohol intake are given.     

The Effects of a Tobacco Intervention on Binge Drinking Among African American Light Smokers

Tobacco use and binge drinking are commonly associated with each other and research has shown that reducing smoking may influence alcohol use in alcohol-dependent populations. Although African Americans report a lower prevalence of binge drinking than other racial/ethnic groups, they are more likely to report consequences associated with this behavior. The aim of this article was to study the effect of a smoking intervention (counseling) on binge drinking prevalence and the frequency and average daily alcohol consumption in a sample of African American light smokers (those who smoke 10 cigarettes or less per day). Multivariate models were used to assess whether counseling type (health education or motivational interviewing) affected binge drinking prevalence and frequency or average daily alcohol consumption among participants (N = 755). Generalized linear models were run to assess the mediation effect of smoking cessation on the relationship between the counseling intervention and drinking outcomes. Finally, smoking cessation (regardless of counseling type) was assessed to determine the effect on alcohol use outcomes. Overall, counseling type was significantly related to a reduction in past 30-day binge drinking prevalence at week 8 among participants in the health education counseling (P = .045); however, these results diminished within 6 months. Smoking cessation did not appear to mediate the relationship between counseling type and alcohol use outcomes. Regardless of counseling type, individuals who quit smoking within the first 8 weeks of the study reported lower past 30-day binge drinking prevalence at week 8 than those who did not quit during the first 8 weeks (P = .035), but the effect was not sustained at the end of the study (week 26). These results show that tobacco interventions can affect binge drinking, but the effect does not appear to be sustained over time.     

Drinking Reasons and Alcohol Problems by Work Venue Among Female Sex Workers in Guangxi,China

Objective: Alcohol use is a key determinant of sexual risk behaviors, but pathways to alcohol use in the context of commercial sex still remain unclear. The present study explores reasons for drinking and their roles on alcohol use problems among female sex workers (FSWs) in different types of commercial sex venues. Method: In 2009, a sample of 1,022 FSWs from Guangxi, China completed a survey containing a 10-item Alcohol Use Disorders Identification Test (AUDIT) and a 28-item measure of reasons for drinking. Factor analysis revealed five reasons for drinking: suppression, disinhibition, work requirement, sexual enhancement, and confidence booster. Results: All identified reasons except confidence booster appeared to be related to a higher tendency of developing alcohol use problems among FSWs. Types of commercial sex venues moderated the relationship between work requirement and alcohol use problems. Conclusions: Alcohol-risk reduction interventions among this population need to provide them with alternative approaches to regulate emotions and modify their misconceptions about alcohol's sexual enhancing function. More attention is needed to FSWs’ vulnerability to the negative influence of occupational drinking.     

Risk factors for alcohol use, frequent use, and binge drinking among young men who have sex with men

We examined the prevalence and patterns of alcohol use within a large, ethnically diverse sample of young men who have sex with men (YMSM) and identified psychosocial correlates of these alcohol-use patterns. A sample of 526 YMSM (ages 18-24 years) was recruited in Los Angeles, CA using a venue-based, stratified probability sampling design. Based on criteria used by previous research with young adults, participants were assigned to one of four alcohol-use/non-use groups according to frequency and number of drinks per sitting in the last 30 days. Findings revealed a high prevalence of alcohol use (91%) within the sample, with 21% reporting binge drinking; of binge drinkers, 40% reported frequent binge drinking. Multinomial logistic regression analyses revealed that race/ethnicity, gay bar attendance, depression, sensation seeking, peer risk behaviors, and age of alcohol initiation significantly differentiated between non-/light users from frequent and binge drinkers. Results also indicated unique psychosocial profiles among frequent/binge drinkers. The heterogeneity of predictors associated with different patterns of alcohol use highlights the need to consider unique risk profiles and alcohol-use trajectories according to exposure to different risk and protective factors.     

Investigating the utility of mobile phones for collecting data about adolescent alcohol use and related mood,stress and coping behaviours: Lessons and recommendations

Introduction and Aims. The trajectory from alcohol use to alcohol use disorders in adolescence is yet to be understood. Momentary sampling may assist in capturing ‘real‐time’ data on young people's alcohol use and associated motivational factors. This paper aims to review the feasibility and usefulness of a mobile phone momentary sampling program to capture data about alcohol use and related behaviours. Design and Methods. Two studies were conducted: a school‐based study with 18 Year 9 and 11 students and a clinical study with eight high‐risk adolescent drinkers. Participants answered questions about their daily activities, alcohol use, stressors and negative mood four times a day for 1 week using a mobile phone momentary sampling program. Results. In the school‐based study, 61% of participants reported drinking alcohol. On drinking days participants spent less time studying (14% vs. 26%), more time sleeping or resting (35% vs. 12%) and more time hanging out (21% vs. 11%) than on non‐drinking days. In the high‐risk sample, 88% of participants reported drinking alcohol. On drinking days, these participants spent a greater proportion of their waking time with their boyfriend or girlfriend (19.2% vs. 6%) and generally had higher negative mood than on non‐drinking days. Discussion and Conclusions. The current mobiletype program was well suited to capturing data on alcohol use in younger, school‐attending adolescents. However, to capture alcohol use in older adolescents who lead less routine lives, it is necessary to make some amendments including targeting particular behaviours and symptoms. Recommendations for future studies are proposed.[Kauer SD, Reid SC, Sanci L & Patton GC. Investigating the utility of mobile phones for collecting data about adolescent alcohol use and related mood, stress and coping behaviours: Lessons and recommendations. Drug Alcohol Rev 2009;28:25–30]     

Adolescent alcohol reduction and cessation expectancies

OBJECTIVE: Although many youths reduce or stop drinking without formal treatment, little is known of cognitive mechanisms influencing such alcohol change efforts during adolescence. The present research examines alcohol cessation expectancies of adolescents in the context of a cognitive-behavioral de-escalation model of alcohol use. Grounded in Developmental Social Information Processing theory (Coie and Dodge, 1998) and empirical findings on adolescent self-change process, alcohol cessation expectancies are defined as anticipated consequences of ceasing or decreasing drinking. The present study is the first to develop a measure of adolescent alcohol cessation expectancies. METHOD: A 23-item measure was administered to 5,446 high school students (51% female) as part of a survey on alcohol and drug use. RESULTS: Using data for adolescents who reported any history of alcohol use (N = 3,098), exploratory and confirmatory factor analyses identified expectations of global changes and social effects. Expectancy factor structure was examined within drinking groups (light, moderate, heavy drinkers) and as a function of age and change goal (reduction and cessation). Predictive validity of the expectancy measure was examined for youth who reported efforts to decrease or stop drinking during the prior year. Our results suggest greater differentiation in cessation expectancies with increased alcohol experience. The findings also provide evidence that youth cessation expectancies uniquely predict alcohol change efforts over and above alcohol use and problems. CONCLUSIONS: Youths maintain several types of alcohol reduction/cessation expectancies predictive of behavioral change efforts. Articulation of this construct for youth contributes to an understanding of mechanisms involved in adolescent efforts to reduce or stop drinking.     

A comparison of African-American versus Caucasian men screened for an alcohol administration laboratory study: recruitment and representation implications

African-Americans are under-represented in alcohol research, especially alcohol administration laboratory studies. Specific recruitment of African-Americans into laboratory studies, however, may also inadvertently affect the generalizability of the findings. In the current study, we compared all African-American young adult men (n=53) who volunteered and met criteria for an alcohol administration study to a sample (n=50) of Caucasian men recruited for the same study. Groups were compared on variables including demographics, quantity and frequency of alcohol consumption and other substance use, consequences of use and psychopathology. Compared to their Caucasian counterparts, African-American men reported less drinking frequency and quantity, less use of other substances and fewer negative consequences, but their alcohol and drug use was more likely to be associated with various measures of psychopathology. Results suggest that even when recruiting participants using criteria that should minimize differences (i.e. all participants were "social drinkers"), differences on key variables were evident. These differences may have important implications for alcohol research.     

Reciprocal effects of alcohol and nicotine in smoking cessation treatment studies

Objective

Smoking and alcohol use are highly related; as such the present study investigated whether alcohol use is associated with failure in tobacco cessation attempts. We first examined the self-reported drinking behavior and smoking over the course of a year at a basic level. Next, we addressed two hypotheses to characterize this relationship at a deeper level: (Hypothesis 1) Alcohol use would be lower for those who attempted to quit smoking (quit for one or more days) during the year compared to those who never quit, and (Hypothesis 2) for those who relapsed to smoking after a quit increases in alcohol consumption would be positively associated with increases in smoking.

Method

Subjects were participants in two smoking cessation programs. One group of participants (N = 139) was part of a smoking cessation study in alcohol dependent smokers in early recovery and the other group of participants (N = 163) was drawn from a smoking cessation study for HIV positive smokers.H1 was tested using t-tests. For H2, a time series analysis examined relationships between smoking and alcohol use within person over a one year period. For H1 and for H2, the analyses utilized bivariate time series procedures. Timeline follow-back data allowed for detailed daily reports of both tobacco and alcohol use.

Results

In the overall sample, there was no difference in alcohol use between those who stopped smoking and those who never stopped. However, when broken up by study, a difference was found in the alcohol dependent sample such that mean drinks were higher for those who stopped compared to those who never stopped smoking (H1). The results indicated a high number of positive significant cross-correlations between tobacco and alcohol use such that one substance predicted current, as well as past and future use of the alternate substance. Same-day cross-correlations were the most common, and dissipated with time (H2).

Conclusions

This analysis provided insights into the proximal influence of one substance on the other. Alcohol is related to relapse in smoking cessation attempts. It is important that smoking cessation efforts in alcohol using populations consider alcohol use in treatment.     

Psychosocial, cultural and genetic influences on alcohol use in Asian American youth

OBJECTIVE: Environmental and cultural factors, as well as a genetic variant of the aldehyde dehydrogenase gene (the ALDH2*2 allele) have been identified as correlates of alcohol use among Asian Americans. However, concurrent examination of these variables has been rare. The present study assessed parental alcohol use, acculturation and ALDH2 gene status in relation to lifetime, current and heavy episodic drinking among Chinese and Korean American undergraduates. METHOD: Participants (N = 428, 51% women; 52% Chinese American, age 18-19 years) were first-year college students in a longitudinal study of substance use initiation and progression. Data were collected via structured interview and self-report, and participants provided a blood sample for genotyping at the ALDH2 locus. RESULTS: Gender, parental alcohol use and acculturation significantly predicted drinking behavior. However, none of the hypothesized moderating relationships were significant. In contrast with previous studies, ALDH2 gene status was not associated with alcohol use. CONCLUSIONS: Results indicate that although the variables examined influence alcohol use, moderating effects were not observed in the present sample of Asian American college students. Findings further suggest that the established association of ALDH2 status and drinking behavior in Asians may not be evident in late adolescence. It is possible that ALDH2 status is associated with alcohol consumption only following initiation and increased drinking experience.     

Extension of the simulated drinking game procedure to multiple drinking games

The present study extended the Simulated Drinking Game Procedure (SDGP) to obtain information about different types of drinking games. Phase I participants (N = 545) completed online screening questionnaires assessing substance use and drinking game participation. Participants who met the selection criteria for Phase II (N = 92) participated in laboratory sessions that consisted of three different periods of drinking game play. Sixty-two percent (N = 57) of the sample was female. Data from these sessions was used to estimate the peak Blood Alcohol Concentration (BAC) a participant would achieve if they consumed alcohol while participating in the SDGP. Total consumption and estimated BAC varied as a function of game type. The total consumption and estimated BAC obtained while playing Beer Pong and Memory varied significantly as a function of group. Total ounces consumed while playing Three Man varied significantly as a function of group; however, the variation in estimated BAC obtained while playing Three Man was not significant. Results indicated that estimated BACs were higher for female participants across game type. Previous experience playing the three drinking games had no impact on total drink consumption or estimated BAC obtained while participating in the SDGP. The present study demonstrated that the SDGP can be used to generate estimates of how much alcohol is consumed and the associated obtained BAC during multiple types of drinking games. In order to fully examine whether previous experience factors in to overall alcohol consumption and BAC, future research should extend the SDGP to incorporate laboratory administration of alcohol during drinking game participation.     

Gender, perceptions of harm, and other social predictors of alcohol use in a Punjabi community in the Toronto area

Based on self-administered face-to-face interviews conducted in 1992-93 with 524 members of the Punjabi community in Peel, near Toronto, this study investigates the factors associated with alcohol use in the community. Results from alcohol and other drug surveys in Ontario are used for comparison between the two samples regarding drinking and sociodemographic characteristics. Bivariate analyses indicate a lower prevalence rate of drinking among the Punjabi sample than the Ontario population, especially among women. In spite of this, a majority of the Punjabi respondents perceive that alcohol problems are widespread in their community. Logistic regression results show that sex, importance of religion, perceived risk of alcohol, and opinion on alcohol price in the province are significantly associated with alcohol use. The effects of socioeconomic status, perception of public drunkenness, and levels of integration appear to be not significant. In light of these results, some implications for "alcohol abuse" prevention strategies are discussed.     

Predictors of short-term course of drinking in untreated rural and urban at-risk drinkers: effects of gender, illegal drug use and psychiatric comorbidity

OBJECTIVE: The purpose of this study was to examine predictors of changes in drinking and drinking consequences in untreated at-risk drinkers in a community sample. METHOD: Four waves of telephone interviews were conducted at 6-month intervals with a probability sample of at-risk drinkers in the rural and urban South (initial N = 733). Participants were interviewed at each wave regarding concurrent drug use, psychopathology and social support, as well as alcohol service use. Individuals reporting receiving services for drinking (n = 69) were dropped from the analyses. Longitudinal data were analyzed for predictors of quantity and frequency of drinking, "safe" drinking levels and diagnoses of recent alcohol disorder. Simultaneous and lagged models were fit for each dependent variable. RESULTS: Over the period of study, drinking quantity and alcohol diagnoses decreased, and safe drinking increased. Only a few variables, including drug use and rural residence, predicted change over time for some outcomes. Remaining significant effects associated with drinking outcomes were constant throughout the study. Women and participants scoring high on religiosity experienced better outcomes; illegal drug use and social consequences of drinking were associated with worse outcomes. Rural residents maintained higher drinking quantity and were less likely to be safe drinkers than urban residents were. Psychiatric comorbidity was significantly associated only with drinking quantity. CONCLUSIONS: These data distinguish which at-risk drinkers might benefit from short or delayed interventions in primary care or community settings, and which should receive more intensive, targeted interventions and be encouraged to enter formal treatment as soon as possible.     

Motives for not drinking alcohol among Australian adolescents: development and initial validation of a five-factor scale.

Why people drink has been the subject of much research, however, why people do not drink has been largely neglected. The aim of the present study was to develop a Motives for Abstaining from Alcohol Questionnaire (MAAQ) based on Cox and Klinger's [Journal of Abnormal Psychology 97 (1988) 168; Why people drink (1990) 291] motivational model of alcohol use to investigate reasons for not drinking alcohol either at all or on certain occasions. An initial 35-item version of the MAAQ was administered to 187 Australian high school students (years 10 and 12). Analyses supported a five-factor model with the final 19-item version explaining 60% of the variance. The factors were easily interpretable and were labeled: fear of negative consequences, dispositional risk, family constraints, religious constraints, and indifference toward alcohol. Regression analyses showed that different motives for not drinking predicted different aspects of alcohol use. Results are discussed in terms of theories of alcohol use that emphasize the interface of opponent motivational pathways toward decisions to drink.     

Rural at-risk drinkers: correlates and one-year use of alcoholism treatment services

OBJECTIVE: The purpose of this study was to identify a community sample of rural and urban at-risk drinkers, to compare them in terms of sociodemographics, access measures and severity of illness, and to study them prospectively to identify rural/urban differences in use of 12-month alcoholism treatment services. METHOD: A brief telephone screening interview of over 12,000 respondents in six southern states identified a sample of at-risk drinkers. A baseline interview was administered to 733 individuals (67% men, 50% rural residents) that obtained information on substance use and psychiatric disorders, psychosocial factors, social support, four dimensions of access to alcoholism treatment services and prior alcoholism service use. Interviews at 6 and 12 months obtained self-reports of subsequent receipt of alcoholism treatment services. RESULTS: We identified modest differences between rural and urban at-risk drinkers. The rural sample was significantly less well-educated and reported significantly less affordability, accessibility and acceptability of some treatment services (p < .05). Rural at-risk drinkers also appeared to possess significantly greater illness characteristics, including more lifetime DSM-IV criteria for alcohol use disorders, more frequent recent alcohol disorders and more chronic medical problems (p < .05). The longitudinal sample comprised 579 participants, of whom 7% reported receiving some form of alcoholism treatment services in the year after the initial interview. In bivariate analysis, rural drinkers in the sample reported greater use of help for their drinking, more use of psychiatrists and more use of inpatient, outpatient and ER treatment settings than did their urban counterparts. However, significant independent predictors of 12-month alcoholism treatment use in multiple logistic regression were female gender (OR = 0.3), greater social support (OR = 2.2) and illness or severity characteristics including recent diagnosis of alcohol dependence (OR = 3.3), social consequences of drinking (OR = 1.7), concurrent medical problems (OR = 2.1) and prior treatment experience (OR = 4.4). CONCLUSIONS: We found modest differences among rural and urban at-risk drinkers and some evidence of greater barriers to treatment and greater illness severity among rural inhabitants. Further research is needed to know whether community interventions with social networks and other interventions to improve social support may help bring at-risk drinkers into treatment in both urban and rural settings as well as provide other support for sobriety.     

College student drinking, attitudes toward risks, and drinking consequences

OBJECTIVE: This study examined whether college students' attitudes toward risks explain significant variance in drinking consequences beyond gender, alcohol use, and self-protective strategies. METHOD: A derivation sample (N=276; 52% women) and a replication sample (N=216; 52% women) of undergraduate students completed the Campus Alcohol Survey (CAS) and the Attitudes Toward Risks Scale (ATRS). RESULTS: Scores on the ATRS correlated positively with students' self-reported typical number of drinks and negative drinking consequences (p<.001). Hierarchical regression analyses indicated that ATRS scores explained significant variance in negative drinking consequences beyond college students' gender, typical number of drinks, and use of protective strategies (p<.001). Furthermore, a significant Drinks x ATRS interaction revealed that heavy-drinking students who scored high on the ATRS experienced the most harm from drinking (p<.01). Students with high-risk attitudes showed a stronger link between typical number of drinks and negative drinking consequences. CONCLUSIONS: Even when controlling for students' gender, alcohol use, and protective strategies, college students' attitudes toward risks explain significant variance in drinking consequences.     

Concurrent treatment for alcohol and tobacco dependence: are patients ready to quit both?

The prevalence of smoking among alcohol abusers is high, yet little is known about this dual-dependency. This study examines mechanisms involved in changing both alcohol and tobacco use concurrently using the transtheoretical model (TTM) measures of change. Alcohol and tobacco dependent outpatients (N=115) entering a dual-substance dependence program were compared on baseline measures of motivation, self-initiated change activities, and self-efficacy associated with each substance use behavior. Differences on these measures were expected for drinking versus smoking. Motivation to change each behavior was also examined as a potential predictor of retention in treatment. Results indicated that patients reported higher self-efficacy to abstain and lower temptation to use alcohol relative to cigarettes. Change activities were also initiated at higher levels for drinking compared with smoking. An interaction between drinking and smoking motivation for change was found in the prediction of treatment retention; those with higher motivation for changing their alcohol use and lower motivation to quit smoking remained longer in treatment, while those who were higher in motivation for changing both behaviors dropped out the earliest. Overall, participants in this dual-dependence program were more confident and active in changing their alcohol use. Initiating cessation of both behaviors equally and simultaneously may prove difficult for this population. This study initiates an understanding of the mechanisms involved in changing alcohol-tobacco dependence and may provide guidance for developing dual cessation interventions.