Do College Students Drink More Than They Think? Use of a Free‐Pour Paradigm to Determine How College Students Define Standard Drinks

RATIONALE: Much of what is known about college drinking comes from self-report survey data. Such surveys typically ask students to indicate how many drinks they consume within a given period of time. It is currently unclear whether college students and researchers use similar operational definitions of a single drink. This information is critical given the widespread reliance on survey data for assessing the correlates and consequences of college drinking. OBJECTIVES: This study investigated whether college students define standard drink volumes in a way that is consistent with the operational definitions commonly used by researchers. METHODS: Students (n = 106) were administered an alcohol survey and then asked to perform three tasks. The tasks involved free-pouring fluid into empty cups of different sizes and estimating the volume of a single beer, a shot of liquor, or the amount of liquor in a mixed drink. The volumes poured by students then were compared with standards used in a well-known nationwide survey (i.e., 12 oz of beer and 1.25 oz of liquor in a shot or mixed drink). RESULTS: In every cup size of every task, students overestimated how much fluid they should pour to create a standard drink. In all three tasks, the magnitude of the discrepancy increased with cup size. Collapsed across cup sizes, students overpoured shots by 26%, mixed drinks by 80%, and beer by 25%. When a more liberal serving size of liquor (1.5 oz) was used as the standard, the results of the mixed drink task remained unchanged. However, the volumes poured by students during the shot free-pour task differed from the standard in only one cup size. CONCLUSIONS: The data suggest that college students drink more alcohol than indicated by their survey responses, raising questions about the validity of widely used alcohol surveys. Efforts to educate students about the alcohol content of standard drinks should be enhanced.     

Older Women and HIV: How Much Do They Know and Where Are They Getting Their Information?

OBJECTIVES: To assess older urban women's knowledge about sexual transmission of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and to evaluate the relationship between their HIV/AIDS knowledge level and sources of information. DESIGN: Cross-sectional survey conducted between June 2001 and July 2002. Trained research assistants administered a questionnaire in a face-to-face interview. SETTING: General medicine clinic in a large public hospital in a high HIV/AIDS incidence area. PARTICIPANTS: Five hundred fourteen women aged 50 and older. MEASUREMENTS: Nine questions assessing knowledge of risk of HIV sexual transmission with potential scores ranging from 0 to 9 correct answers. Participants identified all sources of HIV information. RESULTS: The mean knowledge score was 3.7 out of a possible 9 correct responses (range 0 (3%) to 8 (1%)). Younger age, employment, and higher educational level were associated with higher knowledge scores, whereas marital status was unrelated. No respondent correctly answered all of the nine questions. The most commonly identified sources of HIV/AIDS information were television (85%), friends (54%), and newspapers (51%). Only 38% of respondents identified health professionals as a source of information about HIV/AIDS. Health professionals, newspapers, and family members were each independently associated with higher knowledge scores (P<.05). CONCLUSION: Older women in a general medicine clinic had limited knowledge of sexual transmission of HIV. HIV/AIDS education specifically targeted to this subpopulation is warranted, and health professionals may have an important role in disseminating such messages.     

Drinking Game Behaviors among College Students: How Often and How Much?

Background: Participation in drinking games (DG) has been identified as a common health-risk behavior among college students. However, research suggests that the frequency of DG participation alone may not pose a significant health risk; rather, gaming may be most hazardous when large amounts of alcohol are consumed. Objectives: The present study was designed to examine whether specific gaming behaviors (frequency of play and amount of consumption) place gamers at elevated risk for negative drinking outcomes. Method: Students from 30 U.S. colleges completed self-report questionnaires via the Internet about their drinking attitudes and behaviors. Four groups of student gamers (N = 2,230) were examined: low frequency/low consumption (n = 1,047), low frequency/high consumption (n = 453), high frequency/low consumption (n = 326), and high frequency/high consumption (n = 404). Results: Multilevel regression analyses indicated that the frequency x consumption interaction emerged as a significant predictor of negative drinking consequences. Follow-up analyses indicated that quantity of alcohol consumed during DG predicted negative drinking consequences for high-frequency gamers only. Conclusions/Scientific Contribution: The present results challenge the assumption that all drinking-gaming practices pose equivalent health risks for gamers. Considering only participation in or level of consumption during DG may not tell the complete story with respect to the health hazards involved with gaming behaviors among college students.     

Health Risks of Chronic Moderate and Heavy Alcohol Consumption: How Much Is Too Much?

This article presents the proceedings of a symposium held at the meeting of the International Society for Biomedical Research on Alcoholism (ISBRA) in Mannheim, Germany, in October 2004. Most of what we know about the deleterious effects of alcohol in vivo has been gleaned from studies in sober alcoholics recruited from substance abuse treatment programs. Little is known about effects of chronic drinking in the moderate or heavy range encountered in a much larger fraction of modern society. Extrapolation of information on the adverse effects of chronic drinking on organ function from clinical samples to social drinkers in the general population has to be met with great skepticism, as it may lead to wrong conclusions about the chronic effects of alcohol in social drinkers. Several recent studies suggest that moderate alcohol consumption has certain beneficial health effects, whereas heavy social alcohol consumption has recently been associated with organ abnormalities and cognitive deficits. These social drinking effects have attracted great public interest; reports of benefits of moderate drinking have also inspired inappropriate publications by the media, including misleading advertisements by the alcohol producing and distributing industry. Although adverse effects of moderate to heavy drinking on heart, liver, and cancer development have attracted attention by clinicians and researchers for some time, its compromising effects on brain and cognition have only recently been studied. This symposium brought together researchers from different disciplines, who reviewed and presented new data on consequences of social drinking in the areas of clinical neuropsychology and behavior (Drs. Nixon and Meyerhoff), neurophysiology (Dr. Nixon, Ms. De Bruin), neuroimaging (Ms. de Bruin, Dr. Meyerhoff), hepatic disease (Dr. Bode), and cancer (Dr. Seitz). The symposium aimed to clarify both the potential health benefits of moderate alcohol consumption and risks of moderate and heavy drinking on proper organ function and to provide insights and new data to practicing physicians and public health authorities for education on problem drinking.     

Seasonal Variation in Metabolic Syndrome Components: How Much Do They Influence the Diagnosis of Metabolic Syndrome?

Obesity and hypertension are increasing problems worldwide, resulting in an enormous economic burden to the society. The metabolic syndrome components (ie, central obesity, dyslipidemia, hyperglycemia, and hypertension) are used to identify individuals at high risk of developing cardiovascular disease and type 2 diabetes. The cause of the syndrome is not yet clear, but insulin resistance and dyslipidemia have been proposed. Emerging evidence suggest that increased visceral adipose tissue stimulates secretion of bioactive compounds that promote inflammation, oxidative stress, and impair lipid metabolism and vascular relaxation. Interestingly, all components of the metabolic syndrome display seasonal variation, and hence may influence diagnosis. The seasonal variability in metabolic components is partly explained by changes in climate and lifestyle factors (eg, physical activity and diet). The clinical role for seasonal variations in metabolic risk factors remains to be further elucidated. However, the new findings indicate that seasonal variation should be considered in diagnosis and management decisions.     

The Validity of DSM‐IV Alcohol Dependence: What Do We Know and What Do We Need to Know?

This article presents the proceedings of a symposium at the 2002 RSA Meeting in San Francisco, California. Deborah S. Hasin organized the symposium and co-chaired it with Marc Schuckit. The purpose of the symposium was to provide an overview of what is known about the validity of DSM-IV and ICD-10 alcohol dependence and abuse, with a focus on work done since 1994. Presentations included: (1) Validity of DSM-III-R alcohol dependence in adolescents, by Christopher S. Martin; (2) Reliability and validity of DSM and ICD formulations of alcohol use disorders: findings from epidemiology, by Bridget F. Grant; (3) Validity and reliability of the alcohol-dependence phenotype in the context of genetic studies, by Kathleen K. Bucholz; and (4) DSM-IV and beyond: uniting the clinical utility of categories with the precision of dimensions, by John E. Helzer. The findings supported the validity of DSM-IV alcohol dependence across numerous study designs and samples, suggested some value in a dimensional dependence measure, and raised questions about the validity of the diagnosis of alcohol abuse as currently defined. Marc Schuckit, as discussant for the symposium, placed the issues in perspective for the upcoming DSM-V.     

Do Alcoholics Anonymous Groups Really Work? Factors of Adherence in a Brazilian Sample of Hospitalized Alcohol Dependents

This study was designed to determine factors affecting adherence to Alcoholics Anonymous (AA) groups. This cohort involved 300 alcoholics committed to three hospitals in Porto Alegre, Brazil. They were interviewed again in their homes after six months. The SCID-I and a questionnaire focusing on patient relationship with AA groups were used. The responses obtained through the questionnaire were independently evaluated by two researchers. AA adherence was below 20%. The main factors reported by patients as reasons for non-adherence to AA were relapse, lack of identification with the method, lack of need, and lack of credibility. The factors reported by patients as reasons for adherence were identification with the method and a way to avoid relapse. Although AA is considered an effective intervention for alcoholism, its adherence rate was excessively low. The identification of these nonadherence factors could help health professionals in referring certain alcoholic patients to therapeutic interventions other than AA.     

A Drink Is A Drink? Variation in the Amount of Alcohol Contained in Beer,Wine and Spirits Drinks in a US Methodological Sample

BACKGROUND: Empirically based estimates of the mean alcohol content of beer, wine and spirits drinks from a national sample of US drinkers are not currently available. METHODS: A sample of 310 drinkers from the 2000 National Alcohol Survey were re-contacted to participate in a telephone survey with specific questions about the drinks they consume. Subjects were instructed to prepare their usual drink of each beverage at home and to measure each alcoholic beverage and other ingredients with a provided beaker. Information on the brand or type of each beverage was used to specify the percentage of alcohol. RESULTS: The weighted mean alcohol content of respondents' drinks was 0.67 ounces overall, 0.56 ounces for beer, 0.66 ounces for wine and 0.89 ounces for spirits. Spirits and wine drink contents were particularly variable with many high-alcohol drinks observed. CONCLUSIONS: While the 0.6-ounce of alcohol drink standard appears to be a reasonable single standard, it cannot capture the substantial variation evident in this sample and it underestimates average wine and spirits ethanol content. Direct measurement or beverage-specific mean ethanol content estimates would improve the precision of survey alcohol assessment.     

Biomarkers of Cardiac Stress and Injury in Athletes: What Do They Mean?

Purpose of the Review

Markers of myocardial stress, including troponin, creatine kinase, and brain natriuretic peptide are frequently elevated after endurance athletic pursuits. Here, we summarize the current literature pertaining to the potential mechanism of cardiac enzyme release in athletes and seek to determine the clinical implications of these findings.

Recent Findings

Recent studies have highlighted the potential adverse cardiac effects of long-term extreme endurance exercise. While troponin release occurs in a pattern distinct from ischemic damage, BNP release has been correlated with right ventricular dysfunction and is likely related to wall stress from prolonged increases in cardiac output. Higher intensity pre-race training regimes are associated with lower race-day enzyme release.

Summary

While the holistic benefits of regular moderate exercise are indisputable, recent studies have raised concerns about the potential risks of extreme endurance exercise. Release of serum biomarkers suggesting myocardial damage was first described in the 1970s, yet our understanding of the implications of these findings remains incomplete. The mechanisms of release are complex but appear to be primarily physiological phenomena rather than pathologic.

     

The Health Implications of Sucrose,High-Fructose Corn Syrup,and Fructose: What Do We Really Know?

The epidemic of obesity and related metabolic diseases continues to extract an enormous health toll. Multiple potential causes for obesity have been suggested, including increased fat consumption, increased carbohydrate consumption, decreased physical activity, and, most recently, increased fructose consumption. Most literature cited in support of arguments suggesting a link between obesity and fructose consumption is epidemiologic and does not establish cause and effect. The causes of obesity are well-known and involve the overconsumption of calories from all sources. Research employing a pure fructose model distorts the real-world situation of fructose consumption, which predominantly comes from sweeteners containing roughly equal proportions of glucose and fructose. The fructose hypothesis has the potential to distract us from further exploration and amelioration of known causes of obesity. Randomized prospective trials of metabolic consequences of fructose consumption at normal population levels and from sources typically found in the human diet such as sucrose and high-fructose corn syrup are urgently needed.     

Where,With Whom,and How Much Alcohol Is Consumed on Drinking Events Involving Aggression? Event‐Level Associations in a Canadian National Survey of University Students

Background: Epidemiological research using event‐level data can provide a better understanding of the association between alcohol consumption, characteristics of drinking contexts, and the likelihood of aggressive behavior. The present research assessed whether alcohol intake and characteristics of the drinking context were associated with the likelihood of aggression within individuals across 3 drinking events based on a national sample of university students, taking into account individual characteristics and university level variables. Additionally, we determined whether individual characteristics, particularly drinking pattern, were associated with alcohol‐related aggression controlling for drinking event characteristics, and whether relations of aggression to alcohol and drinking contexts differed by gender. Methods: Secondary analyses of the 2004 Canadian Campus Survey (CCS), a national survey of 6,282 university students (41% response rate) at 40 Canadian universities, were conducted. Respondents were asked about their three most recent drinking events, including whether they were in an argument or fight with someone, number of drinks consumed, and characteristics of the drinking context as well as their usual drinking frequency and heavy episodic drinking. We used multi‐level analyses to account for the nested structure of the data (i.e., drinking events nested within individuals who were nested within universities). Results: The number of drinks consumed was positively associated with aggression. Drinking contexts found to be positively associated with aggression included being at a party, at a fraternity/sorority and/or residence, at three or more drinking places (versus 1 or 2), and having a partner present whereas having a meal reduced the likelihood of aggression. A significant interaction was found between gender and being at a party, with a significant effect found for women but not for men. Conclusions: These results support experimental evidence indicating a direct role of alcohol in aggression and point to characteristics of the drinking context that might be targeted in future prevention initiatives.     

Fatty Acid Ethyl Esters in Meconium: Are They Biomarkers of Fetal Alcohol Exposure and Effect?

BACKGROUND: Biomarkers of fetal exposure to alcohol are important to establish so that early detection and intervention can be made on these infants to prevent undesirable outcomes. The aim of this study was to analyze long-chain fatty acid ethyl esters (FAEEs) in meconium as potential biomarkers of fetal alcohol exposure and effect. METHODS: Fatty acid ethyl esters were analyzed in the meconium of 124 singleton infants by positive chemical ionization gas chromatography/mass spectrometry (GC/MS) and correlated to maternal ethanol use. RESULTS: A total of 124 mother/infant dyads were enrolled in the study: 31 were in the control group and 93 were in the alcohol-exposed group. The incidence (28% vs 9.7%, p = 0.037) of ethyl linoleate detected in meconium was significantly higher in the alcohol-exposed groups than the control groups. Similarly, when the concentrations of ethyl linoleate in meconium were grouped (trichotomized), there was a significant linear by linear association between alcohol exposure and group concentrations of ethyl linoleate (p = 0.013). Furthermore, only alcohol-exposed infants were found in the group with the highest ethyl linoleate concentration. The sensitivity of ethyl linoleate in detecting prenatal alcohol exposure was only 26.9%, and its specificity and positive predictive value were 96.8 and 96.2%, respectively. There was no significant correlation between the concentration of ethyl linoleate in meconium and absolute alcohol consumed (oz) per drinking day across pregnancy, although a trend toward a positive correlation is seen at lower amounts of alcohol consumed. Among the polyunsaturated, long-chain FAEEs, there was weak evidence that the incidence (21.5% vs 6.5%, p = 0.057) and concentration (p = 0.064) of ethyl arachidonate (AA) were significantly higher in the alcohol-exposed groups than the control groups. Ethyl linolenate and ethyl docosahexanoate (DHA) in meconium were found only in the alcohol group, although not at statistically significant levels. Highly significant correlations were found among the concentrations of ethyl linoleate, ethyl linolenate, ethyl AA, and ethyl DHA in meconium (correlations ranged between rs = 0.203, p = 0.024; and rs = 0.594, p < 0.001). CONCLUSION: We conclude that FAEEs in meconium, particularly ethyl linoleate and ethyl AA, are biomarkers of high specificity for prenatal exposure to alcohol in newborn infants. We also propose that ethyl AA and DHA could be potential biomarkers of fetal alcohol effects on the developing fetal brain and should be investigated further.     

Quality of Life in Adult Congenital Heart Disease: What Do We Already Know and What Do We Still Need To Know?

Quality of life (QOL) is a key outcome in patients with congenital heart disease (CHD) because CHD has become a chronic condition accompanied by lifelong impairments. Recently, published studies on QOL in adults with CHD have reported inconsistent findings. Patients’ QOL seems to depend on multiple factors and is not solely determined by their heart defect and various medical or demographic characteristics. For instance, evidence suggests that a strong sense of coherence might be an important pathway to improve QOL. However, studies on QOL and its determinants are characterized by important methodological differences and limitations, making it impossible to draw firm conclusions. To fill the gaps in the current evidence base, longitudinal and international research is needed. Furthermore, the research field on QOL in CHD should move on from observational studies to interventional research to guide health professionals in improving QOL.     

Alpha-Melanocyte-Stimulating Hormone and Agouti-Related Protein: Do They Play a Role in Appetite Regulation in Childhood Obesity?

Objective:

The hypothalamus plays a crucial role in the regulation of feeding behavior. The anorexigenic neuropeptide alpha-melanocyte-stimulating hormone (α-MSH) and the orexigenic neuropeptide agouti-related protein (AgRP) are among the major peptides produced in the hypothalamus. This study investigated the plasma concentrations of α-MSH and AgRP in underweight and obese children and their healthy peers. The associations between α-MSH and AgRP levels and anthropometric and nutritional markers of malnutrition and obesity were also assessed.

Methods:

Healthy sex-matched subjects aged 2 to 12 years were divided into 3 groups, as underweight (n=57), obese (n=61), and of normal weight (n=57). Plasma fasting concentrations of α-MSH and AgRP were measured by enzyme-linked immunosorbent assay. The differences between the three groups as to the relationships between plasma concentrations of α-MSH and AgRP and anthropometric data, serum biochemical parameters and homeostatic model assessment of insulin resistance were evaluated.

Results:

Obese children had significantly lower α-MSH levels than underweight (1194±865 vs. 1904±1312 ng/mL, p=0.006) and normal weight (1194±865 vs. 1762±1463 ng/mL, p=0.036) children; there were no significant differences in the α-MSH levels between the underweight and normal weight children (p=0.811). Also, no significant differences were observed between the underweight and obese children regarding the AgRP levels (742±352 vs. 828±417 ng/mL, p=0.125). We found a significant positive correlation between plasma α-MSH and AgRP levels across the entire sample.

Conclusion:

This study is the first to demonstrate body weight-related differences in α-MSH and AgRP levels in children. Circulating plasma α-MSH levels in obese children were markedly lower than those of underweight and normal-weight children. This suggests that α-MSH could play a role in appetite regulation.     

Advance Directives for Euthanasia in Dementia: How Do They Affect Resident Care in Dutch Nursing Homes? Experiences of Physicians and Relatives

OBJECTIVES: To gain insight into how advance directives for euthanasia affect resident care in Dutch nursing homes. DESIGN: Survey of elderly care physicians and additional qualitative interviews with a selection of elderly care physicians and relatives of people with dementia who had an advance directive for euthanasia. SETTING: Dutch nursing home practice. PARTICIPANTS: Four hundred thirty‐four elderly care physicians completed the general part of the questionnaire; 110 physicians provided case histories. Interviews were conducted with 11 physicians and eight relatives. MEASUREMENTS: The questionnaire contained general questions about the incidence of advance directives for euthanasia in people with dementia. A second part involved questions about the most recent case of a person with dementia and an advance directive for euthanasia who had died. The interviews with elderly care physicians and relatives focused on further exploration of the decision‐making process regarding adherence to the advance directive for euthanasia. RESULTS: Despite law‐based possibilities, advance directives for euthanasia of people with dementia were rarely adhered to, although they seem to have a supportive role in setting limitations on life‐sustaining treatments. Elderly care physicians and relatives were found to be reluctant to adhere to advance directives for euthanasia. Not being able to engage in meaningful communication played a crucial role in this reluctance. CONCLUSION: Advance directives for euthanasia are never adhered to in the Netherlands in the case of people with advanced dementia, and their role in advance care planning and end‐of‐life care of people with advanced dementia is limited. Communication with the patient is essential for elderly care physicians to consider adherence to an advance directive for euthanasia of a person with dementia.     

“They Do Not Know How To Use Their Health Insurance Card”: Implementation of Active Aging Policy and Aging Perceptions in Romanian General Practitioners

Implementing positive aging ideas developed in Western Europe may be difficult to achieve in Eastern European contexts such as the Romanian health system. This might result in inequalities between EU countries in what positive aging is concerned. How health professionals construct old age reflects in the health communication with their aging patients. To analyze how old age and older patients as well as active aging promotion happens, we conducted 30 semi-structured interviews with Romanian general practitioners, the gatekeepers of Romanian health care system. Thematic coding revealed that constructions of the irresponsible old patient prevail. Doctors perceive themselves either as helpless helpers, or as a kind of social worker, performing duties that are outside the range of medical services. Implications of the findings for practice and active aging policy implementation are discussed.