Alcohol content variation of bar and restaurant drinks in Northern California

Objective:  To estimate the average of and sources of variation in the alcohol content of drinks served on premise in 10 Northern Californian counties.
Methods:  Focus groups of bartenders were conducted to evaluate potential sources of drink alcohol content variation. In the main study, 80 establishments were visited by a team of research personnel who purchased and measured the volume of particular beer, wine, and spirit drinks. Brand or analysis of a sample of the drink was used to determine the alcohol concentration by volume.
Results:  The average wine drink was found to contain 43% more alcohol than a standard drink, with no difference between red and white wine. The average draught beer was 22% greater than the standard. Spirit drinks differed by type with the average shot being equal to one standard drink while mixed drinks were 42% greater. Variation in alcohol content was particularly wide for wine and mixed spirit drinks. No significant differences in mean drink alcohol content were observed by county for beer or spirits but one county was lower than two others for wine.
Conclusions:  On premise drinks typically contained more alcohol than the standard drink with the exception of shots and bottled beers. Wine and mixed spirit drinks were the largest with nearly 1.5 times the alcohol of a standard drink on average. Consumers should be made aware of these substantial differences and key sources of variation in drink alcohol content, and research studies should utilize this information in the interpretation of reported numbers of drinks.     

Age–period–cohort modelling of alcohol volume and heavy drinking days in the US National Alcohol Surveys: divergence in younger and older adult trends

Aims   The decomposition of trends in alcohol volume and heavy drinking days into age, period, cohort and demographic effects offers an important perspective on the dynamics of change in alcohol use patterns in the United States.
Design   The present study utilizes data from six National Alcohol Surveys conducted over the 26-year period between 1979 and 2005.
Setting   United States.
Measurements   Alcohol volume and the number of days when five or more and eight or more drinks were consumed were derived from overall and beverage-specific graduated frequency questions.
Results   Trend analyses show that while mean values of drinking measures have continued to decline for those aged 26 and older, there has been a substantial increase in both alcohol volume and 5+ days among those aged 18–25 years. Age–period–cohort models indicate a potential positive cohort effect among those born after 1975. However, an alternative interpretation of an age–cohort interaction where drinking falls off more steeply in the late 20s than was the case in the oldest surveys cannot be ruled out. For women only, the 1956–60 birth cohort appears to drink more heavily than those born just before or after. Models also indicate the importance of income, ethnicity, education and marital status in determining these alcohol measures.
Conclusions   Increased heavy drinking among young adults in recent surveys presents a significant challenge for alcohol policy and may indicate a sustained increase in future US alcohol consumption.     

The critical dimension of ethnicity in liver cirrhosis mortality statistics

BACKGROUND: In 1997, liver cirrhosis was the 10th leading cause of death in the United States. Beginning in the 1950s, liver cirrhosis mortality rates have been consistently higher for black than for white men and women. There has been a gradual adoption of the recommendation that all death certificates include information on the Hispanic origin of decedents, with universal adoption in the 1997 data year. It is the purpose of this study to examine the extent to which relative risks for cirrhosis mortality might shift for different demographic groups when Hispanic origin is considered along with the race and sex of the decedent. METHODS: Age-adjusted death rates were calculated for liver cirrhosis by using public-use data files produced by the National Center for Health Statistics. Trends in cirrhosis mortality rates from 1991 through 1997 are shown for white Hispanic, white non-Hispanic, black Hispanic, and black non-Hispanic men and women. RESULTS: In 1997, white Hispanic men show the highest cirrhosis mortality rates over the period examined, followed by black non-Hispanic and white non-Hispanic men, white Hispanic women, and black non-Hispanic and white non-Hispanic women. Among Hispanic decedents, the largest group was of Mexican ancestry, with large numbers being born outside the United States and having low education levels. CONCLUSIONS: The findings of higher risk for cirrhosis mortality among white men and women of Hispanic origin serve to focus new attention on these demographic groups. Collateral analyses of other causes of death do not support alternate explanations of these findings as artifacts of demographic misclassification. Future studies of amounts and patterns of alcohol consumption should include Hispanic origin among demographic factors examined.     

Drinking contexts and drinking problems among black and white women

This study explored whether black and white women differ in how often they drink in particular types of social settings and if drinking in different contexts independently predicts alcohol-related problems. The analysis was based on the interview responses of 635 black and 663 white women drinkers who represent sub-samples from a nationwide survey of 5221 respondents conducted in 1984. The findings revealed that white women are more likely to attend restaurants, bars and parties away from home than black women and that a larger proportion of their alcohol consumption occurs in these settings than among black women. Factor analysis was used to develop scales on the the frequency of drinking in different social contexts. The results confirmed a three-dimensional factor structure that distinguished between drinking at home; drinking in social settings such as bars, restaurants and parties; and drinking in outdoor public areas like street comers and parks. A simultaneous equations path analysis was used to model the relationships among drinking contexts, the frequency of heavier drinking, drinking problems, race and other social characteristics. The major findings of the resulting models were that drinking contexts independently predict drinking problems and that race is not directly associated with drinking contexts or alcohol-related problems. However racial differences do exert significant indirect effects on social settings and drinking problems through differences in socio-economic status and normative attitudes. The conclusion emphasizes the complexity of the interrelationships of ethnic and social characteristics that underlie visible racial differences in the social patterns and situational contexts of alcohol use.     

The Hispanic Americans Baseline Alcohol Survey: Alcoholic Beverage Preference Across Hispanic National Groups

Background: U.S. Hispanics come from many countries in Latin America, which can lead to different beverage preferences in the United States. This paper examines choice for drinking wine, beer, and liquor across 4 Hispanic national groups: Mexican Americans, Puerto Ricans, Cuban Americans, and South/Central Americans. Methods: A sample of 5,224 individuals 18 years of age and older was selected using multistage cluster procedures from the household population in 5 metropolitan areas of the United States: Miami, New York, Philadelphia, Houston, and Los Angeles. The survey weighted response rate was 76%. Face‐to‐face interviews lasting 1 hour on average were conducted in the respondents’ homes either in English or Spanish. Results: Among men, beer drinkers consume the highest mean number of drinks per week in all national groups. Among women, this is true only of Puerto Ricans and Mexican Americans. Among men who drink beer, beer drinking constitutes 52 to 72% of total alcohol consumption. Among women who drink beer, beer consumption is associated with 32 to 64% of total consumption. Beer is the beverage most associated with binge drinking among Puerto Rican and Mexican American women, while among Cuban Americans and South/Central Americans this is seen for wine. Regression analyses showed no significant differences by national group in the likelihood of drinking 2 or fewer drinks (vs. no drinks) of wine, beer, or liquor. Puerto Ricans were more likely (OR = 1.47; 95% CI = 1.00–2.14) than Cuban Americans to drink 3 or more drinks (compared with no drinks) of beer. There was no association between the likelihood of binge drinking and Hispanic national group. Conclusions: Beverage preference across Hispanic national groups is similar. Beer is the preferred beverage. Alcohol control policies such as taxation and control of sales availability should apply equally to beer, liquor, and wine. Prevention interventions directed at different Hispanic national groups in the United States can be relatively uniform in their focus on the dangers associated with drinking different types of alcoholic beverages.     

Older adults' alcohol consumption and late-life drinking problems: a 20-year perspective

Aims   The aim of this study was to identify changes in patterns of alcohol consumption over a 20-year interval among older women and men, and to examine the associations between guideline-defined excessive drinking and late-life drinking problems.
Design, participants and measures   A community sample of 719 adults between 55 and 65 years of age who consumed alcohol at or prior to baseline participated in a survey of alcohol consumption and drinking problems and was followed 10 years and 20 years later.
Findings   The likelihood of excessive drinking declined over the 20-year interval as adults matured into their 70s and 80s. However, at ages 75–85, 27.1% of women and 48.6% of men consumed more than two drinks per day or seven drinks per week. At comparable guideline levels of alcohol consumption, older men were more likely to have drinking problems than were older women. Consumption of more than two drinks per day or seven drinks per week was identified as a potential conservative guideline for identifying excessive drinking associated with an elevated likelihood of drinking problems.
Conclusions   A substantial percentage of older adults who consume alcohol engage in guideline-defined excessive drinking and incur drinking problems. The finding that older men may be more likely than older women to experience problems when they drink beyond guideline levels suggests that alcohol guidelines for men should not be set higher than those for women.     

Alcohol-Related Problems and Intimate Partner Violence Among White, Black, and Hispanic Couples in the U.S.

OBJECTIVES: This study analyzes gender and ethnic/racial differences in the prevalence of alcohol-related problems among white, black and Hispanic couples in the United States, and assesses their contribution to the risk of intimate partner violence (IPV). METHODS: Our study population consisted of 1440 white, black, and Hispanic couples obtained through a multistage area household probability sample from the 1995 National Alcohol Survey. Alcohol-related problems (i.e., drinking consequences and alcohol dependence symptoms in the last 12 months) were assessed among respondents and their partners. Male-to-female and female-to-male partner violence (MFPV, FMPV) were measured separately using the Conflict Tactics Scale. RESULTS AND CONCLUSIONS: Alcohol-related problems were more prevalent among men than women. Our bivariate analysis demonstrated a significant positive association between male alcohol-related problems and IPV across racial/ethnic groups, and a similar association between female alcohol-related problems and IPV for white and black couples. In the multivariate logistic regression analyses, however, many of these associations were attenuated. After controlling for sociodemographic and psychosocial covariates, male alcohol-related problems were no longer significantly associated with an increased risk of MFPV among white or Hispanic couples. Female alcohol-related problems predicted FMPV, but not MFPV, among white couples. Among black couples, however, male and female alcohol-related problems remained strong predictors of intimate partner violence. SIGNIFICANCE: Alcohol-related problems are important predictors of intimate partner violence, and the exact association between problems and violence seems to be ethnic-specific. Alcohol-related problems, rather than level of alcohol consumption, may be the more relevant factor to consider in the alcohol-partner violence association. Future research is needed to explore the temporal relationships between the development of alcohol-related problems and the occurrence of partner violence.     

The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001-2004.

BACKGROUND: Trichomonas vaginalis infection is a common sexually transmitted protozoal infection and is associated with several adverse health outcomes, such as preterm birth, delivery of a low-birth weight infant, and facilitation of sexual transmission of human immunodeficiency virus. The annual incidence in the United States has been estimated to be 3-5 million cases. However, there are no data on the prevalence of trichomoniasis among all reproductive-age women. We estimated the prevalence of T. vaginalis infection from a nationally representative sample of women in the United States. METHODS: Women aged 14-49 years who participated in the National Health and Examination Survey cycles for 2001-2004 provided self-collected vaginal swab specimens. The vaginal fluids extracted from these swabs were evaluated for the presence of T. vaginalis using polymerase chain reaction. RESULTS: Overall, 3754 (81%) of 4646 women provided swab specimens. The prevalence of T. vaginalis infection was 3.1% (95% confidence interval [CI], 2.3%-4.3%); for non-Hispanic white women, it was 1.3% (95% CI, 0.7%-2.3%); for Mexican American women, it was 1.8% (95% CI, 0.9%-3.7%); and for non-Hispanic black women, it was 13.3% (95% CI, 10.0%-17.7%). Factors that remained associated with increased likelihood of T. vaginalis infection in multivariable analyses included non-Hispanic black race/ethnicity, being born in the United States, a greater number of lifetime sex partners, increasing age, lower educational level, poverty, and douching. CONCLUSIONS: The prevalence of T. vaginalis infection among women in the United States was 3.1%. A significant racial disparity exists; the prevalence among non-Hispanic black women was 10.3 times higher than that among non-Hispanic white and Mexican American women. Optimal prevention and control strategies for T. vaginalis infection should be explored as a means of closing the racial disparity gaps and decreasing adverse health outcomes due to T. vaginalis infection.     

Understanding the Racial and Ethnic Differences in Cost and Mortality Among Advanced Stage Prostate Cancer Patients (STROBE)

The aims of the study were to understand the racial/ethnic differences in cost of care and mortality in Medicare elderly with advanced stage prostate cancer.This retrospective, observational study used SEER-Medicare data. Cohort consisted of 10,509 men aged 66 or older and diagnosed with advanced-stage prostate cancer between 2001and 2004. The cohort was followed retrospectively up to 2009. Racial/ethnic variation in cost was analyzed using 2 part-models and quantile regression. Step-wise GLM log-link and Cox regression was used to study the association between race/ethnicity and cost and mortality. Propensity score approach was used to minimize selection bias.Pattern of cost and mortality varies between racial/ethnic groups. Compared with other racial/ethnic groups, non-Hispanic white patients had higher unadjusted costs in treatment and follow-up phases. Quintile regression results indicated that in treatment phase, Hispanics had higher costs in the 95th quantile and non-Hispanic blacks had lower cost in the 95th quantile, compared with non-Hispanic white men. In terminal phase non-Hispanic blacks and Hispanics had higher cost. After controlling for treatment, all-cause and prostate cancer-specific mortality was not significant for non-Hispanic black men, compared with non-Hispanic white men. However, for Asians, mortality remained significantly lower compared with non-Hispanic white men.In conclusion, relationship between race/ethnicity, cost of care, and mortality is intricate. For non-Hispanic black men, disparity in mortality can be attributed to treatment differences. To reduce racial/ethnic disparities in prostate cancer care and outcomes, tailored policies to address underuse, overuse, and misuse of treatment and health services are necessary.     

Alcohol Price and Intoxication in College Bars

Background:  Many population studies find that alcohol prices are inversely related to alcohol consumption and alcohol-related problems, including among college students and young adults. Yet, little is known about the "micro-level" effects of alcohol price on the behavior of individual consumers in natural drinking settings such as college bars. Therefore, we assessed patron's cost per gram of ethanol consumed at on-premise drinking establishments and its association with intoxication upon leaving an establishment.
Methods:  On 4 consecutive nights during April 2008, data were collected from 804 patrons exiting 7 on-premise establishments in a bar district located adjacent to a large university campus in the southeastern United States. Anonymous interview and survey data were collected as well as breath alcohol concentration (BrAC) readings. We calculated each patron's expenditures per unit of ethanol consumed based on self-reported information regarding the type, size, number, and cost of consumed drinks.
Results:  A multivariable model revealed that a 10-cent increase in cost per gram of ethanol at on-premise establishments was associated with a 30% reduction in the risk of exiting an establishment intoxicated (i.e., BrAC ≥ 0.08 g/210 l).
Conclusions:  The results are consistent with economic theory and population-level research regarding the price elasticity of alcoholic beverages, which show that increases in alcohol prices are accompanied by less alcohol consumption. These findings suggest that stricter regulation of the drink discounting practices of on-premise drinking establishments would be an effective strategy for reducing the intoxication levels of exiting patrons.     

Unhealthy drinking patterns in older adults: prevalence and associated characteristics

OBJECTIVES: To examine the prevalence of unhealthy drinking patterns in community-dwelling older adults and its association with sociodemographic and health characteristics.
DESIGN: Cross-sectional analysis of nationally representative survey data.
SETTING: The data source was the 2003 Access to Care file of the Medicare Current Beneficiary Survey, which represents the continuously enrolled Medicare population.
PARTICIPANTS: Community-dwelling Medicare beneficiaries aged 65 and older (N=12,413).
MEASUREMENTS: The prevalence of unhealthy alcohol use by older adults defined in relation to two parameters of recommended limits: monthly use exceeding 30 drinks per typical month and "heavy episodic" drinking of four or more drinks in any single day during a typical month in the previous year. Sociodemographic and health status variables were also included.
RESULTS: Nine percent of elderly Medicare beneficiaries reported unhealthy drinking, with higher prevalence in men (16%) than women (4%). In logistic regression analyses with the full sample, higher education and income; better health status; male sex; younger age; smoking; being white; and being divorced, separated, or single were associated with higher likelihood of unhealthy drinking. Among drinkers, in addition to sociodemographic variables, self-reported depressive symptoms were positively associated with unhealthy drinking. Among unhealthy drinkers, race and ethnicity variables were associated with likelihood of heavy episodic drinking.
CONCLUSION: Almost one in 10 elderly Medicare beneficiaries report exceeding recommended drinking limits. Several distinct unhealthy drinking patterns were identified and associated with sociodemographic and health characteristics, suggesting the value of additional targeted approaches within the context of universal screening to reduce alcohol misuse by older adults.     

Hazardous drinking by older adults with chronic conditions during the COVID-19 pandemic: Evidence from a Chicago-based cohort

Background

It is unclear how older adults with chronic conditions, who have greater risk of alcohol-related adverse outcomes, used alcohol throughout the COVID-19 pandemic. We assess changes in hazardous drinking prevalence May 2020–December 2021 and factors associated with hazardous drinking.

Methods

Data are from structured phone interviews of older adults (age 60+) with chronic conditions (e.g., hypertension, diabetes, pulmonary disease, heart disease) in a Chicago-based longitudinal cohort (Chicago COVID-19 Comorbidities survey, Waves 3–7, n = 247). We tested differences in the prevalence of hazardous drinking (defined as AUDIT-C score of 3+ for women and 4+ for men) across waves for the full sample, by demographic group (sex, race, and ethnicity), and by chronic condition burden (<3 conditions, 3+ conditions). Generalized estimating equations investigated associations of hazardous drinking with sociodemographic and pandemic coping-related factors (stress, loneliness, outside contacts, depression, anxiety).

Results

Participants were 66.8% female; 27.9% non-Hispanic Black, 14.2% Hispanic, 4.9% other race. Hazardous drinking was reported by 44.9% of participants in May 2020, but declined to 23.1% by July–August 2020 and continued to slowly decline to 19.4% by September–December 2021. Differences from May 2020 were significant at the 0.05 level. Subgroups followed similar trajectories. Hazardous drinking prevalence was initially higher but declined more among men than women, consistently higher among non-Hispanic White respondents than among Hispanic and non-Hispanic Black respondents, and declined more rapidly among adults with 3+ chronic conditions. In adjusted models, race and ethnicity were associated with lower prevalence of hazardous drinking (non-Hispanic Black: adjusted prevalence ratio [aPR] = 0.50, 95% confidence interval [CI] = 0.33, 0.74; other race: aPR = 0.26, 95% CI = 0.09, 0.81, compared with non-Hispanic White). No coping-related factors were significantly associated with hazardous drinking.

Conclusion

Among a cohort of older adults with chronic conditions, almost half engaged in hazardous drinking in early summer of the COVID-19 pandemic. While prevalence fell, these rates reinforce the need for alcohol screening and intervention in clinical settings among this population.     

Racial/ethnic variation in hypertension-related lifestyle behaviours among US women with self-reported hypertension

Healthy lifestyles such as regular physical activity, frequent consumption of fruits and vegetables, weight control/weight loss and limited alcohol consumption are effective and recommended in hypertension control. Using data collected from a total of 131 788 female participants (aged >/=18 years) of the 2003 Behavioral Risk Factor Surveillance System, we examined the racial/ethnic disparities in hypertension-related lifestyle behaviours in 36 770 US women with self-reported hypertension from five races/ethnicities (non-Hispanic white (29 237), non-Hispanic black (4288), Asian (445), American Indian/Alaska native (553) and Hispanic (2247)). The prevalence of hypertension varied by race/ethnicity, with the highest seen in non-Hispanic black population (36.9 versus 20.2-26.8% in other racial/ethnic groups). Of all hypertensive women, using non-Hispanic white women as the referent, we found that non-Hispanic black (adjusted odds ratio (AOR): 0.65; 95% confidence interval (CI): 0.55-0.77), American Indian/Alaska native (AOR: 0.72; 95% CI: 0.52-1.00) and Hispanic women (AOR: 0.70; 95% CI: 0.57-0.86) were significantly less likely to engage in physical activity at recommended levels; non-Hispanic black women were more likely to consume>/=8 servings per day of fruits and vegetables (AOR: 1.70; 95% CI: 1.24-2.34), and less likely to report losing weight (AOR: 0.61; 95% CI: 0.53-0.71). In addition, Hispanic hypertensive women were significantly more likely than non-Hispanic white women to receive weight-loss advice (AOR: 1.97; 95% CI: 1.60-2.44). In contrast, non-Hispanic white women were significantly more likely than those from other races/ethnicities to consume alcoholic beverages or engage in binge drinking. Our results demonstrate that race/ethnicity is an independent predictor of lifestyle behaviours related to hypertension control among American women with hypertension.Journal of Human Hypertension (2008) 22, 608-616; doi:10.1038/jhh.2008.52; published online 22 May 2008.     

Prevalence and Determinants of Alcohol-Related Problems

In this study, we sought to determine what factors, in addition to alcohol consumption, were the best predictors of social and physical alcohol-related problems. Variables examined as possible predictors of problems included circumstances under which people drink, feelings of alienation, and religious affiliation. Data for this study were collected continually from 1984 to 1989 using a random telephone survey of 2094 New York State residents aged 18 or older; the study sample was comprised of the 1076 who had consumed alcohol in the previous 30 days. Stepwise regression analyses examined the main effects of all possible predictors of problems while controlling for alcohol consumption. Forced-entry regressions examined interaction effects of problem predictors while controlling for basic demographics. Drinking with breakfast, smoking marijuana, and drinking in bars alone were all significant predictors of more problems. This suggests that problems are associated with an aberrant lifestyle (i.e., different from a typical lifestyle), although it makes no assumption about motivations. Further investigation of this subject area is warranted to ascertain which population subgroups are the most vulnerable to alcohol-related problems and to guide the design of prevention programs.

The fact that alcohol consumption is the primary contributor to social and physical alcohol-related problems has prompted researchers to study both alcohol consumption and the problems emanating from it; therefore, demographic distributions of each are fairly well understood. This body of research has revealed that distributions of drinking problems match distributions of heavy drinking in the United States . For example, lower socioeconomic status members, males, urbanites, and those who are young and/or single tend to drink more than their counterparts and to experience more problems from their drinking as a result .

In contrast to this wealth of research is the relatively small number of studies focused on whether the traditional problem-experiencing groups continue to have the highest problem rates when alcohol consumption is held constant. Identification of those most at risk of experiencing negative consequences from their drinking requires more than knowing who drinks more and assuming that they will experience more problems as a result; an adequate understanding of alcohol’s untoward effects requires specification of the contexts in which the effects of alcohol are the greatest.

Despite Babor, Kranzler, and Lauerman’s findings that social, moderate, and heavy drinkers are all at risk of experiencing serious health hazards and psychosocial consequences, it is generally reasonable to assume that studies focusing mainly on severe alcohol-related consequences are likely to miss lighter drinkers who experience less severe, yet potentially dangerous, repercussions from their drinking. Since, at most, about 10% of the drinking population in the United States can be classified as chronic, heavy drinkers , studying only people with severe alcohol-related problems would result in missing what is occurring across a broad cross section of the population . Conversely, studying only those with less serious alcohol-related problems (e.g., keeping one’s drinking secret versus developing cirrhosis) would still include heavy drinkers, who are more likely than moderate and social drinkers to experience all problems. In the present study, alcohol-related problems of a less serious nature were analyzed.

Babor et al. found that risk of experiencing social and physical alcohol-related problems is not always a direct function of amount consumed, but may instead reflect complex interactions among many variables. They asserted that occurrence of such problems can be predicted better when those interactions are taken into account. Hilton found that, holding alcohol consumption constant, occurrence of alcohol-related problems had no strong association with frequent binges, gender, age, marital status, income, education, region, or urbanicity. Makela and Simpura found in Finland that physical alcohol-related problems are less responsive than social problems to increased alcohol consumption. They also found that differences in problem rates between the sexes vanished when alcohol consumption was held constant. Knupfer found that, among those who drink enough to get high or drunk, women seem to experience slightly more alcohol-related problems than men, and young men and married men had slightly more problems than older men and single men. Wilsnack, Wilsnack, and Klassen found that, in their category of highest consumption (2 ounces per day or more), women exceeded men in rates of problem consequences, but not in rates of dependence symptoms. Grant and Harford found that the relationship between absolute alcohol intake and alcohol dependence was stronger among younger than among older adults. Herd’s review points out that national survey data suggest black men are more likely to experience alcohol-related problems than white men, even though they have similar alcohol consumption rates. Park’s review suggests that rates of drunkenness among the social classes are more a reflection of police attitudes toward those social classes than of actual differential alcoholism rates among them.

While these past studies are not completely comparable (because definitions of alcohol-related problems vary from study to study) or consistent, it is clear that very different results were obtained from investigations in which alcohol consumption was held constant when compared with those in which it was not. Thus, one of the purposes of this study was to investigate whether chosen groups experience more problems than their counterparts with alcohol consumption held constant. We also sought to identify factors that, in addition to amount of alcohol consumed, were the best predictors of alcohol-related problems. A better understanding of these predictive factors may enhance our capability to identify correctly those individuals most at risk of experiencing alcohol-related problems and to help them through improved design and application of screening, prevention, intervention, and treatment programs.     

High density lipoprotein-cholesterol levels increase with age in American women but not in Hong Kong Chinese women

Objectives  High-density lipoprotein (HDL) cholesterol is a powerful cardiovascular risk factor. Important gender and ethnic differences in plasma HDL levels exist and warrant investigation.
Design  Cross-sectional survey in two different general populations.
Patients  7700 participants of the National Health and Nutrition Examination Survey (NHANES) 1999–2002 and 1944 participants of the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS2) 2000–2004.
Measurements  Plasma HDL levels.
Results  Plasma HDL levels were higher in women than in men in both populations. In the United States women, it increased with age, whereas in Chinese women, it declined with age and converged with male HDL levels. In the United States, 37·1 ± 1·2% men and 38·9 ± 1·1% women had low HDL levels. In Hong Kong, 34·3 ± 1·6% men and 34·5 ± 1·5% women had low HDL levels. In Americans, the independent predictors of low HDL levels were lower age, being non-Mexican Hispanic, waist circumference, triglycerides and not drinking alcohol in men, and lower age, being Hispanic, waist circumference, triglycerides, current smoking and not drinking alcohol in women. In Hong Kong Chinese, the independent predictors of low HDL levels were body mass index, triglycerides, current smoking and not drinking alcohol in men, and lower age, waist circumference, triglycerides, diabetes and former smoking in women.
Conclusions  The decline in plasma HDL with age in Chinese women is opposite to that seen in American women. The increased cardiovascular risk in elderly Chinese women requires further study.     

Prevalence and ethnic differences in gallbladder disease in the United States.

BACKGROUND & AIMS: Gallbladder disease is one of the most common conditions in the United States, but its true prevalence is unknown. A national population-based survey was performed to determine the age, sex, and ethnic distribution of gallbladder disease in the United States. METHODS: The third National Health and Nutrition Examination Survey (NHANES III) conducted gallbladder ultrasonography among a representative U.S. sample of more than 14, 000 persons. The diagnosis of gallbladder disease by detection of gallstones or cholecystectomy was made with excellent reproducibility. RESULTS: An estimated 6.3 million men and 14.2 million women aged 20-74 years had gallbladder disease. Age-standardized prevalence was similar for non-Hispanic white (8. 6%) and Mexican American (8.9%) men, and both were higher than non-Hispanic black men (5.3%). These relationships persisted with multivariate adjustment. Among women, age-adjusted prevalence was highest for Mexican Americans (26.7%) followed by non-Hispanic whites (16.6%) and non-Hispanic blacks (13.9%). Among women, multivariate adjustment reduced the risk of gallbladder disease for both Mexican Americans and non-Hispanic blacks compared with non-Hispanic whites. CONCLUSIONS: More than 20 million persons have gallbladder disease in the United States. Ethnic differences in gallbladder disease prevalence differed according to sex and were only partly explained by known risk factors.     

Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004

This study assesses trends in hypertension prevalence, blood pressure distributions and mean levels, and hypertension awareness, treatment, and control among US adults, age >or=18 years, between the third National Health and Nutrition Examination Survey (1988-1994) and the 1999-2004 National Health and Nutrition Examination Survey, a period of approximately 10 years. The age-standardized prevalence rate increased from 24.4% to 28.9% (P<0.001), with the largest increases among non-Hispanic women. Depending on gender and race/ethnicity, from one fifth to four fifths of the increase could be accounted for by increasing body mass index. Among hypertensive persons, there were modest increases in awareness (P=0.04), from 68.5% to 71.8%. The rate for men increased from 61.6% to 69.3% (P=0.001), whereas the rate for women did not change significantly. Rates remained higher for women than for men, although the difference narrowed considerably. Improvements in treatment and control rates were larger: 53.1% to 61.4% and 26.1% to 35.1%, respectively (both P<0.001). The greatest increases occurred among non-Hispanic white men and non-Hispanic black persons, especially men. Mexican American persons showed improvement in treatment and control rates, but these rates remained the lowest among race/ethnic subgroups (47.4% and 24.3%, respectively). Among all of the race/ethnic groups, women continued to have somewhat better awareness, treatment, and control, except for control rates among non-Hispanic white persons, which became higher in men. Differences between non-Hispanic black and white persons in awareness, treatment, and control were small. These divergent trends may translate into disparate trends in cardiovascular disease morbidity and mortality.     

Patterns of alcohol consumption and alcohol-impaired driving in the United States

Background:  Alcohol-related motor vehicle crashes kill approximately 17,000 Americans annually and were associated with more than $51 billion in total costs in 2000. Relatively little is known about the drinking patterns of alcohol-impaired (AI) drivers in the United States.
Methods:  2006 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed for alcohol consumption and self-reported AI driving among U.S. adults aged ≥18 years for all states. Alcohol consumption was divided into 4 categories: binge/heavy, binge/nonheavy, nonbinge/heavy, and nonbinge/nonheavy. Binge drinking was defined as ≥5 drinks for men or ≥4 drinks for women on one or more occasions in the past month, and heavy drinking was defined as average daily consumption of >2 drinks/day (men) or >1 drink/day (women). The prevalence of AI driving was examined by drinking pattern and by demographic characteristics. Logistic regression analysis was used to assess the association between drinking patterns and AI driving.
Results:  Five percent of drinkers were engaged in AI driving during the past 30 days. Overall, 84% of AI drivers were binge drinkers and 88% of AI driving episodes involved binge drinkers. By drinking category, binge/nonheavy drinkers accounted for the largest percentage of AI drivers (49.4%), while binge/heavy drinkers accounted for the most episodes of AI driving (51.3%). The adjusted odds of AI driving were 20.1 (95% CI: 16.7, 24.3) for binge/heavy, 8.2 (6.9, 9.7) for binge/nonheavy, and 3.9 (2.4, 6.3) for nonbinge/heavy drinkers, respectively.
Conclusions:  There is a strong association between binge drinking and AI driving. Most AI drivers and almost half of all AI driving episodes involve persons who are not heavy drinkers (based on average daily consumption). Implementing effective interventions to prevent binge drinking could substantially reduce AI driving.     

Effects of Acute Alcohol Intoxication and Paroxetine on Aggression in Men

Background:  The purpose of this study was to examine the role of the serotonin (5-HT) system in alcohol-related aggression.
Methods:  Specifically, we experimentally examined the effects of 5-HT augmentation on alcohol-related aggression in men ( n  =   56). After consuming either alcohol (mean blood alcohol concentration of 0.10%) or a placebo (no alcohol) drink, and taking either 20 mg of paroxetine (Paxil®) or a placebo pill, participants were provided the opportunity to administer electric shock to a (faux) opponent during a task disguised as a reaction-time game. Aggression was defined as the intensity of shock chosen and the frequency with which an extreme (clearly painful) shock was chosen. We predicted that 5-HT augmentation would be associated with lower aggressive behavior overall, and also reduce the aggression facilitating effects of acute alcohol intoxication.
Results:  The results indicated that alcohol intoxication increased aggression, particularly under low provocation. Paroxetine decreased aggression, particularly during high provocation. These effects, however, occurred independently of each other.
Conclusions:  The effect of alcohol on extreme aggression was moderated by previous aggression history, with more aggressive individuals showing greater alcohol-related increases in extreme aggression.     

HIV Prevalence Rates Among Men Who Have Sex with Men in the Southern United States: Population-Based Estimates by Race/Ethnicity

States across the U.S. lack effective ways to quantify HIV prevalence rates among men who have sex with men (MSM). We estimated population-based HIV prevalence rates among MSM in the 17 southern states by race/ethnicity. Through 2007, estimated HIV prevalence rates per 100,000 MSM ranged from 2,607.6 among white (non-Hispanic) MSM in Maryland to 41,512.9 among black (non-Hispanic) MSM in the District of Columbia. Black MSM rates significantly exceeded Hispanic and white MSM rates in each state. Significant racial/ethnic disparities in rates persisted in a sensitivity analysis examining the possibility that minority MSM populations had been underestimated in each state. Compared with black, Hispanic, and white non-MSM males, respectively, rates at the regional level were 25.2 times higher for black MSM, 43.0 times higher for Hispanic MSM, and 106.0 times higher for white MSM. State-level analysis of racial/ethnic-specific MSM HIV prevalence rates can help guide resource allocation and assist advocacy.