Gender comparison of alcohol exposure on drinking occasions

OBJECTIVE: This study was designed to assess the influence of gender, age, drinking style and other selected demographic variables on the rate of alcohol beverage consumption on drinking days. The data were used to predict possible differences in ethanol exposure levels (peak blood alcohol concentration [BAC]) among the subgroups examined. METHOD: A representative sample (N = 2,627) of the U.S. adult population was surveyed using computer-assisted telephone interviewing to assess alcohol use (past 12 months) in quantity, frequency and type of beverage, as well as the time (minutes) usually required to consume the typical quantity of alcohol on drinking days. RESULTS: Of the 1,833 current drinkers (1,028 men, 805 women), women reported consuming a mean of 2.2 standard drinks (1 drink = 12 g ethanol) on typical drinking occasions (days); men reported consuming a mean of 3.2. The duration of the drinking episode was similar for women (122 minutes) and men (126 minutes). The hourly rate of drink consumption was thus lower for women (approximately 1.1 drinks/hour) than for men (approximately 1.6 drinks/hour). For both men and women, there was an age-related increase in the frequency of drinking but a decrease with age in predicted peak BACs and in the alcohol intake per drinking episode. Peak BACs achieved during typical drinking episodes were estimated to be quite similar for men (0.037) and for women (0.036) when prediction equations were based on equal rates of alcohol elimination in both genders. The estimated peak BACs were lower in women than in men when the prediction equation assumed a higher rate of ethanol elimination in women. CONCLUSIONS: Information on the rate of alcohol beverage consumption on drinking days facilitates prediction of BACs typically experienced in men and women of different demographic group memberships. The exposure values obtained will depend upon as yet unsettled norms for ethanol elimination rates in men and women.     

Semester and event-specific motives for alcohol use during Spring Break: Associated protective strategies and negative consequences

Motives surrounding alcohol use behavior are important for understanding college student drinking. However, no previous research has addressed how motives for and against drinking during specific events associated with high-risk drinking, such as Spring Break, may differ from motives for and against drinking during the regular semester. Further, we examine the extent to which semester and Spring Break motives are associated with alcohol use, protective behavioral strategies (PBS), and consequences. Participants were college students (N = 261; 55% women) who provided data both immediately prior to (Wave 1) and after (Wave 2) Spring Break. Fun/Social motives for drinking were greater for Spring Break, and Driving motives against drinking were lower for Spring Break, compared to semester drinking. Relax and Image motives for drinking and Physical/Behavioral motives for not drinking during Spring Break did not differ from semester motives. Spring Break motives for and against drinking were associated with total drinks, maximum drinks, PBS, and experienced negative consequences during Spring Break. Students' specific motives regarding drinking during Spring Break predict high-risk drinking and may be utilized in creating salient event-specific interventions.     

Gender differences in treatment outcomes for alcohol dependence among older adults

OBJECTIVE: This study examined clinical characteristics and treatment outcomes of older alcohol-dependent men and women in a mixed-age private outpatient chemical dependency program. METHOD: The sample comprised 92 patients aged 55 to 77 (63 men and 29 women). The measures consisted of demographic characteristics, alcohol and drug use and dependence, drinking history, health status, psychiatric symptoms, length of stay in treatment, use of Alcoholics Anonymous and 6-month treatment outcomes. RESULTS: The women reported later initiation of heavy drinking (5+ drinks per occasion) than the men, but had similar drinking levels at the treatment intake interview. At the 6-month follow-up, 79.3% of women reported abstinence from alcohol and drugs in the prior 30 days versus 54.0% of men (p = .02). Greater length of stay in treatment predicted abstinence at 6 months. Among those who were not abstinent, none of the women reported heavy drinking in the 30 days prior to follow-up, whereas nonabstinent men reported a mean (SD) of 4.0 (9.2) heavy drinking days (p = .025). CONCLUSIONS: The results suggest that older women may have better drinking outcomes compared with older men, following treatment for alcohol dependence.     

A prospective study of risk drinking: at risk for what?

Data from two waves of a nationally representative U.S. population sample were used to link frequency of risk drinking in the year preceding the Wave 1 interview with the incidence or occurrence of various adverse outcomes in the approximately 3-year-period between the two interviews (n=22,122 Wave 1 drinkers who were reinterviewed at Wave 2). Risk drinking was defined as consuming the equivalent of 5+ standard drinks in a day for men and the equivalent of 4+ standard drinks in a day for women. Controls included sociodemographic and health characteristics, mean quantity of drinks consumed on risk drinking days and average volume of intake on non-risk drinking days. The odds of nonhierarchical alcohol abuse and dependence, initiation of smoking and incidence of nicotine dependence were increased at all frequencies of risk drinking and showed a fairly continuous increase in magnitude with increasing frequency, reaching OR of 3.03-7.23 for daily/near daily risk drinking. The incidence of liver disease was strongly increased among weekly or more frequent risk drinkers (OR=2.78-4.76). The odds of social harm and drug use were increased among daily/near daily risk drinkers (OR=1.61-2.54), and the likelihood of drivers license revocation showed near-significant increases at all frequencies of risk drinking. Frequency of risk drinking interacted with volume of intake on non-risk drinking days in predicting alcohol abuse and illicit drug use and with duration of drinking in predicting alcohol dependence. Risk drinking poses a threat of many types of harm, both directly and indirectly through its association with smoking initiation and nicotine dependence. These findings have illustrative value for prevention programs, and they indicate that frequent risk drinking is a strong marker for alcoholism.     

Depression and heavy drinking occasions: a cross-sectional general population study

The purpose of this study was to assess the association between depression and heavy drinking occasions in the Finnish general population. A subsample (2086/4020, response rate 51.9%) of the National FINRISK 2007 Study was used. Depression was assessed with a modified Beck Depression Inventory (short form) and alcohol problems with the Alcohol Use Disorders Identification Test. Total alcohol intake and number of heavy drinking occasions (≥7 drinks for men, ≥5 drinks for women) were evaluated using the Timeline Followback. Of the sample, 13.0% (123/946) of men and 17.4% (198/1140) of women were classified as being depressed. Further, 7.5% (71/946) of men and 3.5% (40/1140) of women reported having at least four heavy drinking occasions in the previous 28days. In an adjusted logistic regression model, these men had a 2.6-fold risk (95% C.I. 1.2-5.3) of depression, as compared to men with less than four heavy drinking occasions. The association was found irrespective of total alcohol consumption and alcohol problems. This association was not found in women.     

Difficulty in demonstrating a risk from drinking pattern in fourteen years of coronary heart disease morbidity and mortality: the Lung Health Study

The health effects of a binge pattern of alcohol consumption have not been widely investigated. The objective of this study is to evaluate cardiovascular consequences of drinking eight or more drinks at a sitting and of usual drinking of alcohol among 3702 men in the Lung Health Study (LHS), a clinical trial where heavy drinkers were excluded from enrollment. Using a 14-year follow-up period, survival graphs were examined. Cox proportional hazards regressions were performed on time to first event for documented hospitalizations and deaths due to coronary heart disease (CHD). The upper two quartiles of usual drinking were protective against CHD in men [hazard ratios (HRs) 0.76 and 0.69] in adjusted models. When eight or more drinks per occasion was combined with models of usual drinking quartiles, its effect was not significant. The measure of eight or more drinks in these data appears to act as a surrogate for heavy drinking, and does not provide a suitable test of the effect of drinking pattern in men, due primarily to the exclusion of heavier drinkers at baseline. The alcohol effects in women in this study were not significant.     

Average, binge and maximum alcohol intake in healthy young men: discriminant function analysis

Blood samples and data on alcohol consumption, diet, exercise, smoking and drug use were collected from 89 undergraduate men affiliated with Greek houses. This population has previously been identified as one that consumed large amounts of alcohol among university undergraduates. Energy and nutrient intake from foods, exercise and drug use (except caffeine) were not different between those reporting consuming more than or less than 1 oz of alcohol per day. Multiple discriminant analysis using a panel of 35 blood tests correctly classified all subjects according to their self-reported intake of more than or less than 2 oz of alcohol per day; 96% were classified correctly at a cut point of 1.5 oz per day. Correct classification was 96-99% using a measure of binge consumption (quantity-frequency of heavy drinking). When maximum number of drinks per occasion was used in the discriminant function, 90-92% were correctly placed. Discriminant analysis based on a panel of common blood tests appears to be a promising technique to identify young drinkers who consume high amounts of alcohol.     

Alcohol consumption predicts hypertension but not diabetes

OBJECTIVE: This study examines the associations between alcohol consumption, Type 2 diabetes and hypertension in a native American population. METHOD: Data were collected in a population-based cross-sectional and prospective study conducted on 3,789 individuals aged > or = 20 years. Reported alcohol consumption was classified as never, occasional or < 1 a day, 1-2 drinks a day, > or = 3 drinks a day, and occasional heavy drinking. The prevalence and incidence of diabetes and hypertension by categories of alcohol intake were determined. RESULTS: About 68% of men and 39% of women reported some degree of alcohol consumption. There was no association between alcohol consumption and prevalence or incidence of diabetes, but a positive, statistically significant association between blood pressure and alcohol consumption was found in both genders. After adjustment for age, body mass index (BMI) and diabetes in a proportional hazards model in men, moderate drinkers (occasional or < 1 drink a day and 1-2 drinks a day combined) had 1.24 (95% confidence interval: 0.98-1.57) and occasional heavy drinkers had 1.49 (1.02-2.17) times the incidence of hypertension as nondrinkers. The corresponding estimates of hypertension incidence for women were 1.53 (1.29-1.83) for moderate drinking and 1.38 (0.81-2.36) for occasional heavy drinking. As only 1% of participants reported > or = 3 drinks a day, this group was excluded from these analyses. CONCLUSIONS: Alcohol consumption did not affect the development of Type 2 diabetes, but it was associated with increased risk of hypertension, and this effect was independent of diabetes or BMI in both genders.     

Reproducibility of Two Approaches for Assessing Alcohol Consumption Among Older Adults

Objectives. In this study, we hypothesized that there is greater disclosure in self reports of alcohol intake when details of quantity-frequency measures of alcohol consumption are ascertained in the context of a general health and life style questionnaire as compared to a directed interview on usual drinking habits. Methods. Data are from the 1993 to 1994 follow-up of the Washington County cohort of men and women 65 years and older, participating in the Cardiovascular Health Study. A total of 918 subjects completed a questionnaire evaluation of their usual alcohol consumption by two separate approaches: (1) alcohol intake was derived from responses to questions contained within a medical and personal history questionnaire; (2) the same questions were asked in the context of a specific alcohol use in older adults questionnaire. Results. The mean alcohol intake for the entire cohort, and for drinkers alone were almost identical when assessed by either questionnaire, with high correlation between the two estimates, irrespective of beverage type. There was 89% agreement classifying drinkers versus nondrinkers by both approaches, with the strength of the agreement good ( &#115 = 0.76). This agreement became moderate if drinkers were further categorized into three levels of alcohol intake. Predictors of the differences in alcohol intake between the two questionnaires were explored by multiple regression. Differences were largest for those who stated that the reason they drank was because they were no longer working, and for those drinking on average more than 24 g (greater than approximately 2 drinks) of alcohol daily. Discussion. Although agreement between the two approaches was generally comparable, some findings may indicate that older adults who are problem drinkers or drink heavily report lower consumption patterns when administered a more directed questionnaire specifically focusing on drinking behavior. These findings have implications in the design of studies measuring alcohol consumption among elderly persons with a relatively low background alcohol intake.     

The A-OCDS predicts both craving and alcohol cue reactivity in adolescent alcoholics

Adolescents with alcohol dependence may experience marked craving and physiologic reactivity in the presence of alcohol cues which could undermine treatment gains. The Adolescent Obsessive Compulsive Drinking Scale (A-OCDS) was developed to help quantify the severity of alcohol craving in adolescents with alcohol use disorders. The A-OCDS is a relatively new instrument, and empirical data are needed to support its value in clinical trials. The present investigation uses data collected as part of a clinical laboratory study examining alcohol craving and cue reactivity in adolescents with and without alcohol dependence. A-OCDS total and subscale scores from adolescent alcoholics (N = 28) were examined regarding their relationship to drinking and several indices of craving and alcohol cue reactivity. In addition, regression analyses were performed to characterize the predictive ability of A-OCDS total scores and drinking indices (drinks per drinking day and percent days abstinent) on two measures of alcohol craving and cue reactivity. Results showed that the A-OCDS total scores, but not drinks per drinking day or percent days abstinent, predicted scores on both indices of craving. The study uses a small but well-defined sample of adolescents with alcohol dependence and supports the construct validity of the A-OCDS and suggests that, as in adults, alcohol craving and drinking behavior are related but separate elements of alcohol dependence. The results are intended to guide future studies in which the A-OCDS may be employed to measure craving and changes in craving over the course of treatment for adolescents with alcohol dependence.     

Mobile phone sensors and supervised machine learning to identify alcohol use events in young adults: Implications for just-in-time adaptive interventions

BackgroundReal-time detection of drinking could improve timely delivery of interventions aimed at reducing alcohol consumption and alcohol-related injury, but existing detection methods are burdensome or impractical.ObjectiveTo evaluate whether phone sensor data and machine learning models are useful to detect alcohol use events, and to discuss implications of these results for just-in-time mobile interventions.Methods38 non-treatment seeking young adult heavy drinkers downloaded AWARE app (which continuously collected mobile phone sensor data), and reported alcohol consumption (number of drinks, start/end time of prior day's drinking) for 28 days. We tested various machine learning models using the 20 most informative sensor features to classify time periods as non-drinking, low-risk (1 to 3/4 drinks per occasion for women/men), and high-risk drinking (> 4/5 drinks per occasion for women/men).ResultsAmong 30 participants in the analyses, 207 non-drinking, 41 low-risk, and 45 high-risk drinking episodes were reported. A Random Forest model using 30-min windows with 1 day of historical data performed best for detecting high-risk drinking, correctly classifying high-risk drinking windows 90.9% of the time. The most informative sensor features were related to time (i.e., day of week, time of day), movement (e.g., change in activities), device usage (e.g., screen duration), and communication (e.g., call duration, typing speed).ConclusionsPreliminary evidence suggests that sensor data captured from mobile phones of young adults is useful in building accurate models to detect periods of high-risk drinking. Interventions using mobile phone sensor features could trigger delivery of a range of interventions to potentially improve effectiveness.     

The role of drinking in suicidal ideation: analyses of Project MATCH data

OBJECTIVE: The associations of suicidal ideation with both the intensity (drinks per drinking day) and frequency of alcohol consumption were examined in a longitudinal study of treated alcoholics. METHOD: The data are from alcohol dependent subjects (1,187 men and 374 women) enrolled in Project MATCH, a multisite clinical trial of psychosocial treatments of alcoholism. Multivariate analyses for correlated data using generalized estimating equation approaches were performed to examine correlates of suicidal ideation at study entry and at 3-, 9- and 15-month follow-up. Analyses were stratified by gender and controlled statistically for depression and alcoholism severity. RESULTS: Suicidal ideation was common among women (15.5%) and men (9.9%) entering treatment, and at least 3.6% of women and 4.2% of men reported suicidal ideation at each follow-up. There were gender patterns in suicidal ideation. In women, intensity was associated with suicidal ideation, but even nonintense drinking became associated with suicidal ideation with more frequent drinking (intensity-frequency interaction). In men, intensity was also associated with suicidal ideation, whereas frequency was unrelated. Antisocial personality disorder in men but not in women, and depression in both groups, were also linked to suicidal ideation. CONCLUSIONS: Suicidal ideation is prevalent among treated alcoholics. Drinking is strongly associated with suicidal ideation and in women even light drinking, if it occurs regularly, is associated with suicidal ideation, with implications for suicide risk-recognition and intervention.     

Sexual risk behaviors and substance use among alcohol abusing HIV-positive men who have sex with men

An ethnically diverse sample (79.0% men of color) of HIV seropositive (HIV+) men who have sex with men (MSM) with alcohol use disorders from the New York City metropolitan area was recruited from a variety of settings frequented by such men. Data were collected using quantitative assessments and calendar based techniques at the baseline assessment of a longitudinal study assessing the relationship between alcohol and substance use and sexual risk behaviors as well as alcohol use and HIV disease progression. Data were selected on a sample of 253 HIV+ MSM (mean age = 38.55, SD = 6.73). Of these, the majority of participants (80.2%, n=203) reported engaging in sexual behaviors with casual partners. In terms of sexual behaviors that put partners at greatest risk for HIV transmission, unprotected anal insertive intercourse was most likely to occur with unknown status casual partners (46.8%, n=95) than with either HIV negative casual partners (19.2%, n=39) or with HIV+ casual partners (40.8%, n=83). Further, bivariate analyses indicated significant relationships between the use of several substances and sexual behaviors that put partners at greatest risk for HIV transmission, as well as a significant positive relationship between drinks per drinking day and viral load.     

Correlations between biological markers and alcohol intake as measured by diary and questionnaire in men

Alcohol intake was measured in 54 men aged 32-45 who were moderate or heavy drinkers--first by questionnaire and then more thoroughly by diary. Blood was drawn for the measurement of suggested biological markers of alcohol intake after the completion of the questionnaire and at the end of two consecutive diary periods. Partial correlations, controlling for smoking, exercise and age, between daily alcohol intake and markers were low and increased only slightly when diary data were analyzed instead of questionnaire data. No improvement was observed when mean intake per drinking day or the highest daily intake during a diary period was substituted in the analyses for mean daily intake. Significant associations (p less than .05) were found for mean cell volume (MCV), serum high-density lipoprotein cholesterol (HDL) and alkaline phosphatase (AFOS), but not for serum gamma-glutamyl transferase (GGT), the HDL: cholesterol ratio or ferritin. Correlations between intake reported by diary and intake predicted by a multivariate model with MCV, HDL, AFOS and GGT as regressors were significant (p less than .05) and higher than any of the bivariate correlation coefficients but were low (r = .30-.31). Low correlations seem to result from the inherent weakness of the suggested markers rather than from inaccuracies in the measurement of alcohol intake.     

Nature of questionnaire options affects estimates of alcohol intake

To estimate the degree of underreporting of alcohol consumption caused by questionnaire options for the frequency and quantity of drinking, two questionnaires (one oriented toward light alcohol consumption and the other toward heavy consumption) were administered to each of 86 patients (13 women) admitted for withdrawal treatment. The estimated mean daily alcohol intake was 137 g of absolute alcohol as measured by the "light" questionnaire and 302 g as measured by the "heavy" one. The Spearman correlation coefficient between individual mean intakes recorded by the two questionnaires was .58, indicating some influence on the rank ordering of drinkers. The intake estimate based on the heavy questionnaire correlated better with the number of drinks needed to overcome the subjective feelings of hangover than did the estimate based on the light questionnaire. A good deal of the underreporting commonly found in general population surveys might be related to the nature of questionnaire options. More detailed options for heavy intake might reveal previously unnoticed correlations between alcohol intake and various health hazards.     

Understanding college drinking: assessing dose response from survey self-reports

OBJECTIVE: One of the most difficult challenges confronting alcohol researchers is the assessment of specific risks associated with specific drinking levels (one, two or three or more drinks). In this article, a model-based method is presented that provides specific measures of dose, exposures and risks related to drinking and enables adequate assessment of dose-response relationships using survey data. METHOD: Survey data collected from 2,102 college students on drinking patterns and related problems were analyzed using a mathematical model that extracts separable measures of dose (number of drinks consumed per occasion) and exposures (numbers of occasions) for every respondent. A constrained class of quadratic risk models was estimated that relates units of exposure at each dose (e.g., number of occasions drinking five drinks) to problem outcomes (e.g., number of hangovers). The resulting dose-response functions provided an estimate of the rate of problems produced on each occasion of drinking at a given drinking level. Population risks were estimated by reintegrating dose response with the population distribution of drinking exposures. RESULTS: The distribution of drinking exposures among college drinkers was markedly peaked at a modal dose of two drinks, with variations in light and heavy drinking between demographic groups. Multivariate analyses showed relative rates of heavier drinking were greatest among white male freshmen and unrelated to residential settings. Most drinking problems showed a marked dose-response relationship to drinking levels. Population risks, however, were typically unimodal, with many problems reported at moderate drinking levels (two or three drinks). CONCLUSIONS: Distributed across a large number of drinkers and drinking occasions, problems reported by students occurred most often at moderate drinking levels (two to three drinks). Nevertheless, heavier drinking remained substantively related to many drinking problems. These observations encourage aview of college drinking that supports interventions related to both moderate and heavy drinking.     

Sex differences in gamma-glutamyltransferase in people aged 40-42 years in two Norwegian counties

Gamma-glutamyltransferase (GGT) is widely used as a marker of alcohol intake, although it is documented that other factors are also associated with serum levels of GGT. The total population of men and women aged 40-42 years in two Norwegian counties was invited to participate in a health survey program. GGT was measured in 8116 men and 8689 women--67 % of the eligible population. In sex-specific multiple regression analyses, GGT showed a positive association with body mass index (BMI), cholesterol, ln triglycerides, systolic blood pressure, and number of drinks per 2 weeks for both men and women. Glucose and 'years of smoking' were significant in women only. Cups of boiled coffee per day and physical activity in spare time were inversely associated with GGT level for both men and women. A significant positive interaction between alcohol intake and BMI was observed for men but not for women. The use of GGT as a marker of alcohol consumption in middle-aged persons should take into account sex, BMI and drinking of boiled coffee.     

Erratum to "Sex differences in gamma-glutamyltransferase in people aged 40-42 years in two Norwegian counties"

Gamma-glutamyltransferase (GGT) is widely used as a marker of alcohol intake, although it is documented that other factors are also associated with serum levels of GGT. The total population of men and women aged 40-42 years in two Norwegian counties was invited to participate in a health survey program. GGT was measured in 8116 men and 8689 women--67 % of the eligible population. In sex-specific multiple regression analyses, GGT showed a positive association with body mass index (BMI), cholesterol, ln triglycerides, systolic blood pressure, and number of drinks per 2 weeks for both men and women. Glucose and 'years of smoking' were significant in women only. Cups of boiled coffee per day and physical activity in spare time were inversely associated with GGT level for both men and women. A significant positive interaction between alcohol intake and BMI was observed for men but not for women. The use of GGT as a marker of alcohol consumption in middle-aged persons should take into account sex, BMI and drinking of boiled coffee.     

Drinking patterns of older Americans: National Health Interview Surveys, 1997-2001

OBJECTIVE: The objective of this study was to estimate the quantity and frequency of alcohol consumption among current drinking Americans age 60 years and older, by gender and age. METHOD: Five years (1997-2001) of cross-sectional National Health Interview Survey data were pooled. Quantity (number of drinks consumed, on average, on drinking days), frequency (number of drinking days per year) and a composite quantity-frequency measure (average number of drinks per day) were defined. Age trends (between age 60 and 84 years) were tested using logistic regression. Analyses were weighted to produce national estimates. RESULTS: Among 40,556 adults age 60 years and older, 52.8% (n = 8,136) of men and 37.2% (n = 8,710) of women were current drinkers. Over increasingly older age groups of current drinking men and women (1) proportions consuming higher quantities of alcohol (two drinks or more) decreased (p trend < .001), whereas proportions consuming lower quantities (one drink) increased (p trend < .001); and (2) proportions drinking least frequently (< 12 days per year) and most frequently (260-365 days per year) increased (p trend < .05), whereas proportions drinking at intermediate frequencies remained stable or decreased. Differences in patterns for quantity alone and frequency alone were obscured by the composite quantity-frequency measure. CONCLUSIONS: In a nationally representative survey, quantity and frequency of alcohol consumption showed strikingly different patterns of cross-sectional age-related change. In epidemiologic studies, quantity and frequency have been differentially associated with medical conditions prevalent in older populations. Investigators studying alcohol consumption in older people should consider reporting results separately by quantity and frequency.     

Alcohol intake during pregnancy and timing of puberty in sons and daughters: A nationwide cohort study

We explored whether maternal alcohol intake in early pregnancy is associated with pubertal timing in sons and daughters. In total, 15,819 children, born 2000–2003 within the Danish National Birth Cohort, gave half-yearly, self-reported information on pubertal development (Tanner stages, voice break, first ejaculation, menarche, acne, and axillary hair) from 11 years during 2012–2018. Information on maternal average alcohol intake in first trimester and binge drinking episodes (intake of ≥5 drinks on the same occasion) in first trimester was self-reported by mothers during pregnancy. Average alcohol intake of 5+ weekly drinks in first trimester was not associated with pubertal timing in sons (with no alcohol intake as the reference). A tendency towards earlier pubertal timing was observed in daughters (-2.0 (95 % confidence interval: -4.2, 0.3) months) when combining the estimates for all pubertal milestones. Binge drinking was not associated with pubertal timing in neither sons nor daughters.