Screening instruments for alcohol problems: a comparison of cut points between Mexican American and Mexican patients in the emergency room

The performance of alcohol use disorder screening instruments (CAGE, BMAST, AUDIT, TWEAK) at various cut points were compared between a Mexican American emergency room (ER) sample (n = 586) and a sample of ER patients in Mexico (n = 1,417) using ICD-10 and DSM-IV criteria for alcohol dependence and harmful drinking/abuse by gender and injury status. Lowering cut points improved instrument performance substantially for females in both samples. Further research is needed to explore instrument performance by gender and level of acculturation.     

Concussion History,Hazardous Drinking,and BrAC Levels Among a Sample of Bar Patrons, 2015

Background: Alcohol consumption and experiencing a concussion are positively correlated. Concussion history has not been examined previously in any alcohol field study (i.e., conducted in a natural setting). Objective: To better understand the relationship between concussion history and alcohol consumption. Methods: We conducted two anonymous field studies among a 2015 sample of bar patrons (N = 544; 62.5% males) in a college town to assess concussion history and two alcohol consumption measures: (1) breath alcohol concentration (BrAC) levels and (2) hazardous drinking scores (based on the AUDIT-C). Next, we conducted a logistic regression analysis to predict concussion history using the two alcohol consumption measures and other potential covariates (i.e., age, gender, race, college student status). Results: Among participants in our sample, the average BrAC level was.070 (SD =.053) and the average hazardous drinking score was 4.7 (SD = 2.5). Less than half of participants indicated that they had experienced a concussion in their lifetime (235; 43.2%). The logistic regression model indicated that hazardous drinking scores were significantly, positively associated with having experienced a concussion, whereas other covariates (i.e., BrAC, age, gender, race, college student status) did not significantly predict concussion history. Conclusions/Importance: Hazardous drinkers were more likely to have experienced a concussion. Therefore, the relationship found in this sample, between hazardous drinking behavior and concussion history, points to hazardous drinking as a possible risk factor for having had a concussion in the past.     

Drinking Patterns and Problems: A Comparison of Primary Care with the Emergency Room

A comparison is made of drinking patterns and problems of probability samples of noninjured patients drawn from the emergency room (ER) (n = 974) versus primary care clinics (n = 767) in the same metropolitan community. Those in the primary care sample were significantly less likely to report heavier drinking, consequences of drinking, alcohol dependence, and ever having treatment for an alcohol problem, controlling for demographic differences between the two sites. The data suggest that while primary care settings remain an important site for early identification and intervention for problem drinking, the ER may hold more potential for targeting prevention efforts in an era of reduced resources.     

Gender and Alcohol Use Disorders Diagnostic Criteria in Emergency Department Patients of Argentina

Background: Alcohol consumption and its related consequences are not equal for women and men, although related studies do not frequently include gender analysis. Objective: Our aim was to characterize differences in endorsement of ICD-10 and DSM 5 alcohol use disorder (AUD) criteria by gender in an Argentinean emergency department population. Methods: A probability sample of patients (N = 923) from the largest emergency department in the city of Mar del Plata, Argentina (44% were females, aged 16 to 86, M (SD) = 37.31(15.20) was collected. Using a structured questionnaire, diagnostic criteria for alcohol use disorders, alcohol consumption, and socio-demographic variables were obtained. Bivariate and multivariate analyses were used to assess differences in the endorsement of each diagnostic criterion by gender. Results: Women were less likely to endorse each of the criteria for each of the diagnostic schemes. Even after controlling alcohol consumption, socio-demographic variables, severity of alcohol use disorders and adjusting for multiple comparisons females had a lower probability than males of endorsing withdrawal and impaired control. Conclusions: gender differences in the endorsement of diagnostic criteria for both the DSM 5 and ICD-10 were found. Some differences in endorsement but not all, might be partially explained by alcohol consumption patterns and socio-demographic factors, and same remained after controlling severity of the AUD. Results also suggest a differential functioning of DSM 5 and ICD-10 AUD criteria for women and men.     

Substance Use and Depressive Symptoms Among Adolescents Treated in a Pediatric Emergency Department

ABSTRACT

The current study examined associations between substance use and depressed mood by gender and type of substance used (no use, alcohol, marijuana, or both alcohol and marijuana) in a sample of 713 adolescents (M_age = 15.3) recruited from a Pediatric Emergency Department (PED). Adolescents who reported any marijuana use had higher overall depressed mood scores compared to all other adolescents. When examined by gender, females with both alcohol and marijuana use reported the highest overall depressed mood symptoms. These results suggest the usefulness of screening and identification of depressive symptoms among adolescents presenting to a PED for substance use-related problems.     

Gender differences among Alaska Native people seeking alcohol withdrawal treatment

ABSTRACT

Background: Few studies focus on gender differences among patients who utilize detoxification services; even fewer focus on detoxification for Alaska Native people. This analysis focused on gender differences at admission among a sample of Alaska Native patients seeking alcohol withdrawal treatment. Methods: The sample included 383 adult Alaska Native patients admitted to an inpatient alcohol detoxification unit during 2006 and 2007. Logistic regression was used to estimate unadjusted and adjusted associations with gender. Results: Women were 88% more likely to have stable housing than men (odds ratio [OR] = 1.88, 95% confidence interval [CI] = 1.15, 3.05, P = .01). Women were 87% less likely to be seasonal workers (OR = 0.13, 95% CI = 0.03, 0.48, P = .003) and 50% less likely than men to be seeking employment (OR = 0.50, 95% CI = 0.29, 0.84, P = .01) at admission. Women had more than 5 times the odds of having children in the home at admission (OR = 5.64, 95% CI = 3.03, 10.56, P < .001) and almost 3 times the odds of experiencing physical abuse than men (OR = 2.96, 95% CI = 1.31, 6.66, P = .01). Additionally, women were 50% less likely to accept a referral to substance abuse treatment following detoxification (OR = 0.50, 95% CI = 0.30, 0.83, P = .01). Conclusions: The study found significant differences based upon gender. For instance, women are in need of services that accommodate women with children and services that address histories of physical abuse. Conversely, men are in need of housing and employment opportunities. Post detoxification follow-up, case management, and transition to care should include gender as a factor in treatment planning.     

Screening for alcohol problems in two emergency service samples in Poland: comparison of the RAPS4, CAGE and AUDIT

Prior research on alcohol-related problems among emergency service patients in Poland found substantial alcohol involvement on the part of injured males, suggesting emergency services may be a productive venue for identifying patients who could benefit from a brief intervention or referral for treatment. Performance of the RAPS4, CAGE and AUDIT against ICD-10 and DSM-IV criteria for alcohol dependence and for alcohol abuse/harmful drinking was compared in probability samples of emergency service patients from two regions of Poland. Sensitivity of the RAPS4 and AUDIT was significantly better than the CAGE for alcohol dependence among males in Warsaw, but specificity was poorer. Among females, although numbers were small, sensitivity for alcohol abuse/harmful drinking and for alcohol dependence or abuse/harmful drinking was significantly better for the RAPS4-QF than for the CAGE or AUDIT at a cut point of 8 across both sites. Performance of the AUDIT at a cut point of 3 was similar to the RAPS4-QF for females. Among males, sensitivity was higher but specificity considerably lower for the RAPS4-QF compared to the CAGE at a cut point of 1 or for the AUDIT at a cut point of 8. Alternate cut points for the AUDIT optimized performance. Findings suggest some regional and gender differences in performance of screening instruments in these Polish samples, but no instrument or cut point is optimal in identifying those with alcohol use disorders. Additional cross-cultural research is needed to evaluate the performance of instruments, especially among females with alcohol use disorders.     

Violence Related Injuries in the Emergency Room: Alcohol,Depression, and Conduct Problems

Objective.?The aim of this study was to obtain epidemiological measures of the association between alcohol consumption and emergency room (ER) attendance due to violence, compared to the general population in the city of Pachuca, Mexico, during October–November, 1996 and June–July, 1997. Method.?The study was a population-based case-control design. Intervention and Measurements: Data consisted of an interviewer-administered questionnaire, collected on a 24-h basis, during the entire week. Setting and Participants: Cases were 127 patients (78% male) admitted to the ER because of an injury that was the result of violence (being in a fight or being attacked by someone). A sample of residents from Pachuca (n = 920) was the comparison group. Results.?Patients reporting drinking within 6 h compared to nondrinkers were more likely to suffer a violence-related injury [34.0 (17.5–66.2)] and alcohol dependent patients were more likely to be involved in a violence-related injury [7.4 (3.5–15.6)] compared to noncurrent drinkers. When both alcohol prior and alcohol dependence were considered simultaneously in multiple models among current drinkers, patients with violence-related injuries were more likely to report alcohol prior but not to be positive for alcohol dependence. Depressive symptoms, but not conduct problem behavior, were also associated with violent injury in simultaneous regressions that included alcohol variables. Conclusions.?In the city of Pachuca, Mexico, a large relationship between drinking prior to the event and violence-related injury, regardless of alcohol dependence, was found. Depression was also related to violence, suggesting the need for more comprehensive intervention with these patients.     

Are There Gender,Racial, or Religious Denominational Differences in Religiosity’s Effect on Alcohol Use and Binge Drinking Among Youth in the United States? A Propensity Score Weighting Approach

Background: Alcohol use/misuse is a prevalent health issue among youth and may lead to adverse consequences. Religiosity has been identified as a protective factor against alcohol use/misuse among youth. Identifying moderators in the religiosity-alcohol relationship has important implications for intervention development. Objective: This study aims to examine whether gender, race, or religious denomination moderate the religiosity-alcohol relationship. Method: This study overcame previous studies’ limitations by using longitudinal data from a nationally representative sample and robust analytical methods (N?=?1969). This study used the propensity score weighting method to control for a large number of confounders. Propensity score weights were estimated using Generalized Boosted Models. Results: Findings indicate that gender and religious denomination might not moderate the religiosity-alcohol relationship, whereas racial difference was present. Among White youth, religiosity was found to have a buffering effect against alcohol use (average treatment effect [ATE] = –0.57, CI_.95 = –0.83, –0.32) and binge drinking (ATE = 0.54, CI_.95 = 0.38, 0.71). However, among non-White youth, religiosity was not found to have an effect on alcohol use (ATE = 0.08, CI_.95 = –0.31, 0.47) or binge drinking (ATE = 1.07, CI_.95 = 0.68, 1.64). Conclusions: Findings suggest that preventions/interventions of youth alcohol involvement that are religiously based may not need to adapt their efforts based on youth’s gender or religious denominations. More importantly, when addressing alcohol use/misuse issue among White American youth, religious and faith-based organizations, youth religious group leaders, and clergy should be included in the prevention/intervention efforts.     

Adolescent Social Networks and Alcohol Use: Variability by Gender and Type

Background: Scientists have established that social networks influence adolescents' substance use behavior, an influence that varies by gender. However, the role of gender in this mechanism of influence remains poorly understood. Particularly, the role an adolescent's gender, alongside the gender composition of his/her network, plays in facilitating or constraining alcohol use is still unclear. Objectives: This study examined the associations among the gender composition of adolescents' networks, select network characteristics, intrapersonal and interpersonal factors, and alcohol use among a sample of adolescents in the United States. Methods: We assessed cross-sectional data from a 2010 study of 1,523 high school students from a school district in Los Angeles. Analyses of adolescents' network characteristics were conducted using UCINET 6; and logistic regression analyses testing the associations between gender composition of the network and alcohol use were conducted using SPSS 20. Results: Our results indicate that the gender composition of adolescents' networks in our sample is associated with alcohol use. Adolescents in predominantly female or predominantly male friendship networks were less likely to report alcohol use compared to adolescents in an equal/balanced network. In addition, depending upon the context/type of network, intrapersonal and interpersonal factors varied in their association with alcohol use. Conclusions/Importance: Based on these findings, we make several recommendations for the future research. We call for researchers to further examine gender as a risk factor for alcohol abuse, particularly within the complex interplay between gender and network contexts.     

Alcohol expectancies and drinking behaviors in Mexican American college students

Research with non-Latinos has shown that alcohol expectancies ("the anticipated effects of alcohol use") are associated with drinking behaviors; however, prior studies have not fully examined such relations in Latino college students. This investigation examines positive alcohol expectancies and their association with contextual drinking and alcohol-related problem behaviors in a sample of 107 Mexican American college students (mean age=25; 54% female) who completed self-report surveys. Results showed that students who endorsed expectancies of physical and social pleasure and increased social assertiveness were likely to engage in frequent heavy drinking and imbibe in less personal settings. Furthermore, gender (being male) and the expectancy of enhanced sexual performance and experience were associated with involvement in risk behaviors due to drinking. This study highlights the link between specific alcohol expectancies and alcohol-related problem behaviors in Mexican American college students. Intervention approaches aimed at modifying drinking expectancies in physical, social, and sexual domains could prove useful in this population.     

Alcohol Use Severity Among Adult Hispanic Immigrants: Examining the Roles of Family Cohesion,Social Support,and Gender

Background: This study examined (a) the direct association of family cohesion on alcohol use severity among adult Hispanic immigrants; (b) the indirect association of family cohesion on alcohol use severity via social support; and (c) if gender moderates the direct and indirect associations between family cohesion and alcohol use severity. Method: Mediation and moderation analyses were conducted on a cross-sectional sample of 411 (men = 222, women = 189) participants from Miami-Dade, Florida. Results: Findings indicate that higher family cohesion was directly associated with higher social support and lower alcohol use severity. Higher social support was also directly associated with lower alcohol use severity. Additionally, family cohesion had an indirect association with alcohol use severity via social support. Moderation analyses indicated that gender moderated the direct association between family cohesion and alcohol use severity, but did not moderate the indirect association. Conclusions: Some potential clinical implications may be that strengthening family cohesion may enhance levels of social support, and in turn, lower alcohol use severity among adult Hispanic immigrants. Furthermore, strengthening family cohesion may be especially beneficial to men in efforts to lower levels of alcohol use severity.     

Usefulness of the CRAFFT to Diagnose Alcohol or Cannabis Use Disorders in a Sample of Emerging Adults with Past-Month Alcohol or Cannabis Use

Background: Emerging adults between the ages of 18 and 25 have the highest rates of illicit drug use and heavy alcohol use. The purpose of this study was to determine the performance of the Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) screening to identify alcohol and cannabis use disorders using Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria in a sample of emerging adults who use alcohol or cannabis or both. Methods: Study participants were recruited as part of a larger intervention study of health behaviors among emerging adults between the ages of 18 and 25 reporting alcohol and/or cannabis use. As part of baseline data collection, responses to the CRAFFT (score range: 0–6) and the Structured Clinical Interview for DSM-IV (SCID) were recorded. Additional questions about craving permitted approximation with DSM-5 diagnoses of alcohol and cannabis use disorders. Results: Participants (N = 382) averaged 21 (±2.1) years of age, 47% were male, 65% were non-Latino Caucasian, and using the SCID 42% met criteria for an alcohol use disorder and 45% met criteria for cannabis use disorder. When evaluating for any alcohol use disorder alone, using a cutoff score of 4, the sensitivity was 81.4% but the specificity was only 45.3%. At a cutoff score of 4, sensitivity for identifying any cannabis use disorder alone was 83.7% and specificity was 48.6%. Conclusions: In emerging adults who report using alcohol or cannabis, the CRAFFT had low specificity for predicting alcohol or cannabis use disorder, despite using higher cut scores than previously published. The CRAFFT's utility in determining clinical substance use disorders in this population may be limited.     

The Association between Engaging in Romantic Relationships and Mexican Adolescent Substance Use Offers: Exploring Gender Differences

Gender differences in alcohol, tobacco, and other drugs use in Mexico are rapidly disappearing. This study explores the possible relationship between engaging in romantic relationships on substance use offers and the moderating effects of gender among a group of adolescents (N = 432) living in Guadalajara, Jalisco, Mexico. The data used to test these relationships were collected through self-administered surveys in 2010. OLS regressions were estimated, predicting substance offers. The results demonstrate an association between having been in a relationship and receiving substance use offers in the previous 12 months. Having had a boyfriend/girlfriend had a significant influence on the offers received by adolescent females, but not for males.     

Associations of Father's Lifetime Cannabis Use Disorder with Child's Initiation of Cannabis Use,Alcohol Use,and Sexual Intercourse by Child Gender

Background: Early initiation of alcohol use, cannabis use, and sexual intercourse among adolescents is an important public health concern in the United States. Parents' history of substance use disorder is an important contributing factor for children's problem behaviors. Objectives: The associations of fathers' lifetime cannabis use disorder with children's initiation of cannabis use, alcohol use, and sexual intercourse were examined. In addition, child's gender was considered as a moderator of each association. Methods: Data from two companion longitudinal studies was utilized, the Rochester Youth Developmental Study and its intergenerational extension, the Rochester Intergenerational Study. Multiple linear regression analyses were conducted to examine the associations of the father's lifetime cannabis use disorder with the child's initiation of cannabis use, alcohol use, and sexual intercourse. To test gender differences in the associations, the study sample was stratified by child's gender. Results: The average age of first cannabis use (b = –3.71, p < .05), alcohol use (b = –3.65, p < .05), and sexual intercourse (b = –2.94, p < .05) among daughters of fathers with a lifetime cannabis use disorder was lower than that of their counterparts after adjusting for all other control variables, whereas no significant differences were detected in a father–son relationship. Conclusions: Homotypic continuity of cannabis use, as well as heterotypic continuity from the father's cannabis use to the child's alcohol use and sexual intercourse existed in a father–daughter relationship. These findings suggest that family-based interventions for female adolescents whose father has suffered from a cannabis use disorder be developed to prevent better adolescents' early substance use and sexual intercourse.     

Association Between Intimate Partner Violence and Help Seeking for Alcohol Problems

Abstract

Objectives: The primary aim of this study is to determine the association between intimate partner violence, alcohol problems, and help seeking behaviors for alcohol problems. In addition, the study was conducted to examine ethnic differences in the reporting of intimate partner violence, alcohol problems and treatment or help seeking for alcohol problems.

Methods: A probability sample (n = 1468) of White, Black and Hispanic couples 18 years of age or older in the U.S. household population was interviewed in 1995 with a response rate of 85%. Help seeking was defined as talking to someone or seeking treatment for an alcohol problem; therefore, the bivariate and multivariate analyses exclude lifetime abstainers.

Results: Multivariate analysis controlling for ethnicity, gender, age, education, and income indicated that those with alcohol problems and intimate partner violence together were 1.5 (95% CI = 0.8-2.6) times more likely to seek help than those reporting alcohol problems alone.

Conclusions: The coexistence of intimate partner violence and alcohol problems may prompt individuals to seek help for alcohol problems. However, a majority of people who report intimate partner violence and alcohol problems or alcohol problems alone do not seek help.     

A Validated Questionnaire to Assess the Knowledge of Psychiatric Aspects of Alcohol Use Disorder

ABSTRACT. Background: To the best of our knowledge, there is no validated instrument for measuring knowledge of psychiatric aspects of alcohol use disorder (AUD) amongst medical students. Our aim was to develop an instrument for this purpose and to describe the instrument's psychometric properties. We also investigated whether the instrument could demonstrate a significant change in scores following an educational intervention consisting of a 60-minute PowerPoint lecture on AUD, associated handouts, and role-plays. Methods: The Knowledge of Psychiatric Aspects of Alcohol Questionnaire (KPAAQ) was developed from the Kaplan and Saddock textbook synopsis chapter on alcohol related disorders. The questionnaire included 6 categories of clinically relevant material: metabolism of alcohol, short-term effects of alcohol, long-term effects of alcohol, AUD, alcohol withdrawal, and alcohol use in pregnancy. The KPAAQ was administered to 75 medical students in Years 4 and 5 from the Hebrew University in Jerusalem, Israel, during a relevant clinical rotation. Following the initial administration of the KPAAQ, the students attended a 60-minute lecture (in Hebrew) based on material from the University of Sydney's learning module on alcohol. The KPAAQ was readministered to the students immediately following the lecture. Results: The KPAAQ demonstrated good reliability (Cronbach α =.92 for all questions) and validity r(209) =.674, P <.001. Knowledge of alcohol and alcoholism significantly increased after the educational intervention (F(2, 154) = 151.60, P <.001). Post hoc comparisons using the Scheffe test revealed a significant positive change in knowledge after students received the intervention (mean difference = 33, P <.001). Conclusions: These initial findings suggest that the KPAAQ is a reliable and valid instrument for assessing medical student knowledge of psychiatric aspects of AUD over 6 clinical categories.     

The Role of Family Support and Parental Monitoring as Mediators in Mexican American Adolescent Drinking

This study contributes to the current gap in the literature on drinking behaviors among Mexican American youth by exploring the role of family relationships as a mediator against alcohol use. This is a secondary analysis of data from a nationally representative study on Adolescent Health (ADD Health) collected in 1995 and focuses on a sample (n = 1,424) of Mexican American teens across the United States. Analysis of the data utilizes multiple regression to identify risks and protective factors of adolescent drinking in Mexican American youth. The study's implications and limitations are noted and important areas for future research are considered.     

Gender Differences in Stressful Life Events,Social Support,Perceived Stress,and Alcohol Use Among Older Adults: Results From a National Survey

Stressful life events, perceived stress, and social support relationships with consumption, at-risk drinking, and alcohol use disorder (AUD) were studied in a population-based sample of current drinkers age 60+ in the National Epidemiologic Survey of Alcohol and Related Conditions (Wave 2; 2004–2005; n = 4,360). Stressful life events were associated with AUD among men and women, and crime victimization among men only. However, greater perceived stress was associated with lower consumption among women and greater odds of AUD in men, highlighting differences in the relationship between stress and alcohol use by gender that may be the result of the stress alcohol link.     

Gender and Direction of Effect of Alcohol Problems and Internalizing Symptoms in a Longitudinal Sample of College Students

Background: Alcohol problems and internalizing symptoms are consistently found to be associated but how they relate to each other is unclear. Objective: The present study aimed to address limitations in the literature of comorbidity of alcohol problems and internalizing symptoms by investigating the direction of effect between the phenotypes and possible gender differences in college students. Method: We utilized data from a large longitudinal study of college students from the United States (N = 2607). Three waves of questionnaire-based data were collected over the first two years of college (in 2011–2013). Cross-lagged models were applied to examine the possible direction of effect of internalizing symptoms and alcohol problems. Possible effects of gender were investigated using multigroup modeling. Results: There were significant correlations between alcohol problems and internalizing symptoms. A direction of effect was found between alcohol problems and internalizing symptoms but differed between genders. A unidirectional relationship varying with age was identified for males where alcohol problems initially predicted internalizing symptoms followed by internalizing symptoms predicting alcohol problems. For females, a unidirectional relationship existed wherein alcohol problems predicted internalizing symptoms. Conclusions/Importance: We conclude that the relationship between alcohol problems and internalizing symptoms is complex and differ between genders. In males, both phenotypes are predictive of each other, while in females the relationship is driven by alcohol problems. Importantly, our study examines a population-based sample, revealing that the observed relationships between alcohol problems and internalizing symptoms are not limited to individuals with clinically diagnosed mental health or substance use problems.