Test of measurement invariance of the FTND across demographic groups: assessment, effect size, and prediction of cessation

Background

Measurement non-invariance of the Fagerstrom test for nicotine dependence (FTND) across demographic groups could significantly bias group comparisons and screening for recruitment into treatment and genetic studies. Here clinically meaningful bias in the FTND across European-American and African-American men and women was assessed by: (1) testing measurement invariance; (2) estimating effect sizes of non-invariance; and (3) assessing impact of adjusting for bias on the association between FTND and cessation.

Methods

European-American and African-American current and former smokers (n = 8301) were identified from a community-based telephone screening of 25,265 individuals from metropolitan Detroit, MI and St. Louis, MO. The FTND was administered to measure current dependence and lifetime dependence when smoking the most. Cessation was measured as having smoked 100 or more cigarettes but not smoked in the past 30 days.

Results

Statistically significant measurement non-invariance for the FTND was found and more pronounced for lifetime than current dependence. However, the magnitude of effects appeared negligible. The largest variance in item response explained by measurement non-invariance was 3.1%. Adjusting for measurement non-invariance made no difference in the associations between nicotine dependence and quitting smoking across groups.

Conclusions

Although European-American and African-American men and women often report different scores on the FTND and have different response patterns to items on the FTND, it does not appear that such differences result from meaningful item-level measurement bias.     

The association between partner and non-partner aggression and suicidal ideation in patients seeking substance use disorder treatment

Objective

The present study was designed to examine the relationship between prior partner and non-partner aggression and suicidal ideation in patients seeking drug and alcohol treatment.

Method

Patients entering drug and alcohol treatment (n = 488) were screened for prior partner and non-partner aggression as well as recent suicidal thoughts. We examined the association between aggression and suicidal ideation in bivariate and multivariate models.

Results

Within the past two weeks, 33% (159/488) of the sample reported suicidal ideation. In bivariate analyses, neither psychological nor physical aggression towards a non-partner was related to suicidal ideation. Partner psychological aggression was related to suicidal ideation in bivariate but not multivariate analyses. Physical aggression towards a partner was consistently related to higher rates of suicidal ideation even after controlling for other known risk factors (OR = 1.8; CI = 1.1–2.7). Mediational analyses indicate that this relationship was no longer significant after accounting for current negative affect.

Conclusion

Suicidal ideation is common in patients seeking drug and alcohol treatment and particularly likely in those who report prior aggression towards a partner.     

Cross-cultural invalidity of alcohol dependence measurement across Hispanics and Caucasians in 2001 and 2002

Aims

Do assessments of alcohol dependence demonstrate similarly validity across Hispanics and non-Hispanic Caucasians? This investigation examined this question.

Method

It employed confirmatory factor analyses for ordered-categorical measures to search for measurement bias on the AUDADIS, a standardized measure of alcohol dependence, across Hispanic (n = 4819) and non-Hispanic Caucasians (n = 16, 109) in a nationally representative survey of alcohol use in the United States conducted in 2001 and 2002.

Measurement

Analyses considered whether 27 items operationalizing the DSM-IV alcohol dependence construct provided equivalent measurement.

Findings and conclusions

Nine items revealed statistically significant bias, suggesting strong caution regarding the cross-ethnic validity of alcohol dependence. Sensitivity analyses established that item level differences erroneously impact alcohol dependence estimates among the 2001–2002 US Hispanic population. Biased measurement underestimates differences between Hispanics and non-Hispanic Caucasians, underestimates Hispanics' true use levels, and falsely minimizes current increases in drinking behavior evidenced among Hispanics. Findings urge improved public health efforts among the Hispanic community and underscore the necessity for cultural sensitivity when generalizing measures and constructs developed in the majority to Hispanic individuals.     

Age and gender as moderators of the relationship between physical activity and alcohol use

Objective

Understanding moderators of the relationship between physical activity (PA) and alcohol use is important for clarifying the mechanisms underlying these behaviors and informing health promotion interventions. This study examined age and gender as two candidate moderators of the PA-alcohol use link.

Method

As part of a correlational, cross-sectional population-based study of US 34,653 adults, participants were administered surveys assessing demographics, alcohol use, moderate and vigorous PA, and other characteristics. Composite indices of the frequency and quantity of alcohol use and PA were utilized in analyses.

Results

Age moderated the association between past-year vigorous PA and alcohol use (ps ≤ .01). Vigorous PA was positively associated with alcohol use in individuals under 50 years of age (ps ≤ .05), but not in individuals over 50 years of age (ps ≥ 0.05). Gender moderated the association between past-year moderate PA and alcohol use (ps < .001). The relation was stronger in males (β = .72) than in females (β = .41). Each of the findings remained significant even when controlling for demographics, psychiatric variables, and other potential confounds.

Conclusion

Among the American population of adults, age appears to moderate the relationship between vigorous PA and alcohol use, whereas gender appears to moderate the relationship between moderate PA and alcohol use. These findings shed light on the underlying mechanisms that may account for increased alcohol use in exercisers and may have clinical implications for alcohol screening and interventions in adults who lead active lifestyles.     

Stop smoking clinics in Malaysia: characteristics of attendees and predictors of success

Introduction

As Stop Smoking Clinics (SSCs) become more common across the globe, it is important to know how far one can make broad generalisations concerning characteristics of smokers who attend these clinics and factors that predict their success. This involves accumulation of data from different countries.

Objective

The aim of this study was to identify characteristics of smokers and factors leading up to quitting with clinics in Malaysia.

Method

Records from 629 smokers who had sought help from five selected SSCs in Malaysia from January 2006 to June 2007 were analysed.

Results

The characteristics of smokers attending Malaysian smoking clinics were broadly similar to those in Western countries. Consistent with the findings from other countries, older age and longest duration of previous quit attempts were associated with successful smoking cessation. Greater baseline carbon-monoxide readings (OR 0.96, 95% CI 0.93–0.99; p = 0.013), but not Fagerstrom Test for Nicotine Dependence (FTND), predicted failure to quit at six-month in multivariate analysis. Success rates varied greatly between clinics even after adjusting for all other predictors.

Conclusion

In these rare data from a non-Western culture some predictors of successful smoking cessation appeared to generalise from Western smokers but the universal validity of the FTND in particular needs to be examined further.     

Differential drinking patterns of family history positive and family history negative first semester college females

Objective

This study compares the natural drinking patterns of family history positive and family history negative women during their first semester of college, a transitional period known to coincide with considerable alcohol-related risks.

Method

Seventy-two incoming undergraduate females, approximately half of whom reported a family history of alcohol misuse, completed initial questionnaires as well as Timeline Followback assessments. In addition, participants completed five successive weeks of online behavioral diaries measuring three categories of prospective alcohol consumption: total drinks, maximum drinks, and heavy episodic drinking events. Repeated measures ANCOVA models, controlling for prior alcohol consumption, examined participants' drinking behavior.

Results

Over the course of the five assessed weeks, first semester females with a genetic predisposition to alcohol problems were found to consume significantly more total drinks (p < .05), maximum drinks (p < .05), and were more likely to drink heavily (p < .05) than family history negative peers.

Conclusions

Findings highlight increased alcohol-related risks faced by incoming first-year college females with a reported family history of problematic drinking and, thus, emphasize the need for early interventions targeted toward this at-risk group.     

Alcohol policy support among mandated college students

Background

Alcohol consumption on college campuses is high, and often dangerous. College administrators have created policies to control alcohol consumption, but student body support or opposition of specific policies has been relatively unexplored.

Method

The current study examined the relations of alcohol policy support with gender and alcohol consumption. Mandated students (N = 229; 44% women) completed self-report assessments of alcohol policy support and alcohol consumption.

Results

Women supported policies to a greater extent than did men, as did lighter drinkers relative to heavier drinkers. Drinks per drinking day fully mediated the relation between gender and alcohol policy support.

Conclusion

While alcohol policy support differs by gender, this covariation is explained by differences in alcohol consumption. Findings have implications for addressing alcohol policy support among mandated college students.     

Validation of the Dutch version of the brief young adult alcohol consequences questionnaire (B-YAACQ)

Purpose

The purpose of this study was to validate the Dutch version of the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ).

Method

The B-YAACQ was translated into the Dutch language and 800 students were invited to complete the questionnaire. A number of drinking behaviors were also assessed; including weekly drinking, age of drinking onset, and blood alcohol concentration on a typical night out. Students also completed a short version of the Alcohol Use Disorders Identification Test (AUDIT-PC).

Results

Data from 667 undergraduate and graduate students (184 men and 483 women) who reported alcohol use during the past year was used in the analysis. On average, students in this study report 4.7 alcohol-related consequences. The Dutch B-YAACQ was shown to have a high reliability and validity: Cronbach's Alpha was 0.816, and B-YAACQ scores correlated significantly with AUDIT-PC scores (r = 0.747). B-YAACQ scores correlated significantly (p < 0.01) with various drinking variables, including drinking onset age, drinking days per week, alcoholic drinks per week, number of drinks on a night out and blood alcohol concentration when returning home.

Conclusion

The Dutch B-YAACQ is a useful new tool for screening of alcohol-related consequences.     

Effects of an alcohol intervention on drinking among female college students with and without a recent history of sexual violence

Objective

Alcohol misuse among college students is a significant public health problem that can have negative long-term implications. One important correlate of problem drinking among college female populations is sexual violence. The current study investigated: (1) past year sexual violence and its association with alcohol consumption and related psychosocial variables (stress, coping, and mental health); and (2) whether the impact of an alcohol intervention was different for college women with a history of sexual violence compared to those without such a history.

Methods

Female undergraduate students (N = 351) who participated in the Brief Alcohol Screen in College Students (BASICS) completed web-based surveys measuring alcohol and drug use, psychosocial factors, and sexual violence at baseline and six-month follow-up.

Results

At baseline, women who experienced sexual violence reported less use of protective alcohol strategies, more positive coping skills, and more mental health symptoms. Following the intervention, alcohol consumption decreased significantly among the entire sample; however no significant differences in consumption were identified based on a history of sexual violence. Yet, compared to women not reporting sexual violence, women who reported recent sexual violence showed greater improvements in mental health outcomes (p < 0.05).

Conclusions

Findings suggest that brief alcohol interventions may have a differential impact on alcohol-related outcomes based on whether or not women have experienced recent sexual violence.     

Early life exposure to violence and substance misuse in adulthood-The first Brazilian national survey

Background

Substance misuse has been a major source of health and social problems in developing societies as it has been elsewhere. There is a growing body of evidence from developed nations linking early exposure to violence in childhood with substance misuse in adulthood. The role of depression on this association is not clear. This study estimates the association between early life exposure to violence, alcohol disorders and illegal substance use in adulthood and the role of depression on these associations using a national Brazilian sample.

Methods

The first Brazilian National Alcohol Survey gathered information on early exposure to violence and use of psychoactive substances in 1880 participants aged 20 to 60 years old selected at random from the Brazilian household population. We used weighted logistic regression to calculate adjusted odds ratios for the associations between early exposure to violence and substance misuse. To assess the mediating effect of depression on these associations we used the Sobel–Goodman Mediation Test.

Results

Witnessing violence during childhood or adolescence was reported by nearly 20% of the participants whilst over 8% reported having been victims of at least one form of violence. There was a statistically significant association between early exposure to violence and alcohol abuse and/or dependence and use of illegal substances in adulthood with a dose–response relationship. Depression partially explained the association between early exposure to violence with alcohol dependence (18.77% p < 0.001) and did not have a statistically significant mediating effect on the association with illegal substance use (5.83% p = 0.220).

Conclusions

Adverse early life events may affect individual's susceptibility to substance misuse which can be partially mediated by depression. Prevalence of substance misuse in adulthood may be in part attributed to the prevalence of adverse childhood experience. While prevention is the ideal goal, detection and intervention with children exposed to violence must be prioritised.     

What Oregon's parity law can tell us about the federal Mental Health Parity and Addiction Equity Act and spending on substance abuse treatment services

Background

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires commercial group health plans offering coverage for mental health and substance abuse services to offer those services at a level that is no more restrictive than for medical-surgical services. The MHPAEA is notable in restricting the extent to which health plans can use managed care tools on the behavioral health benefit. The only precedent for this approach is Oregon's 2007 state parity law. This study aims to provide evidence on the effect of comprehensive parity on utilization and expenditures for substance abuse treatment services.

Methods

A difference-in-difference analysis compared individuals in five Oregon commercial plans (n = 103,820) from 2005 to 2008 to comparison groups exempt from parity in Oregon (n = 19,633) and Washington (n = 39,447). The primary outcome measures were annual use and total expenditures.

Results

Spending for alcohol treatment services demonstrated statistically significant increase in comparison to the Oregon and Washington comparison groups. Spending on other drug abuse treatment services was not associated with statistically significant spending increases, and the effect of parity on overall spending (alcohol plus other drug abuse treatment services) was positive but not statistically significant from zero.

Conclusions

Oregon's experience suggests that behavioral health insurance parity that places restrictions on how plans manage the benefit may lead to increases in expenditures for alcohol treatment services but is unlikely to lead to increases in spending for other drug abuse treatment services.     

Demographic, emotional and social determinants of cannabis use in early pregnancy: the Generation R study

Aims

To ascertain demographic, emotional and social determinants of cannabis use in early pregnancy.

Design

This study was embedded in the Generation R study, a multiethnic population-based cohort of parents and their children, followed from pregnancy to childhood.

Setting

Rotterdam, The Netherlands.

Participants

Mothers enrolled in pregnancy who answered questions about their own and their partners substance use before and during pregnancy (n = 7610).

Measurements

Using self-report questionnaires, information was collected on maternal demographics, psychopathology, delinquency, childhood trauma, social stress, family functioning, and parental alcohol, tobacco and substance use. Multinomial logistic regression analysis was used, with non-using women as reference.

Findings

246 (3.2%) women used cannabis before pregnancy and 220 (2.9%) women used cannabis both before and during pregnancy. The strongest determinant for maternal cannabis use during pregnancy was cannabis use by the biological father of the child (OR = 38.56; 95%CI = 26.14–58.88). Maternal cannabis use during pregnancy was also independently associated with being single (OR = 4.25; 95%CI = 2.33–7.75) or having a partner without being married (OR = 2.75; 95%CI = 1.56–4.85), childhood trauma (OR = 1.39; 95%CI = 1.22–1.57) and delinquency (OR = 3.37; 95%CI = 1.90–5.98), but not with maternal age, ethnicity, psychopathology, family functioning and perceived stress. Being religious was protective (Islam: OR = 0.25; 95%CI = 0.09–0.65) for maternal cannabis use during pregnancy. Additionally, lower educational level determined continued cannabis use in ever-users (OR = 3.22; 95%CI = 1.54–6.74).

Conclusions

Our results showed that multiple demographic, emotional and social characteristics were associated with maternal cannabis use. These characteristics should be considered when investigating offspring exposed to cannabis in utero, as they may play an important role in mother–child interaction and child development.     

Development and validation of the Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ) in adult cannabis users in treatment

Background

There are few valid clinical assessment instruments for cannabis. Self-efficacy, or the ability of users to resist temptation, is a central feature of social cognitive theory. This study outlines the development and validation of the Cannabis Refusal Self-Efficacy Questionnaire (CRSEQ), which measures the situational confidence to refuse cannabis.

Method

One thousand two hundred and forty-six patients referred for cannabis assessment completed the CRSEQ including measures of cannabis consumption and dependence severity (Severity of Dependence Scale-Cannabis, SDS-C). The CRSEQ was subject to independent exploratory (n = 621, mean age 26.88, 78.6% male) and confirmatory (n = 625, mean age 27.51, 76.8% male) factor analysis.

Results

Three factors: Emotional Relief, Opportunistic and Social Facilitation were identified. They provided a good statistical and conceptual fit for the data. Emotional Relief cannabis refusal self-efficacy was identified as most predictive of cannabis dependence, after controlling for cannabis consumption.

Conclusions

The CRSEQ is recommended as a psychometrically sound and clinically useful measure for cannabis misuse treatment planning and assessment.     

Nicotine dependence, psychological distress and personality traits as possible predictors of smoking cessation. Results of a double-blind study with nicotine patch

Aim

Nicotine replacement therapy (NRT) is an effective treatment for smokers who want to quit, however, the rates of successful quitting can be improved even more. In this context, nicotine dependence (assessed via the Fagerström Tolerance Questionnaire, FTQ), psychological distress (measured via the Symptom Rating Test, SRT), and personality traits (evaluated via the Adult Eysenck Personality Inventory, AEPI) were evaluated as possible predictors of smoking cessation.

Results

A total of 297 cigarette smokers were followed for one year as part of a NRT double-blind, parallel group, randomized trial. Baseline nicotine dependence (weeks 12 and 26: p < 0.05), AEPI neuroticism (weeks 12 and 52: p < 0.05), and AEPI psychoticism (weeks 12 and 52: p < 0.05) scores significantly influenced the outcome of smoking cessation during one-year of follow-up. An increase in psychological distress during follow-up was associated with a lower probability of quitting smoking (p = 0.000).

Conclusions

Nicotine dependence, neuroticism, psychoticism and, over time, psychological distress were the main factors influencing the long-term outcome (i.e., up to 12 months) of smoking cessation under NRT.     

Coincident posttraumatic stress disorder and depression predict alcohol abuse during and after deployment among Army National Guard soldiers

Background

Although alcohol problems are common in military personnel, data examining the relationship between psychiatric conditions and alcohol abuse occurring de novo peri-/post-deployment are limited. We examined whether pre-existing or coincident depression and post-traumatic stress disorder (PTSD) predicted new onset peri-/post-deployment alcohol abuse among Ohio Army National Guard (OHARNG) soldiers.

Methods

We analyzed data from a sample of OHARNG who enlisted between June 2008 and February 2009. Participants who had ever been deployed and who did not report an alcohol abuse disorder prior to deployment were eligible. Participants completed interviews assessing alcohol abuse, depression, PTSD, and the timing of onset of these conditions. Logistic regression was used to determine the correlates of peri-/post-deployment alcohol abuse.

Results

Of 963 participants, 113 (11.7%) screened positive for peri-/post-deployment alcohol abuse, of whom 35 (34.0%) and 23 (32.9%) also reported peri-/post-deployment depression and PTSD, respectively. Soldiers with coincident depression (adjusted odds ratio [AOR] = 3.9, 95%CI: 2.0–7.2, p < 0.01) and PTSD (AOR = 2.7, 95%CI: 1.3–5.4, p < 0.01) were significantly more likely to screen positive for peri-/post-deployment alcohol abuse; in contrast, soldiers reporting pre-deployment depression or PTSD were at no greater risk for this outcome. The conditional probability of peri-/post-deployment alcohol abuse was 7.0%, 16.7%, 22.6%, and 43.8% among those with no peri-/post-deployment depression or PTSD, PTSD only, depression only, and both PTSD and depression, respectively.

Conclusions

Coincident depression and PTSD were predictive of developing peri-/post-deployment alcohol abuse, and thus may constitute an etiologic pathway through which deployment-related exposures increase the risk of alcohol-related problems.     

Shared genetic contributions to early-onset drinking and drinking to cope motives

Introduction

Recent evidence from empirical studies indicates that individuals who begin drinking at an early age may be more likely to use alcohol to cope with negative mood states and stress; however, the mechanisms underlying this association are unclear. One possibility is that early drinking directly increases risk for drinking to cope (DTC). Alternatively, the association between early drinking and DTC may be indirect, attributable to overlapping genetic or environmental factors. No prior genetically informative study has investigated the sources of covariation underlying the early-onset drinking-DTC association.

Method

Early-onset drinking (before age 15) was assessed using structured clinical interviews in a sample of 7130 male and female participants aged 19–56 years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD, Kendler &; Prescott, 2006). DTC was assessed using the mood management scale of the alcohol use inventory (Horn &; Wanberg, 1983). The sources of the covariation between early first drink and DTC were estimated using bivariate twin modeling.

Results

Early drinking onset was reported by 28% of males and 16% of females and was associated with significantly higher DTC scores (phenotypic correlation: males = .19, females = .22). Results from bivariate twin models indicated that the association between early-onset drinking and DTC was completely attributable to shared genetic factors that contribute to both behaviors.

Conclusions

Greater DTC among early-onset drinkers may not reflect a direct causal process, as shared biological pathways may explain vulnerability to stress-related drinking seen among early-onset drinkers.     

The associations between early alcohol use and suicide attempts among adolescents with a history of major depression

Objective

Previous studies have identified significant associations between alcohol initiation before the age of 13 years and risk for suicide attempts. However, these associations have not been extensively tested using data obtained from populations with clinically significant psychopathology. The current study seeks to extend knowledge of the associations between early alcohol initiation and risk for suicide by identifying the associations between age of first alcohol use and suicide attempts among a sample of youth age 13 to 15 years with a history of major depression.

Methodology

Data were obtained from the National Study of Drug Use and Health (NSDUH), a household-based survey of U.S. adolescents and adults age 12 years and older.

Results

Results from these analyses confirm previous reports of significant associations between age of first alcohol use and suicide attempts and extend previous understanding of risk by using data obtained from a household-based survey and from adolescents with clinically relevant psychopathology.

Conclusions

These findings provide further support for the implementation, enforcement, and continued support of both targeted and universal prevention strategies designed to reduce underage drinking.     

All-cause mortality among individuals with disorders related to the use of methamphetamine: A comparative cohort study

Background

Understanding the mortality rate of methamphetamine users, especially in relation to other drug users, is a core component of any evaluation of methamphetamine-related harms. Although methamphetamine abuse has had a major impact on United States (US) drug policy and substance-abuse treatment utilization, large-scale cohort studies assessing methamphetamine-related mortality are lacking.

Methods

The current study identified cohorts of individuals hospitalized in California from 1990 to 2005 with ICD-9 diagnoses of methamphetamine- (n = 74,139), alcohol- (n = 582,771), opioid- (n = 67,104), cannabis- (n = 46,548), or cocaine-related disorders (n = 48,927), and these groups were followed for up to 16 years. Age-, sex-, and race-adjusted standardized mortality rates (SMRs) were generated.

Results

The methamphetamine cohort had a higher SMR (4.67, 95% CI 4.53, 4.82) than did users of cocaine (2.96, 95% CI 2.87, 3.05), alcohol (3.83, 95% CI 3.81, 3.85), and cannabis (3.85, 95% CI 3.67, 4.03), but lower than opioid users (5.71, 95% CI 5.60, 5.81).

Conclusions

Our study demonstrates that individuals with methamphetamine-use disorders have a higher mortality risk than those with diagnoses related to cannabis, cocaine, or alcohol, but lower mortality risk than persons with opioid-related disorders. Given the lack of long-term cohort studies of mortality risk among individuals with methamphetamine-related disorders, as well as among those with cocaine- or cannabis-related conditions, the current study provides important information for the assessment of the comparative drug-related burden associated with methamphetamine use.     

The separate and interactive effects of drinking motives and social anxiety symptoms in predicting drinking outcomes

Purpose

Our goal was to test the separate and interactive effects of drinking motives and social anxiety symptoms in predicting drinking-related consumption and problems.

Methods

Participants (N = 730; 59.7% female) were undergraduate college students who completed measures of social anxiety symptoms, drinking motives, alcohol consumption, and drinking problems.

Results

Greater social anxiety symptoms were significantly associated with less alcohol consumption, and there was some evidence that greater social anxiety symptoms were also associated with greater alcohol-relevant problems. Significant interactions between social anxiety and motives indicated that a) alcohol use was most pronounced for individuals high in enhancement motives and low in social anxiety symptoms; and b) among participants low in coping motives, drinking problems were greater for individuals high (vs. low) in social anxiety symptoms.

Conclusions

More fully identifying the individual difference factors that link social anxiety symptoms with drinking outcomes is important for informing prevention and intervention approaches.