Alcohol-related harms and risk behaviours among adolescents: Does drinking style matter

Aims: The aim of this study was to examine to what extent reported harms and risk behaviours related to alcohol use were associated with 15–16-year-old adolescents' frequency of alcohol drinking, subjective state of intoxication, self-control, and family factors such as parental control, family composition, and family's financial situation.

Methods: Cross-sectional survey data from Finnish Self-Reported Delinquency Study were collected in 2008 (n = 5826).

Results: The multivariate analyses indicate that drunkenness oriented drinking style was strongly associated with variety of alcohol-related harms. While physiological and social harms were especially connected with situational heavy drunkenness, delinquency and sexual risk-taking behaviour were associated with both drunkenness and frequency of alcohol drinking. Low self-control was associated most strongly with delinquency and sexual risk behaviour; whereas low parental control was related to social harms and delinquency.

Conclusions: These findings should be taken into account when planning more comprehensive policies to reduce both alcohol drinking and related harms.     

Alcohol Expectancies,Pregaming, Drinking Games,and Hazardous Alcohol Use in a Multiethnic Sample of College Students

Pregaming is a risky drinking behavior that occurs when students drink alcohol before a primary social gathering or event. The paucity of research on pregaming highlights the need for research on the correlates of drinking behaviors, such as alcohol expectancies, that might increase the likelihood of pregaming. Thus, we sought to examine how alcohol expectancies and the valuations (i.e., desirability) of these expectancies are associated with frequency of pregaming, drinking game (DG) participation, and hazardous alcohol use. Students (N = 1327) from nine U.S. colleges and universities completed self-report surveys. Results showed sufficient discriminant validity among pregaming behaviors, DG participation, and hazardous alcohol use. Findings also revealed that pregaming mediated the associations between positive alcohol expectancies and hazardous drinking behaviors. Finally, when we tested for invariance across gender, ethnicity, and legal versus underage alcohol users, we found full invariance across gender and ethnicity, but not for legal versus underage alcohol users. Future research directions and potential implications for prevention efforts are discussed.     

Prevalence of problem drinking and characteristics of a single-question screen

Hazardous drinking and alcohol use disorders (i.e, abuse and dependence) are common in Emergency Departments (EDs). This study examined 1) the prevalence of these conditions among ED patients and 2) characteristics of a single screening question (having consumed at least five drinks for males or four for females during a single day). Data from the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Logistic regression for clustered data was used to estimate the relative risk for past-year ED use associated with hazardous drinking, abuse, and dependence. Contingency tables were analyzed to estimate the sensitivity and specificity of the single-question screen for detecting these conditions. Hazardous drinking was not associated with ED utilization. Alcohol abuse was associated with a relative risk of 1.3 (95% confidence interval [CI] 1.1-1.5) and alcohol dependence with a relative risk of 1.9 (95% CI 1.6-2.2). For current drinkers, the single question screen was 0.96, 0.85, and 0.90 sensitive for hazardous drinking, alcohol abuse, and alcohol dependence, respectively. Individuals with a positive screen in the past year were considered at least hazardous drinkers, and specificity was 0.80, 0.64, and 0.65 for hazardous drinking, abuse, and dependence, respectively. Specificity was modestly increased in women. Most problem drinkers were hazardous drinkers, but only severe alcohol use disorders were particularly prevalent in the ED. The single heavy-drinking-day item appears sensitive for problem drinking. Positive tests must be followed by additional assessment to differentiate hazardous drinking from alcohol use disorders.     

The association of long-term alcohol biomarkers with risk for alcohol-related injury: Implications for screening

Alcohol misuse is a leading risk factor for serious injury and death. For those experiencing trauma in emergency care settings, recent alcohol misuse history is typically assessed via self-report measures. Since underreporting may be a problem in these settings, objective indicators like long-term biomarkers may be useful for identifying hazardous drinkers who may need intervention. Recognizing this, we investigated (1) whether hazardous drinking was linked to reports of alcohol-related injury in a probability sample of over 600 college students from a large, Midwestern, urban university; (2) whether elevated long-term biomarkers showed similar associations in the same sample. Associations derived from responses to the Alcohol Use Disorder Identification Test-C (AUDIT-C) as well as from hair and fingernails tested for ethyl glucuronide, a direct alcohol biomarker, suggested that hazardous drinking is significantly associated with elevated risk for alcohol-related injury. Implications for screening and intervention in health care settings are discussed.     

Review article: Effectiveness of ultra‐brief interventions in the emergency department to reduce alcohol consumption: A systematic review

To assess the effectiveness of ultra‐brief interventions (ultra‐BI) or technology‐involved preventive measures in the ED to reduce alcohol harm and risky drinking. Medline, Embase, PsycINFO, CINAHL and EBM reviews were searched for articles published between 1996 and 2015. Randomised controlled trials and quasi‐randomised trials, which compared an ultra‐BI with screening, standard care or minimal intervention for adults and adolescents at risk for alcohol‐related harm presenting to an ED, were included. Outcomes of interest were frequency of alcohol consumption, quantity of alcohol consumed, binge drinking and ED representation. Thirteen studies (nine single centre and four multicentre) were included. Six studies showed a significant reduction in the quantity consumed with intermediate effect size at 3 months (d = ?0.40) and small effect size at 12 months (d = ?0.15). Two studies showed a significant reduction in binge drinking with small effect size at 3 months (d = ?0.12) and 12 months (d = ?0.09). No studies showed an effect on frequency of alcohol consumption or ED representation. Heterogeneity in study design, definition of risky, harmful or hazardous alcohol use, intervention types, outcomes, outcome timeframes and outcome measures prevented the performance of quantitative meta‐analysis. Despite its limited effectiveness in reducing alcohol use in the short‐term, with the large number of people attending EDs with risky drinking, the use of an effective ultra‐BI would have the potential to have a measurable population effect.     

‘Unintended’ audiences of alcohol advertising: exposure and drinking behaviors among Australian adolescents

Purpose: To measure associations between exposure to alcohol advertising and drinking behaviors among secondary students in Victoria, Australia.

Methods: Students aged 12–17 years completing a cross-sectional survey in 2011 (n = 4,413) indicated their exposure to alcohol advertising via multiple media channels. Students also indicated whether they had consumed alcohol in the past month and the number of alcoholic drinks consumed on each of the seven days preceding the survey. Students drinking five or more drinks on one of these seven days were classified as ‘risky drinkers’. Logistic regression analyses examined associations between exposure to alcohol advertising media and alcohol consumption measures, controlling for student-level demographic variables.

Results: Exposure to alcohol advertising was most common through television (58%), alcohol branded merchandise (42%), and the internet (39%). After controlling for other advertising exposure measures, weekly exposure to alcohol advertising via billboards/newspapers/magazines and ownership of at least one alcohol branded item was significantly associated with consuming alcohol in the past month and at risky levels.

Conclusions: Findings show high exposure to alcohol advertising among Australian youth and associations with drinking behaviors, suggesting the need for increased regulation of alcohol advertising across traditional and non-traditional media.     

Parenting styles and typology of drinking among children and adolescents

Background: Recent studies show that the parenting styles may play a significant role in the patterns of alcohol use among children and adolescents. Aim: The aim of our study is to examine the influence of specific parenting factors on the incidence of drunkenness and frequency of alcohol use and, on the basis of these findings, propose a typology of drinking among children and adolescents. Methods: A cross-sectional survey was conducted using the EFE Survey Questionnaire – Adolescents Questionnaire. The research sample, selected using a two-stage random sampling design, consisted of 1255 students aged 10–18 years (mean age?=?14.7 years, 54% boys and 46% girls). Results: The results indicate a significant relationship between the frequency of alcohol use among the children, adolescents and perceived family rules, family communication, and parental control and warmth/affection. The incidence of drunkenness in the last 30 days correlated significantly with perceived the family rules, parental control, emotional warmth, and discussion of problems. Conclusion: Parental behaviour and parenting styles may significantly affect the pattern of adolescent drinking. Primary prevention therefore needs to focus both on research and the practical application and implementation of the programmes, in which parents and their children are involved.     

Parent–student communication regarding alcohol use: an examination of tacit approval

Background: First-year college students appear to be at particular risk for experiencing negative alcohol-related consequences. This risk has fostered a need to identify malleable factors associated with first-year student alcohol consumption. Studies have shown significant positive associations between perceived parental approval of drinking and alcohol use and associated consequences. However, researchers have not yet identified the exact mechanism responsible for this relationship.

Objectives: This study examined a potential vehicle by which parents may communicate approval of drinking to their college aged children. Specifically, we tested if less parent communication about alcohol use would be perceived as tacit approval on the part of first-year college students.

Methods: Two hundred seventy-nine first-year undergraduate students age 18–20 answered online surveys of perceived parental approval of drinking, negative alcohol-related consequences, perceived parental knowledge, and parent–student communication regarding alcohol use.

Results: Contrary to hypothesis, our findings indicate the amount of parent–student communication regarding alcohol use did not predict perceived parental approval of drinking in first-year students, after controlling for the influence of gender, perceived parental knowledge, and negative consequences of alcohol use.

Conclusions: Results suggest that first-year college students may not interpret less parent–student communication regarding alcohol as tacit approval of drinking.     

Effects of an intervention brochure on emergency department patients' safe alcohol use and knowledge

Alcohol abuse is a leading cause of morbidity and mortality in the United States, contributing to over 100,000 deaths and costing society over 185 billion dollars each year. The objective of this study was to evaluate the effects of the American College of Emergency Physician's brief alcohol use intervention brochure on patients' hazardous drinking behavior and knowledge of safe alcohol use. We conducted a controlled trial comparing Emergency Department (ED) subjects receiving the alcohol use intervention brochure vs. receiving no brochure. One-month outcome measures included the following: 1) change in days of hazardous drinking; 2) change in knowledge of safe alcohol use; and 3) movement along a readiness-to-change continuum for excessive alcohol use. Of 277 subjects, 252 (91.0%) agreed to participate, and 188 of these (74.6%) were successfully contacted for 1-month follow-up assessment. We did not find any significant decreases in days of hazardous drinking or increases in knowledge of safe drinking limits for either the intervention or comparison groups. However, among the subgroup of excessive alcohol users (n = 100), we found that significantly more intervention subjects had advanced along the readiness-to-change continuum than comparison subjects (p < 0.01). This effect was even greater among the intervention group subjects who stated that they read the brochure (p < 0.001). A brief alcohol use intervention brochure does not affect ED patients' hazardous drinking behavior or knowledge of safe alcohol use. The brochure, however, may affect certain patients' motivation to change their drinking behavior. Changing drinking behavior requires more than simply handing out a brochure in the ED; referral to community resources for those motivated to change is likely an important component to successful management of this problem.     

Factors predictive of alcohol consumption among senior high school students in Phayao province,Thailand

Abstract

Objectives: To identify factors predictive of alcohol consumption among senior high school students in Phayao province, Thailand, where there is a high prevalence of alcohol consumption among adolescents.

Methods: A cross-sectional study in which 317 grade 11 senior high school students participated in a survey during June 2012. Data were collected by face-to-face interviews. Chi-square and multivariate logistic regression were used to determine the factors predictive of alcohol consumption among the subjects.

Results: Over two-thirds of the students (66.9%) had consumed alcohol in their lifetime, 58.7% in the previous year and 17.4% in the previous month. Following univariate analysis, seven factors – gender, age, GPA, allowance, first age of drinking, peer drinking and alcohol knowledge were identified as being significantly associated with drinking (p?<?0.05). Multivariate analysis revealed four factors to be predictive of alcohol among high school students: peer drinking (OR?=?3.59, 95%CI?=?1.99–6.44), alcohol knowledge (OR?=?2.64, 95%CI?=?1.47–4.72), GPA?≥?2.5 (OR?=?0.32, 95%CI?=?0.16–0.64) and allowance (OR?=?0.15, 95%CI?=?0.04–0.58).

Conclusion: Peer drinking was the strongest predictor of adolescent alcohol consumption, while alcohol knowledge had negative correlation with alcohol consumption. Hence, peer influence and appropriate alcohol knowledge should be considered as key areas in attempts to reduce alcohol consumption among senior high school students.     

All it takes is one: drinking games,prepartying, and negative drinking consequences among high school students

Abstract

Prepartying (i.e. drinking before a social event/gathering) and participation in drinking games are two high-risk drinking behaviors practiced by adolescents.?Engaging in both these drinking behaviors may contribute to a multiple risk paradigm, wherein the risk associated with one’s general drinking is combined with the additional risk of rapidly ingesting alcohol as a result of one or both these activities.?The present study examines this paradigm among high school students who reported alcohol use (N?=?240).?Controlling for age and typical alcohol consumption, results indicated that participation in prepartying or drinking games was associated with more negative alcohol-related outcomes than non-participation. However, participation in both risky behaviors, as opposed to one, did not give rise to negative additive effects. Thus, students who participate in just one of these activities warrant the same attention from health professionals and school personnel as those who participate in both.?Importantly, results also showed that students who reported drinking games participation and prepartying endorsed social and coping drinking motives just as frequently as students who only reported drinking games participation.?However, students who engaged in multiple high-risk drinking behaviors were more inclined to drink to enhance the intensity of the “high” associated with alcohol use.     

Alcohol use and misuse in older people: a local prevalence study comparing English and Irish inner‐city residents living in the UK

Background: Alcohol consumption was assessed in English and Irish men and women aged 65 and over, living in an inner‐city area of London, UK.

Method: Participants were assessed using Quantity/Frequency measures of alcohol use and validated questionnaires (SMAST‐G, 10‐item AUDIT, SF‐36).

Results: Sixty subjects with a mean (SD) age of 77.5 (1.2) years were recruited. English subjects showed greater changes between lifetime and last year drinking patterns (chi‐square = 18.9, d.f. = 4, p = 0.001). Irish subjects had a significantly higher mean AUDIT score (2.8 vs. 1.0; Mann–Whitney U = 225, Z = ?3.5, p<0.0001) and were significantly more likely (14/30 vs. 3/30) to have a family psychiatric history (chi‐square = 10.6, d.f. = 1, p = 0.001). Irish subjects were more likely to drink at least once a week, showed a higher mean alcohol intake (6.4 vs. 2.4 g) over the previous year and were more likely to show binge drinking (8/30 vs. 1/30) and drinking above sensible limits (8/30 vs. 1/30). None of these latter observations retained their significance after statistical correction.

Conclusions: The main implication of the study is that closer attention is required in screening for alcohol use in older Irish men in the UK.     

Hazardous drinkers in the accident and emergency department—Who accepts advice?

Methods: Patients presenting to an A&E department were screened using the Paddington Alcohol Test. All patients identified as hazardous drinkers were offered advice about their drinking. Data were collected on patients' age, sex, presenting condition, and alcohol consumption. Binary logistic regression was used to identify variables that predicted acceptance of the offer of advice.

Results: The presenting condition, together with the total number of units consumed on a single occasion, predict the uptake of an offer of help.

Conclusions: Patients identified as hazardous drinkers who present after a fall, head injury, or other accident are less likely to accept help. Clinicians should emphasise the potential relation between alcohol consumption and health related consequences to encourage the uptake of advice for these patients.

     

Alcohol use among young adults presenting to the emergency department

Objectives: To determine the prevalence of young ED patients at risk from hazardous alcohol consumption, to identify high‐risk patient subgroups and evaluate the feasibility of use of the Alcohol Use Disorders Identification Test (AUDIT) in this setting. Methods: We undertook a cross‐sectional survey of 336 ED patients aged 18–30 years, inclusive. All were breathalysed prior to self‐administering the AUDIT. A ‘positive’ AUDIT score (≥8) defined hazardous alcohol consumption. AUDIT scores were correlated with sex and trauma diagnosis. Results: One hundred and thirty‐one (39.0%, 95% confidence interval [CI] 33.8–44.5) patients were classified as AUDIT‐positive. Men were significantly more likely to be AUDIT‐positive (49%vs 23%, P < 0.001) and had significantly higher total AUDIT scores (P < 0.001) than women. Trauma patients were significantly more likely to be AUDIT‐positive (P < 0.001) and had significantly higher AUDIT scores than non‐trauma patients (P < 0.001). Of the six patients who recorded a positive breath alcohol reading, all were AUDIT‐positive. One hundred (76.3%, 95% CI 68.0–83.1) AUDIT‐positive patients did not report others being concerned about their drinking or had not been given advice to cut down. Conclusion: It is feasible to use the AUDIT screening tool in the ED to identify those at risk from hazardous drinking. In our ED there is a high prevalence of hazardous alcohol consumption in young adult patients, many of whom have not previously received advice to cut down on their drinking.     

“She’s getting married; I’m getting drunk”: women’s risk and protective strategies at bachelorette parties

Objective: Bachelorette parties comprise a common setting where young, reproductive-aged women engage in high-risk drinking behaviors. This study examines drinking behaviors among bachelorette party attendees, and identifies the individual and party related characteristics that influence these behaviors. Method: 122 young women (Mean age = 25.1 ± 4.0 years) responded to an online survey assessing drinking-related behaviors associated with the most recent bachelorette party attended in the past 12 months. Results: More than 80% of our sample reported drinking at the bachelorette party they attended, with an average of five drinks consumed the day of the party. Drinking behaviors of party attendees bore a strong correspondence to their typical drinking behaviors. Parties organized in public locations and with larger sizes were more likely to be associated with heavier drinking than parties organized in private settings and with fewer attendees. Overall, the presence of safety plans was associated with a lower likelihood of drunk driving; however in the presence of underage attendees, safety plans were linked to greater alcohol consumption. Conclusions: Given the rise in bachelorette parties and the high costs associated with binge-drinking among women, there is a growing need to develop interventions that can reduce women’s involvement in risky drinking behaviors.     

Positive Social Alcohol Outcome Expectancies,Social Anxiety,and Hazardous Drinking in College Students

Although social anxiety and problematic alcohol use co-occur at alarmingly high rates, the mechanism for this co-occurrence is not well understood. The current study examined the mediating role of positive social alcohol expectancies (i.e., beliefs related to the desirable social effects of drinking) in the relationship between social anxiety and hazardous drinking (i.e., heavy drinking and negative consequences) among an ethnically and racially diverse (87% racial and/or ethnic minority) sample of undergraduate volunteers (n = 610; Mage = 19.1; 69% women). The results of structural equation modeling analyses (using AMOS 7.0) indicated that social (but not tension reduction, sexual enhancement, positive cognitive changes, or negative affective changes) alcohol outcome expectancies partially mediated the association between social anxiety and hazardous drinking; however, social anxiety had a negative direct effect on hazardous drinking. Findings implicate social alcohol outcome expectancies as a mechanism to target in treatment and prevention among socially anxious students.     

The effect of personal use and family history on the attitudes of medical students toward alcohol and drug users

Objective: To investigate the effects of the personal exposure/usage of alcohol and drugs in medical students on their attitudes toward alcohol and drug users. Negative attitudes in health care practitioners about alcohol and drug users may lead to poor patient care. Personal experience on alcohol and drug use can influence the attitudes of health care professionals.

Method: This study used a quantitative cross-sectional methodology, utilizing a self-report survey on the personal use of alcohol and drug use, and the family history of alcohol and tobacco use. The “Substance Abuse Attitude Survey” (Chappel J. N., Veach, T. L., & Krug, R. S. (1985). The Substance Abuse Attitude Survey: An instrument for measuring attitudes. Journal of Studies on Alcohol, 46, 48–52.) measured attitudes (n = 417).

Results: The attitudes of medical students towards alcohol and drug users were weakly linked to their own personal use, and family history of alcohol and drug use. Increased use of alcohol was positively correlated with non-stereotyping. Length of time in medical school, number of years drinking alcohol, and high frequency of binge drinking were negatively correlated with non-moralism.

Conclusions: This study demonstrated that the attitudes of future medical professionals are fairly neutral toward alcohol and drug users. Given that alcohol and drug abuse are now considered medical illnesses health professionals themselves may attach fewer stigmas and stereotypes to the use and abuse of alcohol.     

Containing the Uncontainable: Alcohol Misuse and the Personal Choice Community ProgrammeBarbara ElliotWhurr Publishers Ltd. ISBN: 1‐861‐56368‐X, 2003, 69 pp. with index, £17.99

Aims: The paper constructs and tests summary measures for different areas of alcohol‐related problems, using general population data. The main emphasis is on the rather unexplored area of measuring social harm from drinking.

Methods: The data analysed is a Swedish national survey on drinking behaviour and related consequences, collected in 2002 by means of telephone interviews with 5469 adult Swedes. In total, 38 items on both personal and social problems by respondents attributed to their drinking were subjected to factor analysis in order to identify different problem areas for which summary measures could be constructed. The psychometric properties of the measures were then tested.

Results: In line with others' findings, the problem items tended to load on a single factor. After Varimax rotation, 11 factors were built, only in part fitting a logical conceptual pattern. In the light both of the dimensions identified in the factor analysis and of face validity, measures of five areas of alcohol‐related problems were constructed: impaired self‐control, chronic health problems, public disorder, interpersonal problems and alcohol‐related social problems. The last measure is a summary scale including both items covered by public disorder and interpersonal problems scales, as well as a few other items. In terms of internal consistency and test–retest reliability (analysing a smaller sample from a test–retest pilot study), the five measures showed satisfactory psychometric properties.

Conclusions: In the light of others' findings, the measures developed here seem to be more consistent and reliable than a number of other scales. In order to establish comparability, it seems reasonable to develop and test similar measures across different drinking cultures and, perhaps, modify them thereafter.     

The Irish drinking habits of 2002—Drinking and drinking‐related harm in a European comparative perspective

Aims: To examine drinking habits and experiences of adverse consequences of drinking among men and women in Ireland 2002 and to compare some results with earlier European studies using similar data and methods.

Methods: Data on self‐reported drinking habits and experiences of alcohol‐related problems were obtained from a general population survey undertaken in 2002. Two approaches were used: (1) cross‐tabulations of drinking habits and the experience of adverse consequences in various demographic groups (2) logistic regressions predicting the likelihood of experiencing problems.

Results: Self‐reported alcohol consumption confirms statistics on alcohol sales; a lot of alcohol is consumed in Ireland today despite a large fraction of abstainers in the population. Binge drinking is very common, and, out of 100 drinking events, 58 end up in binge drinking for men and 30 for women. Irish drinkers also experience harmful drinking‐related consequences to a larger extent than in other western European countries. Both volume of drinking and binge drinking affect the likelihood of experiencing most alcohol‐related harms. Conclusions: Drinkers in Ireland drink more than in other western European countries and many have risky drinking habits that lead to adverse consequences. It will be an important challenge to find preventive measures that can reduce these problems in Ireland.