OBJECTIVE:Prior research has shown that designated drivers (DD) are widely used as a preventive measure for driving under the influence. Despite the prevalence of alcohol involvement in boating accidents, much less is known about the use of a designated boat operator (DBO). The current study investigated the prevalence of DBO use in recreational boating and compared the characteristics of DD users and DBO users.METHOD:Several survey questionnaires were distributed to a group of undergraduate students at a large southwestern university for the purpose of investigating demographic characteristics, alcohol-use pattern, and other alcohol-related problem behaviors, such as driving and boating under the influence.RESULTS:Approximately 45% of the boaters reported they had drunk alcohol while boating, and approximately 70% had used a DBO in the most recent boating event. The DBO users were found to be similar to the DD users in terms of drinking pattern, age of drinking onset, and driving behaviors.CONCLUSIONS:High rates of alcohol use in recreational boating suggest the need for prevention strategies. Furthermore, future studies are needed to investigate the selection process of the DBOs and the differences between passengers and boat operators, which could shed light on strategies to prevent alcohol- involved boating injuries.
Objective: The present study seeks to establish the extent to which media coverage acknowledges alcohol's contribution to violent crime as well as to motor vehicle injuries and other injury incidents. Method: The study content-analyzes a unique sample, closely approximating national representativeness, of local and national television news, local newspapers, and national magazines randomly sampled during a 2-year period. Results: Alcohol's role in violent crime and, to a lesser extent, in motor vehicle and other injury incidents is underreported relative to available estimates regarding alcohol-attributable fractions. Relative frequency of various news frames for coverage of alcohol and illegal drugs and differences in coverage of alcohol and illegal drugs as a function of the type of story and news medium are described. Conclusions: The underreporting in the United States of alcohol's contribution to serious and fatal injury from these causes may reduce public perceptions of alcohol-related risks, potentially influencing behavior, including public support of alcohol-control policies. This provides an opportunity for media-advocacy approaches to improve public health content of news coverage.
Objective: A theory-based protection/risk model was applied to explain variation in college students' heavy episodic drinking. Key aims were (1) to establish that psychosocial and behavioral protective factors and risk factors can account for cross-sectional and developmental variation in heavy episodic drinking, and (2) to examine whether protection moderates the impact of risk on heavy episodic drinking. Method: Random- and fixed-effects maximum likelihood regression analyses were used to examine data from a three-wave longitudinal study. Data were collected in fall of 2002, spring of 2003, and spring of 2004 from college students (N = 975; 548 men) who were first-semester freshmen at Wave 1. Results: Psychosocial and behavioral protective and risk factors accounted for substantial variation in college-student heavy episodic drinking, and protection moderated the impact of risk. Findings held for both genders and were consistent across the three separate waves of data. Key predictors of heavy episodic drinking were social and individual controls protection (e.g., parental sanctions for transgression and attitudinal intolerance of deviance, respectively); models risk (peer models for substance use); behavioral protection (attendance at religious services); and behavioral risk (cigarette smoking and marijuana use). Changes in controls protection, models risk, and opportunity risk were associated with change in heavy episodic drinking. Conclusions: An explanatory model based on both psychosocial and behavioral protective and risk factors was effective in accounting for variation in college-student heavy episodic drinking. A useful heuristic was demonstrated through the articulation of models, controls, support, opportunity, and vulnerability to characterize the social context, and of controls, vulnerability, and other behaviors to characterize individuals.
Objective: This study investigated whether young people's Substance Use and aggressive behaviors are related to their listening to music containing messages of substance use and violence. Method: Using self-administered questionnaires, data were collected from a sample of community-college students, ages 15-25 years (N = 1,056; 57% female). A structural equation model (maximum likelihood method) Was used to simultaneously assess the associations between listening to various genres of music and Students' alcohol use, illicit-drug use, and aggressive behaviors. Respondents' age, gender, race/ethnicity, and level of sensation seeking were included in the analyses as control variables. Results: Listening to rap music was significantly and positively associated with alcohol use, problematic alcohol use, illicit-drug use, and aggressive behaviors when all other variables were controlled. In addition, alcohol and illicit-drug use were positively associated with listening to musical genres of techno and reggae. Control variables (e.g., sensation seeking, age, gender and race/ethnicity) were significantly related to substance use and aggressive behaviors. Conclusions: The findings Suggest that Young people's substance use and aggressive behaviors may be related to their frequent exposure to music containing references to substance use and violence. Music listening preference, conversely, may reflect some personal predispositions or lifestyle preferences. There is also the possibility that substance use, aggression, and music preference are independent Constructs that share common "third factors."
OBJECTIVE:An 18-site randomized trial was conducted to determine the effectiveness of social norms marketing (SNM) campaigns in reducing college student drinking. The SNM campaigns are intended to correct misperceptions of subjective drinking norms and thereby drive down alcohol consumption.METHOD:Institutions of higher education were randomly assigned to treatment and control groups. At the treatment group institutions, SNM campaigns delivered school-specific, data-driven messages through a mix of campus media venues. Cross-sectional student surveys were conducted by mail at baseline (n = 2,771) and at posttest 3 years later (n = 2,939). Hierarchical linear modeling was applied to examine multiple drinking outcomes, taking intraclass correlation into account.RESULTS:Controlling for other predictors, having an SNM campaign was significantly associated with lower perceptions of student drinking levels and lower alcohol consumption, as measured by a composite drinking scale, recent maximum consumption, blood alcohol concentration for recent maximum consumption, drinks consumed when partying, and drinks consumed per week. A moderate mediating effect of normative perceptions on student drinking was demonstrated by an attenuation of the Experimental Group x Time interaction, ranging from 16.4% to 39.5% across measures. Additional models that took into account the intensity of SNM campaign activity at the treatment institutions suggested that there was a dose-response relationship.CONCLUSIONS:This study is the most rigorous evaluation of SNM campaigns conducted to date. Analysis revealed that students attending institutions that implemented an SNM campaign had a lower relative risk of alcohol consumption than students attending control group institutions.
OBJECTIVE:Harmful alcohol consumption is a leading cause of death in the United States. The majority of people who die from alcohol use begin drinking in their youth. In this study, we estimate the impact of interventions to reduce the prevalence of drinking among youth on subsequent drinking patterns and alcohol-attributable mortality.METHOD:We first estimated the effect of public health interventions to decrease harmful drinking among youth from literature reviews and used life table methods to estimate alcohol-attributable years of life lost by age 80 years among the cohort of approximately 4 million U.S. residents aged 20 in the year 2000. Then, from national survey data on transitions in drinking habits by age, we modeled the impact of interventions on alcohol-attributable mortality.RESULTS:A tax increase and an advertising ban were the most effective interventions identified. In the absence of intervention, there would be 55,259 alcohol-attributable deaths over the lifetime of the cohort. A tax-based 17% increase in the price of alcohol of dollar 1 per six pack of beer could reduce deaths from harmful drinking by 1,490, equivalent to 31,130 discounted years of potential life saved or 3.3% of current alcohol-attributable mortality. A complete ban on alcohol advertising would reduce deaths from harmful drinking by 7,609 and result in a 16.4% decrease in alcohol-related life-years lost. A partial advertising ban would result in a 4% reduction in alcohol-related life-years lost.CONCLUSIONS:Interventions to prevent harmful drinking by youth can result in reductions in adult mortality. Among interventions shown to be successful in reducing youthful drinking prevalence, advertising bans appear to have the greatest potential for premature mortality reduction.
OBJECTIVE:The purpose of this study was to assess the relationship between level of intoxication and the frequency and severity of aggression at the person, incident, visit, and bar level for aggressive incidents observed in bars or clubs.METHOD:Hierarchical Linear Modeling (HLM) analysis of 1025 incidents of aggression documented by trained observers during 1334 nights of observation in 118 bars and clubs in Toronto, Canada, was conducted.RESULTS:Both level of intoxication of the crowd during the visit as well as mean level of intoxication at the bar level significantly predicted frequency of aggression. There was a positive association between level of intoxication and severity of aggression at both the incident and person level except for the highest level of intoxication at the person level, where severity of aggression was less than for moderate intoxication. A person-incident level interaction between intoxication and severity of aggression was also found.CONCLUSIONS:These results suggest that prevention efforts should focus on both identifying bars that typically have more intoxicated patrons and reducing the intoxication levels of patrons across bars generally. The results also showed a strong positive relationship between level of intoxication and severity of aggression (except at the highest levels), indicating that intoxication increases risk in terms of both frequency and severity of aggression. The significant interaction between person- and visit-level intoxication suggests that greater attention needs to be paid to group dynamics in alcohol-related aggression.
Objective: Studies of mixed-aged samples have suggested that a majority of problem drinkers achieve remission "naturally," without formal treatment. We sought to describe the life history predictors of untreated remission among older adults. Method: We compared 330 older untreated remitters to 120 older treated remitters and to 130 untreated nonremitters. Results: A majority (73%) of remitted, older problem drinkers attained remission without any formal treatment for drinking problems. Compared with treated remitters, late-life untreated remitters were more likely to be women and had completed more schooling, reached their peak alcohol consumption and ceased development of new drinking problems earlier, had much less severe drinking and depression histories, and were less likely to have received any advice to reduce consumption. Compared with untreated nonremitters, untreated remitters were more likely to be women, reached their peak alcohol consumption and stopped developing new drinking problems almost a decade earlier, had somewhat less severe drinking histories, were less likely to have been advised to reduce consumption, and were more likely to have reacted to late-life health problems by reducing their alcohol consumption. Conclusions: Many late-life problem drinkers with milder drinking problems achieve remission without treatment or advice to reduce consumption. However, a notable percentage of untreated older individuals who have more severe drinking problems Could benefit from public health efforts to aid detection of late-life drinking problems and interventions aimed at reducing alcohol consumption. Results suggest that such interventions should highlight the negative health consequences of excessive late-life drinking.
OBJECTIVEAlthough much research has explored overall alcohol use in the workforce, little research has explored the extent of alcohol use and impairment in the workplace. This study explored the overall prevalence, frequency, and distribution of alcohol use and impairment during the workday.METHODData were collected from a national probability sample of 2805 employed adults using a random digit dialing telephone survey. Alcohol use within 2 hours of reporting to work, alcohol use during the workday, working under the influence of alcohol, and working with a hangover were assessed for the 12 months preceding the interview.RESULTSWorkplace alcohol use and impairment directly affect an estimated 15% of the U.S. workforce (19.2 million workers). Specifically, an estimated 1.83% (2.3 million workers) drink before work, 7.06% (8.9 million workers) drink during the workday, 1.68% (2.1 million workers) work under the influence of alcohol, and 9.23% (11.6 million workers) work with a hangover. The results also suggest that most workplace alcohol use and impairment occur infrequently. The distribution of workplace alcohol use and impairment differs by gender, race, age, marital status, occupation, and work shift.CONCLUSIONWorkplace alcohol use and impairment are prevalent enough that additional research should focus on their causes and impact on employee productivity. Moreover, clear policies should be in place regarding alcohol use and impairment at work. But despite management's responsibility for the development and enforcement of such policies, managers report elevated rates of consuming alcohol during the workday, working under the influence of alcohol, and working with a hangover.
Objective: Using self-report survey data and measures of breath alcohol concentration (BrAC), this study examined the validity of an estimate of blood alcohol concentration (eBAC). Differences between eBAC and BrAC were modeled to identify sources of error related to survey-derived eBAC. Further, using hierarchical multilevel analyses, environmental event characteristics were examined as sources of eBAC error. Method: College students were interviewed and provided breath samples at randomly selected parties on Friday and Saturday nights. Interviews included items assessing the total number of drinks consumed, duration of drinking event, gender, and weight, which allowed for the calculation of eBAC. Results: Overall, eBACs were inaccurate. Total number of drinks consumed was associated with underestimates of eBAC, whereas time drinking was associated with overestimates of eBAC. Environmental variables, including party size, rowdy behavior, having food present, and observing many intoxicated partygoers, were also associated with eBAC errors. Conclusions: Current self-report survey methodology to calculate eBAC may be insufficient to estimate BAC with any accuracy. Environmental factors associated with the last drinking event for which BAC is being estimated should be considered when calculating eBAC.
Objective: The present study was undertaken to assess the rate and severity of alcohol craving symptoms among registered alcohol-dependent patients at a Veterans Affairs outpatient clinic. We also examined the relationship between alcohol craving and the clinical characteristics of alcohol-dependent patients. Method: Participants included 101 alcohol-dependent veterans enrolled in an outpatient addiction clinic. Alcohol craving was measured by the Penn Alcohol Craving Scale. Alcoholism severity and clinical characteristics were assessed with the Addiction Severity Index, Timeline Followback method, and other instruments. Three alcohol-craving groups (low, moderate, and high) were identified and compared using their demographic and clinical characteristics. Multiple regression analysis was performed to evaluate the relationship between the potential predictors and alcohol craving. Results: The rate of alcohol craving was as follows: low craving (46%), moderate craving (29%), and high craving (25%). When these three craving groups were compared using univariate analyses, patients with higher alcohol craving had significantly higher alcohol composite scores (last 30 days) and severe alcohol dependence (last 1 year). In multiple regression analysis, the model explained 50% of the variance in alcohol craving, with alcoholism severity (42%), withdrawal symptoms (5%), and depression (3%) as significant predictors. Conclusions: Patients in an outpatient treatment setting had a wide range of alcohol cravings. Level of alcohol craving was directly associated with several increased indices of alcohol- and non-alcohol-related morbidity.
Objective: Problems with alcohol remain a serious public health concern despite decreased use among some populations. Here we examine the relationship between alcohol problems and religiosity, hypothesizing that social resources may mediate this relationship. Method: Using data from a longitudinal cohort study of a black community population (N=1242) followed from age 6 to 32, analysis of moment structures (AMOS) multiple regression analyses were used to examine the association of religious involvement and alcohol-use problems, taking into account mediators, moderators, or both. Results: Findings from this study support and extend the current literature that being male, having a major depressive disorder, completing fewer years of education, being unemployed, moving more frequently, and not attending church at least monthly are associated with serious problems with alcohol use in blacks. Those who were depressed and attended church frequently were no more likely to have alcohol problems than those who were not depressed. However, depression was strongly associated with alcohol problems for those who did not attend church frequently. Conclusions: Frequency of church attendance was associated with fewer alcohol problems, and this relationship was moderated by depression. Other measures of religiosity were not significantly related to alcohol problems, and social resources did not mediate the relationship between alcohol problems and religiosity.
Objective: Previous research has shown that students overestimate the drinking of their peers, and that perceived norms are strongly associated with drinking behavior. Explanations for these findings have been based largely on cross-sectional data, precluding the ability to evaluate the stability of normative misperceptions or to disentangle the direction of influence between perceived norms and drinking. The present research was designed to evaluate (1) the stability of normative misperceptions and (2) temporal precedence of perceived norms and drinking. Method: Participants were college students (N = 164; 94 women) who completed assessments of perceived norms and reported behavior for drinking frequency and weekly quantity. Most participants (68%) completed the same measures again two months later. Results: Results indicated large and stable overestimations of peer drinking for frequency and weekly quantity. Results also showed that for weekly quantity, perceived norms predicted later drinking, but drinking also predicted later perceived norms. Results for frequency revealed perceived norms predicted later drinking, but drinking did not predict later perceived norms. Conclusions: These findings underscore the importance of longitudinal designs in evaluating normative influences on drinking. The present findings suggest that normative misperceptions are stable, at least over a relatively short time period. Findings support a mutual influence model of the relationship between perceived norms and drinking quantity but are more strongly associated with conformity explanations for the relationship between perceived norms and drinking frequency. Results are discussed in terms of implications for prevention interventions.
OBJECTIVE:The objective of this study was to determine whether the nonlinear association between alcohol and depressive symptoms observed in middle-aged and older men and women is present in young adults and is independent of culture, socioeconomic position, and health status.METHOD:Data were from the International Health and Behaviour Survey, involving 6,932 male and 8,816 female university students ages 17-30 years from 20 countries. Alcohol consumption was assessed in terms of number of drinks per week and number of drinks per episode, and the Beck Depression Inventory (BDI) was administered. Analyses were adjusted for clustering by country.RESULTS:The proportion of respondents with elevated BDI scores was 19.3%, 16.3%, and 20.0% for nondrinkers, moderate drinkers, and heavy drinkers, respectively. The odds of elevated BDI scores for nondrinkers compared with moderate drinkers were 1.22 (95% confidence interval [CI]: 1.06-1.42) after adjusting for age, gender, living arrangements, socioeconomic status, and self-rated health. Analysis based on the number of alcoholic drinks consumed in the past 2 weeks indicated that, in comparison with those who consumed 5-13 drinks, the odds of elevated BDI scores for nondrinkers were 1.25 (CI: 1.02-1.53) after adjusting for the same covariates. Heavy drinkers also had higher BDI scores than moderate consumers.CONCLUSIONS:The results suggest that the "U"-shaped association between alcohol consumption and depressive symptoms previously identified in Western countries is present in young people from a variety of cultural backgrounds. The relationship is not secondary to variations in health status, socioeconomic background, age, and gender.
Objective: Cost-effectiveness analyses using preference-weighted health status as the measure of effectiveness allow for the direct comparison of cost-effectiveness ratios for physical and mental health interventions. However, these analyses are not commonly used for substance use-disorders interventions. We conducted a methodological evaluation of the relationship between preference-weighted health status and 6-month substance use-disorders treatment outcomes. Method: The design was all observational study of clients receiving substance use-disorders treatment. Fifteen high-volume treatment centers within a regional managed behavioral health care organization participated. There were 165 subjects (117 men, 48 women) diagnosed with current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, substance dependence in the analysis. Baseline and 6-month data included substance-use quantity, frequency, and diagnostic criteria and preference-weighted Medical Outcomes Study Short Form-36 scores based on visual analog scale (VAS) and standard gamble (SG) conversion formulas. Results: Controlling for sociodemographic variables, VAS change for early remission at 6 months was 0.107 (p = .0002) (reference category continued dependence). SG change for early remission at 6 months was 0.041 (p < .0004). Using heavy drinkers as the reference category, VAS preference-weighted change was 0.062 (p = .10) for abstinent and 0.112 (p = .01) for moderate drinkers. SG preference-weighted change was 0.027 (p = .08) for abstinent and 0.046 (p = .01) for moderate drinkers. Conclusions: These findings support the construct validity of preference-weighted health status in substance use-disorders treatment. Direct comparisons of the cost-effectiveness of Substance use-disorders treatment with other mental or physical health interventions arc critical during times of limited health care resources.
Objective: The purpose of this study was to investigate the effects of transitional life events related to education, employment, and family formation on the likelihood of recovery from alcohol dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), distinguishing the short- and long-term effects of these events and potential effect modification by treatment history, gender, and severity of dependence. Method: This analysis is based on data from the Wave 1 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional, retrospective survey of a nationally representative sample of U.S. adults 18 years of age and older. The analytic sample consisted of 4,422 individuals with prior-to-past-year (PPY) onset of DSM-IV alcohol dependence. Time-dependent proportional hazards models were used to estimate the effects of completing school, starting full-time work, getting married, becoming separated/divorced/widowed, and becoming a parent on the outcomes of nonabstinent recovery (NR; e.g., low-risk asymptomatic drinking) and abstinent recovery (AR). Results: Entry into and exit from a first marriage each increased the likelihood of NR during the first 3 years after those events occurred (hazard rate ratio [HRR] = 1.37 and 1.76, respectively). However, individuals who were still dependent 3 or more years after those events occurred had a decreased likelihood of subsequent NR (HRR = 0.70 for both events), as did those who were still dependent 3 or more years after completing schooling (HRR = 0.54). The likelihood of AR was more than doubled in the 3 years after first becoming a parent (HRR = 2.22) but was decreased among individuals still dependent 3 or more years after starting full-time work. For the outcome of NR, all of the negative effects associated with still being dependent 3 or more years after the occurrence of key life events were more strongly negative among individuals with less severe cases of dependence. Conclusions: Transitional life events demonstrate many effects on recovery, including both direct effects consistent with role socialization and associations more reflective of selectivity than causation. Taken as a whole, these events appear to contribute to (but by no means fully explain) the high rates of recovery from alcohol dependence that have been observed even in the absence of treatment.
OBJECTIVE:Previous research suggests that abstinence from alcohol during the first year posttreatment for alcohol-use disorders (AUDs) is an important, independent predictor of longer-term alcohol consumption and related functioning. The purpose of this study was to test the hypothesis that abstinence during the first year posttreatment initiation predicts alcohol use at Months 37-39. A second aim of this study was to explore the relationship between "moderate" drinking in the first year and drinking at Months 37-39.METHOD:Secondary data analyses were conducted on the outpatient Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) sample (N = 952 at baseline and 802 at Months 37-39). For these analyses, participants were classified first as abstainers, moderate drinkers, or heavy drinkers based on their alcohol use in the first year posttreatment initiation.RESULTS:Analyses of covariance showed that the first-year drinker classification predicted both percentage of days abstinent and drinks per drinking day at Months 37-39. Subsequent analyses showed that the abstainers functioned significantly better than (1) both of the other drinker groups combined and (2) either of the other two groups, which did not differ from each other on either measure of alcohol use. A third set of exploratory analyses evaluated first-year abstinence and heavy drinking as continuous variables and showed an essentially linear relationship between them and drinking at 3 years.CONCLUSIONS:This study confirmed the strong relationship between first-year abstinence and later drinking but did not show that participants who engaged in moderate drinking during the first year had positive alcohol-use outcomes at 3 years. The clinical implications of the findings, their generalizability to different populations of individuals presenting for specialty alcohol treatment, and future research directions are discussed.
OBJECTIVEThe objective of this study is to investigate the impact of distilled spirits, wine, and beer taxes on cirrhosis mortality using a large-panel data set and statistical models that control for various other factors that may affect that mortality.METHODThe analyses were performed on a panel of 30 U.S. license states during the period 1971-1998 (N = 840 state-by-year observations). Exogenous measures included current and lagged versions of beverage taxes and income, as well as controls for states' age distribution, religion, race, health care availability, urbanity, tourism, and local bans on alcohol sales. Regression analyses were performed using random-effects models with corrections for serial autocorrelation and heteroscedasticity among states.RESULTSCirrhosis rates were found to be significantly related to taxes on distilled spirits but not to taxation of wine and beer. Consistent results were found using different statistical models and model specifications.CONCLUSIONSConsistent with prior research, cirrhosis mortality in the United States appears more closely linked to consumption of distilled spirits than to that of other alcoholic beverages.
OBJECTIVE:This study examines the impact of a social norms intervention to reduce alcohol misuse among student-athletes. The intervention was designed to reduce harmful misperceptions of peer norms and, in turn, reduce personal risk.METHOD:A comprehensive set of interventions communicating accurate local norms regarding alcohol use targeted student-athletes at an undergraduate college. An anonymous survey of all student-athletes was conducted annually for 3 years (2001: n = 414, 86% response; 2002: n = 373, 85% response; and 2003: n = 353, 79% response). A pre/post comparison of student-athletes was conducted separately for new and ongoing athletes at each time point to isolate any general time period effects from intervention effects. A cross-sectional analysis of student-athletes with varying degrees of program exposure was also performed.RESULTS:The intervention substantially reduced misperceptions of frequent alcohol consumption and high-quantity social drinking as the norm among student-athlete peers. During this same time period, frequent personal consumption, high-quantity consumption, high estimated peak blood alcohol concentrations during social drinking, and negative consequences all declined by 30% or more among ongoing student-athletes after program exposure. In contrast, no significant differences across time were seen for new student-athletes each year with low program exposure. Among student-athletes with the highest level of program exposure, indications of personal misuse were at least 50% less likely on each measure when compared with student-athletes with the lowest level of program exposure.CONCLUSIONS:This social norms intervention was highly effective in reducing alcohol misuse in this high-risk collegiate subpopulation by intensively delivering data-based messages about actual peer norms through multiple communication venues.
