Dennis L. Thombs

Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons

AIM To assess event-level associations between energy drink consumption, alcohol intoxication, and intention to drive a motor vehicle in patrons exiting bars at night. METHOD Alcohol field study. Data collected in a U.S. college bar district from 802 randomly selected and self-selected patrons. Anonymous interview and survey data were obtained as well as breath alcohol concentration (BrAC) readings. RESULTS Results from logistic regression models revealed that patrons who had consumed alcohol mixed with energy drinks were at a 3-fold increased risk of leaving a bar highly intoxicated (BrAC> or =0.08g/210L), as well as a 4-fold increased risk of intending to drive upon leaving the bar district, compared to other drinking patrons who did not consume alcoholic beverages mixed with energy drinks. DISCUSSION These event-level associations provide additional evidence that energy drink consumption by young adults at bars is a marker for elevated involvement in nighttime risk-taking behavior. Further field research is needed to develop sound regulatory policy on alcohol/energy drink sales practices of on-premise establishments.

A Test of the Perceived Norms Model to Explain Drinking Patterns Among University Student Athletes

Abstract The author tested the ability of perceived drinking norms to discriminate among drinking patterns in a sample of National Collegiate Athletic Association (NCAA) Division I student athletes. He used an anonymous questionnaire to assess 297 athletes, representing 18 teams, at a public university in the Midwest. Alcohol use patterns showed considerable variation, with many athletes (37.1%) abstaining during their season of competition. A discriminant function analysis revealed that higher levels of alcohol involvement are disproportionately found among athletes who began drinking regularly at an early age. Perceived drinking norms were less important in the discrimination of student athlete drinker groups. Women and those with higher grade point averages were somewhat more likely to refrain from in-season drinking than other survey respondents.

Carbon Monoxide Levels Among Patrons of Hookah Cafes

BACKGROUND Individuals who use a hookah (water pipe) as a method of tobacco smoking are exposed to high levels of carbon monoxide (CO). Assessing hookah use in one of the venues of its use (hookah bars) will aid the understanding of the toxins and exposure for the user. In Florida, smoking is prohibited in public places under the Florida Clean Indoor Act but permitted in establishments that have less than 10% gross revenue from food. PURPOSE To assess the CO level of hookah cafe patrons, using traditional bar patrons as a comparison. METHODS After IRB approval, a nighttime field study of patrons (aged >18 years) exiting hookah cafes and traditional bars in 2009 was conducted, using sidewalk locations immediately outside these establishments in a campus community. As hookah cafes and bars are typically entered and exited in groups, every other group of people exiting the establishment was approached. For comparison purposes, the sample collected was similar in number, 173 hookah cafe and 198 traditional bar participants. RESULTS Results from analysis conducted in 2010 indicate that patrons of hookah cafes had significantly higher CO levels (mean=30.8 parts per million [ppm]) compared to patrons of traditional bars (mean=8.9 ppm). Respondents who indicate no cigarette use in the past month but had visited a hookah cafe still demonstrated significantly higher CO values (mean=28.5 ppm) compared to those exiting traditional bars (mean=8.0 ppm). Current cigarette smokers also produced significantly more CO if exiting a hookah cafe (mean=34.7 ppm) compared to a traditional bar (mean=13.3 ppm). CONCLUSIONS CO levels are higher for patrons of hookah cafes, for both current and non-cigarette smokers. Although users report that they perceive hookah to be less harmful than cigarettes, the greater CO exposure for hookah users that was observed in this study is not consistent with that perception.

Is there a misplaced focus on AmED? Associations between caffeine mixers and bar patron intoxication

BACKGROUND Previous research on alcohol mixed with energy drinks (AmED) suffers from measurement problems. Missing from the research literature are studies that assess caffeine-alcohol co-ingestion in natural drinking environments. METHODS This field study collected data in a U.S. college bar district from 328 randomly selected patrons. Anonymous data were obtained from face-to-face interviews and self-administered surveys, and from breath tests. RESULTS Cola-caffeinated alcoholic beverage consumers left bars in a more highly intoxicated state than those who consumed alcohol only. There was no significant difference between the intoxication level of the AmED group and the cola-caffeinated alcoholic beverage group. Results from a multivariate regression model indicated that quantity of caffeinated alcoholic beverage consumption had a significant, positive association with bar patron intoxication after adjusting for potential confounders. CONCLUSIONS Findings indicate that caffeine may have a dose-dependent relationship with alcohol intoxication in the bar/nightclub setting. In addition, results revealed that cola-caffeinated alcoholic drinks may pose similar levels of risk to bar patrons as those associated with AmED beverage consumption. Product labeling requirements about alcohol risks may need to be extended not only to energy drinks, but to caffeinated soft drinks as well.

Artificial Sweeteners, Caffeine, and Alcohol Intoxication in Bar Patrons

BACKGROUND Previous laboratory research on alcohol absorption has found that substitution of artificially sweetened alcohol mixers for sucrose-based mixers has a marked effect on the rate of gastric emptying, resulting in elevated blood alcohol concentrations. Studies conducted in natural drinking settings, such as bars, have indicated that caffeine ingestion while drinking is associated with higher levels of intoxication. To our knowledge, research has not examined the effects of alcohol mixers that contain both an artificial sweetener and caffeine, that is, diet cola. Therefore, we assessed the event-specific association between diet cola consumption and alcohol intoxication in bar patrons. We sought to determine whether putative increases in blood alcohol, produced by accelerated gastric emptying following diet cola consumption, as identified in the laboratory, also appear in a natural setting associated with impaired driving. METHODS We conducted a secondary analysis of data from 2 nighttime field studies that collected anonymous information from 413 randomly selected bar patrons in 2008 and 2010. Data sets were merged and recoded to distinguish between energy drink, regular cola, diet cola, and noncaffeinated alcohol mixers. RESULTS Caffeinated alcohol mixers were consumed by 33.9% of the patrons. Cola-caffeinated mixed drinks were much more popular than those mixed with energy drinks. A large majority of regular cola-caffeinated mixed drink consumers were men (75%), whereas diet cola-caffeinated mixed drink consumers were more likely to be women (57%). After adjusting for the number of drinks consumed and other potential confounders, number of diet cola mixed drinks had a significant association with patron intoxication (β = 0.233, p < 0.0001). Number of drinks mixed with regular (sucrose-sweetened) cola and energy drinks did not have significant associations with intoxication (p > 0.05). CONCLUSIONS Caffeines effect on intoxication may be most pronounced when mixers are artificially sweetened, that is, lack sucrose which slows the rate of gastric emptying of alcohol. Risks associated with on-premise drinking may be reduced by greater attention given to types of mixers, particularly diet colas.

Efficacy of a Brief Image-Based Multiple-Behavior Intervention for College Students

BackgroundEpidemiologic data indicate most adolescents and adults experience multiple, simultaneous risk behaviors.PurposeThe purpose of this study is to examine the efficacy of a brief image-based multiple-behavior intervention (MBI) for college students.MethodsA total of 303 college students were randomly assigned to: (1) a brief MBI or (2) a standard care control, with a 3-month postintervention follow-up.ResultsOmnibus treatment by time multivariate analysis of variance interactions were significant for three of six behavior groupings, with improvements for college students receiving the brief MBI on alcohol consumption behaviors, F(6, 261) = 2.73, p = 0.01, marijuana-use behaviors, F(4, 278) = 3.18, p = 0.01, and health-related quality of life, F(5, 277) = 2.80, p = 0.02, but not cigarette use, exercise, and nutrition behaviors. Participants receiving the brief MBI also got more sleep, F(1, 281) = 9.49, p = 0.00, than those in the standard care control.ConclusionsA brief image-based multiple-behavior intervention may be useful in influencing a number of critical health habits and health-related quality-of-life indicators of college students.

Are effects from a brief multiple behavior intervention for college students sustained over time

OBJECTIVE This study examined whether 3-month outcomes of a brief image-based multiple behavior intervention on health habits and health-related quality of life of college students were sustained at 12-month follow-up without further intervention. METHODS A randomized control trial was conducted with 303 undergraduates attending a public university in southeastern US. Participants were randomized to receive either a brief intervention or usual care control, with baseline, 3-month, and 12-month data collected during fall of 2007. RESULTS A significant omnibus MANOVA interaction effect was found for health-related quality of life, p=0.01, with univariate interaction effects showing fewer days of poor spiritual health, social health, and restricted recent activity, ps<0.05, for those receiving the brief intervention. Significant group by time interaction effects were found for driving after drinking, p=0.04, and moderate exercise, p=0.04, in favor of the brief intervention. Effect sizes typically increased over time and were small except for moderate size effects for social health-related quality of life. CONCLUSION This study found that 3-month outcomes from a brief image-based multiple behavior intervention for college students were partially sustained at 12-month follow-up.

Adolescent Perceptions of College Student Drinking.

OBJECTIVE To extend knowledge about perceived drinking norms by assessing perceptions of college student drinking in a sample of 7th- to 12th-graders. METHODS Anonymous questionnaire was administered to 2,017 adolescents in two Ohio school districts. RESULTS By seventh grade, 89.6% of the students had formed normative perceptions of collegiate drinking. A canonical correlation analysis revealed that perceptions of collegiate drinking have substantial, independent relationships not only with alcohol use intensity and drinking onset, but also with indicators of tobacco and other drug use as well. CONCLUSIONS Exaggerated perceptions of college student drinking are psychosocial markers of substance use in 7th- to 12th-graders.

A Brief Image-based Prevention Intervention for Adolescents

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print materials based on the behavior-image model. Health behavior goal setting increased for participants receiving the brief intervention, with an effect size in the small range (d = 0.33). Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small (ds = 0.16-0.21) and in favor of the brief intervention. However, adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol, frequency and quantity of cigarette smoking, and reported fewer alcohol/drug problems, with larger effects ranging from small to approaching medium in size (ds = 0.32-0.43, ps < .01). This study suggests that brief image-based messages may increase health behavior goal setting and reduce substance use, particularly among drug-using older adolescents.

A Cluster Analytic Study of Osteoprotective Behavior in Undergraduates.

OBJECTIVE To derive an empirical taxonomy of osteoprotective stages using the Precaution Adoption Process Model (PAPM) and to identify the predisposing factors associated with each stage. METHODS An anonymous survey was completed by 504 undergraduates at a Midwestern public university. RESULTS Cluster analytic findings indicate that only 2 osteoprotective stages exist in young adults: less engaged and engaged. These two groups were best distinguished by health motivation, sex, a perceived barrier to exercise, and exercise self-efficacy. CONCLUSION Fine-grained stages of osteoprotective behavior are not apparent in young adults, suggesting that the PAPM may not be useful for explaining the adoption of osteoporosis precautions.