Lorraine T. Midanik

A 10-year national trend study of alcohol consumption, 1984-1995: is the period of declining drinking over?

OBJECTIVES Data from the 1984, 1990, and 1995 National Alcohol Surveys were used to investigate whether declines shown previously in drinking and heavy drinking across many demographic subgroups have continued. METHODS Three alcohol consumption indicators--current drinking (vs abstaining), weekly drinking, and weekly heavy drinking (5 or more drinks in a day)--were assessed for the total US population and for demographic subgroups. RESULTS Rates of current drinking, weekly drinking, and frequent heavy drinking, previously reported to have decreased between the 1984 and 1990 surveys, remained unchanged between 1990 and 1995. Separate analyses for each beverage type (beer, wine, and spirits) and most demographic subgroups revealed similar temporal patterns. CONCLUSIONS Alcohol consumption levels, declining since the early 1980s, may reach a minimum by the 21st century. Consumption levels should be monitored carefully over the next few years in the event that long-term alcohol consumption trends may be shifting.

“Culture of Drinking” and Individual Problems with Alcohol Use

Binge drinking is a substantial and growing health problem. Community norms about drinking and drunkenness may influence individual drinking problems. Using data from the New York Social Environment Study (n = 4,000) conducted in 2005, the authors examined the relation between aspects of the neighborhood drinking culture and individual alcohol use. They applied methods to address social stratification and social selection, both of which are challenges to interpreting neighborhood research. In adjusted models, permissive neighborhood drinking norms were associated with moderate drinking (odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.05, 1.55) but not binge drinking; however, social network and individual drinking norms accounted for this association. By contrast, permissive neighborhood drunkenness norms were associated with more moderate drinking (OR = 1.20, 95% CI: 1.03, 1.39) and binge drinking (OR = 1.92, 95% CI: 1.44, 2.56); the binge drinking association remained after adjustment for social network and individual drunkenness norms (OR = 1.58, 95% CI: 1.20, 2.08). Drunkenness norms were more strongly associated with binge drinking for women than for men (p(interaction) = 0.006). Propensity distributions and adjustment for drinking history suggested that social stratification and social selection, respectively, were not plausible explanations for the observed results. Analyses that consider social and structural factors that shape harmful drinking may inform efforts targeting the problematic aspects of alcohol consumption.

Telephone versus in-person interviews for alcohol use: results of the 2000 National Alcohol Survey

This study assesses differences in reports of alcohol use and alcohol-related harms using telephone and in-person interviews in a subsample of the 2000 National Alcohol Survey (NAS) (N = 411). Respondents were given a brief telephone interview which assessed their alcohol use and alcohol-related harms in the last 12 months followed by an in-person interview 2 months later that obtained the same data. Approximately 90% (n = 371) reported their drinking status consistently between interviews (277 current drinkers; 94 non-drinkers). Approximately 7% (n = 29) became current drinkers and 2.7% (n = 11) became non-drinkers at the second interview. The majority of respondents who changed their drinking status in either direction were low level drinkers. Using logistic regression modeling, no significant associations were found between demographic factors and consistency of reported drinking status. Further, there were no differences by mode for the two alcohol consumption measures (mean daily volume and mean number of days drank five or more drinks in the last 12 months) and alcohol-related harms in the last 12 months for current drinkers (n = 277). In conjunction with other mode studies, these findings support the use of telephone interviewing in large national surveys to obtain alcohol use and alcohol-related harms data.

ALCOHOL AND NON-FATAL INJURY IN THE U.S. GENERAL POPULATION: A RISK FUNCTION ANALYSIS

This paper reports a risk function analysis of average daily volume of alcohol consumed and the frequency of consuming 5 or more drinks during a single day with reporting an injury in a probability sample of the U.S. adult household population living in the 48 contiguous states. The data are from the 1990 National Alcohol Survey on a weighted sample of 1150 respondents, 748 of whom were current drinkers. Risk of injury was found to increase with an average daily volume of 1 drink for both males and females and for those 30 and younger and those over 30, and to increase with a frequency of consuming 5 or more drinks on one day more often than twice a year. These data suggest that risk for injury may be increased at relatively low levels of consumption and, if so, that preventive efforts aimed at more moderate drinkers may have a greater impact on the reduction of alcohol-related accidents than efforts focused on heavier drinkers who are fewer in number.

Tobacco, marijuana, and sensation seeking: comparisons across gay, lesbian, bisexual, and heterosexual groups.

This study examined patterns of smoked substances (cigarettes and marijuana) among heterosexuals, gays, lesbians, and bisexuals based on data from the 2000 National Alcohol Survey, a population-based telephone survey of adults in the United States. We also examined the effect of bar patronage and sensation seeking/impulsivity (SSImp) on tobacco and marijuana use. Sexual orientation was defined as lesbian or gay self-identified, bisexual self-identified, heterosexual self-identified with same-sex partners in the past 5 years, and exclusively heterosexual (heterosexual self-identified, reporting no same-sex partners). Findings indicate that bisexual women and heterosexual women reporting same-sex partners had higher rates of cigarette smoking than exclusively heterosexual women. Bisexual women, lesbians, and heterosexual women with same-sex partners also used marijuana at significantly higher rates than exclusively heterosexual women. Marijuana use was significantly greater and tobacco use was elevated among gay men compared with heterosexual men. SSImp was associated with greater use of both of these substances across nearly all groups. Bar patronage and SSImp did not buffer the relationship between sexual identity and smoking either cigarettes or marijuana. These findings suggest that marijuana and tobacco use differ by sexual identity, particularly among women, and underscore the importance of developing prevention and treatment services that are appropriate for sexual minorities.

DSM-IV alcohol dependence and drinking in the U.S. population: A risk analysis

PURPOSE This paper examines the relationship between alcohol dependence according to the criteria found in the 4th edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association and drinking in the U.S. general population. METHODS The data set under analysis is the 1988 National Health Interview Survey, which interviewed a probability sample of 22,102 adult drinkers in the U.S. household population. The response rate was 86%. RESULTS Results indicate that there is a linear relationship between DSM-IV dependence and the mean number of drinks consumed per day, or the number of days drinking five or more glasses of alcohol in the past 12 months. Respondents who reported consuming five or more drinks in a day have about six times more chances of being dependent than respondents who did not report such pattern of drinking. Older drinkers are less at risk than younger drinkers. CONCLUSIONS There is a risk of alcohol dependence at relatively low volumes of consumption. The risk increases gradually with the volume of consumption. An added and higher risk exists when drinkers engage in a pattern of consumption involving the ingestion of five or more drinks per day.

ALCOHOL CONSUMPTION AND UTILIZATION OF HEALTH SERVICES IN A HEALTH MAINTENANCE ORGANIZATION

OBJECTIVES This study examined the relation between alcohol use and utilization of health services during a 3-year period in a sample of 4,264 adult respondents to a member health survey in a health maintenance organization. METHODS Respondents were categorized as abstainers (no drinks in the past year, n = 1,139), lighter drinkers (less than seven drinks/week, n = 2,330), moderate drinkers (seven to 13 drinks/week, n = 498), and heavier drinkers (> or =14 drinks/week, n = 297). Each drinker group was compared with abstainers on outpatient visits, hospital days, and number of hospitalizations controlling for age, race, and health plan membership. RESULTS The mean number of outpatient visits was inversely related to the amount of alcohol consumed. Significant differences also were found for mean number of hospitalizations and mean days hospitalized per year. Compared with the three drinker groups, abstainers were significantly higher on both inpatient measures. CONCLUSIONS These results might be explained by the inclusion in the abstainer group of exdrinkers who quit because of illness, inattention to health problems by heavier drinkers, or lower rates of illness among drinkers. The findings underscore the importance of replicating our study in other cohorts in which problem drinkers can be identified and compared with non-problem drinkers and in which lifelong abstainers can be separated from exdrinkers in the analysis.

Alcohol problems and sense of coherence among older adults

The relation between alcohol problems and sense of coherence (SOC), a salutogenic model developed by Antonovsky, was assessed on a sample of 952 older members of a health maintenance organization. Data on alcohol problems (5-item index) and SOC (9-item scale) were obtained from mailed questionnaires. Multiple regression analyses indicated that SOC was a significant negative predictor of alcohol problems while controlling for alcohol consumption level, frequency of drunkenness and demographic characteristics. In addition, SOC scores were significantly higher for a subsample of lighter drinkers who reported no alcohol problems in the last year and had not been drunk in the last year (n = 419) as compared to heavier drinkers who reported at least one alcohol problem in the last year, and reported being drunk at least once in the last year (n = 107). These findings emphasize the importance of assessing factors which contribute to healthier behaviors as opposed to focusing exclusively on predictors of pathogenic outcomes.

Condom use among gay/bisexual male substance abusers using the timeline follow-back method.

Sexual risk for HIV transmission under the influence of alcohol and/or other drugs is not simply a cause-effect relationship: not everyone who drinks or uses other drugs has unprotected sex. The purpose of this study is to explore differences between substance using gay/bisexual men who use condoms during anal sex from those who do not. These differences are identified by comparing men whose anal sex while under the influence of alcohol and/or drugs is consistently protected to men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected. Gay/bisexual men entering substance abuse treatment at a gay-identified agency in San Francisco were recruited to complete surveys and to be interviewed about sexual behavior, substance use, and related variables using an extended version of the Timeline Follow-back (TL). The TL procedure uses a blank calendar form and a series of questions to cue recall of drinking, drug use, and anal intercourse on each of the 30 days prior to the last date of alcohol and/or drug use. Men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected were significantly more likely to report having less than a college education (p = .04), more likely to have an income of less than

Face-to-Face versus Telephone Interviews: Using Cognitive Methods to Assess Alcohol Survey Questions:

20,000 (p = .01), more likely to use amyl nitrite (p = .01) and cocaine (p = .02), and more likely to report a higher frequency of anal sex (p = .007). In addition, they were less likely to approve of sex without love (p = .003), less likely to perceive that safer sex is the community norm (p < .001), and less likely to have encouragement from friends to practice safer sex (p = .001). However, HIV status did not differentiate between the two groups. These two groups provide clear and interesting contrasts in terms of behavior, thus comparisons of the factors influencing sexual safety in these subgroups may enhance our understanding of risk taking. A better understanding of possible mediating variables can be important both in guiding future research in this area and in formulating intervention strategies to target gay men who drink or use drugs in combination with sexual activity.