Wenxing Zha

Age of Drinking Onset, Alcohol Use Disorders, Frequent Heavy Drinking, and Unintentionally Injuring Oneself and Others After Drinking

OBJECTIVE. To explore whether early age of drinking onset is prospectively associated with respondents unintentionally injuring themselves and others when respondents were under the influence of alcohol, controlling for current alcohol dependence/abuse, frequency of consuming 5 drinks per occasion, and other demographic characteristics. METHODS. From 2001 to 2002, in-person interviews were conducted with a national multistage probability sample of 43 093 adults aged 18 years older. From 2004 to 2005, of 39 959 eligible respondents, 34 653 were reinterviewed. The cumulative 2-survey response rate was 70.2%. Respondents were asked the age at which they first started drinking (not counting tastes or sips), diagnostic questions for alcohol dependence and abuse, questions about behaviors that increase risk of injury, and whether respondents, when under the influence of alcohol, injured themselves or someone else as a driver in a motor vehicle crash or in some other way. RESULTS. Logistic regression analyses revealed that the younger respondents were when they started drinking, the greater the likelihood that, between the 2 surveys, they experienced alcohol dependence/abuse, drank 5 drinks per occasion at least weekly drove under the influence of alcohol, and placed themselves in situation after drinking where they could be hurt. After controlling for those injury risk and sociodemographic characteristics, respondents who began drinking at earlier ages remained more likely between the 2 surveys to have, under the influence of alcohol, unintentionally injured themselves and someone else. More than one third of those injuries occurred when respondents 25 years of age were under the influence, although only 7% of respondents were 25 years of age. Persons other than respondents experienced 20% of those unintentional injuries, more than one third of them in traffic. CONCLUSION. Delaying drinking onset may help reduce unintentional alcohol-related injuries that drinkers may inflict on themselves and others.

Physician Advice to Adolescents About Drinking and Other Health Behaviors

BACKGROUND: This report assessed the proportion of US 10th graders (average age, 16) who saw a physician in the past year and were asked and given advice about their drinking. We hypothesized that advice would vary by whether students were asked about drinking and their drinking, bingeing, and drunkenness frequency. METHODS: A nationally representative sample of 10th graders in 2010 (N = 2519) were asked their past 30-day frequency of drinking, bingeing, and intoxication and whether, during their last medical examination, their drinking was explored and they received advice about alcohol’s risks and reducing or stopping. RESULTS: In the past month, 36% reported drinking, 28% reported bingeing, and 23% reported drunkenness (11%, 5%, and 7%, respectively, 6 or more times). In the past year, 82% saw a doctor. Of that group, 54% were asked about drinking, 40% were advised about related harms, and 17% were advised to reduce or stop. Proportions seeing a doctor and asked about drinking were similar across drinking patterns. Respondents asked about drinking were more often advised to reduce or stop. Frequent drinkers, bingers, and those drunk were more often advised to reduce or stop. Nonetheless, only 25% of them received that advice from physicians. In comparison, 36% of frequent smokers, 27% of frequent marijuana users, and 42% of frequent other drug users were advised to reduce or quit those behaviors. CONCLUSIONS: Efforts are warranted to increase the proportion of physicians who follow professional guidelines to screen and counsel adolescents about unhealthy alcohol use and other behaviors that pose health risks.

Drinking Beyond the Binge Threshold: Predictors, Consequences, and Changes in the U.S.

INTRODUCTION Binge drinking, five or more drinks on an occasion for men and four or more for women, marks risky alcohol use. However, this dichotomous variable removes information about higher, more dangerous consumption. This paper examines predictors, consequences, and changes over a decade in drinking one to two times, two to three times, and three or more times standard gender-specific binge thresholds, labeled Levels I, II, and III. METHODS In 2001-2002 and 2012-2013, respectively, 42,748 and 36,083 U.S. respondents aged ≥18 years were interviewed in person in cross-sectional waves of the National Epidemiologic Survey on Alcohol and Related Conditions (response rates, 81% and 61%). Respondents were asked their past-year maximum drink consumption per day, categorized as Levels I, II, or III. Predictors and whether Levels II and III were associated with more negative consequences were analyzed in 2012-2013 data. RESULTS In 2001-2002, 23% of adults reported past-year binge drinking, with 15% peaking at Level I, 5% at Level II, and 3% at Level III. In 2012-2013, those percentages increased significantly to 33% binging, and 20%, 8%, and 5% binging at Levels I, II, and III, respectively. After adjusting for alcohol use disorder, the strongest predictor of Level I, II, and III binging, Level III versus I and non-binge drinkers had higher odds of past-year driving after drinking and, after drinking, experiencing physical fights, injuries, emergency department visits, arrests/detentions, and other legal problems. CONCLUSIONS Level II and III-relative to Level I-binging is associated with more negative alcohol consequences and may be increasing nationally. Research needs to explore prevention and counseling interventions.

Alcohol-induced blackouts as predictors of other drinking related harms among emerging young adults

BACKGROUND Alcohol-related blackouts are periods of amnesia that reflect the failure of the brain to record memories of what transpires while drinking. This paper examined the incidence, predictors, and behavioral correlates of blackouts among emerging adults and examined whether questions about blackouts could serve as better markers of risk for other alcohol related harms than questions about levels of consumption. METHODS In 2012 to 2013, 1,463 (68%) of 2,140 respondents 1-year past high school reported having consumed alcohol. They were asked whether, in the past 6 months because of drinking, they forgot where they were or what they did. The survey also explored demographics, substance use behaviors, and other alcohol-related problems in the past 6 months. Chi-square and logistic regression analyses explored bivariate and multivariate predictors of blackouts and other alcohol-related problems. RESULTS Twenty percent of respondents who ever drank alcohol reported a blackout in the past 6 months. Blackouts were more prevalent among females and those who, in the past 30 days, used multiple drugs, more frequently binged, were drunk, smoked, had lower body weight, and lived in college dorms. After controlling for drinking levels, having a blackout was the strongest independent predictor of most other alcohol problems examined, including in the past 6 months because of drinking, missing class or work, getting behind in work or school, doing something respondents later regretted, arguing with friends, experiencing an overdose, and total number of alcohol problems reported. It was also an independent predictor of hangovers, damaging property, getting hurt, and trouble with police. CONCLUSIONS Because blackouts indicate drinking at levels that result in significant cognitive and behavioral impairment, questions about blackouts could serve as important, simple screeners for the risk of experiencing other alcohol related harms. Additional work on this subject is warranted.

The usefulness of 'age at first drink' as a concept in alcohol research and prevention.

1. Kuntsche E., Rossow I., Engels R., Kuntsche S. Is ‘age at first drink’ a useful concept in alcohol research and prevention? We doubt that. Addiction 2016; 111: 957–65. 2. Meier M. H., Caspi A., Ambler A., Harrington H., Houts R., Keefe R. S. et al. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci USA 2012; 109: E2657–64. 3. Horwood L. J., Fergusson D. M., Hayatbakhsh M. R., Najman J. M., Coffey C., Patton G. C. et al. Cannabis use and educational achievement: findings from three Australasian cohort studies. Drug Alcohol Depend 2010; 110: 247–53. 4. Maimaris W., McCambridge J. Age of first drinking and adult alcohol problems: systematic review of prospective cohort studies. J Epidemiol Community Health 2014; 68: 268–74. 5. Sartor C. E., Lynskey M. T., Bucholz K. K., Madden P. A., Martin N. G., HeathA. C. Timingof first alcohol use and alcohol dependence: evidence of common genetic influences.Addiction 2009; 104: 1512–8. 6. Caetano R., Mills B. A., Vaeth P. A., Reingle J. Age at first drink, drinking, binge drinking, and DSM-5 alcohol use disorder among Hispanic national groups in the United States. Alcohol Clin Exp Res 2014; 38: 1381–9. 7. Bava S., Tapert S. F. Adolescent brain development and the risk for alcohol and other drug problems. Neuropsychol Rev 2010; 20: 398–413. 8. Nixon K., McClain J. A. Adolescence as a critical window for developing an alcohol use disorder: current findings in neuroscience. Curr Opin Psychiatry 2010; 23: 227–32. 9. United Nations Office on Drugs and Crime (UNODC) International Standards on Drug Use Prevention. Vienna: United Nations; 2015. THE USEFULNESS OF ‘AGE AT FIRST DRINK ’ AS A CONCEPT IN ALCOHOL RESEARCH AND PREVENTION

Screening and Brief Alcohol Counseling of College Students and Persons Not in School

Associated with the top 3 causes of adolescent death (unintentional injuries, homicides, and suicides), underage drinking is annually responsible for 4000 to 5000 deaths and contributes to unprotected sex, social problems, and poor academic performance.1 A substantial body of experimental research indicates screening and brief intervention for risky alcohol use conducted in adult primary care settings is effective in reducing alcohol misuse and related problems.2 Evidence concerning effectiveness among young adults and adolescents is also accumulating.3,4 Unfortunately, screening and brief alcohol counseling for adolescents and college-aged emerging adults is not routine.5 College students more often drink 5 or more drinks on an occasion and drive under the influence of alcohol more than same-age, noncollege peers.6 Important unanswered questions are whether college students are (1) more or less likely than same-age peers to be asked about their substance use, (2) given advice about related health risks, and (3) encouraged to reduce or stop substance use.

Changes in and predictors of driving after drug use and involvement in traffic crashes because of drugs, 1992–2005

This paper explores whether the proportions of U.S. adults who report driving after drug use and independent predictors of being in motor vehicle crashes under the influence of drugs have changed since 1991–1992. The National Longitudinal Alcohol Epidemiologic Survey (NLAES) and National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) involved face-to-face interviews with, respectively, 42 862 and 43 092 adults ages 18 and older in 1991–1992 and 2001–2002.

Transitions to and from at-risk alcohol use in adults in the United States

ABSTRACT Introduction: The objective of this research is to study transitions to and from at-risk alcohol use. Methods: Logistic regression analyses (done 2015–2016) assessed transitions to and from past-year at-risk drinking in a representative sample of U.S. adults surveyed twice (in 2001–2002 and 2004–2005). Results: Among 34,653 adults, 28% reported at-risk use at time 1. Of those, 73% had at-risk use at time 2. Of those without at-risk use at time 1, 15% reported at-risk use at time 2. Positive high-risk drinking transition predictors were, at time 1, being young, male, white, childless, in good to excellent health, ever smoking, using drugs, military membership (time 1 but not 2), and becoming divorced or separated by time 2. Positive low-risk drinking transition predictors were being elderly (age ≥ 65), female, non-white, never smoking or using drugs, no alcohol use disorder, alcohol treatment, and, after time 1, having children. Conclusions: Many adults transition to and from at-risk alcohol use; youth is the strongest positive predictor of transition to at-risk and not transitioning to low-risk drinking. Persons transitioning to legal drinking age are most likely to transition to high-risk and least likely to low-risk drinking.

Screening and brief counseling among young adults: comparison of college students, community college students, and persons not in school

those not enrolled, 15%, 19%, and 28%, respectively, were advised to reduce or stop drinking; 14%, 20%, and 30% smoking; and 14%, 20%, and 26% drug use. Higher percentages were encouraged to exercise, improve their diet, and avoid pregnancy and sexually transmitted diseases. Conclusions More physicians should ask and advise emerging adults about substance use risks and to reduce or stop substance use. Advice to reduce or stop drinking is particularly needed, as alcohol is the most used substance in that group and often used in hazardous ways, especially by college students.