Heavy Episodic Drinking Research Articles

Evaluating the Sick Quitting Hypothesis for Frailty Status and Reducing Alcohol Use Among People With HIV in a Longitudinal Clinical Cohort Study.

"Sick quitting," a phenomenon describing reductions in alcohol consumption following poor health, may explain observations that alcohol appears protective for frailty risk. We examined associations between frailty and reductions in drinking frequency among people with HIV (PWH). At six Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites between January 2012 and August 2021, we assessed whether frailty, measured through validated modified frailty phenotype, precedes reductions in drinking frequency. We associated time-updated frailty with quitting and reducing frequency of any drinking and heavy episodic drinking (HED), adjusted for demographic and clinical characteristics in Cox models. Among 5,654 PWH reporting drinking, 60% reported >monthly drinking and 18% reported ≥monthly HED. Over an average of 5.4 years, frail PWH had greater probabilities of quitting (HR: 1.56, 95% confidence interval [95% CI] [1.13-2.15]) and reducing (HR: 1.35, 95% CI [1.13-1.62]) drinking frequency, as well as reducing HED frequency (HR: 1.58, 95% CI [1.20-2.09]) versus robust PWH. Sick quitting likely confounds the association between alcohol use and frailty risk, requiring investigation for control.

Mixed method examination of alcohol and suicidality among actively suicidal adults who engage in heavy episodic drinking

Suicide is a serious public health problem in the United States. Alcohol use has been substantially documented as a risk factors for suicide, yet it is unclear how alcohol is associated with suicidal ideation (SI) and behavior (SIB) at the event level. We examined the association between alcohol use and SI using a mixed methods approach that included daily assessments from 13 adults who engage in heavy episodic drinking with current SI and qualitative interviews among 12 of those adults. Participants were recruited on social media. Separate mixed effects logistic regression models indicated that individuals’ alcohol use on a given day was associated with SI (OR = 1.37), and suicidal urges (OR = 1.41). Adjusting for repeated measures, the expected marginal mean for intensity of SI (EMM = 3.33) and urges (EMM = 2.94) were higher on days with reported drinking behavior than days without reported drinking (EMM = 2.68 and EMM = 2.62 respectively). Qualitative data indicated that the association between alcohol use and SIB is more complex than a single directionality. Instead, the association can be unidirectional, bidirectional, and/or dependent on factors including mental health and amount of alcohol consumed. Overall, these findings emphasize a need for integrated alcohol and SIB interventions while providing insight on possible daily, just-in-time adaptations.

The Interaction of Cannabis Consumption with Heavy Episodic Drinking and Alcohol-induced Blackouts in Relation to Cannabis Use Consequences Among Recent Undergraduate College Cannabis Users.

Risky alcohol use patterns, characterized by heavy episodic drinking (HED) and alcohol-induced blackout, are prevalent in college students. However, it is not clear if experiencing HED and blackout among college-attending cannabis users heightens risk for adverse cannabis use consequences. The purpose of this study was to examine whether heavy episodic drinking and blackout episodes moderate the relationship between cannabis consumption and cannabis use consequences among college students. Undergraduate college students (n = 4331) were recruited from a Midwest University in 2021. This analysis used a subset of data from past 6-month cannabis users (n= 772; 17.8% of the full sample). Among cannabis users, 64.5% identified as female and 87.8% were White with an average age of 19.99 (SD=2.88). A linear regression was conducted with two two-way interactions of cannabis consumption and HED frequency as well as cannabis consumption and alcohol-induced blackout episodes. Results showed a statistically significant positive association between cannabis consumption and cannabis use consequences (B=0.73, p<.001), adjusting for the other variables in the model. Blackout, but not HED, was a significant moderator (B=0.19, p=.003). The findings of this study indicate that blackout experiences amplify the relationship between cannabis use and cannabis-related consequences among college students. This underscores that blackouts not only signal a risk of problematic drinking but also exacerbate the association between cannabis use and its negative consequences. Findings may inform college campus interventions targeting cannabis and alcohol concurrent-users who experience alcohol-induced blackouts to reduce their additional risk for cannabis-related consequences.

Sexual alcohol expectancies moderate the relation between alcohol use and sexual behavior among men who have sex with men

BackgroundHIV transmission remains a significant health concern for men who have sex with men (MSM) in the United States. Heavy episodic drinking (HED) is related to increased rates of condomless anal intercourse (CAI) among MSM, though evidence suggests that this association may vary by individual difference factors. The present secondary analysis tested whether sexual alcohol expectancies (SAEs) moderate the associations between frequency of HED and anal intercourse (AI) with and without a condom among moderate-to-heavy drinking HIV- MSM. MethodsTwo hundred and forty-eight moderate-to-heavy drinking MSM completed self-report questionnaires including the Sexual Behavior Questionnaire, the Modified Daily Drinking Questionnaire, and the Sexual Alcohol Expectancies Questionnaire. ResultsNegative binomial regressions indicated that SAEs moderated the association between frequency of HED and AI with a condom, but not between the frequency of HED and condomless AI (CAI). ConclusionsThese results suggest that stronger SAEs play a role in alcohol-related sexual behavior among MSM, but do not provide evidence that SAEs are associated with increased risk for HIV transmission through CAI.

Adolescent Hazardous Drinking and Socioeconomic Status in France: Insights Into the Alcohol Harm Paradox

PurposeThe “alcohol harm paradox” has been evidenced among adults, but it is still largely unexplored among adolescents. We examined in a sample of French adolescents the relation between family socioeconomic status (SES), family living arrangement and parental substance use on 1 hand, and heavy episodic drinking (HED), lifetime alcohol-induced emergency room visits (A-ERV), and number of alcoholic drinks and solitary drinking during the last episode on the other hand. MethodsA cross-sectional nationwide survey in March 2017 involved 13,314 French adolescents aged 17–18.5 years. They completed a pen and paper questionnaire about their own and their parents’ alcohol and tobacco consumption. We used risk ratios (RRs) from modified Poisson regressions to assess the relationships. ResultsAdolescents from the lowest SES had reduced likelihood of reporting 1–2 or 3–5 episodes of heavy drinking compared to those from the highest SES (RR = 0.58, 95% confidence interval = [0.50; 0.66] and 0.35 [0.27; 0.45]), but no difference for six or more episodes (RR = 0.81 [0.59; 1.12]). A-ERV was more frequent among lowest SES adolescents (RR = 1.86 [1.05; 3.30]), possibly due to drinking larger quantities of alcohol and to more frequent solitary drinking in their last episode (p < .001). SES, parental substance use, and family living arrangement were independently associated with HED. DiscussionOur findings reveal an “alcohol harm paradox” in late adolescence in France. Lower SES adolescents exhibit reduced HED but were more likely to consume large quantities alone and experience A-ERV. This emphasizes the significance of considering social determinants in alcohol-related research and interventions.

Rural-urban health differences among aging adults in India

BackgroundThe aim of this study was to determine the rural-urban health differences among aging adults in India. MethodsThe national cross-sectional data of 67,489 individuals (≥45 years) in 2017–2018 from 35 states and union territories of India (excluding Sikkim) in 2017–2018 were analysed. Various sociodemographic data, well-being indicators, lifestyle factors and physical conditions were assessed by face-to-face interviews and physical measurement. Univariable and multivariable logistic regression was utilized to assess the predictors between residence status (rural dweller, urban migrant, and urban dweller) and various health indicator outcomes. ResultsMajority (70.4 %) of the participants lived in rural areas, 10.3 % were urban migrants and 19.3 % urban dwellers. In the multivariable logistic regression analysis, urban migrants and urban dwellers had a higher self-rated health status, cognitive functioning, physical inactivity, overweight or obesity and abdominal obesity than rural dwellers, while urban migrants and/or urban dwellers had lower functional disability, insomnia symptoms, current smokeless tobacco use, current smoking, heavy episodic drinking and underweight than rural dwellers. Furthermore, urban migrants and/or urban dwellers had higher odds of diabetes, hypertension, heart disease, cancer, high cholesterol than rural dwellers, while urban migrants and/or urban dwellers had lower odds of persistent headaches, major injury, recurrent fall, physical pain, periodontal disease, vision impairment, and gastrointestinal problems than rural dwellers. ConclusionAmong 30 health indicators assessed, 16 had an urban migrant and/or urban dweller advantage, 8 had urban migrant and/or urban dweller penalty, and 6 did not differ between rural-urban groups. Public health promotion and health care should address differing health care needs of rural and urban middle-aged and older adults.

A mobile phone intervention to reduce heavy drinking: a preliminary analysis of anchoring heuristics

BackgroundPreliminary evidence has been presented for interventions focused on preventing alcohol consumption or reducing the occurrence of episodes of excessive drinking. The anchoring text message intervention is a newly proposed theory-based approach to reducing heavy drinking among youth. The current study tests the preliminary efficacy of this intervention for reducing heavy drinking among Mexican youth.MethodsFocusing on a sample of sixteen Mexican youths—nine not-heavy drinkers and seven heavy drinkers—the participants completed a survey on alcohol consumption and anchoring heuristics. Pretest and post-test questionnaire data were collected to evaluate the effectiveness of the intervention. The anchoring text messages consisted of strategies to limit alcohol use and feedback reminder messages. Assessments were conducted at baseline, four weeks of intervention, and post-intervention.ResultsLogistic regression analyses indicated a significant effect on heavy drinking episodes post-intervention. The post-intervention anchoring effects among the heavy drinker participants were different from those among the non-heavy drinkers in terms of reporting heavy drinking and future drinking. The anchoring heuristic-based intervention reduced the quantity of drinking and the future estimation of drinking and improved the ability to reject alcohol in the heavy drinker group.ConclusionsThese findings provide preliminary support for the effectiveness of the anchoring heuristic-based intervention, conducted through text messages sent by mobile phone to reduce alcohol consumption. The intervention promoted a reduction in alcohol consumption. Future research should be directed toward investigating the anchoring effects among heavy drinkers.

Social disparities in alcohol consumption among Canadian emerging adults.

Young adult drinking is a public health priority, but knowledge of socioeconomic status (SES) indicators and alcohol use among emerging adults (EAs; aged 18-29 years) is primarily informed by college samples, populations in their late teens and early twenties and non-Canadian data. We compared the association of three different SES indicators with monthly heavy episodic drinking (HED), less-than-monthly HED, no HED, and no drinking among Canadian EAs. We pooled the 2015 to 2019 waves of the Canadian Community Health Survey to include participants aged 18 to 29 years (n = 29 598). Using multinomial regression, we calculated weighted estimates of alcohol use by education, household income and area-level disadvantage, adjusting for adult roles and sociodemographic characteristics. Approximately 30% of EAs engaged in monthly HED, whereas 16% did not drink at all in the past year. Compared to those in the lowest household incomes, being in the top income quintile was significantly associated with increased relative odds of monthly HED (e.g. in combined SES model, RRR = 1.21, 95% CI: 1.04-1.39). Higher levels of education, being in higher income quintiles and living in less disadvantaged areas were significantly associated with reduced relative odds of no HED and not drinking. Adjusting for adult roles did not substantially change the associations between SES and alcohol use. Higher SES was associated with HED among EAs, although the magnitude of association was small. Universal prevention measures addressing the affordability, availability and marketing of alcohol could be complemented by interventions targeting EA populations at higher risk of HED.

Could reasons for admission help to screen unhealthy alcohol use in emergency departments? A multicenter French study

BackgroundMany patients admitted to general emergency departments (EDs) have a pattern of drinking that could lead to future alcohol-related complications. However, it is often difficult to screen these patients in the context of emergency. The aim of this study is to analyze whether reasons for admission could help to screen patients who have an unhealthy alcohol use.MethodPatients were recruited among six public hospital ED in France, between 2012 and 2014. During a one-month period in each hospital, anonymous questionnaires including sociodemographic questions, AUDIT-C and RAPS4-QF were administered to each patients visiting the ED. The reason for admission of each patient was noted at the end of their questionnaire by the ED practitioner.ResultsTen thousand Four hundred twenty-one patients were included in the analysis. Patients who came to the ED for injuries and mental disorders were more likely to report unhealthy alcohol use than non-harmful use or no use. Among male patients under 65 years old admitted to the ED for a mental disorder, 24.2% drank more than four drinks (40 g ethanol) in typical day at least four time a week in the last 12 months. Among these patients, 79.7% reported daily or almost daily heavy episodic drinking (HED, 60 g ethanol), and all were positive on the RAPS4-QF.ConclusionThis study highlights that unhealthy alcohol use is frequent among ED patients and particularly among those who come for injuries or mental disorders. Men under 65 years old with a mental disorder require special attention because of their increased prevalence of daily or almost daily HED.

Alcohol consumption patterns, suppliers and online alcohol marketing: Before and during COVID-19 alcohol bans

COVID-19-related alcohol sales bans and stay-at-home orders prompted the alcohol industry in South Africa to increase their online alcohol sales promotions. We investigated changes in alcohol-related behaviour and the drivers of illegal alcohol sales through a self-reported Facebook survey that ran from July to November 2020. Questions included socio-demographics and comparison of alcohol purchasing behaviour and intake during 2019 and 2020. Statistical tests were applied to find associations between illegal alcohol purchasing and alcohol-related behaviours. A total of 792 participants took part in the survey, 69.7% of whom were female. During lockdown periods, most participants (55.3%) bought alcohol illegally from illegal outlets or friends. Online alcohol-delivery marketing increased by 20 percentage points from 2019 to 2020, with participants stating that they saw a lot of advertisements per day and 80% of persons under 25 years were not asked to verify their age in 2020 upon delivery. Home-brewed beer and vodka intake increased in 2020 during the alcohol sales bans. Men from the Western Cape who engaged in daily or weekly heavy episodic drinking were more prone to purchase alcohol illegally. The Western Cape, which is South Africa’s most prolific wine-producing region, had the highest odds of people buying alcohol illegally, with wine being found to be the most frequently bought alcohol online and consumed by these participants. There is a need for further research into the differences in alcohol-related behaviour affecting illegal alcohol purchasing according to income group, proximity to alcohol producers and underage alcohol sales and marketing through online applications. Significance: Alcohol sales bans have the potential to reduce and stop the alcohol intake of moderate drinkers, but may make heavy episodic drinkers drink more than usual. During COVID-19 lockdown, illegal alcohol sales were taking place through unlicenced alcohol outlets and friends, and not through licenced online applications. Unlicenced alcohol outlets need to be addressed to prevent future illegal alcohol sales. Stricter regulations aimed at legal online alcohol sales applications should be put in place to prevent alcohol sales to minors and those who have already consumed too much alcohol. There should be a ban on marketing of addictive substances, such as alcohol.

Trends in alcohol-related harm among Swedish youth: Do in-patient care registry data match drinking trends?

Youth drinking has been declining in Sweden since the year 2000. There is a paucity of studies examining trends in alcohol-related harm during this period. The overall aim of the present study is to examine how trends in alcohol-related harm match trends in drinking among Swedish youths during 2000-2021. Measures of alcohol use were obtained from national school surveys. Prevalence rates of any alcohol use and heavy episodic drinking were used. Alcohol-related harm indicators were obtained from registry information from the National Board of Health and Welfare. Annual trends in harm indicators were tested with linear regression models and correlations between alcohol use and alcohol-related harm indicators were assessed using Pearson's correlation on annual data. Statistically significant negative trends were observed for all alcohol-related harm indicators for the period 2000-2021. Significant correlations were found for both measures of alcohol use and all alcohol-related harm indicators. The levels of alcohol-related harm have declined among youths in Sweden during the period 2000-2021. The trends in harm seem to reflect the decline in youth drinking that has occurred during the same period.

Have there been changes in daily smoking and cigarette consumption among adolescents? Investigation between 1999 and 2019 among Finnish adolescents.

It is postulated that due to decreased smoking rates and increased denormalisation of smoking, those who start and maintain smoking have more socially disadvantaged characteristics and are more dependent on nicotine than those who do not (the so-called 'hardening' hypothesis). The aim of this study was to measure changes in daily smoking and cigarette consumption among Finnish adolescents according to background factors. A repeated cross-sectional study using data from European School Survey Project on Alcohol and other Drugs (ESPAD) on six representative cross-sections of 15- to 16-year-old students between 1999 and 2019 in Finland. A total of 11 377 males and 12 247 females. The outcome measures included the proportion of daily smokers among current smokers, daily smoking and the estimated mean number of smoked cigarettes per day (CPD). Substance use, parental monitoring and school performance were used as independent variables. All measures were self-reported. Daily smoking decreased over time and daily smokers constituted a smaller part of current smokers in 2019 compared with 1999 (the ratio among boys 0.68 and 0.43, respectively; among girls 0.59 and 0.43). Boys using cannabis (interaction between cannabis*survey year: P = 0.020; in 2019 odds ratio [OR]: 3.68, 95% confidence interval [CI] 2.23-6.08) and girls with heavy episodic drinking (interaction between heavy episodic drinking*survey year: P = 0.006, in 2019 OR: 9.00, 95% CI 5.61-14.42) had elevated adjusted odds for daily smoking over time. The estimated mean number of CPD decreased among daily smokers from 9.0 in 1999 to 7.2 in 2019 (P = 0.0002) and the differences diminished between groups based on gender, snus/alcohol use and parental monitoring. The between-group differences remained with regard to cannabis use (P = 0.0233 in 2019) and school performance (P = 0.0111 in 2019). Among currently smoking Finnish adolescents, the proportion of daily smokers decreased between 1999 and 2019, as did the number of cigarettes smoked per day (CPD) among daily smokers, suggesting an absence of 'hardening' in this group. However, differences were observed related to the odds of daily smoking and the mean number of CPD, indicating the change has been less favorable among some adolescent groups than others.

Age-related patterns in high-risk alcohol and cannabis use and their associations with positive and negative affect in young adulthood

ObjectiveWe examined age-varying associations between young adult simultaneous alcohol and marijuana/cannabis use (SAM) and heavy episodic drinking (HED) and positive and negative affect to inform harm reduction efforts. MethodsYoung adults reporting past-year alcohol use (n = 556; ages 19–25) were recruited in a state where alcohol and nonmedical cannabis use was legal for those 21 +. Participants provided 24 repeated monthly assessments. Among those reporting past-month cannabis use on at least one survey, logistic time-varying effect models estimated (1) the age-varying prevalence of and associations between past-month SAM and HED and (2) age-varying unique associations of affect with SAM and HED. ResultsThere was a positive age-varying association between HED and SAM over time that was highest at age 19 (OR = 7.56), decreased until age 20.7 (OR = 3.39), increased until age 23.0 (OR = 4.85), and decreased until the association became non-significant by age 25. Negative affect was positively associated with SAM from ages 20.7 to 23.0, peaking at age 21.8 (OR = 1.36). Positive affect was positively associated with HED from ages 19.4 to 20.4 (peak OR = 1.25) and ages 22.5 to 24.5 (peak OR = 1.38). In contrast, positive affect was not uniquely associated with SAM nor negative affect with HED across ages 19–25. ConclusionsWhile HED and SAM were positively associated throughout young adulthood and interventions could target them in tandem, their associations with affect suggest differential etiologic processes. Preventive intervention and harm reduction efforts should attend to psychological context in which these behaviors occur.

College men's use of protective behavioral strategies for sexual aggression, risky sexual behavior, and heavy episodic drinking.

Sexually aggressive behavior (SAB), risky sexual behavior (RSB), and heavy episodic drinking (HED) are serious behavioral health problems among college men. The present study substantially revises and validates protective behavioral strategies (PBS) measures in the SAB and RSB domains; evaluates the relations among PBS usage in the SAB, RSB, and HED domains; and determines whether college men with SAB, RSB, or HED histories report lower PBS usage. College students who identified as men (n = 1,121) completed measures of PBS, SAB, RSB, HED, rape-supportive attitudes, sociosexuality, and bar/party attendance. Factor analyses resulted in three PBS scales (SAB, RSB-General, and RSB-Protection) that showed good fit and cross-validated well. Average scores for all four PBS measures converged moderately to strongly. Men reporting histories of SAB, RSB, or HED reported much lower domain-specific PBS use, and domain-specific PBS predicted concurrent SAB, RSB, or HED in the presence of other established predictors. Four well-developed and validated PBS measures now provide an expanded set of potential harm-reduction strategies for college men who drink and engage in sexual activity. Given the strong concurrent associations between PBS use and problems, as well as the interrelatedness of PBS use across domains, future research should examine the impact of simultaneous personalized normative feedback on PBS use across alcohol and sexual domains. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for College Men’s Use of Protective Behavioral Strategies for Sexual Aggression, Risky Sexual Behavior, and Heavy Episodic Drinking

Supplemental Material for College Men’s Use of Protective Behavioral Strategies for Sexual Aggression, Risky Sexual Behavior, and Heavy Episodic Drinking

Relative importance of behavior-specific determinants of heavy episodic drinking among U.S. young adults

ABSTRACTThe study examined the relative importance of heavy episodic drinking (HED)-specific determinants on past 2-week HED status among White, Black, and Hispanic young adults. Analyzing data from the wave III binge sample of the National Longitudinal Study of Adolescent to Adult Health, the study found that the relevance of HED-specific beliefs/expectancies, injunctive and descriptive norms, social images/prototypes, self-efficacy, and anticipatory emotions may vary within and across these construct domains, and by race and ethnicity. These findings highlight the need for alcohol prevention programs tailored by demographic characteristics such as race and ethnicity to enhance intervention effects. Larger-scale studies are necessary to confirm these results.

Alcohol and inflammation: Examining differences at the intersection of sexual identity and race/ethnicity

Sexual minorities (SMs; e.g., lesbian, gay, bisexual, and other non-heterosexual individuals) are more likely to be current alcohol drinkers than their heterosexual peers while separately experiencing elevated inflammation. Yet, little research has assessed the association between alcohol use and inflammation among subgroups of SMs, let alone potential differences among people with multiple marginal identities (e.g., race/ethnicity and sexual identity).Data came from the National Health and Nutrition Survey 2015–2016. Survey-weighted multivariable linear regression analysis was used to assess the relationship between alcohol use categories, heavy episodic drinking, and log-CRP (C-reactive protein). Models were stratified by sexual identity to determine whether associations between alcohol use and inflammation or between race/ethnicity and inflammation differed by sexual identity.Among 3220 participants, 1000 (36.8%) reported light alcohol use, 870 (32.0%) reported moderate use, and 483 (17.8%) reported heavy use. Mean raw CRP was 4.1 mg/L (SD = 8.1). The association between race/ethnicity and CRP differed in stratified relative to non-stratified models with key differences in CRP among individuals with multiple marginalized identities. We also observed that while the “classic” J-shaped relationship between alcohol use and systemic inflammation persists among heterosexuals in this sample, it does not hold among subgroups of sexual minorities. In particular, bisexuals who report heavy alcohol use, compared to non-users, experience significantly elevated CRP. Finally, we did not observe any association between heavy episodic drinking and CRP among subgroups of sexual minorities.Future studies assessing alcohol and biomarker data need to strive to include subgroups of sexual minorities and people with multiple marginal identities to better target behavioral and biomedical interventions aimed at reducing health disparities.

How executive functioning moderates the relation between implicit alcohol associations and heavy episodic drinking: The roles of planning and working memory.

Heavy episodic drinking (HED) is common among college students and poses risks for negative consequences. Evidence suggests that HED is more frequent among those with stronger implicit alcohol associations, and the impact of these implicit associations on drinking may be moderated by executive functioning. This study examined the role of two executive function components-working memory (WM) and planning-as moderators of implicit alcohol-approach associations and HED among college students who drink alcohol. One hundred forty-one participants completed measures of alcohol use, implicit alcohol-approach associations, WM, and planning. Regression analyses were conducted to examine the respective two-way and three-way interactions between implicit alcohol associations, WM, and planning on HED. Results showed that WM and planning each moderated the relation between alcohol implicit association test (IAT) and HED. IAT scores were positively associated with HED when WM and planning were low (-1 SD) but not high (+1 SD). Although results from the three-way interaction exhibited a nonsignificant trend, the pattern of results showed that the association between IAT and HED was stronger at lower levels of WM, but only when planning was also low, not high. Findings support the view that HED among college students who drink alcohol may be a function of automatic alcohol associations and that these associations may be stronger among those with lower WM and planning abilities. These results replicate and extend our understanding of how executive functioning may moderate the impact of implicit alcohol cognitions on risky drinking and suggests potential intervention targets. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for How Executive Functioning Moderates the Relation Between Implicit Alcohol Associations and Heavy Episodic Drinking: The Roles of Planning and Working Memory

Supplemental Material for How Executive Functioning Moderates the Relation Between Implicit Alcohol Associations and Heavy Episodic Drinking: The Roles of Planning and Working Memory

Odds of gambling among adolescents: a secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs

BackgroundGambling among adolescents is associated with gambling disorder in adulthood. This study investigated factors associated with gambling and excessive gambling in adolescents. MethodsThis secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) used nationally representative data from the Irish cohort of the 2019 ESPAD wave. Data were collected between March and May 2019. We included 1949 students aged 15–16 years (946 [48·5%] male, 1003 [51·5%] female), with a response rate of 85%. We calculated past year gambling prevalence as the rate of those who had gambled for money on at least one of four games of chance (slot machines, cards or dice, the lottery, betting on sports or animals) in the past 12 months. An adapted version of the three-item Consumption Screen for Problem Gambling was used to identify excessive gambling (score ≥4). We carried out descriptive and logistic regression analyses using binary covariates with Stata v16.1. We included 19 variables in the multivariable analysis. Ethics approval was granted by Dublin Institute of Technology's Ethics Committee. Non-consent forms were issued to all parents to opt out. FindingsOverall, 447 (23%) of 1949 students gambled in the past year, of whom 45 (10%) engaged in excessive gambling. Using a mutually adjusted multivariable logistic regression analysis, past year gambling was associated with alcohol use (adjusted odds ratio [aOR] 1·6, 95% CI 1·1–2·2), experiencing serious arguments (aOR 1·4, 1·1–1·9), and trouble with the police (aOR 1·9, 1·2–2·8). Female gender was a protective factor (aOR 0·6, 0·4–0·9). In the univariable analysis, excessive gambling was associated with gaming (OR 2·3, 1·0–5·1), tobacco use (2·1, 1·1–4·2), e-cigarette use (2·1, 1·1–4·1), heavy episodic drinking (2·7, 1·4–5·1), trouble with the police (2·8, 1·5–5·4, p<0·01), and deliberately hurting themselves (2·8, 1·4–5·6). Female gender (OR 0·3, 0·1–0·6) and social media use (0·4, 0·2–0·8) were protective factors. Excessive gambling was also associated with betting on sports and animals (OR 3·6, 1·6–8·4), slot machines (2·9, 1·5–5·8), card or dice (2·4, 1·2–4·6), and online gambling (4·2, 2·0–8·0). InterpretationA large proportion of 15–16 year olds in Ireland have gambled for money in the past year, with one in ten of those having engaged in excessive gambling. This number is likely to be underestimated due to recall and social desirability bias. Reducing the availability, access, and appeal of gambling products in Ireland should be addressed through ongoing gambling reform. FundingInstitute of Public Health.