Lower Alcohol Use Research Articles

Global, regional, and national burden of tuberculosis and attributable risk factors for 204 countries and territories, 1990-2021: a systematic analysis for the Global Burden of Diseases 2021 study.

Tuberculosis (TB) remains a major global health threat. Despite ongoing efforts to control and eradicate TB, various factors including socioeconomic issues, policy modifications, and unexpected public health crises like COVID-19 pandemic have posed new obstacles to achieving TB elimination. This study aims to analyze the changes in global tuberculosis burden over the past 32 years, and provide scientific support for global initiatives targeting the eradication of TB in the post-pandemic period. The data for this study were obtained from the Global Burden of Disease (GBD) 2021 database, with age-standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASDR), and disability-adjusted life years (DALYs) as the primary assessment indicators. Dynamic changes in the TB burden were analyzed by estimating the annual percentage changes (EAPCs). The attributable ratios of six main risk factors to TB burden were calculated, and the correlation between the Socio-Demographic Index (SDI) and the TB burden was analyzed using Pearson correlation tests. The global TB incidence decreased from 8.6million cases in 1990 to 8.4million cases in 2021, with a corresponding decline in deaths. However, the TB burden remains higher among men than women. The highest incidence and mortality rates were observed in the age group of 15-69 years, with a notable gender disparity, especially in Eastern Europe. These rates were generally elevated in low-income and lower-middle-income regions, with significantly higher Age-Standardized Incidence Rates and Age-Standardized Death Rates in males compared to females. A significant negative correlation was found between SDI values and TB burden. Analyzing risk factors from the Global Burden of Disease study, it was determined that globally, dietary risks, high body-mass index, high fasting plasma glucose, low physical activity, tobacco, and alcohol use were the main contributors to TB age-standardized Disability-Adjusted Life Years, with tobacco and alcohol use having the most significant impact. Analysis of risk factors suggests that tailored public health interventions for specific genders and regions can effectively lessen the TB burden.

Right Orchiopexy to Correct Undescended Testicle and Circumcision to Correct Phimosis

Cryptorchidism is a condition in which one or both testicles fail to descend to its normal position in the scrotum. The testicle may reside in the retroperineum, in the internal inguinal ring, in the inguinal canal, or even at the external ring. The exact cause is unknown but several risk factors have been linked to this condition such as premature birth, low birth weight, family history, Down syndrome, alcohol use, and cigarette smoking. Undescended testis occurs in approximately 30% of preterm infants and 1-3% of term infants. Diagnosis is made during examination at birth or shortly thereafter, and timely recognition and management of this condition prevents adverse consequences. The goal of treatment is to relocate the undescended testicle to its proper location in the scrotum. Treatment before 1 year of age lowers the risk of complications such as infertility, testicular cancer, inguinal hernia, and testicular torsion. Treatment can be hormonal, surgical or a combination of both. Hormones such as hCG can sometimes induce descent of the testicle; however, surgery is the preferred option. Orchiopexy is the surgical procedure to free an undescended testicle and implant it in the scrotum. Phimosis is the inability to retract the foreskin covering the glans of the penis. It may appear as a tight ring of the foreskin around the tip of the penis preventing full retraction. Phimosis can be physiologic or pathologic. Physiologic phimosis is seen in children born with tight foreskin at birth and separation occurs naturally overtime while pathologic phimosis is caused by scarring, infection or inflammation. A tight foreskin can interfere with the passage of urine as seen as ballooning of the foreskin during urination. This can lead to inflammation of the penis called balanitis or inflammation of the penis and foreskin called balanoposthitis. Physiologic phimosis does not require intervention and will resolve with daily gentle retraction while pathologic phimosis is treated with topical steroid cream or circumcision. Here we present the case of a young male with an undescended right testicle and phimosis. The right testicle was located in the right inguinal area and was brought down into the scrotum. Circumcision was also done to resolve the phimosis.

An observational cohort study of alcohol use and cognitive difficulties among post-9/11 veterans with and without TBI and PTSD

BackgroundTraumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and alcohol use are highly prevalent among military Veterans and independently associated with cognitive difficulties; less is known about the combined effects. This study aimed to investigate the association between alcohol use patterns and cognitive diagnoses in Veterans with TBI and/or PTSD. MethodsUsing electronic health record data,193,663 Veterans were classified into three alcohol use trajectory groups (consistently low, initially high transitioning to low, initially moderate transitioning to high) based on self-reported Alcohol Use Disorders Identification Test-C (AUDIT-C) scores. Cox proportional hazards models were used to examine the association between alcohol use patterns, TBI, PTSD, and the risk of cognitive diagnosis, while adjusting for demographic factors and comorbidities. ResultsVeterans with initially high transitioning to low (HR = 1.21, 95 % CI: 1.11–1.31) and initially moderate transitioning to high (HR = 1.42, 95 % CI: 1.33–1.51) alcohol use patterns had a significantly greater risk of cognitive diagnosis compared to those with consistently low alcohol use when accounting for TBI, PTSD, and comorbidities. TBI (HR = 5.40, 95 % CI: 5.06–5.76) and PTSD (HR = 2.42, 95 % CI: 2.25–2.61) were also independently associated with an elevated risk of cognitive diagnosis. ConclusionsFindings suggest that Higher levels of alcohol consumption, even if decreasing over time, may confer an increased risk of cognitive diagnosis for Veterans with TBI and/or PTSD. Long-term alcohol use patterns should be considered in clinical assessments and interventions to identify individuals at greater risk for experiencing cognitive difficulties.

Implicit Social Attunement and Alcohol Use: The Effect of Peer Feedback on Willingness to Drink in Social Settings

AbstractSocial context plays an important role in alcohol consumption. While most studies focus on explicit social drinking norms, this study aimed to (1) develop an implicit social attunement (ISA) task to experimentally assess how willingness to drink alcohol is affected by social alcohol drinking (SAD), social non-alcohol drinking (SNAD), and social non-drinking (SND) settings and peer feedback on willingness to drink in these settings, and (2) assess how ISA is associated with explicit social attunement, age, alcohol use and related problems. Participants (N = 506) aged 16–60 years completed the ISA task and questionnaires assessing alcohol use and alcohol use–related problems, age, and explicit social attunement online. Willingness to drink was highest in the SAD setting (SAD: M(SD) = 5.70 (2.68); SNAD: M(SD) = 4.03 (2.20); SND: M(SD) = 2.02 (1.30)) and—regardless of social setting—lower peer willingness to drink induced higher ISA than higher peer willingness to drink (SAD: t(325) = − 2.929, p = .035; SNAD: t(325) = − 2.888 p = .036; SND: t(325) = − 6.764, p < .001). Higher ISA to higher peer willingness in the SAD (r = .15, p = .001) and SNAD (r = .11, p = .011) settings was associated with higher alcohol use and related problems, while higher ISA to lower peer willingness in the SND setting was associated with lower alcohol use and related problems (r = − .18, p = .002) and recent alcohol use (standard drinks: r = − .14, p = .011; binge drinking days: r = − .16, p = .005). Explicit social attunement, but not ISA, mediated the association between lower age and higher alcohol use and related problems (b = − .013, p = .009). Results indicate that peer feedback can be a protective or risk factor for alcohol use, depending on the social setting. Future studies are needed to elucidate differences between implicit and explicit social attunement behaviors in their associations with age and alcohol use and related problems.

The combined association of physical activity and alcohol use with long-term mortality: an age-stratified analysis

BackgroundThe combined association of physical activity (PA) and alcohol use (AU) with long-term mortality is yet to be investigated.MethodsFor the current study, 12,621 participants aged ≥ 20 years were enrolled from the National Health and Nutrition Examination Survey (1999–2004). The study endpoint was all-cause mortality. Cox proportional hazards regression models were used to examine the combined effect of PA and AU on long-term mortality.ResultsThe study population was divided into young (< 60 years, N = 8,258) and old (≥ 60 years, N = 4,363) groups. The median follow-up time was 203 months. In both young and old group, sedentary lifestyle combined with even minimal AU were associated with elevated risk of death (all P < 0.05). In young group, the integration of high volume AU with any degree of PA, including sedentary PA (HR = 2.35, 95% CI 1.24–4.44, P = 0.009), low PA (HR = 1.64, 95% CI 1.01–2.68, P = 0.047), and moderate-to-vigorous PA (HR = 1.99, 95% CI 1.03–3.84, P = 0.041), was associated with an increased risk of mortality. This relationship persisted as significant after adjusting for potential confounders (all P < 0.05). In old group, combining moderate-to-vigorous PA and low volume AU (HR = 0.59, 95% CI 0.37–0.94, P = 0.027) was associated with a reduction in mortality. After adjustment, the combination of moderate-to-vigorous PA and low volume AU was independently associated with favorable prognostic outcomes (all P < 0.05).ConclusionsIn both age groups, combining sedentary lifestyle with even minimal AU was a risk factor for death. In young group, combining any level of PA with high volume AU was associated with increased mortality. In old group, combining moderate-to-vigorous PA with low volume AU was related to reduced mortality.

Discrimination experiences and problematic alcohol and cannabis use in young adulthood.

Limited research has examined how discrimination in young adulthood relates to substance use. We examined how multiple and specific types (e.g., race-based) of experiences of unfair treatment are related to problematic alcohol and cannabis use. We analyzed cross-sectional data from a diverse cohort of young adults (mean age 24.7) predominantly residing in southern California (n = 2303) to examine associations of multiple (count) and specific experiences (race-, sexual orientation-, gender-based) of perceived everyday discrimination with self-reported alcohol and cannabis use outcomes (consequences, use disorders, and solitary use). We also tested interactions between the three specific discrimination experiences and sociodemographic characteristics (e.g., race-based discrimination × race/ethnicity). In this diverse sample (e.g., 47% Latinx/o and 22% Asian; 22% sexual/gender diverse; 56% female) of young adults, about 46% reported up to four different discrimination experiences and 27% reported race-, 26% gender-, and 5% sexual orientation-based discrimination. Race- and gender-based discrimination and experiencing more types of discrimination were associated with worse cannabis use outcomes. Race-based discrimination was associated with fewer alcohol consequences and lower Alcohol Use Disorders Identification Test (AUDIT) scores. Associations with sexual orientation-based discrimination and the interactions were not significant. Findings build on limited research on associations of discrimination with cannabis use in young adults. More work is needed to understand the mechanisms by which discrimination influences drinking behaviors. This study advances the field by examining the unique contributions of specific and multiple types of discrimination experiences in young adulthood, a critical developmental period in which substance use peaks.

Social ecological model of alcohol use among youth living with HIV

ABSTRACT The goal of this study was to identify predictors of alcohol use among youth living with HIV (YWH) using a social ecological approach that examines the individual and the context in which they are embedded. The sample consisted of 183 YWH ages 17–24 from five sites within the Adolescent Medicine Trials Network (ATN). Structural equation modeling was used to test the social ecological model of alcohol use in this sample. The model tested predictors at the individual, interpersonal, and environmental level. Results showed that mental health distress (b = 0.21, p < 0.05), social norms of alcohol use (b = 0.29, p < 0.05) and alcohol outlets (b = 0.23, p < 0.05) were associated with alcohol use. Externalizing behaviors were indirectly associated with problematic alcohol use, while social norms of alcohol use mediated this relationship (z = 2.42, p = 0.015). Our findings identified factors across multiple systems related to alcohol use among YWH supporting the social ecological model. Findings suggest treatment for alcohol use behavior would benefit from also addressing the individual by focusing on mental health issues as well. Additionally, at the interpersonal level, considering one’s social norms of drinking in their social network, especially among youth who are more prone to externalizing behaviors, would lower alcohol use. Furthermore, public policy should examine ways to limit the accessibility of alcohol in higher risk environments.

A Look Into How the "Blue Zone" Lifestyle May Affect Patients' Lives Before and After Hip Fracture: A Propensity-Matched Cohort Study.

Hip fractures are life-changing injuries with associated one-year mortality up to 30%. Five locations in the world have been termed "blue zones," where the longevity of the population is markedly higher than that of surrounding areas and there are 10 times more centenarians. The United States has one blue zone (Loma Linda, California), which is believed to be because of the lifestyle of the Seventh-day Adventist population living there. We hypothesized that patients from the blue zone experience low-energy, frailty-driven, osteoporotic hip fractures later in life and an increased postinjury longevity relative to non-blue zone control subjects. A review of patients treated for hip fracture between January 2010 and August 2020 from a single institution was conducted. Demographic data were collected, and the end point of mortality was assessed using death registry information, queried in April 2024. Groups were divided into blue zone and non-blue zone. Statistical analysis was conducted with P < 0.05 considered significant. Complete data were available for 1,032 patients. The blue zone cohort sustained low-energy hip fractures 12 years later in life (83.2 versus 71.1, P < 0.01). Propensity score matching was used to account for this difference. After propensity score matching, age, body mass index, American Society of Anesthesiologists score, surgery performed, sex, mechanism, ethnicity, diabetes, chronic obstructive pulmonary disease, CHF, chronic kidney disease grade, dementia, surgical time, and drug/tobacco/marijuana use were similar between groups. Blue zone patients had lower mortality at both 1 and 2 years postoperatively (12% versus 24%, P = 0.03 and 20% versus 33%, P = 0.03, respectively), had more hypertension (76% versus 62%, P = 0.03), reported lower alcohol use (7% versus 20%, P < 0.01), and included more Seventh-day Adventists (64% versus 15%, P < 0.01). The blue zone lifestyle affected the onset of frailty and delayed osteoporotic hip fracture by 12 years in this propensity-matched cohort study. Postoperative mortality was also markedly lower in the blue zone cohort.

Mesocorticolimbic system reactivity to alcohol use-related visual cues as a function of alcohol sensitivity phenotype: A pilot fMRI study

Low sensitivity (LS) to alcohol is a risk factor for alcohol use disorder (AUD). Compared to peers with high sensitivity (HS), LS individuals drink more, report more problems, and exhibit potentiated alcohol cue reactivity (ACR). Heightened ACR suggests LS confers AUD risk via incentive sensitization, which is thought to take place in the mesocorticolimbic system. This study examined neural ACR in LS and HS individuals. Young adults (N = 32, Mage=20.3) were recruited based on the Alcohol Sensitivity Questionnaire (HS: n = 16; LS: n = 16; 9 females/group). Participants completed an event-related fMRI ACR task. Group LS had higher ACR in left ventrolateral prefrontal cortex than group HS. In group LS, ACR in left caudomedial orbitofrontal cortex or left putamen was low at low alcohol use levels and high at heavier or more problematic alcohol use levels, whereas the opposite was true in group HS. Alcohol use level also was associated with the level of ACR in left substantia nigra among males in group LS. Taken together, results suggest elevated mesocorticolimbic ACR among LS individuals, especially those using alcohol at hazardous levels. Future studies with larger samples are warranted to determine the neurobiological loci underlying LS-based amplified ACR and AUD risk.

Abstract MP21: Differences in Cardiovascular Risk Factors Across Age Strata in Five Race and Ethnic Groups: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) and Multi-Ethnic Study of Atherosclerosis (MESA) Studies

Introduction: Few studies have comprehensively examined if South Asian Americans develop atherosclerotic cardiovascular disease (ASCVD) risk factors at younger ages than other race/ethnicity groups. We compared ASCVD risk factors across age strata by race/ethnic group from two US community cohorts. Methods: We included 1164 South Asians from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study and 2262 non-Hispanic White, 1892 Black, 1496 Hispanic, and 804 Chinese adults from the Multi-Ethnic Study of Atherosclerosis (MESA) study. Participants were 40-85 years (mean = 61.4, SD = 10.3) at initial exam. Mixed-effects linear or logistic regression models were used to predict the prevalence of risk factors by race/ethnic group at ages 45, 55, 65, and 75 years. We tested whether prevalence at age 45 and trends over time were different for South Asians compared to other groups. All models controlled for education, insurance status, and baseline smoking status. Results: At age 45, South Asians had a higher prevalence of hypertension than White, Chinese, and Hispanic/Latino adults, the highest prevalence of prediabetes or diabetes, and more dyslipidemia than Black and Chinese individuals. At age 45, South Asians reported higher diet quality and more exercise than other race/ethnic groups, and they also had significantly lower alcohol use than White, Black, and Hispanic groups. In addition, the change in these risk factors over time in South Asians differed from the trends in the other race/ethnic groups, (Table). Conclusions: South Asians have a high level of clinical risk factors and lower level of behavioral risk factors at age 45 compared to other race/ethnic groups. There are also different trends in risk factors with increasing age by race/ethnic group. Understanding trends and disparities in risk and protective factors across the lifecourse can help equitably improve prevention and treatment strategies for US populations.

A novel cost-palatability bi-objective approach to the menu planning problem with an innovative similarity metric using a path relinking algorithm

Bad eating habits are considered with low exercise, tobacco, and alcohol use, among the greatest health risk factors in high-income countries. Here, the spread of non-communicable diseases related to diet contrasts with the increasing availability of diet guidelines and health information. We are all left wondering, why are we not eating healthier? Palatability and cost appear as the two most important barriers to adherence to any prescribed diet. This work aims to generate high-adherence healthy menus attending to Mediterranean standards, modelling and solving a cost palatability bi-objective optimisation problem. Although the latter is implicitly considered in most current models, its use as a quantifiable objective is novel. For this, a novel Similarity Function is introduced, which evaluates the proximity of two different menus and returns a similarity metric between 0 and 1. A multi-criteria optimisation method is used to design nutritious menu plans and analyse the trade-off between the cost and palatability of menus. A Path Relinking algorithm is later applied to improve the objective values, with specific considerations to palatability, designing healthy menus that can beat those adherence barriers.

Beyond the Laws: Parental Monitoring, Perceived Acceptability of Underage Drinking and Alcohol Use Among Belgian Youth.

Parental monitoring behaviors are negatively associated with adolescent substance use. Yet, the processes explaining these associations are still unclear. The current study examined adolescents' knowledge of minimum legal drinking age laws and their perceived acceptability of underage drinking as potential mediators of the links between parental monitoring behaviors and youth alcohol use. The sample included 1154 Belgian adolescents (Mage = 16.34, SD = 1.33; 71% girls), who were recruited in Wallonia (54.9%) and in Flanders (45.1%). Path analyses revealed that higher parental rule setting, but not solicitation, was related to lower alcohol use. Acceptability of underage drinking mediated this link, but not knowledge of the laws. Results suggest that beyond laws regulating the minimum legal drinking age, alcohol use prevention programs should consider the importance of parental rule setting and youth's perceived acceptability of underage drinking.

Problematic Alcohol Use Trajectories in U.S. Military Veterans during a Public Health Crisis: Results from a 3-year, Nationally Representative, Longitudinal Study.

A growing number of studies have examined alcohol use during the COVID-19 pandemic. However, few longitudinal studies evaluated the prevalence and correlates of different trajectories of problematic alcohol use in vulnerable segments of the population, such as US veterans, over the 3-year course of the COVID-19 pandemic.Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, longitudinal study of 2,441 US veterans. Latent growth mixture modeling was used to identify the trajectories and correlates of problematic alcohol use.Four trajectories were identified: consistent (N = 170, weighted 7.2%), decreasing (N = 38, weighted 2.2%), increasing (N = 22, weighted 1.2%), and low (N = 2,211, weighted 89.4%) problematic alcohol use. Greater household income, pre-pandemic drug use disorder (DUD), lower social support, and COVID-19 infection to self or non-household members were associated with an increasing relative to decreasing problematic alcohol use trajectory. Greater household income, adverse childhood experiences (ACEs), pre-pandemic DUD, lower social support, and greater COVID-related social restriction stress were associated with an increasing relative to a low problematic alcohol use trajectory. Younger age, male sex, ACEs, pre-pandemic DUD, lower pre-pandemic and greater decline in protective psychosocial characteristics, COVID-19 infection to non-household member, and lower COVID-related financial stress were associated with a consistent relative to a low problematic alcohol use trajectory. Overall, pre-pandemic greater income, DUD, and lower social support were associated with an increase in problematic alcohol use among US veterans during the COVID-19 pandemic. Results may help inform prevention efforts to mitigate problematic alcohol use during prolonged crises in this population.

Assessing disparities in pancreatic cancer outcomes in African Americans.

612 Background: Pancreatic Adenocarcinoma (PA) is a leading cause of cancer-related death across the world, with poorer outcomes noted in minority populations. The observed variation in outcomes has been attributed to delayed diagnosis, barriers to optimal treatment and health care related disparities. We evaluated the impact of race on clinical presentation and outcomes in pancreatic cancer at a large academic teaching center. Methods: We performed a retrospective review of patients with pancreatic adenocarcinoma diagnosed between January 2016 to December 2021. The demographic characteristics (age, tobacco use, alcohol use, BMI); comorbidities (diabetes, acute/chronic pancreatitis); pathology, treatment (chemotherapy regimen, radiation, surgery) and recurrence free survival (RFS) and overall survival based on race were analyzed. Results: The cohort (N=947) consisted of 147 (16%) African Americans (AA) and 775 (82%) Non-Hispanic Whites (NHW). The mean age at diagnosis was 68 years (±10) among AA and 70 years (±11) in NHW. Thirty-seven (26%) of AA and 104 (14%) of NHW were current smokers; 46 (33%) of AA and 323 (45%) of NHW consumed alcohol regularly. Among AA, 32 (22%) were obese (BMI&gt;30), compared to 194 (25%) in NHW. Other comorbidities included diabetes (35% in AA vs. 32% in NHW) and acute/chronic pancreatitis (11% among AA vs. 9% among NHW). Eighteen percent (18%) of AA and 17% of NHW had stage II disease, 16% and 12% had stage III and 48% in both had stage IV disease respectively. The treatment modality consisted of chemotherapy (63% in AA vs. 66% in NHW), surgery (25% in AA vs. 26% in NHW) and radiation (10% in AA vs. 12% in NHW). The median time to treatment initiation was 30 (17, 41) months for AA and 26 (16, 40) months for NHW. On univariate analysis, AA race was associated with younger age at diagnosis (p 0.043), higher current tobacco use (p 0.001), lower alcohol use (p 0.012), lower rates of obesity (p 0.024) and higher rate of acute pancreatitis (p 0.037) in pancreatic cancer. On multivariate analysis, race was not associated with difference in recurrence free survival (12 months in AA vs. 14 months in NHW; p 0.96) when adjusted for age, sex, alcohol use, tobacco use, cancer stage and chemotherapy. High mean age, clinical stage II, III and IV, current alcohol use, underweight and BMI&gt;30 and cerebrovascular accident as a comorbidity was associated with worse overall survival when adjusted for other variables. Conclusions: Our study revealed that pancreatic cancer in AA was diagnosed at a younger age, associated with active smoking and pancreatitis. We observe there was no difference in treatment initiation among AA and NHW. There was no significant difference in recurrence free survival and overall survival compared to NHW when adjusted for other variables. Future studies incorporating germline mutations, novel biomarkers are needed to determine impact of racial health disparities on outcomes in pancreatic cancer.

METABOLIC SYNDROME, LIFESTYLE FACTORS, AND SLEEP-DISORDERED BREATHING IN US HISPANICS: IMPLICATIONS FOR MID LIFE

Abstract US Hispanics/Latinos are disproportionately susceptible to metabolic syndrome (MetS), attributed in part to health and lifestyle factors such as low physical activity levels, diet quality, alcohol use, tobacco use, and sleep-disordered breathing. The risk of MetS and MetS-related complications increases with age. We examined the relationships between select health and lifestyle factors and MetS among Hispanic gender-heritage subgroups and determined whether gender and heritage moderate those relationships. Participants included 14,155 Hispanic Americans aged 18–76 (59% women, mean age 45.92 ± 13.97) from seven heritage subgroups. This secondary analysis of cross-sectional data from the observational Hispanic Community Health Study / Study of Latinos dataset used multinomial logistic regression and Hayes’ PROCESS macro to test these relationships; the dependent variable, MetS, included four categories delineating MetS and related medication use. Results include low physical activity (p&amp;lt; .001) and sleep-disordered breathing (p&amp;lt; .001) were associated with the MetS with medication use group. High alcohol use decreased the probability of being in this group (p&amp;lt; .001). Cigarette pack years were not significantly associated with MetS outcomes. Gender moderated the association between MetS and diet quality (p&amp;lt; .001), alcohol use (p&amp;lt; .001), cigarette pack-years (p&amp;lt; .001), and sleep-disordered breathing (p&amp;lt; .001). Low physical activity and sleep-disordered breathing was significantly associated with MetS group membership, whereas low and high alcohol use were associated with decreased MetS risk. Gender-heritage differences were prominent in each of the study variables. Midlife may be an important target for prevention and intervention; other considerations for aging will be discussed.

Daily associations between cannabis use and alcohol use among people who use cannabis for both medicinal and nonmedicinal reasons: Substitution or complementarity?

People who use cannabis for medicinal (vs. nonmedicinal) reasons report greater cannabis use and lower alcohol use, which may reflect a cannabis-alcohol substitution effect in this population. However, it is unclear whether cannabis is used as a substitute or complement to alcohol at the day level among people who use cannabis for both medicinal and nonmedicinal reasons. This study used ecological momentary assessment to examine this question. Participants (N = 66; 53.1% men; mean age 33 years) completed daily surveys assessing previous-day reasons for cannabis use (medicinal vs. nonmedicinal), cannabis consumption (both number of different types of cannabis used and grams of cannabis flower used), and number of standard drinks consumed. Multilevel models revealed that, in general, greater cannabis consumption on a given day was associated with greater same-day alcohol use. Further, days during which cannabis was used for medicinal (vs. exclusively nonmedicinal) reasons were associated with reduced consumption of both cannabis and alcohol. The day-level association between medicinal reasons for cannabis use and lower alcohol consumption was mediated by using fewer grams of cannabis on medicinal cannabis use days. Day-level cannabis-alcohol associations may be complementary rather than substitutive among people who use cannabis for both medicinal and nonmedicinal reasons, and lower (rather than greater) cannabis consumption on medicinal use days may explain the link between medicinal reasons for cannabis use and reduced alcohol use. Still, these individuals may use greater amounts of both cannabis and alcohol when using cannabis for exclusively nonmedicinal reasons. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Serum uric acid and risk of diabetic neuropathy: a genetic correlation and mendelian randomization study.

Previous observational studies have indicated an association between serum uric acid (SUA) and diabetic neuropathy (DN), but confounding factors and reverse causality have left the causality of this relationship uncertain. Univariate Mendelian randomization (MR), multivariate MR and linkage disequilibrium score (LDSC) regression analysis were utilized to assess the causal link between SUA and DN. Summary-level data for SUA were drawn from the CKDGen consortium, comprising 288,648 individuals, while DN data were obtained from the FinnGen consortium, with 2,843 cases and 271,817 controls. Causal effects were estimated primarily using inverse variance weighted (IVW) analysis, supplemented by four validation methods, with additional sensitivity analyses to evaluate pleiotropy, heterogeneity, and result robustness. The LDSC analysis revealed a significant genetic correlation between SUA and DN (genetic correlation = 0.293, P = 2.60 × 10-5). The primary methodology IVW indicated that each increase of 1 mg/dL in SUA would increase DN risk by 17% (OR = 1.17, 95% CI 1.02-1.34, P = 0.02), while no causal relationship was found in reverse analysis (OR = 1.00, 95% CI 0.98~1.01, P = 0.97). Multivariate MR further identified that the partial effect of SUA on DN may be mediated by physical activity, low density lipoprotein cholesterol (LDL-C), insulin resistance (IR), and alcohol use. The study establishes a causal link between elevated SUA levels and an increased risk of DN, with no evidence for a reverse association. This underscores the need for a comprehensive strategy in DN management, integrating urate-lowering interventions with modulations of the aforementioned mediators.

Family ties: examining family functioning and alcohol use among American Indian youth

PurposeThis study aims to examine a second-order latent variable of family functioning built from two established protective factors for American Indian (AI) youth, i.e. family cohesion and parental monitoring. This study then examines if family functioning is related to alcohol use frequency or age of initiation for AI youth. Additionally, this study examines if family functioning served as a moderator for the risk factor of peer alcohol use.Design/methodology/approachData came from the 2021 Our Youth, Our Future survey. Participants were 4,373 AI adolescents from Grades 6–12 across the contiguous USA. Structural equation modeling (SEM) was used to test the latent variable of family functioning. Structural paths and interaction terms between peer use and family functioning were added to the SEM to explore direct and moderating effects.FindingsFamily cohesion and parental monitoring were best represented by a second-order latent variable of family functioning, which was related to later initiation and lower alcohol use frequency.Practical implicationsThe findings regarding the initiation of alcohol use may be applicable to prevention programs, with family functioning serving as a protective factor for the initiation of alcohol use. Programs working toward alcohol prevention may be best served by focusing on family-based programs.Originality/valueThe latent variable of family functioning is appropriate for use in AI samples. Family functioning, which is an inherent resilience factor in AI communities, was shown to be protective against harmful alcohol use behaviors.

Assessing the feasibility of SMART Recovery for sexual and gender minority individuals: Results from a feasibility and preliminary outcomes trial

Sexual and gender minority individuals (SGMI; e.g., lesbian, gay, bisexual, transgender, and queer people) experience increased rates of alcohol use disorder and additional barriers to participating in alcohol use interventions compared to their cisgender and heterosexual counterparts. This suggests a need for accessible, evidence-based alcohol use interventions for these populations. Through conducting a feasibility and preliminary effectiveness trial of SMART Recovery, a cognitive-behavioral mutual help group for addictive behaviors, with a sample of SGMI (N = 32), this study evaluated the feasibility and preliminary outcomes of SMART Recovery for reducing alcohol use and related problems for SGMI. Primary feasibility metrics included average number of sessions attended per participant and average number of participants per session; preliminary outcomes were evaluated by comparing alcohol use symptoms at pre- and post-test through a t-test. Results suggest that SMART Recovery is potentially a feasible and effective intervention for SGMI experiencing challenges with alcohol use. On average, participants attended 5.36 sessions (target: 4–6 sessions). The average session was attended by 3.63 participants (tentative target: 5 participants). A comparison of pre and post-tests (n = 13) suggested significantly lower alcohol use among participants at the end of the intervention relative to the beginning (t = 1.92; p < 0.05).

Who affiliates with SMART recovery? A comparison of individuals attending SMART recovery, alcoholics anonymous, both, or neither.

Mutual-help organizations (MHOs) play a crucial role for many individuals with alcohol use disorder (AUD) or other substance use disorders in achieving stable remission. While there is now substantial research characterizing who uses 12-step MHOs, very little is known about who becomes affiliated with newer and rapidly growing MHOs, such as Self-Management and Recovery Training ("SMART" Recovery). More research could inform knowledge regarding who may be best engaged by these differing pathways. We conducted a cross-sectional analysis of participants (N = 361) with AUD recruited mostly from the community who were starting a new recovery attempt and self-selected into one of four different recovery paths: (1) SMART Recovery ("SMART-only"; n = 75); (2) Alcoholics Anonymous ("AA-only"; n = 73); (3) Both SMART and AA ("Both"; n = 53); and (4) Neither SMART nor AA ("Neither"; n = 160). We compared the groups on demographics, clinical history, treatment and recovery support service use, and indices of functioning and well-being. We computed descriptives and conducted inferential analyses according to the data structure. Compared to study participants choosing AA-only or Both, SMART-only participants were more likely to be White, married, have higher income and more education, be full-time employed, and evince a pattern of lower clinical severity characterized by less lifetime and recent treatment and recovery support services usage, lower alcohol use intensity and fewer consequences, and less legal involvement. AUD symptom levels, lifetime psychiatric diagnoses, psychiatric distress, and functioning were similar across MHO-engaged groups. SMART Recovery appears to attract individuals with greater psychosocial stability and economic advantage and less severe histories of alcohol-related impairment and legal involvement. Findings suggest that certain aspects specific to the SMART Recovery group approach, format, and/or contents may appeal to individuals exhibiting this type of profile. As such, SMART appears to provide an additional resource that expands the repertoire of options for individuals with AUD who seek recovery.