Low-risk Drinkers Research Articles

Alcohol and cause-specific mortality in Russia: the Know Your Heart Study 2015-23.

Alcohol-related mortality in Russia exceeds the world average and presents a critical public health concern. This study assesses the impact of alcohol consumption levels on mortality and investigates mortality predictors among Russians, including people treated for alcohol-related diagnoses (narcology patients). We examined 2629 men and women aged 35-69 years who participated in the Know Your Heart study (2015-17), Arkhangelsk, Russia. The participants were categorized into five drinking levels (non-drinking, low-risk, hazardous, harmful, narcology patients) and followed up using a regional mortality database. We used Cox proportional hazards regressions to analyze sociodemographic and cardiovascular biomarkers as mortality predictors among narcology patients and general population and to compare mortality risks across the five drinking levels. During a median follow-up of 6.3 years, 223 (8.5%) participants died. Age- and sex-standardized all-cause mortality rates per 100,000 person-years were 1229 (95% CI: 691-1767) in non-drinking participants, 890 (95%CI: 684-1096) and 877 (95%CI: 428-1325) in low-risk and hazardous drinking participants, 2170 (95%CI: 276-4064) in those with harmful drinking, and 4757 (95%CI: 3384-6131) in narcology patients. The largest proportions of deaths were caused by cardiovascular diseases (37.2%), neoplasms (20.2%), and external causes (13.9%). Compared with low-risk drinkers, narcology patients had higher risks of death with hazard ratios of 3.23 (95%CI: 2.02-5.16) for all-cause mortality, 3.25 (95%CI: 1.52-6.92) for cardiovascular diseases, 9.36 (95%CI: 2.63-33.3) for external causes, and 7.79 (95%CI: 3.34-18.1) for other causes. Neoplasm-related mortality did not differ between groups. All-cause mortality in the general population had positive associations with smoking, waist-to-hip ratio, resting heart rate, systolic blood pressure, high-sensitivity C-reactive protein, and negative associations with left ventricular ejection fraction (LVEF) and higher education. These associations were substantially weaker and non-significant in narcology patients. Cardiovascular mortality in narcology patients was increased with higher education, while male sex, LVEF and N-terminal prohormone of brain natriuretic peptide had less impact compared to the general population sample. Narcology patients face markedly higher mortality risks-threefold from all causes and cardiovascular diseases, ninefold from external causes, and sevenfold from other causes. Compared with the general population, conventional mortality risk factors were less predictive of deaths in narcology patients.

Alcohol Consumption Patterns and Mortality Among Older Adults With Health-Related or Socioeconomic Risk Factors

Alcohol consumption is a leading cause of morbidity and mortality that may be more important in older adults with socioeconomic or health-related risk factors. To examine the association of alcohol consumption patterns with 12-year mortality and its modification by health-related or socioeconomic risk factors. This prospective cohort study used data from the UK Biobank, a population-based cohort. Participants were current drinkers aged 60 years or older. Data were analyzed from September 2023 to May 2024. According to their mean alcohol intake in grams per day, participants' drinking patterns were classified as occasional: ≤2.86 g/d), low risk (men: >2.86-20.00 g/d; women: >2.86-10.00 g/d), moderate risk (men: >20.00-40.00 g/d; women: >10.00-20.00 g/d) and high risk (men: >40.00 g/d; women: >20.00 g/d). Health-related risk factors were assessed with the frailty index, and socioeconomic risk factors were assessed with the Townsend deprivation index. All-cause and cause-specific mortality were obtained from death certificates held by the national registries. Analyses excluded deaths in the first 2 years of follow-up and adjusted for potential confounders, including drinking patterns and preferences. A total of 135 103 participants (median [IQR] age, 64.0 [62.0-67.0] years; 67 693 [50.1%] women) were included. In the total analytical sample, compared with occasional drinking, high-risk drinking was associated with higher all-cause (hazard ratio [HR], 1.33; 95% CI, 1.24-1.42), cancer (HR, 1.39; 95% CI, 1.26-1.53), and cardiovascular (HR, 1.21; 95% CI, 1.04-1.41) mortality; moderate-risk drinking was associated with higher all-cause (HR, 1.10; 95% CI, 1.03-1.18) and cancer (HR, 1.15; 95% CI, 1.05-1.27) mortality, and low-risk drinking was associated with higher cancer mortality (HR, 1.11; 95% CI, 1.01-1.22). While no associations were found for low- or moderate-risk drinking patterns vs occasional drinking among individuals without socioeconomic or health-related risk factors, low-risk drinking was associated with higher cancer mortality (HR, 1.15; 95% CI, 1.01-1.30) and moderate-risk drinking with higher all-cause (HR, 1.10; 95% CI, 1.01-1.19) and cancer (HR, 1.19; 95% CI, 1.05-1.35) mortality among those with health-related risk factors; low-risk and moderate-risk drinking patterns were associated with higher mortality from all causes (low risk: HR, 1.14; 95% CI, 1.01-1.28; moderate risk: HR, 1.17; 95% CI, 1.03-1.32) and cancer (low risk: HR, 1.25; 95% CI, 1.04-1.50; moderate risk: HR, 1.36; 95% CI, 1.13-1.63) among those with socioeconomic risk factors. Wine preference (>80% of alcohol from wine) and drinking with meals showed small protective associations with mortality, especially from cancer, but only in drinkers with socioeconomic or health-related risk factors and was associated with attenuating the excess mortality associated with high-, moderate- and even low-risk drinking. In this cohort study of older drinkers from the UK, even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. The attenuation of mortality observed for wine preference and drinking only during meals requires further investigation, as it may mostly reflect the effect of healthier lifestyles, slower alcohol absorption, or nonalcoholic components of beverages.

Potential impact of alcohol calorie labelling on the attitudes and drinking behaviour of hazardous and low-risk drinkers in England: a national survey

ObjectivesWe investigated the hypothetical impact of mandatory alcohol calorie labelling, comparing non-drinkers, low-risk and hazardous drinkers in terms of attitudes, knowledge about calorie content and hypothetical behaviour changes should labelling...

Alcohol and substance use in older adults with treatment-resistant depression.

Alcohol and substance use are increasing in older adults, many of whom have depression, and treatment in this context may be more hazardous. We assessed alcohol and other substance use patterns in older adults with treatment-resistant depression (TRD). We examined patient characteristics associated with higher alcohol consumption and examined the moderating effect of alcohol on the association between clinical variables and falls during antidepressant treatment. This secondary and exploratory analysis used baseline clinical data and data on falls during treatment from a large randomized antidepressant trial in older adults with TRD (the OPTIMUM trial). Multivariable ordinal logistic regression was used to identify variables associated with higher alcohol use. An interaction model was used to evaluate the moderating effect of alcohol on falls during treatment. Of 687 participants, 51% acknowledged using alcohol: 10% were hazardous drinkers (AUDIT-10 score ≥5) and 41% were low-risk drinkers (score 1-4). Benzodiazepine use was seen in 24% of all participants and in 21% of drinkers. Use of other substances (mostly cannabis) was associated with alcohol consumption: it was seen in 5%, 9%, and 15% of abstainers, low-risk drinkers, and hazardous drinkers, respectively. Unexpectedly, use of other substances predicted increased risk of falls during antidepressant treatment only in abstainers. One-half of older adults with TRD in this study acknowledged using alcohol. Use of alcohol concurrent with benzodiazepine and other substances was common. Risks-such as falls-of using alcohol and other substances during antidepressant treatment needs further study.

Types and Effectiveness of Community-Based Cardiovascular Disease Preventive Interventions in Reducing Alcohol Consumption: A Systematic Review and Meta-Analysis.

Cardiovascular disease (CVD) poses a global health challenge, with modifiable risk factors, notably alcohol consumption, impacting its onset and progression. This review synthesizes evidence on the types and effectiveness of community-based interventions (CBIs) aimed at reducing alcohol consumption for CVD prevention. Electronic databases were systematically searched until October 31, 2019, with updates until February 28, 2023. Given the heterogeneity in outcome measures, we narratively synthesized the effectiveness of CBIs, adhering to the synthesis without meta-analysis (SWiM) guidelines for transparent reporting. For selected homogenous studies, a random-effects meta-analysis was utilized to estimate the effects of CBIs on alcohol consumption. Twenty-two eligible studies were included, with 16 demonstrating that CBIs reduced alcohol consumption compared to controls. Meta-analysis findings revealed reductions in above moderate-level alcohol consumption (pooled odds ratio (OR)=0.50, 95% confidence interval (CI): 0.37, 0.68), number of alcohol drinks per week (standardized mean difference=-0.08, 95% CI: -0.14, -0.03), and increased odds of low-risk drinking (pooled OR=1.99, 95% CI: 1.04, 3.81) compared to the control groups. Multi-component interventions (particularlythose combining health education, awareness, and promotion activities) and those interventions with a duration of 12 months or more were notably effective. The beneficial effects of CBIs focusing on achieving a reduction in alcohol consumption showed promising outcomes. Implementing such interventions, especially multicomponent interventions, could play a significant role in mitigating the increasing burden of CVDs. Future studies should also consider employing standardized and validated tools to measure alcohol consumption outcomes to enhance the consistency and comparability of findings.

Profiles and the impact of affective temperaments on alcohol use disorder: a cross-sectional study.

This study aimed to explore the profiles and impact of affective temperaments, together with social and clinical backgrounds, including affective symptoms, in patients with alcohol use disorder (AUD). This study included 314 low-risk drinkers and 257 patients with AUD. To assess affective temperament, we used the short version of the temperament evaluation of Memphis, Pisa, Paris, and San Diego. To evaluate depressive and mixed symptoms, the quick inventory of depressive symptomatology self-report Japanese version and 12-item questionnaire for the quantitative assessment of the depressive mixed state were used. We compared the profiles of affective temperaments as well as social and clinical backgrounds, including affective symptoms, between the two groups and further performed logistic regression analyses to explore the factors contributing to AUD. Our analysis showed higher cyclothymic, hyperthymic, and irritable temperament scores and lower depressive temperament scores in patients with AUD than that in nonclinical drinkers. Regarding other social and clinical backgrounds, patients with AUD were less educated and employed and more experienced depressive and mixed symptoms. Logistic regression analysis identified hyperthymic temperament as a positive contributor and depressive temperament as a negative contributor to AUD. Our findings indicated potential bipolarity in patients with AUD, as manifested by a more hyperthymic temperament in contrast to less depressive temperament. Despite their self-perceived adaptive temperament profiles, patients showed poorer social outcomes and more affective symptoms. This gap may be partly explained by a lack of insight unique to AUD psychology, which potentially disturbs problem recognition.

A quantitative feedback intervention to reduce binge drinking in young adults.

Existing binge drinking reduction interventions such as brief intervention and personalized normative feedback have shown modest impact. The purpose of this study was to evaluate the feasibility (recruitment and retention rates), acceptability, and preliminary efficacy testing of a short-term "know your numbers (KYN)" intervention on motivating young adults to reduce their engagement in binge drinking. Young adults (N=94, mean age 21 years) with a history of binge drinking received a 4-week KYN intervention that included information about their U.S. Alcohol Use Disorders Test (USAUDIT) scores and the alcohol biomarker phosphatidylethanol (PEth) level in relationship to different risk levels of alcohol use. At baseline and 4-weeks, measures included USAUDIT scores, PEth levels, motivation (Alcohol Contemplation Ladder) and other drinking measures. Focus groups were conducted at 4-weeks for feedback on the KYN approach. The recruitment rate was 82.26% (retention rate 76.9%). At 4-weeks there was a 62% increase in contemplation scores (indicating higher motivation), a decrease in USADUIT scores with an increase in the percent of participants classified as low-risk drinkers. No differences were found between baseline and 4-week PEth levels or number of binge episodes. Focus group results revealed satisfaction with the KYN approach but the need to understand how PEth levels and USAUDIT scores corresponded to health consequences and alcohol use levels. Results from this pilot study support the acceptability and potential use of a KYN approach in helping young adults understand their drinking levels.

Effects of At-Risk Drinking on Ambulatory Blood Pressure in Young Adults

Introduction: At-risk drinking is associated with an increased risk of cardiovascular diseases (CVD) even in young adults. However, this association is mainly based on offce blood pressure (BP) measurement. Ambulatory BP monitoring captures diurnal variation in BP and is a more sensitive CVD predictor than offce BP. Therefore, the purpose of this study is to investigate the effects of at-risk drinking on ambulatory BP in young healthy adults with normal offce BP. Method: A total of 20 healthy men and women (21-35 years), non-smokers, were included in this cross-sectional study. All participants had an offce BP lower than 130/80 mmHg. Using the US Alcohol Use Disorders Identification Test (USAUDIT), at-risk drinkers were defined as those having a total USAUDIT score higher than 7 for men (6 for women). All participants underwent 24-hour ambulatory BP monitoring (Oscar 2™, SunTech Medical®). To investigate the vascular mechanisms underlying the effects of at-risk drinking on ambulatory blood pressure, aortic arterial stiffness and wave reflection were measured as pulse wave velocity (PWV) and augmentation index (AIx) by using SphygmoCor XCEL system (AtCor Medical). Results: No differences were found in age and BMI between at-risk drinkers (n=10) vs. low-risk drinkers (n=10; mean ± SD for age: 26.7 ± 3.7 vs. 26.6 ± 4.3 years, P>0.99 and BMI: 24.5 ± 2.4 vs. 23.8 ± 2.9 kg/m2, P=0.6). At-risk drinkers had a higher total USAUDIT score (10.6 ± 2.7 vs. 1.4 ± 1.2, p<0.001). While there was no difference between at-risk drinkers and low-risk drinkers in 24-hour, daytime, and nighttime systolic and diastolic BP (P≥0.5), at-risk drinkers had a higher blood pressure morning surge compared to low-risk drinkers (systolic: 34 ± 10 vs. 22 ± 6 mmHg, P=0.014 and diastolic: 29 ± 9 vs. 15 ± 4 mmHg, P=0.002). No significant difference was found in PWV (5.7 ± 0.6 Vs. 5.5 ± 0.7 m/sec, P=0.4) and AIx (8 ± 8 Vs. 15 ± 11, P=0.1). Conclusion: Our results indicate that despite similar offce BP, young adult at-risk drinkers had higher BP morning surge, an independent risk factor for cardiovascular events, than low-risk drinkers. These findings provide implications in using USAUDIT and out-of-offce BP measurements for cardiovascular disease risk assessment. This work was supported by NIAAA AA028537 to CLH. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Brain correlates and functional connectivity linking stress, autonomic dysregulation, and alcohol motivation

High stress is a key risk factor for alcohol use disorder (AUD) and often accompanied by physiological dysregulation including autonomic nervous system (ANS) disruptions. However, neural mechanisms underlying drinking behaviors associated with stress and ANS disruptions remain unclear. The current study aims to understand neural correlates of stress, ANS disruptions, and subsequent alcohol intake in social drinkers with risky drinking. Using functional magnetic resonance imaging (fMRI), we investigated brain and heart rate (HR) autonomic responses during brief exposure to stress, alcohol, and neutral cues utilizing a well-validated, individualized imagery paradigm in 48 social drinkers of which 26 reported high-risk drinking (HD) while 22 reported low-risk drinking (LD) patterns. Results indicated that HD individuals showed stress and ANS disruptions with increased basal HR, stress-induced craving, and decreased brain response to stress exposure in frontal-striatal regions including the ventromedial prefrontal cortex (VmPFC), anterior cingulate cortex, striatum, insula, and temporal gyrus. Furthermore, whole-brain correlation analysis indicated that greater basal HR was associated with hypoactive VmPFC, but hyperactive medulla oblongata (MOb) responses during stress, with an inverse association between activity in the VmPFC and Mob (whole-brain corrected (WBC), p < 0.05). Functional connectivity with the MOb as a seed to the whole brain indicated that HD versus LD had decreased functional connectivity between the VmPFC and MOb during stress (WBC, p < 0.05). In addition, those with more compromised functional connectivity between the VmPFC and MOb during stress consumed greater amount of alcohol beverage during an experimental alcohol taste test conducted on a separate day, as well as in their self-reported weekly alcohol intake. Together, these results indicate that stress-related, dysfunctional VmPFC control over brain regions of autonomic arousal contributes to greater alcohol motivation and may be a significant risk factor for hazardous alcohol use in non-dependent social drinkers. Findings also suggest that restoring VmPFC integrity in modulating autonomic arousal during stress may be critical for preventing the development of AUD.

Investigating cognitive and motivational proximal outcomes in a randomized clinical trial of writing about the future self to reduce drinking.

Drinking identity (the extent to which one links the self with drinking alcohol) is a unique risk factor for college students' hazardous drinking that is not directly targeted by existing interventions. We conducted a study that aimed to decrease drinking identity among college students with hazardous drinking. We adapted a writing task about the future self and tested whether three writing sessions could decrease drinking identity and change drinking. We also investigated whether two additional factors (writing perspective and inclusion of participants' social networks) would enhance task impact. The present study evaluated whether posited proximal cognitive and motivational outcomes (drinking identity, self-efficacy, readiness to change, and drinking intentions) changed immediately after each writing session. The study is a randomized clinical trial in which hypotheses and analyses were pre-registered. Participants were 328 college students who met hazardous drinking criteria. The study had a 2 (narrative writing topic: low-risk drinker vs. reduced smartphone use) × 2 (writing perspective: first-person vs. non-first-person) × 2 (social network instruction: instructed to include vs. not) factorial design. Proximal outcomes were drinking identity, self-efficacy, readiness to change, and drinking intentions. The clinical outcome was alcohol consumption. Participants completed three laboratory sessions at weekly intervals that included the writing task and pre- and post-task assessments. Results were largely null, except that readiness to reduce drinking was higher in the low-risk drinker condition and increased over the lab sessions. Time effects indicated that reductions in drinking identity, drinking intentions, and alcohol consumption, and increases in self-efficacy were observed but did not change above and beyond control conditions. Findings indicate the need to strengthen the writing task and select a more appropriate control task to target proposed proximal outcomes. Future studies might try personalizing the task, evaluating its efficacy with individuals motivated to change their drinking, and using a control task that does not involve imagining a future self.

Where do high-risk drinking occasions occur more often? A cross-sectional, cross-country study.

The current paper examines the proportion of drinking occasions and total alcohol consumed that takes place at off-premise locations. Comparisons are made between high-income countries: Australia, New Zealand, England and Scotland, and across drinker-types: high-risk and lower-risk. Data were taken from the International Alcohol Control study in Australia (N = 1789), New Zealand (N = 1979), England (N = 2844) and Scotland (N = 1864). The cross-national survey measures location and beverage-specific alcohol consumption. The number of drinking occasions and mean consumption across on- and off-premise locations and the proportion of drinking occasions that high- and lower-risk drinkers had at on- and off-premise locations was estimated for each country. The majority of drinking occasions among high-risk drinkers occurred at off-premise locations across all four countries; Australia 80.1%, New Zealand 72.0%, England 61.7% and Scotland 60.7%. High-risk drinkers in Australia had significantly larger proportions of drinking occasions occurring at off-premise locations compared to England and Scotland. Across all countries, high-risk drinkers and lower-risk drinkers consumed significantly larger quantities of alcohol per occasion at off-premise locations compared to on-premises locations. Finally, the majority of total alcohol consumed occurred at off-premise locations across all countries for high- and lower-risk drinkers. As the accessibility to alcohol outside of licensed premises continues to increase, particularly with the expansion of home delivery services, it is important to be mindful of the high proportion of heavy drinking occasions that occur off-premise.

Alcohol consumption in early middle-aged Australian women and access to primary healthcare services: A cross-sectional study.

This study describes the prevalence of risky alcohol consumption in Australian women aged 40-45 years. It explores the relationship between demographic factors and access to and usage of primary healthcare services. Data were obtained from the Australian Longitudinal Study on Women's Health, Survey 8 (1973-78 cohort). Descriptive statistics and univariate logistic regression were used to assess associations of specific factors with risky alcohol consumption. Eleven per cent of respondents reported drinking >10 standard drinks per week. These 'risky alcohol drinkers' attend general practice as frequently as low-risk drinkers despite perceived poorer health. They reported 'rarely or never' seeing the same general practitioner (GP) and described themselves as having 'poor' access to a GP that bulk bills. This study provides unique insight into the primary healthcare attendance patterns and health status of early middle-aged Australian women who are 'risky alcohol drinkers'. They do not consistently see the same GP, which might present challenges in identifying them in primary care.

Bodily confusion: Lower differentiation of emotional and physiological states in student alcohol users.

Alexithymia, difficulty in recognising and naming emotions, is common among people who use alcohol. There is also emerging evidence that people with alexithymia are unable to distinguish emotions from non-emotional physiological states. The project aimed to test if alcohol use is related to the way student drinkers experience emotions and physiological states in the body. We employed a novel method to study bodily sensations related to emotions and physiological states in the context of alcohol use: the emBODY tool, which allowed participants to mark areas of the body in which they experience various emotions and physiological states. Students who showed a hazardous pattern of alcohol use (alcohol use disorders identification test [AUDIT] score ≥ 7, N = 91), overall, presented higher alexithymia levels and coloured larger areas for emotions and physiological states (showed less specificity) than those who show low-risk alcohol consumption (AUDIT ≤ 4, N = 90). Moreover, statistical classifiers distinguished feeling-specific maps less accurately for hazardous drinkers than low-risk drinkers [F(1,1998) = 441.16; p < 0.001], confirming that higher alcohol use is related to higher confusion of emotional and non-emotional bodily feelings. Plausibly, this increased bodily confusion drives alcohol consumption: alcohol may serve as a means of dealing with undifferentiated changes in psychophysiological arousal accompanying emotional states.

Longitudinal clustering of health behaviours and their association with multimorbidity in older adults in England: A latent class analysis.

Health-risk behaviours such as smoking, unhealthy nutrition, alcohol consumption, and physical inactivity (termed SNAP behaviours) are leading risk factors for multimorbidity and tend to cluster (i.e. occur in specific combinations within distinct subpopulations). However, little is known about how these clusters change with age in older adults, and whether and how cluster membership is associated with multimorbidity. Repeated measures latent class analysis using data from Waves 4-8 of the English Longitudinal Study of Ageing (ELSA; n = 4759) identified clusters of respondents with common patterns of SNAP behaviours over time. Disease status (from Wave 9) was used to assess disorders of eight body systems, multimorbidity, and complex multimorbidity. Multinomial and binomial logistic regressions were used to examine how clusters were associated with socio-demographic characteristics and disease status. Seven clusters were identified: Low-risk (13.4%), Low-risk yet inactive (16.8%), Low-risk yet heavy drinkers (11.4%), Abstainer yet inactive (20.0%), Poor diet and inactive (12.9%), Inactive, heavy drinkers (14.5%), and High-risk smokers (10.9%). There was little evidence that these clusters changed with age. People in the clusters characterised by physical inactivity (in combination with other risky behaviours) had lower levels of education and wealth. People in the heavy drinking clusters were predominantly male. Compared to other clusters, people in the Low-risk and Low-risk yet heavy drinkers had a lower prevalence of all health conditions studied. In contrast, the Abstainer but inactive cluster comprised mostly women and had the highest prevalence of multimorbidity, complex multimorbidity, and endocrine disorders. High-risk smokers were most likely to have respiratory disorders. Health-risk behaviours tend to be stable as people age and so ought to be addressed early. We identified seven clusters of older adults with distinct patterns of behaviour, socio-demographic characteristics and multimorbidity prevalence. Intervention developers could use this information to identify high-risk subpopulations and tailor interventions to their behaviour patterns and socio-demographic profiles.

The prevalence and correlates of biomarker positive unhealthy alcohol use among women living with and without HIV in San Francisco, California.

The objective of this study was to identify the prevalence and correlates of phosphatidylethanol (PEth) levels suggestive of unhealthy alcohol use among women living with and without HIV who self-reported no or low-risk drinking. We analyzed data from a cross-sectional study among women enrolled in the San Francisco Bay Area site of the Women's Interagency HIV Study (WIHS). Between October 2017 and March 2018, PEth was tested from dried blood spots in 192 women enrolled in the San Francisco site of the WIHS. Using multivariable logistic regression, we identified the correlates of PEth levels suggestive of unhealthy alcohol use (>50 ng/ml) among the 168 women who reported no or low-risk drinking (<7 drinks per week) in the past six months, while controlling for age in years and race/ethnicity. Among the 168 women in the analysis sample, the median age was 55; 51% identified as Black/African American, 47% were living with HIV and 28% had PEth levels ≥50 ng/ml which are suggestive of unhealthy alcohol use. Factors independently associated with PEth levels ≥50 ng/ml in adjusted models were: identifying as Black/African American (adjusted odds ratio [aOR] = 8.34, 95% CI = 2.06-33.72), having an alanine transaminase to aspartate aminotransferase ratio > 1 (aOR = 3.10, 95% CI = 1.18-8.13), higher high-density lipoprotein levels (aOR = 1.31 per 10 mg/dL increase, 95% CI = 1.01-1.70), and consuming a greater number of drinks per week in the past six months (aOR = 1.40, 95% CI = 1.10-1.78). Nearly a third of women in this study had PEth levels suggestive of unhealthy alcohol use and potentially under-reported their use. To optimize alcohol related health care, there is a need to consider approaches to improve ascertainment of unhealthy alcohol use, especially among Black/African American women and those living with liver disease, so that interventions can be initiated.

The Relation of Social-ecological Factors and Health Literacy to Medical Students' Alcohol Use Behavior in Hubei Province, China.

Health literacy (HL) plays a crucial role in the adolescent's behavior. Inadequate HL can contribute to engaging in risky alcohol consumption, but little is known about this relationship among medical students. We aimed to investigate the relationship between HL and alcohol use among Chinese medical students. Study Design: A cross-sectional design. This research was conducted on 1146 medical students in Hubei province, China. The data were collected using a web-based online questionnaire. Multiple logistic regression was applied to investigate factors related to alcohol use. Approximately 45.3% of medical students were drinkers, about 11.5% were hazardous drinkers, and 33.8% were low-risk drinkers; furthermore, about 49.3% of them reported lower levels of HL. In both the low-risk and hazardous drinking groups, the subjects who had low levels of all six dimensions of HL were more likely to use alcohol after adjusting for other covariates, including cognitive skill (adjORfor low-risk=3.50; 95% CI: 2.41, 5.07, adjORhazardous=2.07; 95% CI: 1.22, 3.51), access skill (adjORfor low-risk=2.11; 95% CI: 1.46, 3.05, adjORhazardous=2.40; 95% CI: 1.37, 4.19), communication skill (adjORfor low-risk=1.72; 95% CI: 1.20, 2.47, adjORhazardous=2.21; 95% CI: 1.22, 4.00), self-management skill (adjORfor low-risk=1.73; 95% CI: 1.15, 2.59, adjORhazardous=4.01; 95% CI: 1.91, 8.44), media skill (adjORfor low-risk=1.50; 95% CI: 1.01, 2.23, adjORhazardous=4.68; 95% CI: 2.15, 10.17), and decision skill (adjORfor low-risk=2.12; 95% CI: 1.49, 3.00, adjORhazardous=2.25; 95% CI: 1.35, 3.74). Inadequate HL plays an important role in increasing alcohol use. Thus, prevention and intervention strategies should be based on improving medical students' HL.

Characteristics of high- and low-risk drinkers who use online alcohol home delivery in Western Australia.

Variation in alcohol availability is an important driver of levels of consumption and harm, with recent increases in online alcohol home delivery use expanding availability. There is limited research on the impacts of these changes and the characteristics of consumers who use alcohol home delivery. This study presents findings from an online survey (n = 465) of Western Australian adults who had purchased alcohol for home delivery within the past 6 months. Analyses compared high-risk and low-risk drinkers on use of, and exposure to, alcohol home delivery. Compared to low-risk drinkers, high-risk drinkers were significantly more likely to make more frequent online purchases (odds ratio 5.42), utilise same day delivery (odds ratio 2.91) and purchase through specialised online-only retailers (odds ratio 2.69). High-risk drinkers also reported receiving deliveries while intoxicated more often (odds ratio 11.62), and ordering alcohol for delivery to continue a current drinking session (odds ratio 7.47). High-risk drinkers also received advertising for alcohol home delivery more frequently (odds ratio 1.60) than low-risk drinkers. High-risk drinkers also ordered larger quantities of alcohol than low-risk drinkers (M = 49 vs. 32 standard drinks). Findings from this study indicate that these services are popular with high-risk drinkers and potentially undermine other policy efforts to reduce drinking. Within Australia, stronger legislation (such as mandatory delay between order and delivery) and monitoring (e.g., test purchasing for compliance) are recommended.

Longitudinal clustering of risk behaviours and their association with multimorbidity in older adults

Abstract Smoking, unhealthy nutrition, alcohol consumption, and physical inactivity (SNAP risk behaviours) are leading risk factors for multimorbidity and tend to cluster within specific subpopulations. Little is known about how these clusters change with age in older adults and their association with multimorbidity. Repeated measures latent class analysis using data from Waves 4-8 of the English Longitudinal Study of Ageing (n = 4759) identified clusters of respondents with common patterns of SNAP behaviours over time. Disease status (from Wave 9) was used to assess eight body system disorders, multimorbidity, and complex multimorbidity. Logistic regressions examined how clusters were associated with socio-demographic characteristics and disease status. Seven clusters were identified: Low-risk (13.4%), Low-risk yet inactive (16.8%), Low-risk yet heavy drinkers (11·4%), Abstainer yet inactive (20%), Poor diet and inactive (12.9%), Inactive, heavy drinkers (14.5%), and High-risk smokers (10·9%). There was little evidence these clusters changed with age. Clusters characterised by physical inactivity (in combination with other risky behaviours) were associated with lower levels of education and wealth. The heavy drinking clusters were predominantly male. Compared to other clusters, Low-risk and Low-risk yet heavy drinkers had a lower prevalence of all diseases studied. In contrast, the Abstainer but inactive cluster comprised mostly women and had the highest prevalence of multimorbidity, complex multimorbidity, and endocrine disorders. High-risk smokers were most likely to have respiratory disorders. Health-risk behaviours tend to be stable as people age and ought to be addressed early. By identifying seven clusters of older adults with distinct behaviour patterns, socio-demographic characteristics, and disease prevalence, our study provides valuable information for identifying high-risk subpopulations and tailoring interventions to their behaviour patterns and socio-demographic profiles. Key messages • We identified seven clusters of older adults with distinct behaviour patterns, socio-demographic characteristics and disease prevalence. • Health-risk behaviours tend to be stable as people age and ought to be addressed early.

High-resolution examination of changes in drinking during the COVID-19 pandemic: Nine-wave findings from a longitudinal observational cohort study of community adults

Few multi-wave longitudinal studies have examined changes in drinking across extended periods of the coronavirus 2019 (COVID-19) pandemic. Using multiple indicators over three years, the current study examined: a) overall drinking changes; b) sex, income, age, and pre-COVID drinking level as moderators of changes; and c) the clinical significance of the observed changes. Using a longitudinal observational cohort design with nonclinical adults from the general community (N = 1395), assessments were collected over nine waves, two pre-COVID (April 2019 and October 2019) and seven intra-COVID (April 2020–April 2022). Drinking was measured as percent drinking days, percent heavy drinking days, and the Alcohol Use Disorders Identification Test (AUDIT) score. Clinically significant changes were defined based on the World Health Organization risk levels. All indicators exhibited significant changes from pre-pandemic to intra-pandemic periods, with drinking changes comprising early pandemic increases followed by subsequent decreases and AUDIT scores consistently declining. Pre-pandemic drinking level substantially moderated all changes. Heavier drinkers exhibited larger decreases compared to other drinking groups. In terms of clinically important changes, ∼10% of pre-pandemic abstinent or low-risk drinkers transitioned to medium- or high-risk status during the pandemic. In contrast, 37.1% of medium-risk drinkers and 44.6% of high-risk drinkers exhibited clinically significant decreases during the intra-pandemic period. Collectively, these findings highlight the multifarious impacts of the pandemic on drinking over time, comprising both increases and decreases in drinking behaviour.

Writing about the future self to shift drinking identity: An experimental investigation

College student drinking is prevalent and costly to public and personal health, leading to calls to identify and target novel mechanisms of behavior change. We aimed to manipulate drinking identity (a cognitive risk factor for hazardous drinking) via three sessions of narrative writing about a future self. We tested whether writing could shift drinking identity and would be accompanied by changes in alcohol consumption and problems. Participants were college students meeting hazardous drinking criteria (N = 328; Mage = 20.15; 59% women, 40% men, 1% gender-diverse; 60% white; 23% Asian; 12% multiple races; 2% other racial groups; 8% identified as Hispanic/Latino/a/x). The study had a 2 [narrative writing topic: low-risk drinker vs. reduced smartphone use] × 2 [writing perspective: first person vs. non-first-person] × 2 [social network instruction: instructed to include vs. not] factorial design. Outcomes were drinking identity, drinking refusal self-efficacy, alcohol consumption, alcohol-related problems, and craving. Participants completed three writing sessions and online follow-up assessments at 2, 4, and 12 weeks. The study is a registered clinical trial; hypotheses and analyses were preregistered (https://osf.io/vy2ep/). Contrary to predictions, narrative writing about a future self as a low-risk drinker did not significantly impact outcomes. Null results extended to expected interactions with writing perspective and social network instructions. The narrative writing task did not shift drinking or alcohol-related outcomes. Future experimental work may benefit from greater flexibility in conceptualizing a future self, recruiting individuals interested in behavior change, and more sensitive measures of drinking identity.