Alcohol Risk Research Articles

Investigating behavioural addictions in adults with and without attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) confers greater risk of alcohol and substance use disorders, which may be linked to altered compulsivity and impulsivity within the condition. However, no study has investigated the link between these constructs and behavioural addictions in ADHD. The aim of this study was to investigate whether individuals with ADHD show increased impulsivity, compulsivity, and associated distress, as well as addictive behaviour for gambling, exercise, and internet use, and to assess the relationship between these factors. Adults with and without ADHD were recruited from across the UK and completed an online survey measuring impulsivity, compulsivity, gambling, internet use and exercise addiction. Three hundred and forty-six adults took part (Healthy control = 137, ADHD-medicated = 110, ADHD-unmedicated = 99). Those declaring a diagnosis of ADHD reported greater internet use problems and greater withdrawal from exercise. Medicated individuals also reported higher exercise continuance and were more likely be symptomatic for exercise dependency. Individuals identifying with ADHD had greater levels of impulsivity and compulsivity, with impulsivity correlated with all behavioural addictions, whilst compulsivity correlated only with exercise and internet use. Regression analyses indicated that the distress caused by impulsivity and compulsivity was associated with internet use. Although further research is needed, this study indicates that the greater risk of behavioural addictions found in those with ADHD may relate to impulsivity and compulsivity, and that this should be considered when managing ADHD.

Association of Alcohol and Incremental Cardiometabolic Risk Factors with Liver Disease: A National Cross-Sectional Study.

New nomenclature allows a single cardiometabolic risk factor (CMRF) with alcohol to classify metabolic dysfunction-associated steatotic liver disease (MASLD) and with "increased alcohol intake" (MetALD), which is controversial because alcohol causes CMRFs. Studies regarding incremental CMRFs and liver-related outcomes among alcohol users would be informative. Using NHANES (1/2001-3/2020), we included participants aged≥20 with complete alcohol and CMRF status. CMRFs were defined by the National Cholesterol Education Program's Adult Treatment Panel III. Increased alcohol use corresponded to ≥140g/week[women] / ≥210g/week[men]. The primary outcome was FIB-4 >2.67. Among 40,898 participants, 2,282 had increased vs. 38,616 without increased alcohol use. Prevalence of high FIB-4 among increased vs. without increased alcohol use was higher at each quantity of CMRFs, and with each incremental CMRF: zero (2.3%[95%CI 1.0-5.0%] vs. 0.7%[0.5-0.9%]), one (3.0%[1.6-5.6%] vs. 1.7%[1.4-2.1%]), two (3.3%[2.1-5.1%] vs. 2.1%[1.8-2.4%]), three (5.9%[3.5-9.6%] vs. 2.5%[2.1-2.9%]), and four or five (6.1%[3.3-9.7%] vs. 4.0%[3.5-4.5%]) CMRFs. Among increased alcohol users, in multivariable logistic regression, three (aOR 2.57[0.93-7.08]), four or five (aOR 2.64[1.05-6.67]) CMRFs was associated with 2-fold higher odds of high FIB-4 (vs. 0 CMRFs), but not one (aOR 1.24[0.41-3.69]) or two (aOR 1.39[0.56-3.50]) CMRFs. Among individuals with increased alcohol use, sensitivity/specificity-based Euclidean distance suggested an optimal cut-off of ≥3 CMRFs to differentiate higher probability of high FIB-4. Stratifying MetALD as ≥3 CMRFs, rather than 1 CMRF may provide more optimal fibrosis stratification. Diabetes, high waist circumference, and hypertension, are associated with significant liver fibrosis among individuals with increased alcohol use, but not dyslipidemia.

Unhealthy Alcohol Use and Risk of Coronary Heart Disease among Young and Middle-Aged Adults

Unhealthy Alcohol Use and Risk of Coronary Heart Disease among Young and Middle-Aged Adults

College drinking and sexual health behaviors at a rural northeastern institution: Implications for tailored multilevel intervention

Objective College students experience elevated rates of alcohol and sexual risk behaviors, but underrepresentation of rural institutions precludes tailored intervention. This study characterizes prevalence and short-term alcohol-sex risk at a rural institution. Participants Undergraduates at a rural northeastern university. Method Online health behavior surveys at Time 1 (T1; N = 327) and Time 2 (T2; n = 150, M interval=34 ± 7 days). Results 75% reported lifetime, 73% past-year, and 65% past-month drinking at T1. Despite past-month sexual risk behavior (48% without barrier, 31% under influence of alcohol/drugs, 12% without querying STI status), only 23% endorsed past-year STI testing. Drinking students were more likely than non-drinking peers to endorse all sexual risk behaviors. T1 drinking was associated with T2 sex, sex under the influence of alcohol/drugs, and unprotected sex. Conclusions College drinking predicted short-term sexual risk behaviors at this rural institution, suggesting potential unique risk mechanisms. Findings may inform multilevel, culture-centered intervention for students attending rural universities.

Planned versus unplanned alcohol and cannabis use: Motivational and contextual correlates among sexual minority women and gender diverse individuals.

Unplanned alcohol use has been theorized to contribute to experiencing more consequences at the daily level, and several risk factors have been identified in the general population. However, it remaines unclear whether these risk factors apply to sexual and gender minorities (SGM); if unique risk factors for substance use among SGM (e.g., microaggressions) are associated with elevated risk for unplanned alcohol or cannabis use; and if risk factors for unplanned drinking also apply to unplanned cannabis use. We aimed to address these gaps by examining differences between planned and unplanned alcohol and cannabis use in motives, contexts of use, and SGM-specific factors at the daily level among 380 sexual minority women and gender diverse individuals assigned female at birth using daily diary data. Although unplanned alcohol and cannabis use were associated with lighter use, unplanned cannabis use was associated with more consequences. Social and enhancement motives and drinking with other SGM were linked to a lower likelihood of unplanned alcohol use, while conformity motives were associated with a higher likelihood of unplanned alcohol use. Microaggressions and coping motives were not associated with unplanned alcohol or cannabis use. Results demonstrated differences in motivational and contextual factors associated with unplanned alcohol compared to cannabis use and identified one SGM-specific correlate. Future research should continue to explore factors that contribute to unplanned cannabis use days being associated with more consequences even in the absence of heavier use on unplanned days.

P-2000. A Case-Control Study of the Risk of COVID-19 Infection in Underserved Persons with HIV (PWH) in Middle Tennessee

Abstract Background The COVID-19 pandemic had disproportionately affected racial and ethnic minorities. We undertook this study to examine the risk factors for COVID-19 infection and death in African Americans with HIV. Methods We conducted a prospective case-control study to assess the risk for COVID-19 infection in a clinic serving predominantly underserved African Americans in Middle Tennessee. Matched cases and controls were tested for COVID-19 by PCR around the same time. COVID-19 information, demographics, clinical and social determinants of health (SDoH) data were collected from electronic health records. Chi-square and Fisher’s exact tests were applied to evaluate the associations between outcome and predictor variables. Binary logistic regression was used to examine the effects of 18 predictors on COVID-19 infection. R/RStudio version 4.3.2 was used. The local IRB approved the study protocol. Results From 4/2020 to 11/2023, 91 PWH tested COVID-19-positive and 181 negative. We excluded 11 cases and 29 controls due to missing SDoH data; 81.0% of the patients were African American, 26.3% were female, and 46.1% fell into the 45-64-year-old age group. Among 73 symptomatic cases, the most common symptoms were cough, fever, and chills. 28/91 were admitted to the hospital, 11/28 went to ICU, and 8/28 died. All the deceased had >1 cardiovascular risk factor. 12/91 cases had a CD4 cell count < 200/mm3 and 73/91 had an HIV-1 RNA level < 200 copies/mL. In the bivariate analysis, incarceration (p < 0.001), renal failure (p < 0.001), smoking (p < 0.001), alcoholism (p = 0.003), drug use (p = 0.023), and cardiovascular risk (p = 0.023) were highly associated with COVID-19 infection. In the multivariable model, the most strongly associated risks were incarceration [OR = 18.68; 95% CI: (4.66, 74.87); p < 0.001], renal failure [OR = 40.62; 95% CI: (3.96, 416.83); p = 0.002], hyperlipidemia [OR = 3.94; 95% CI: (1.54, 10.06); p = 0.004], 25-44 years of age [OR = 2.48; 95% CI: (1.10, 5.58); p = 0.028], no insurance [OR = 0.36; 95% CI: (0.14, 0.92); p = 0.033], and smoking [OR = 2.20; 95% CI: (1.01, 4.82); p = 0.048]. Conclusion Incarceration, renal failure, and cardiovascular disease were very strong risk factors for COVID-19 infection in this population of PWH in Middle Tennessee. Disclosures Vladimir Berthaud, MD MPH, GILEAD SCIENCES: Grant/Research Support|GSKVIIV: Grant/Research Support|MODERNA: Grant/Research Support|NOVAVAX: Grant/Research Support

Substance Use Classes Among YMSM in an HIV Digital Health Intervention Program: Implications for Acceptability, Engagement, and Health Outcomes.

Young men who have sex with men (YMSM) have high rates of substance use, which increases their risk for HIV. Digital Health Interventions (DHI) have the potential to address HIV risk overall and reduce harms in the context of substance use. However, there is limited research on how YMSM with different substance use patterns respond to HIV DHIs and how these programs impact participant outcomes. In this study, we used latent class analysis (LCA) to identify subgroups of participants with specific substance use behaviors in the Keep It Up! (KIU! ) program, an HIV DHI with prior documented effectiveness. This study involved 2,124 participants in a Type III Hybrid trial, comparing two implementation strategies: one via 22 community-based organizations and another through direct-to-consumer recruitment. Evaluations were done at baseline and 12-week follow-up. This analysis identified four classes of substance use: Low Use (minimal alcohol risks, low illicit drug use, infrequent marijuana), Heavy Use (highest alcohol problems, frequent marijuana, elevated illicit drug use), Alcohol and Marijuana Use (high alcohol problems, frequent marijuana), and Methamphetamine and GBH Use (low alcohol risk, moderate marijuana frequency, high illicit drug use). Participants in the Meth & GHB User class were more likely to have an STI at baseline compared to those in the Low User class. Moreover, Heavy Use, Alcohol & Marijuana Use, and Meth & GHB Use reported a greater number of condomless anal sex partners compared to Low Use. Additionally, although Alcohol & Marijuana Use were more likely to use PrEP at the time of their most recent casual partner at baseline, they exhibited the smallest increase in PrEP use during follow-up compared to the other substance use classes. Our analysis did not unveil substantial differences in the success of implementation in terms of reach, suggesting that both implementation strategies effectively engaged YMSM with different levels of substance use. Our research showed a similar level of engagement, as evidenced by the completion rates of modules and time spent, across all substance use classes. However, those within the Meth & GHB category found the intervention highly acceptable, but less so compared to Low Use and Alcohol & Marijuana Use. Understanding how distinct substance use profiles influence intervention outcomes and exploring varied implementation methods can augment future prevention endeavors, broadening the scope and impact of public health initiatives.

Culturally informed risk perceptions among young adult drinkers in Denmark, Estonia and Italy

Alcohol researchers have debated whether increased globalisation has reduced national differences in alcohol consumption and thus made alcohol cultures more similar. Building on this interest, this article examines the cultural perceptions of alcohol risk among young adult drinkers in Denmark, Estonia and Italy to find out if important cultural differences still exist in Europe. The study is based on 24 focus groups (n = 128) in the three countries with people aged 20–30 and 30–40. Our study shows how each of the three countries had different narratives about risk and drinking. Estonian participants described how heavy drinking could lead to neglecting one’s responsibilities as an adult, which could result in a loss of social status. Italian participants’ alcohol risk assessments were more related to the value of togetherness and social community and the embarrassment that could be felt if this was compromised. Danish participants mentioned few alcohol-related risks and these were primarily linked to the individual and not, as among the Italian and Estonian participants, to the social group or family. The findings of the study are analysed and discussed in the light of overall cultural narratives in each of the three countries and we conclude that alcohol cultures and everyday risk assessments of alcohol may be changing but only slowly.

Alcohol consumption and incident heart failure in men and women.

Regular heavy alcohol consumption may lead to the development of alcohol-related cardiomyopathy and symptomatic heart failure (HF) later in life. However, the dose-response relationship between alcohol consumption and risk for incident HF, and whether these associations vary by sex and type of alcoholic beverage remains unclear. A total of 407 014 participants (52% women, age 56 years) from the UK Biobank who completed alcohol-related questionnaires and without a history of HF at baseline were included in the study. Competing-risk model and cubic spline regression analyses were used to calculate hazard ratios of the association between alcohol consumption and incident HF in men and women. The associations were adjusted for an extensive set of potential confounders. During a median follow-up of 12 years, 11 735 (34% women) cases of incident HF were identified. Total alcohol consumption was higher in men than in women (median consumption: 16 vs. 8 drinks/week, p < 0.001). A J-shaped association was observed between total alcohol consumption and incident HF in both men and women. Drinking alcohol <28 units/week was associated with a lower risk for developing HF, with a ~20% maximum risk reduction at 14 units/week in men and 7 units/week in women, independent of common confounders. Similar trends were observed in wine consumption. However, the risk of incident HF increases with beer consumption, particularly in women (p for sex interaction = 0.002). Consuming 7-14 units/week of beer was associated with a 29% increased risk of incident HF in women. Alcohol consumption was higher among men compared with women. Although low to moderate total alcohol consumption appears to be associated with a reduced risk of developed HF, beer drinkers, particularly women, were at higher risk of developed HF.

Association between alcohol consumption and risk of type 2 diabetes in Japan: a population-base longitudinal cohort study

Heavy alcohol consumption is a known risk factor for type 2 diabetes (T2D), However, the moderating effect of fasting plasma glucose (FPG) levels remains unclear. This study explores the relationship between alcohol intake and T2D risk across FPG strata in a Japanese cohort. Data from 15,453 participants in the NAGALA cohort were analyzed over 5.4 years. Baseline assessments included alcohol consumption and FPG, categorizing individuals into elevated FPG (EFPG, 100–125 mg/dL) and normal FPG (NFPG, < 100 mg/dL). Cox proportional hazards regression assessed alcohol intake levels and T2D risk, stratified by FPG. Among EFPG individuals, heavy drinkers (Men > 280 g/week, Women > 140 g/week) had an 88% increased T2D risk (HR 1.88, 95% CI 1.24–2.84). Conversely, in NFPG, heavy alcohol intake did not significantly affect T2D risk (HR 1.10, 95% CI 0.48–2.53). Men with EFPG and heavy alcohol intake had an HR of 1.83 (95% CI 1.08–3.08), supported by propensity score matching (HR 1.94, 95% CI 1.13–3.34). No significant relationships were found in NFPG. Heavy alcohol consumption significantly raises T2D risk in Japanese men with EFPG but not in women or those with NFPG. Further studies are warranted for validation and gender-specific insights.

Mortality of gastrointestinal cancers attributable to smoking, alcohol, and metabolic risk factors, and its association with socioeconomic development status 2000-2021: GI Cancer Mortality and Risk Factors.

Gastrointestinal (GI) cancers account for one-third of global cancer mortality, with nearly half being preventable. This study updates the global burden of GI cancers attributed to major risk factors: smoking, alcohol, and metabolic disturbances. We utilized data from the Global Burden of Disease Study 2021 to examine trends in death and age-standardized death rates related to GI cancers caused by smoking, alcohol, high body mass index (BMI), and high fasting blood glucose (FBG) from 2000 to 2021. Trends were analyzed based on countries' developmental status using a sociodemographic index (SDI). In 2021, there were 1.12 million GI cancer deaths related to smoking, alcohol, high BMI, and high FBG, which was 53.6% higher than in 2000. The largest proportion of GI cancer mortality was attributed to smoking (43.3%), followed by alcohol (20.6%), high FBG (20.5%), and high BMI (15.6%). The increases in GI cancer deaths between 2000 and 2021 were related to high BMI (+102.54%) and FBG (+107.69%), particularly in liver and pancreatic cancer. In 2021, GI cancer mortality in low, low-middle, and middle SDI countries represented 44.3% of the global GI cancer mortality attributed to smoking, 41.9% for alcohol, 34.3% for high BMI, and 31.6% for high FBG. Since 2000, these proportions have increased by +4.5% for smoking, +7.6% for alcohol, +12.3% for high BMI, and +6.4% for high FBG. From 2000 to 2021, GI cancer mortality increased substantially, driven primarily by obesity and alcohol. Lower SDI countries are increasingly contributing to the global GI cancer mortality burden. Immediate interventions are necessary to mitigate this growing burden.

Alcohol Plus Additional Risk Factors: Rodent Model of Liver Injury

Alcohol-associated liver disease (ALD), primarily caused by chronic excessive alcohol consumption, is a leading cause of chronic liver disease worldwide. ALD includes alcohol-associated steatotic liver, alcohol-associated hepatitis (AH), fibrosis, cirrhosis, and can even progress to hepatocellular carcinoma (HCC). Existing research indicates that the risk factors of ALD are quite numerous. In addition to drinking patterns, factors such as aldehyde dehydrogenase 2 (ALDH2) deficiency, smoking, medication administration, high-fat diet (HFD), hepatitis virus infection, and disruption of circadian rhythms can also increase susceptibility to ALD. However, there is limited understanding regarding the exacerbation of liver injury by alcohol plus additional risk factors. This review presents rodent models of EtOH + “X,” which simulate the synergistic effects of alcohol and additional risk factors in causing liver injury. These models offer a further exploration of the interactions between alcohol and additional risk factors, advancing the simulation of human ALD and providing a more reliable platform for studying disease mechanisms and exploring therapeutic interventions. We summarize the modeling methods, relevant indicators of liver injury, and focus on the targets of the synergistic effects as well as the associated mechanisms.

A Rare Case Report on Jaundice, Alcoholic Liver Disease with a History of Herbal Medicine Induced Liver Injury

Background: Alcoholic liver disease (ALD) is a complex condition caused by excessive alcohol consumption, affecting fatty liver, alcoholic hepatitis, and cirrhosis. Risk factors include alcohol intake, genetic predisposition, and co-existing liver conditions. Alcoholic fatty liver disease (AFLD) accumulates excessive fat in the liver, leading to steatosis and fibrosis. ALD complications include portal hypertension, liver failure, and hepatocellular carcinoma. The use of herbal medicines, such as tamarind and neem extracts, is also concerning due to potential liver damage. Increased awareness and caution are needed from patients and healthcare providers. Case report: A 33-year-old male patient presented with symptoms including right hypochondrium pain, yellowish discoloration of the sclera, fever, decreased urine output, light yellow tongue, and generalized weakness. He was a chronic alcoholic, consuming various alcoholic beverages for 15 years. His dietary routine was mixed, but he preferred non-vegetarian foods. His family suggested he consume traditional herbal medicine to treat jaundice. After collecting his history, lab tests were conducted to confirm his diagnosis of alcoholic liver disease (ALD) with herbal medicine-induced liver (DILI). LFT tests were alarming, and he was diagnosed with alcoholic liver disease with jaundice and DILI due to herbal medicine. To improve his symptoms and prevent liver failure complications, he was prescribed a list of medications to improve his symptoms and to prevent complications of liver failure. Discussion: A holistic treatment approach is needed for patients with alcoholic liver disease and herbal medicine-induced liver injury, focusing on symptom relief, liver function enhancement, and complication prevention. This includes lifestyle changes, nutritional support, and managing potential issues. Regular monitoring is crucial for adjustments. Conclusion: This case report highlights the complex relationship between alcoholic liver disease and herbal medicine-induced liver injury, especially in jaundice cases. It emphasizes the need for thorough patient histories, increased awareness of hepatotoxic potential, and educating patients about alcohol and herbal supplement risks. It calls for multidisciplinary collaboration, enhanced regulation, and safety evaluations of herbal medicines to protect public health. It also underscores the importance of continuous monitoring and monitoring patients with liver injury histories. Keywords: ALD, Herbal medicine, DILI, Liver failure, Patient care

Consumer reactions to multiple and single health warnings on static alcohol ads: A factorial survey experiment with a convenience sample of adults in Ireland.

As part of several measures to inform consumers about the health risks of alcohol, the Irish Government signed into law the Public Health (Alcohol) Act 2018, with Section 13 requiring the implementation of multiple health warnings in all alcohol ads. Although health warnings on product labels have been subject to intensive political discussion and academic research, health warnings in alcohol ads have received little attention. A between-subject factorial survey experiment was conducted with a convenience sample of adults in Ireland (n = 932) to compare single-text, multiple-text and shocking image-and-text health warnings displayed on two types of static alcohol ads-an ad with social imagery featuring people drinking alcohol and an ad featuring only the alcohol product. Believability of health warnings, negative emotions, perceived risks of alcohol use and self-efficacy to drink less were measured after viewing each alcohol ad with or without health warnings. Single-text health warnings, with and without shocking imagery, were more effective in increasing negative emotions than multiple-text health warnings (p ≤ 0.001), whereas multiple-text warnings were found to be more believable than single-text warnings (p ≤ 0.001). No significant effects were found on perceived risks of alcohol use and self-efficacy to drink less (p > 0.05). The warnings did not differ across demographic groups and the type of alcohol ads on all outcomes (p > 0.05). A single health warning emphasising cancer risk could be a useful starting point for policymakers when implementing health warnings in alcohol ads.

Role of Momentary Alcohol Cognitions in Event-Level Relations Between PTSD Symptoms and Alcohol Outcomes: Le rôle des cognitions momentanées liées à l'alcool au niveau de l'événement entre les symptômes du TSPT et la consommation d'alcool.

Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur. Momentary alcohol cognitions may represent in-the-moment, modifiable risk factors to target in interventions for comorbid PTSD and AUD. However, the role of such cognitions in risk for problematic drinking as it emerges in response to individuals' fluctuating PTSD symptoms across their daily lives remains unknown. The present study aimed to test whether state-level PTSD-alcohol expectancies and/or drinking motives modulate in-the-moment associations between PTSD symptoms and alcohol outcomes. Frequent drinking adults with current PTSD (n = 54) reported on their posttraumatic symptoms and alcohol cognitions, craving, and consumption during four momentary surveys each day for 14 days (3,024 observations) in an ecological momentary assessment design. Multilevel moderation analyses tested whether in-the-moment PTSD-alcohol expectancies and/or drinking motives moderated relations of PTSD symptoms with alcohol craving and consumption. Findings demonstrated a significant interaction between PTSD symptoms and coping drinking motives on in-the-moment alcohol craving. Specifically, greater experience of PTSD symptoms related more strongly to craving for alcohol during events in which drinkers endorsed higher levels of coping drinking motives. There were no additional interaction effects for drinking motives or PTSD-alcohol expectancies on either alcohol craving or consumption. Coping drinking motives appear to convey strong in-the-moment risk for PTSD-related alcohol craving yet not subsequent alcohol consumption. Future research should delineate concurrent alcohol risk and possible protective processes active in the presence of PTSD symptoms to help identify targets for interventions tailored to the unique risk processes maintaining comorbid PTSD and AUD.

Alcohol consumption trajectories and risk of breast cancer among postmenopausal women: a Danish cohort study

Alcohol consumption is a risk factor for breast cancer (BC), yet little is known about longitudinal alcohol consumption patterns and risk of BC. This study aimed to investigate whether trajectory profiles of alcohol consumption across adulthood were associated with risk of first primary malignant BC in postmenopausal women. At baseline, 28,720 pre-and postmenopausal women aged 50–65 years from the Danish Diet, Cancer and Health Cohort reported their average alcohol intake over the past 12 months and their average alcohol intake at the ages of 20, 30, 40, and 50 years. Alcohol consumption trajectories were estimated using latent class mixed models. BC cases were identified through record linkage to the Danish Cancer Registry. To examine associations between alcohol consumption trajectories and BC, we fitted a proportional hazard model adjusted for potential confounding factors using data from 24,543 postmenopausal women without missing covariate information. We identified 4 alcohol consumption trajectory profiles. During a median follow-up of 16.5 years, 1,591 cases of BC occurred. A mean alcohol consumption trajectory of > 10 g/day was associated with higher risk of BC (HR: 1.65, 95%CI: 1.35–2.03) compared to a mean alcohol consumption trajectory of < 6 g/day. We found no association between trajectory profiles characterized by lower alcohol intakes in early adulthood followed by increasing consumption of alcohol in adulthood compared to a consistently low intake of alcohol. Postmenopausal women drinking consistently high amounts of alcohol throughout adulthood had a higher risk of BC compared to women with a consistently low intake of alcohol.

Associations Between Maternal Periconceptional Alcohol Consumption and Risk of Craniosynostosis Among Offspring, National Birth Defects Prevention Study, 1997-2011.

Previous studies of maternal alcohol consumption and craniosynostosis have reported null or inverse associations. We updated a previous analysis of National Birth Defects Prevention Study (NBDPS) data to further examine associations between maternal alcohol consumption and craniosynostosis. NBDPS was a multi-site, population-based case-control study. Mothers of craniosynostosis cases and randomly selected liveborn controls delivered during 1997-2011 completed a telephone interview about pregnancy exposures. We examined associations for self-reported periconceptional maternal alcohol consumption (during the month before conception through the third gestational month) and odds of craniosynostosis in offspring. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between any alcohol consumption and binge consumption and craniosynostosis, overall and by affected suture. Finally, we performed a probabilistic bias analysis using a range of assumptions about the sensitivity and specificity of self-reported consumption by case/control status. We analyzed interview data from 1435 mothers of craniosynostosis cases and 11,216 mothers of controls. Periconceptional alcohol consumption prevalence was similar among case (36.9%) and control (38.2%) mothers. We observed point estimates near or below 1.0 for alcohol consumption (any and binge) and all suture subtypes of craniosynostosis, with all CIs including the null. Our bias-adjusted estimates for periconceptional alcohol consumption were higher than our conventional estimates but supported the null findings. We observed primarily null associations between maternal periconceptional alcohol consumption and craniosynostosis. However, our findings do not diminish the prevailing clinical guidance in the United States that pregnant people should abstain from alcohol consumption.

Magnitude and risk factors of khat, alcohol and cigarettes use among pregnant women in Africa: a systematic review and meta-analysis

BackgroundThe use of khat, alcohol, and cigarettes during pregnancy is a serious public health problem associated with harmful outcomes for the fetus and the mother’s health. Studies that investigated khat, alcohol, and cigarettes usage during pregnancy yielded varied and contradictory results. This study used a systematic review and meta-analysis to estimate the pooled prevalence and associated factors of khat, alcohol, and cigarettes use among pregnant women in Africa.MethodsA review of eligible studies was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. This review has been registered in PROSPERO with protocol ID CRD42021289074. Literature published in English from January 1, 2002 to November 30, 2021 was retrieved from PubMed, Google Scholar, Cochrane, HINARI, African Journal Online, and Science Direct databases. The quality of included articles was assessed using the Joanna Briggs Institute’s (JBI) critical appraisal checklist. The I2 statistic and Cochran’s Q test were used to assess the presence of heterogeneity between studies. To assess publication bias, a funnel plot and Egger’s regression test were utilized. The random effect model was used to estimate the summary prevalence and the corresponding 95% confidence interval (CI) of risk factors for khat, alcohol, and cigarettes use.ResultsOut of the 1509 studies identified, 71 met the inclusion criteria. The pooled prevalence of khat chewing, alcohol drinking, active smoking, and secondhand smoke exposure during pregnancy was 18.93%, 22.20%, 11.85%, and 43.45%, respectively. The subgroup analysis by UN sub-region showed the highest pooled prevalence of alcohol use during pregnancy in Middle Africa (25.69%) and the lowest in Northern Africa (1.10%). Several factors were identified as risk factors for alcohol use, including low educational level, younger age women, pre-pregnancy alcohol use, unplanned pregnancy, history of abortion, poor social support, mental distress, poor knowledge on alcohol risks, and partner alcohol use.ConclusionThis review indicated that the pooled magnitude of khat, alcohol and cigarette use during pregnancy was higher in Africa. Substance use screening and brief interventions (SBI) should be routinely delivered in antenatal care settings to reduce pregnant women’s substance use.

Social and Environmental Predictors of Youth Alcohol and Cannabis Initiation Risk: The Moderating Role of Family History of Substance Use Disorders

Background: The social and local-home environment impacts youth’s likelihood of early substance use initiation (SUI). Yet, it is unknown whether protective or risk factors are salient for all forms of youth SUI, or may be specific to certain substances (e.g., alcohol, cannabis). Additionally, certain family factors – such as having a family history of SUD (FH+)—may exacerbate risk for and mitigate protection from alcohol (AUI) and cannabis (CUI) use initiation. Objectives: Using a longitudinal cohort of 387 adolescents, we aimed to understand how the link between social and local-home factors on AUI and CUI was moderated by FH status. Results: Results indicated that affiliating with risky peers significantly increased the risk of AUI and CUI, but that this relationship was not moderated by FH status. On the other hand, the link between mother-youth relationship quality and CUI, was potentially moderated by FH status such that being FH+ attenuated the protective effect of a positive relationship with parents on SUI. Conclusions: This research could provide evidence that youth who are at risk of early SUI, particularly those who are FH+, may benefit from programs designed to reduce affiliation with risky peers.

Economic costs attributable to modifiable risk factors: an analysis of 24 million urban residents in China

BackgroundEstimating the economic burden of modifiable risk factors is crucial for allocating scarce healthcare resources to improve population health. We quantified the economic burden attributable to modifiable risk factors in an urban area of China.MethodsOur Shanghai Municipal Health Commission dataset covered 2.2 million inpatient admissions for adults (age ≥ 20) in public and private hospitals in 2015 (1,327,187 admissions) and 2020 (837,482 admissions). We used a prevalence-based cost-of-illness approach by applying population attributable fraction (PAF) estimates for each modifiable risk factor from the Global Burden of Diseases Study (GBD) to estimate attributable costs. We adopted a societal perspective for cost estimates, comprising direct healthcare costs and productivity losses from absenteeism and premature mortality. Future costs were discounted at 3% and adjusted to 2020 prices.ResultsIn 2020, the total societal cost attributable to modifiable risk factors in Shanghai was US$7.9 billion (95% uncertainty interval [UI]: 4.6–12.4b), mostly from productivity losses (67.9%). Two health conditions constituted most of the attributable societal cost: cancer (51.6% [30.2–60.2]) and cardiovascular disease (31.2% [24.6–50.7]). Three modifiable risk factors accounted for half of the total attributable societal cost: tobacco (23.7% [16.4–30.5]), alcohol (13.3% [8.2–19.7]), and dietary risks (12.2% [7.5–17.7]). The economic burden varied by age and sex; most of the societal costs were from males (77.7%), primarily driven by their tobacco and alcohol use. The largest contributor to societal costs was alcohol for age 20–44, and tobacco for age 45 + . Despite the COVID-19 pandemic, the pattern of major modifiable risk factors remained stable from 2015 to 2020 albeit with notable increases in attributable healthcare costs from cancers and productivity losses from cardiovascular diseases.ConclusionsThe substantial economic burden of diseases attributable to modifiable risk factors necessitates targeted policy interventions. Priority areas are reducing tobacco and alcohol consumption and improving dietary habits that together constitute half of the total attributable costs. Tailored interventions targeting specific age and sex groups are crucial; namely tobacco in middle-aged/older males and alcohol in younger males.