Self-reported Alcohol Research Articles

Contribution of alcohol use in HIV/hepatitis C virus co-infection to all-cause and cause-specific mortality: A collaboration of cohort studies.

Among persons with HIV (PWH), higher alcohol use and having hepatitis C virus (HCV) are separately associated with increased morbidity and mortality. We investigated whether the association between alcohol use and mortality among PWH is modified by HCV. Data were combined from European and North American cohorts of adult PWH who started antiretroviral therapy (ART). Self-reported alcohol use data, collected in diverse ways between cohorts, were converted to grams/day. Eligible PWH started ART during 2001-2017 and were followed from ART initiation for mortality. Interactions between the associations of baseline alcohol use (0, 0.1-20.0, >20.0 g/day) and HCV status were assessed using multivariable Cox models. Of 58,769 PWH, 29,711 (51%), 23,974 (41%) and 5084 (9%) self-reported alcohol use of 0 g/day, 0.1-20.0 g/day, and > 20.0 g/day, respectively, and 4799 (8%) had HCV at baseline. There were 844 deaths in 37,729 person-years and 2755 deaths in 443,121 person-years among those with and without HCV, respectively. Among PWH without HCV, adjusted hazard ratios (aHRs) for mortality were 1.18 (95% CI: 1.08-1.29) for 0.0 g/day and 1.84 (1.62-2.09) for >20.0 g/day compared with 0.1-20.0 g/day. This J-shaped pattern was absent among those with HCV: aHRs were 1.00 (0.86-1.17) for 0.0 g/day and 1.64 (1.33-2.02) for >20.0 g/day compared with 0.1-20.0 g/day (interaction p < .001). Among PWH without HCV, mortality was higher in both non-drinkers and heavy drinkers compared with moderate alcohol drinkers. Among those with HCV, mortality was higher in heavy drinkers but not non-drinkers, potentially due to differing reasons for not drinking (e.g. illness) between those with and without HCV.

Syndemic trajectories of heavy drinking, smoking, and depressive symptoms are associated with mortality in women living with HIV in the United States from 1994 to 2017

BackgroundHeavy drinking, smoking, and depression are common among people with HIV. Little is known about the co-occurring, synergistic effect of having two or more of these conditions long-term –a sustained syndemic – on mortality among women with HIV (WWH). MethodsData from 3282 WWH of the Women’s Interagency HIV Study from 1994 to 2017 were utilized. National Death Index review identified cause of death (n=616). Sustained syndemic phenotypes were based on membership in high-risk groups defined by group-based trajectory models of repeated self-reported alcohol use, smoking, and depressive symptoms and their co-occurrence. Cox proportional hazard models estimated associations of sustained syndemic phenotypes with all-cause, non-AIDS, and non-overdose mortality, adjusting for age, race/ethnicity, education, enrollment wave, illicit drug use, and time-varying HIV viral load and CD4+ T-cell count. ResultsWWH were 58% Black and 26% Hispanic, with a mean baseline age of 36.7 years. Syndemic phenotypes included zero (45%, n=1463), heavy drinking only (1%, n=35), smoking only (28%, n=928), depressive symptoms only (9%, n=282), and 2+ trajectories (17%, n=574). Compared to zero trajectories, having 2+ trajectories was associated with 3.93 times greater all-cause mortality risk (95% CI 3.07, 5.04) after controlling for confounders and each high-risk trajectory alone. These findings persisted in sensitivity analyses, removing AIDS- and overdose-related mortalities. ConclusionsClustering of 2+ conditions of heavy drinking, smoking, and depression affected nearly one in five WWH and was associated with higher mortality than zero or one condition. Our findings underscore the need for coordinated screening and parsimonious treatment strategies for these co-occurring conditions.

Trees for brains: Current residential tree cover density and its association with brain structure in young adults

Previous research has suggested an association between living environment during the first 15 years of life and brain structure. More precisely, urbanicity during upbringing has been shown to be negatively related to prefrontal cortex grey matter. The present study focusses instead on the current living environment of 677 younger adults recruited from different cities across Europe. We observed a positive association between amount of tree cover density, in a radius of 500m around the current home address and grey matter volume in right orbitofrontal cortex (rOFC). Of note, the volume of the rOFC cluster identified, showed a positive association with cognitive performance in the Wechsler Adult Intelligence Scale, namely in the verbal and spatial ability domain (Vocabulary, Block Design), and a negative association with both, self-reported and behavioural markers of impulsivity (delay discounting). Moreover, rOFC volume showed a negative association with self-reported alcohol use problems. The data provide strong evidence in favour of a link between geographical features of the current living environment (particularly trees) and brain structure above and beyond childhood and upbringing. Interestingly, the respective brain correlates are associated with cognitive, behavioural and personality characteristics which have been considered as risk factors for several psychiatric disorders. Environmental neuroscience may in the long run provide a knowledge base for evidence-based urban landscape planning to facilitate mental health.

Associations of alcohol intake with subclinical carotid atherosclerosis in 22,000 Chinese adults

Background and aimsWe investigated the causal relevance of alcohol intake with measures of carotid artery thickness and atherosclerosis in Chinese adults. MethodsThe study included 22,384 adults from the China Kadoorie Biobank, with self-reported alcohol use at baseline and resurvey, carotid artery ultrasound measurements, and genotyping data for ALDH2-rs671 and ADH1B-rs1229984. Associations of carotid intima media thickness (cIMT), any carotid plaque, and total plaque burden (derived from plaque number and size) with self-reported (conventional analyses) and genotype-predicted mean alcohol intake (Mendelian randomization) were assessed using linear and logistic regression models. ResultsOverall 34.2% men and 2.1% women drank alcohol regularly at baseline. Mean cIMT was 0.70 mm in men and 0.64 mm in women, with 39.1% and 26.5% having carotid plaque, respectively. Among men, cIMT was not associated with self-reported or genotype-predicted mean alcohol intake. The risk of plaque increased significantly with self-reported intake among current drinkers (odds ratio 1.42 [95% CI 1.14–1.76] per 280 g/week), with directionally consistent findings with genotype-predicted mean intake (1.21 [0.99–1.49]). Higher alcohol intake was significantly associated with higher carotid plaque burden in both conventional (0.19 [0.10–0.28] mm higher per 280 g/week) and genetic analyses (0.09 [0.02–0.17]). Genetic findings in women suggested the association of genotype-predicted alcohol with carotid plaque burden in men was likely to due to alcohol itself, rather than pleiotropic genotypic effects. ConclusionsHigher alcohol intake was associated with a higher carotid plaque burden, but not with cIMT, providing support for a potential causal association of alcohol intake with carotid atherosclerosis.

Trends in the rate of regular exercise among adults: results from chronic disease and risk factor surveillance from 2010 to 2018 in Jiangsu, China.

The aims of this study were to estimate the rates of regular exercise and its trends among the adult population in Jiangsu, from 2010 to 2018, China, and to assess associations with sociodemographic factors. Chronic disease and risk factor surveillance data from adults aged ≥18 years were gathered in Jiangsu Province from 2010 to 2018. Rates of regular exercise were calculated after post-stratification weighting, and time trends were compared among participants with different characteristics, including gender, age, urban-rural region, educational level, occupation, annual household income, body mass index (BMI), baseline self-reported chronic diseases, smoking status, alcohol consumption, and region. Multivariable logistic regression analyses were performed to assess the associations of sociodemographic characteristics with regular exercise. A total of 33,448 participants aged 54.05 ± 14.62 years and 55.4% female (8,374 in 2010, 8,302 in 2013, 8,372 in 2015, and 8,400 in 2018) were included in this study. The weighted rate of regular exercise was 12.28% (95% confidence interval [CI]: 9.11-15.45%) in 2010 and 21.47% (95% CI, 17.26-25.69%) in 2018, showing an overall increasing trend (P for trend = 0.009). Nevertheless, stratification analysis showed that the regular exercise rate decreased from 33.79% in 2010 to 29.78% in 2018 among retired adults. Significant associations were observed between regular exercise and age >45 years (45- < 60 years, odds ratio [OR]: 1.24, 95% CI: 1.14-1.34; ≥60 years, OR: 1.20, 95% CI: 1.08-1.34), urban residence (OR: 1.43, 95% CI: 1.32-1.54), higher education (primary, OR: 1.30, 95% CI: 1.16-1.46; secondary, OR: 2.00, 95% CI: 1.79-2.25; college or higher, OR: 3.21, 95% CI: 2.77-3.72), occupation (manual work, OR: 1.52, 95% CI: 1.33-1.73; non-manual work, OR: 1.69, 95% CI: 1.54-1.85; not working, OR: 1.22, 95% CI: 1.03-1.44; retired, OR: 2.94, 95% CI: 2.61-3.30), higher income (¥30,000- < ¥60,000, OR: 1.16, 95% CI: 1.06-1.28; ≥¥60,000, OR: 1.20, 95% CI: 1.10-1.32), higher BMI (overweight, OR: 1.12, 95% CI: 1.05-1.20), self-reported chronic disease at baseline (OR: 1.24, 95% CI:1.16-1.33), former smoking (OR: 1.15, 95% CI: 1.01-1.31) and ever (30 days ago) drinking (OR: 1.20, 95% CI: 1.11-1.29). The rate of regular exercise among adults in Jiangsu Province was low, but this rate increased by 9.17% from 2010 to 2018, showing an upward trend. There were differences in the rate of regular exercise among different sociodemographic factors.

Alcohol consumption and all-cause and cause-specific mortality among US adults: prospective cohort study

BackgroundPrevious studies have shown inconsistent findings regarding the association of light to moderate alcohol consumption with cause-specific mortality. Therefore, this study sought to examine the prospective association of alcohol consumption with all-cause and cause-specific mortality in the US population.MethodsThis was a population-based cohort study of adults aged 18 years or older in the National Health Interview Survey (1997 to 2014) with linkage to the National Death Index records through December 31, 2019. Self-reported alcohol consumption was categorized into seven groups (lifetime abstainers; former infrequent or regular drinkers; and current infrequent, light, moderate, or heavy drinkers). The main outcome was all-cause and cause-specific mortality.ResultsDuring an average follow-up of 12.65 years, among the 918,529 participants (mean age 46.1 years; 48.0% male), 141,512 adults died from all causes, 43,979 from cardiovascular disease (CVD), 33,222 from cancer, 8246 from chronic lower respiratory tract diseases, 5572 from accidents (unintentional injuries), 4776 from Alzheimer’s disease, 4845 from diabetes mellitus, 2815 from influenza and pneumonia, and 2692 from nephritis, nephrotic syndrome, or nephrosis. Compared with lifetime abstainers, current infrequent, light, or moderate drinkers were at a lower risk of mortality from all causes [infrequent—hazard ratio: 0.87; 95% confidence interval: 0.84 to 0.90; light: 0.77; 0.75 to 0.79; moderate 0.82; 0.80 to 0.85], CVD, chronic lower respiratory tract diseases, Alzheimer’s disease, and influenza and pneumonia. Also, light or moderate drinkers were associated with lower risk of mortality from diabetes mellitus and nephritis, nephrotic syndrome, or nephrosis. In contrast, heavy drinkers had a significantly higher risk of mortality from all causes, cancer, and accidents (unintentional injuries). Furthermore, binge drinking ≥ 1 day/week was associated with a higher risk of mortality from all causes (1.15; 1.09 to 1.22), cancer (1.22; 1.10 to 1.35), and accidents (unintentional injuries) (1.39; 1.11 to 1.74).ConclusionsInfrequent, light, and moderate alcohol consumption were inversely associated with mortality from all causes, CVD, chronic lower respiratory tract diseases, Alzheimer’s disease, and influenza and pneumonia. Light or moderate alcohol consumption might also have a beneficial effect on mortality from diabetes mellitus and nephritis, nephrotic syndrome, or nephrosis. However, heavy or binge had a higher risk of all-cause, cancer, and accidents (unintentional injuries) mortality.

The association of alcohol dependence and consumption during adolescence with depression in young adulthood, in England: a prospective cohort study

The role of alcohol use in the development of depression is unclear. We aimed to investigate whether alcohol dependence, but not high frequency or quantity of consumption, during adolescence increased the risk of depression in young adulthood. In this prospective cohort study, we included adolescents who were born to women recruited to the Avon Longitudinal Study of Parents and Children in Avon, UK, with delivery dates between April 1, 1991, and Dec 31, 1992. Alcohol dependence and consumption were measured at about age 16 years, 18 years, 19 years, 21 years, and 23 years using the self-reported Alcohol Use Disorders Identification Test, and at about age 18 years, 21 years, and 23 years using items corresponding to DSM-IV symptoms. The primary outcome was depression at age 24 years, assessed using the Clinical Interview Schedule Revised. Analyses were probit regressions between growth factors for alcohol dependence and consumption and depression, before and after adjustments for confounders: sex, housing tenure, maternal education, maternal depressive symptoms, parents' alcohol use, conduct problems at age 4 years, being bullied from age 12-16 years, and frequency of smoking cigarettes or cannabis. Adolescents were included in analyses if they had data from at least one timepoint for alcohol use and confounders. We included 3902 adolescents (2264 [58·0%] female; 1638 [42·0%] male) in our analysis, and 3727 (96·7%) of 3853 participants with data on ethnicity were White. After adjustments, we found a positive association between alcohol dependence at 18 years of age (latent intercept) and depression at 24 years of age (probit coefficient 0·13 [95% CI 0·02 to 0·25]; p=0·019), but no association between rate of change (linear slope) and depression (0·10 [-0·82 to 1·01]; p=0·84). There was no evidence of an association between alcohol consumption and depression (latent intercept probit coefficient -0·01 [-0·06 to 0·03]; p=0·60; linear slope 0·01 [-0·40 to 0·42]; p=0·96) after adjustments. Psychosocial or behavioural interventions that reduce the risk of alcohol dependence during adolescence could contribute to preventing depression in young adulthood. UK Medical Research Council and Alcohol Research UK (grant number MR/L022206/1).

Associations between psychosocial and lifestyle factors and biological age acceleration among long-term survivors of childhood cancer: A prospective study from the St. Jude Lifetime Cohort.

10049 Background: Survivors of childhood cancers may be at risk for premature, or accelerated, biological age aging, which is associated with cancer treatment exposures. However, life course theory and a growing body of evidence suggest that psychosocial and lifestyle factors may also contribute. The objective of this study was to explore associations between psychosocial and lifestyle factors and biological age acceleration in the St. Jude Lifetime Cohort. Methods: In this cross-sectional study, we applied physiology-based methods (Klemera-Doubal method and Phenotypic Age) and DNA methylation-based epigenetic clocks (Horvath’s, Hannum’s, Levine’s PhenoAge, GrimAge, and DunedinPACE clocks) to compare biological age acceleration, estimated as the residual from regressing biological age on chronological age, among survivors (n = 4,117) and age- and sex-frequency-matched non-cancer community controls (n = 606). We compared psychosocial and lifestyle factors between survivors and controls using t-tests/Wilcoxan rank sums, and chi-square. Multivariable linear regression was used to assess associations of self-reported smoking, alcohol use, physical activity, overweight/obesity, and depressive symptoms with biological age acceleration in survivors, adjusted for age, race/ethnicity, sex, education, and cancer treatment. Results: Childhood cancer survivors at a mean chronological age of 35.1 years (SD 10.2) were biologically older than controls according to KDM-BA, Phenotypic Age, Hannum’s clock, Levine’s PhenoAge clock, and DunedinPACE, with biological age acceleration ranging from 1.7-4.7 years (p &lt; 0.05.) A greater proportion of survivors reported elevated depressive symptoms (10.3% v. 8.7%), current smoking (17.8% v. 12.3%), &lt; 150 minutes of physical activity (47.3% v. 38.2%), and were overweight/obese (66.0% v. 59.9%) compared to controls (p’s &lt; 0.001). In survivors, &lt; 150 minutes of physical activity (B’s (difference in biological age acceleration [years]) = 1.10-2.68), current (B’s = 1.18-5.96) and former smoking (B’s = 2.53-4.29) were consistently associated with higher biological age acceleration across measures (p’s &lt; 0.05). Risky drinking and higher depressive symptoms were associated with higher biological age acceleration, but only for KDM (B = 1.26, p &lt; 0.021) and DunedinPACE measures (B = 0.15, p &lt; 0.001), respectively. Conclusions: Biological aging in childhood cancer survivors is associated with psychosocial and lifestyle factors. Interventions designed to optimize healthy behaviors and mitigate poor emotional health may have potential to prevent or remediate this phenotype in childhood cancer survivors.

Addressing the smoking-hypertension paradox in pregnancy: insight from a multiethnic US birth cohort.

Smoking during pregnancy has been associated with reduced risk of a spectrum of hypertensive (HTN) disorders, known as the "smoking-hypertension paradox." We sought to test potential epidemiologic explanations for the smoking-hypertension paradox. We analyzed 8510 pregnant people in the Boston Birth Cohort, including 4027 non-Hispanic Black and 2428 Hispanic pregnancies. Study participants self-reported tobacco, alcohol, cannabis, opioids, or cocaine use during pregnancy. We used logistic regression to assess effect modification by race/ethnicity, and confounding of concurrent substances on hypertensive disorders or prior pregnancy. We also investigated early gestational age as a collider or competing risk for pre-eclampsia, using cause-specific Cox models and Fine-Gray models, respectively. We replicated the paradox showing smoking to be protective against hypertensive disorders among Black participants who used other substances as well (aOR: 0.61, 95% CI: 0.41, 0.93), but observed null effects for Hispanic participants (aOR: 1.14, 95% CI: 0.55, 2.36). In our cause-specific Cox regression, the effects of tobacco use were reduced to null effects with pre-eclampsia (aOR: 0.81, 95% CI: 0.63, 1.04) after stratifying for preterm birth. For the Fine-Gray competing risk analysis, the paradoxical associations remained. The smoking paradox was either not observed or reversed after accounting for race/ethnicity, other substance use, and collider-stratification due to preterm birth. These findings offer new insights into this paradox and underscore the importance of considering multiple sources of bias in assessing the smoking-hypertension association in pregnancy.

Alcohol consumption and risks of more than 200 diseases in Chinese men

Alcohol consumption accounts for ~3 million annual deaths worldwide, but uncertainty persists about its relationships with many diseases. We investigated the associations of alcohol consumption with 207 diseases in the 12-year China Kadoorie Biobank of >512,000 adults (41% men), including 168,050 genotyped for ALDH2-rs671 and ADH1B-rs1229984, with >1.1 million ICD-10 coded hospitalized events. At baseline, 33% of men drank alcohol regularly. Among men, alcohol intake was positively associated with 61 diseases, including 33 not defined by the World Health Organization as alcohol-related, such as cataract (n = 2,028; hazard ratio 1.21; 95% confidence interval 1.09–1.33, per 280 g per week) and gout (n = 402; 1.57, 1.33–1.86). Genotype-predicted mean alcohol intake was positively associated with established (n = 28,564; 1.14, 1.09–1.20) and new alcohol-associated (n = 16,138; 1.06, 1.01–1.12) diseases, and with specific diseases such as liver cirrhosis (n = 499; 2.30, 1.58–3.35), stroke (n = 12,176; 1.38, 1.27–1.49) and gout (n = 338; 2.33, 1.49–3.62), but not ischemic heart disease (n = 8,408; 1.04, 0.94–1.14). Among women, 2% drank alcohol resulting in low power to assess associations of self-reported alcohol intake with disease risks, but genetic findings in women suggested the excess male risks were not due to pleiotropic genotypic effects. Among Chinese men, alcohol consumption increased multiple disease risks, highlighting the need to strengthen preventive measures to reduce alcohol intake.

Safety and tolerability of isoniazid preventive therapy for tuberculosis for persons with HIV with and without alcohol use: a single arm trial.

Isoniazid (INH) preventive therapy is recommended to prevent tuberculosis (TB) disease for persons with HIV (PWH), except for those with regular and heavy alcohol consumption, due to hepatotoxicity concerns. We aimed to quantify the incidence of severe INH-related toxicity among PWH with and without recent alcohol consumption. Prospective study of PWH receiving INH. We included PWH in southwest Uganda with recent (prior three months) (n = 200) or no (prior year) self-reported alcohol consumption (n = 101), on antiretroviral therapy, TB infected (≥5 mm on tuberculin skin test), and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2x the upper limit of normal (ULN). Grade 3+ INH-related toxicity was ALT or AST ≥5x the ULN or severe symptoms; we stopped IPT upon detection. Grade 2 INH-related toxicity was ALT or AST 2-5x the ULN or moderate symptoms. The cumulative incidence of Grade 3+ INH-related toxicity was 8.3% (95% CI: 5.7-12.0); all resolved after INH cessation. Incidence was 6.0% (95% CI: 3.1-10.2) among those reporting recent alcohol use and 12.9% (95% CI: 7.0-21.0) of those reporting no prior year alcohol use. We found no differences by baseline phosphatidylethanol-confirmed alcohol severity. The cumulative incidence of Grade 2 toxicities (without Grade 3+) was 21.7% (95% CI: 17.2-27.0); 25.0% (95% CI: 19.0-31.8) among those with recent alcohol use and 14.8% (95% CI: 8.1-23.9) among those with no prior year alcohol use. Alcohol use does not appear to increase risk for serious INH-related toxicity among PWH without significant liver enzyme elevations at baseline (≤2x ULN).

Causal associations of alcohol with ECG-derived cardiovascular phenotypes in chinese adults

Abstract Funding Acknowledgements Type of funding sources: None. Background Heavy alcohol consumption is associated with increased risk of stroke, but its role, especially moderate drinking, in other types of cardiovascular disease (CVD) remains inconclusive. Understanding how alcohol intake affects cardiac traits measured by electrocardiogram (ECG) can improve our understanding of the relationships between alcohol intake and risk of different types of CVD. Purpose This study aims to assess the causal associations of alcohol and ECG-derived cardiovascular phenotypes in Chinese adults, where two genetic variants which alter alcohol metabolism and greatly affect alcohol intake can be used in a Mendelian randomisation approach. Methods The prospective China Kadoorie Biobank recruited 512,715 adults from ten diverse regions in China between 2004-2008 and recorded baseline alcohol use and other characteristics. 151,035 participants were genotyped for two genetic variants that affected alcohol metabolism (ALDH2-rs671 and ADH1B-rs1229984), and 25,041 participants had ECG measurements taken at the 2013-2014 resurvey, broadly defined into phenotypes (ischaemia, left ventricular hypertrophy (LVH), arrhythmia) and continuous traits. Self-reported alcohol intake (conventional analysis) and genotype-predicted alcohol intake (genetic analysis) were related to the odds of ECG-derived cardiovascular phenotypes and the mean values of ECG continuous traits using multivariable logistic and linear regression models respectively. Results Among men, 35.0% drank alcohol regularly. There was a J-shaped association between ECG-defined ischaemia with self-reported alcohol intake, with a clear dose-response among current drinkers (OR 1.56, 95%CI 1.25-1.94 per 280g/week increase in alcohol intake (Figure 1)). However, there was no clear causal association in genetic analysis (1.02, 0.82-1.27 per 280g/week (Table 1)). There were no associations between alcohol intake and LVH or arrhythmia in conventional or genetic analysis. Among women, only 2.3% drank alcohol regularly, and there were no clear associations between alcohol intake and ECG measurements and derived phenotypes in either the conventional or genetic analyses. Genotype-predicted alcohol intake was associated with smaller P, QRS, and T-axis, and longer QRS and QTc duration in men, and marginally associated with ventricular rate in women. Conclusion This study found no clear causal associations of alcohol with ECG-derived cardiovascular phenotypes and continuous traits, and no evidence of a cardioprotective effect of moderate drinking on myocardial ischaemia.

High- versus low-intensity internet interventions for alcohol use disorders (AUD): A two-year follow-up of a single-blind randomized controlled trial

Alcohol Use Disorders (AUD) are widespread and have serious consequences, but are among the most undertreated mental disorders. Internet interventions have been found effective in treating AUD, but we know little about long-term outcomes, two years or more after treatment. This study explored 12- and 24-month outcomes in alcohol consumption following initial 6-month improvements after a therapist-guided high-intensity internet intervention and an unguided low-intensity internet intervention among individuals with alcohol use disorder. Between-group comparisons were analyzed, as well as within-group comparisons with (1) pre-treatment measurements (2) post-treatment measurements. Participants consisted of a general population sample of internet help-seekers in Sweden. A total of 143 adults (47% men) with a score of 14 (women)/16 (men) or more on the Alcohol Use Disorders Identification Test, alcohol consumption of 11 (women)/14 (men) or more standard drinks the preceding week and ≥ 2 DSM-5 alcohol use disorder (AUD) criteria based on a diagnostic interview were included. The high- and low-intensity internet interventions (n = 72 and n = 71 respectively) consisted of modules based on relapse prevention and cognitive-behavioral therapy. The primary outcome was self-reported alcohol consumption in the preceding week measured as (1) number of standard drinks and (2) number of heavy drinking days. Attrition from self-reported questionnaires was 36% at the 12-month follow-up and 53% at the 24-month follow-up. No significant between-group differences occurred in outcomes at either long-term follow-up. Regarding within-group differences, compared to pre-treatment, alcohol consumption was lower in both high- and low-intensity interventions at both long-term follow-ups [within-group standard drinks effect sizes varied between g = 0.38–1.04 and heavy drinking days effect sizes varied between g = 0.65–0.94]. Compared to post-treatment, within-group alcohol consumption in the high intensity intervention increased at both follow-ups; for the low-intensity intervention, within-group consumption decreased at 12-month follow-up, but did not differ compared to post-treatment at 24 months. Both high- and low-intensity internet interventions for AUD were thus associated with overall reductions in alcohol consumption at long term follow-ups, with no significant differences between the two. However, conclusions are hampered by differential and non-differential attrition.

Resting state connectivity in people living with HIV before and after stopping heavy drinking.

Heavy alcohol use in people living with HIV (PLWH) has widespread negative effects on neural functioning. It remains unclear whether experimentally-induced reduction in alcohol use could reverse these effects. We sought to determine the effects of 30-days drinking cessation/reduction on resting state functional connectivity in people with and without HIV. Thirty-five participants (48.6% PLWH) demonstrating heavy alcohol use attempted to stop drinking for 30 days via contingency management (CM). MRI was acquired at baseline and after thirty days, and functional connectivity across five resting-state fMRI (rsfMRI) networks was calculated with the Conn toolbox for Matlab and examined in relation to transdermal alcohol concentration (TAC) recorded by the ankle-worn secure continuous remote alcohol monitor (SCRAM) and self-reported alcohol use (timeline follow-back; TLFB). Associations between alcohol use and reduction, HIV status, functional connectivity, and change in functional connectivity across five major rsfMRI networks were determined relative to the pre- and post-CM timepoints. Baseline resting-state functional connectivity was not significantly associated with average TAC-AUC during the pre-CM period, though higher self-reported alcohol use over the preceding 30 days was significantly associated with higher baseline connectivity within the Dorsal Attention Network (DAN; p-FDR < 0.05). Baseline connectivity within the Salience network was significantly negatively related to objective drinking reduction after intervention (DAN; p-FDR < 0.05), whereas baseline connectivity within the Limbic network was positively associated with self-reported drinking reduction (p-FDR < 0.05). Change in between-networks functional connectivity after intervention was significantly positively associated with biosensor-confirmed drinking reduction such that higher reduction was associated with stronger connectivity between the limbic and fronto-parietal control networks (p-FDR < 0.05). PLWH with lower DAN connectivity at baseline demonstrated poorer alcohol reduction than those with higher DAN connectivity at baseline. Lower resting-state functional connectivity of the Salience network significantly predicted stronger drinking reduction across all participants, suggesting a potential biomarker for reduced susceptibility to the environmental and social cues that often make alcohol use reduction attempts unsuccessful. Increased between-networks connectivity was observed in participants with higher alcohol reduction after CM, suggesting a positive benefit to brain connectivity associated with reduced drinking. PLWH with lower baseline DAN connectivity may not benefit as greatly from CM for alcohol reduction.

Racial and Ethnic Bias in the Diagnosis of Alcohol Use Disorder in Veterans.

Studies show that racially and ethnically minoritized veterans have a higher prevalence of alcohol use disorder (AUD) than White veterans. The investigators examined whether the relationship between self-reported race and ethnicity and AUD diagnosis remains after adjusting for alcohol consumption, and if so, whether it varies by self-reported alcohol consumption. The sample included 700,012 Black, White, and Hispanic veterans enrolled in the Million Veteran Program. Alcohol consumption was defined as an individual's maximum score on the consumption subscale of the Alcohol Use Disorders Identification Test (AUDIT-C), a screen for unhealthy alcohol use. A diagnosis of AUD, the primary outcome, was defined by the presence of relevant ICD-9 or ICD-10 codes in electronic health records. Logistic regression with interactions was used to assess the association between race and ethnicity and AUD as a function of maximum AUDIT-C score. Black and Hispanic veterans were more likely than White veterans to have an AUD diagnosis despite similar levels of alcohol consumption. The difference was greatest between Black and White men; at all but the lowest and highest levels of alcohol consumption, Black men had 23%-109% greater odds of an AUD diagnosis. The findings were unchanged after adjustment for alcohol consumption, alcohol-related disorders, and other potential confounders. The large discrepancy in the prevalence of AUD across groups despite a similar distribution of alcohol consumption levels suggests that there is racial and ethnic bias, with Black and Hispanic veterans more likely than White veterans to receive an AUD diagnosis. Efforts are needed to reduce bias in the diagnostic process to address racialized differences in AUD diagnosis.

Impact of increased alcohol consumption during the COVID-19-related lockdowns on admissions with liver disease, gastrointestinal bleeding and pancreatitis in Melbourne, Victoria.

This audit collates data on alcohol-related gastrointestinal (GI) admissions at Monash Health, Victoria, during the prolonged, coronavirus disease 2019 (COVID-19)-related lockdown July to October 2020 compared with the same periods in 2019 and 2021. We found a 58% increase in admissions in 2020 and a 16% increase in 2021, which also increased disproportionately to overall health service emergency presentations. Self-reported alcohol consumption increased by 2.5-fold and was greatest in 2020. Clinical severity was unchanged and cirrhosis was the only factor associated with severe disease. This study suggests an association between the pandemic-related lockdown, alcohol consumption and alcohol-related GI hospitalisation. Our study provides support for resourcing and adapting alcohol and other drug services during and beyond the COVID-19 lockdown.

Investigating the Relative Influence of Romantic Sex Partners and Close Friends on Adolescent Alcohol and Marijuana Use.

A large body of research has identified peer exposure as a key factor driving adolescent substance use. However, findings on the role of sex partners are less robust and mixed. This study aims to fill this gap by examining the independent contribution of close friends' and sex partners' alcohol and marijuana use on adolescents' use of these substances. A secondary data analysis of social network data collected in 2000-2002 from a household sample of African American youth (14-19years old) in the Bayview and Hunter's Point neighborhoods of San Francisco was conducted. Index participants and their nominated close friends and romantic sex partners (N = 104 triads) self-reported recent alcohol and marijuana use (defined as any use in the past 3months). Generalized estimated equations were used to estimate the independent association between adolescent's recent substance use and their friend's and sex partner's use. Adolescents with a marijuana-using romantic sex partner had a nearly six-fold higher odds of using marijuana compared to adolescents with a non-using partner, controlling for close friend's marijuana use and other confounders [OR:5.69, 95%CI: 1.94, 16.7]; no association with close friend's marijuana use was found. A similar pattern was observed for alcohol use. Adolescents with an alcohol-using romantic sex partner had increased odds of using alcohol compared to adolescents with a non-using partner, controlling for close friend's alcohol use and other confounders [OR:2.40, 95%CI: 1.02, 5.63]; no association with close friend's alcohol use was found. Romantic sex partners may play a unique and significant role in adolescent substance use. Peer-focused interventions may be more effective if they consider romantic sex partners. Future research should consider the role of romantic sex partners in changing social context related to substance use from adolescence to young adulthood.

Phosphatidylethanol and self-reported alcohol consumption among people living with HIV in Thai Nguyen, Vietnam.

Phosphatidylethanol (PEth) is a biomarker for recent alcohol consumption that would ideally validate self-reported alcohol consumption behaviors. We assessed the relationship between PEth and several self-reported alcohol consumption metrics among hazardous alcohol users living with HIV in Vietnam. Participants in a three-arm randomized controlled trial assessing two alcohol interventions reported recent alcohol consumption on a 30-day timeline follow-back interview and had a PEth assessment at enrollment, 3 months, and 12 months of the study follow-up. We examined the relationship between self-reported alcohol consumption and quantitative PEth results using Spearman rank correlation and receiver-operating characteristic (ROC) curves to calculate the area under the curve (AUC). We assessed associations between categorical PEth results and self-reported drinking behaviors using prevalence ratios calculated with regression models and generalized estimating equations. Among 1221 study visits (n = 439 participants; 425 (97%) men), the median PEth result was 71 ng/mL (Interquartile range (IQR): 20, 212), and participants reported a median of 11 (IQR: 4, 24) drinking days and 25 (IQR: 8, 71) standard drinks in the previous 28 days. Quantitative PEth results were moderately correlated with drinking days (ρ = 0.26-0.35) and standard drinks consumed (ρ = 0.23-0.38) in the same period. AUCs ranged from 0.54 (any binge drinking in the past 28 days) to 0.82 (any alcohol consumed in the past 21 days). Positive PEth results (≥50 ng/mL) were 2.24 (95% Confidence Interval [CI]: 1.49, 3.35) times as prevalent among participants who reported drinking in the previous 28 days compared with those who did not. Although PEth values and self-reported alcohol use were correlated, the observed associations were modest. Additional research into the dynamics of PEth production and elimination is warranted across diverse populations to better understand how PEth assessments can best be integrated into research and clinical care.

Frequency and Timing of Sent and Received Alcohol-Related Text Messages: Associations with Alcohol Use and Related Consequences among Adolescents and Young Adults

Background: Research supports the notion that adolescents and young adults communicate about alcohol via text messages and that this form of communication is associated with alcohol use. However, little is known about how this compares to social media content sharing or about the timing of sending and receiving alcohol-related text messages and associations with alcohol-related outcomes. The present study aimed to 1) document whether adolescents and young adults are willing to share alcohol content via text messages they are not willing to share via social media, and 2) determine associations between frequency and timing of alcohol-related text messages (both sent and received) with self-reported alcohol use and consequences. Methods: A total of 409 participants (63.30% female; age 15–25, M = 21.10, SD = 2.69) completed a baseline survey as part of a larger study. Results: While 84.50% of participants reported that they were willing to send text messages referencing alcohol that they would not share on social media, 90.00% reported that their friends would be willing to do so. Results of negative binomial regressions indicated that sending and receiving more alcohol-related text messages per week and sending and receiving text messages before and during drinking, but not after drinking, were positively associated with typical drinks per week. Neither frequency of sending and receiving text messages or timing (before, during, after) were associated with negative consequences. Conclusions: Results suggest that frequency and timing of alcohol-related text messaging may provide insights into alcohol consumption patterns among adolescents and young adults and warrants future research.

Prevalence of probable mental, neurological and substance use conditions and case detection at primary healthcare facilities across three districts in Ghana: findings from a cross-sectional health facility survey

BackgroundFew studies have examined the prevalence of mental, neurological and substance use (MNS) conditions, case detection and treatment in primary healthcare in rural settings in Africa. We assessed prevalence and case detection at primary healthcare facilities in low-resource rural settings in Ghana.MethodsA cross-sectional survey was conducted at the health facility level in three demonstration districts situated in Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region) in Ghana. The study participants were resident adult (> 17 years) out-patients seeking healthcare at primary care facilities in each of the three demonstration districts. Data were collected on five priority MNS conditions: depression, psychosis, suicidal behaviour, epilepsy and alcohol use disorders.ResultsNine hundred and nine (909) people participated in the survey. The prevalence of probable depression was 15.6% (142/909), probable psychotic symptoms was 12% (109/909), probable suicidal behaviour was 11.8% (107/909), probable epilepsy was 13.1% (119/909) and probable alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, self-reported psychotic symptoms, epilepsy and alcohol use disorders (AUD) ranged from 94.4 to 99.2%, and was similar across study districts. Depression was associated with self-reported psychotic symptoms (RR: 1.68; 95% CI: 1.12–1.54). For self-reported psychotic symptoms, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39–0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02–0.84). Increased risk of suicidal behaviour was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27–4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93–5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20–0.90) was associated with reduced risk of epilepsy. Being female (RR: 0.19; 95% CI: 0.12–0.31) and having a tertiary education (RR: 0.27; 95% CI: 0.08–0.92) were associated with reduced risk of AUD.ConclusionsOur study found a relatively high prevalence of probable MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage MNS conditions.