ALCOHOL REPORTS

Tuesday, May 21, 2013

Genetic influences on alcohol use across stages of development: GABRA2 and longitudinal trajectories of drunkenness from adolescence to young adulthood

Longitudinal analyses allow us to understand how genetic risk unfolds across development, in a way that is not possible with cross-sectional analyses of individuals at different ages. This has received little attention in genetic association analyses. In this study, we test for genetic effects of GABRA2, a gene previously associated with alcohol dependence, on trajectories of drunkenness from age 14 to 25.

We use data from 1070 individuals who participated in the prospective sample of the Collaborative Study on the Genetics of Alcoholism, in order to better understand the unfolding of genetic risk across development. Piecewise linear growth models were fit to model the influence of genotype on rate of increase in drunkenness from early adolescence to young adulthood (14–18 years), the change in drunkenness during the transition to adulthood (18–19 years) and the rate of change in drunkenness across young adulthood (≥ 19 years).

Variation in GABRA2 was associated with an increase in drunkenness that occurred at the transition between adolescence and adulthood. The genotypic effect was more pronounced in females.

These analyses illustrate the importance of longitudinal data to characterize how genetic effects unfold across development. The findings suggest that transitions across important developmental periods may alter the relative importance of genetic effects on patterns of alcohol use. The findings also suggest the importance of considering gender when evaluating genetic effects on drinking patterns in males and females.

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Request Reprint E-Mail: ddick@vcu.edu

World Health Organization to tackle non-communicable disease

The 66th World Health Assembly opened in Geneva today. One of the main issues is how the increasing burden of non-communicable diseases (NCD) will be handled in the future. Referring to the difference between malaria and NCDs the Director General of WHO, Dr. Margaret Chan, in her opening speech stated that “Mosquitoes do not have front groups, and mosquitoes do not have lobbies.” > > > > Read More

Cohort Study of Risk Factors for Breast Cancer in Post Menopausal Women

The present study assessed more than 800 potential risk factors to identify new predictors of breast cancer and compare the independence and relative importance of established risk factors.

Data were collected by the Women's Health Initiative and included 147,202 women ages 50 to 79 who were enrolled from 1993 to 1998 and followed for 8 years. Analyses performed in 2011 and 2012 used the Cox proportional hazard regression to test the association between more than 800 baseline risk factors and incident breast cancer.

Baseline factors independently associated with subsequent breast cancer at the p<0 .001="" age="" and="" aspiration="" at="" biopsies="" births="" breast="" cancer="" decreasing="" digitalis="" estrogen="" family="" fewer="" greater="" history="" in="" level="" live="" menopause="" of="" order="" progestin="" significance="" statistical="" strong="" tenderness="" thyroid="" use="" weight="" were="">alcohol intake, white race, not restless, no vaginal dryness, relative with prostate cancer, colon polyps, smoking, no breast augmentation, and no osteoporosis. Risk factors previously reported that were not independently associated with breast cancer in the present study included socioeconomic status, months of breast feeding, age at first birth, adiposity measures, adult weight gain, timing of initiation of hormone therapy, and several dietary, psychological, and exercise variables. Family history was not found to alter the risk associated with other factors.

These results suggest that some risk factors not commonly studied may be important for breast cancer and some frequently cited risk factors may be relatively unimportant or secondary.

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Impaired odor identification in children with histories of heavy prenatal alcohol exposure

Prenatal alcohol exposure can lead to behavioral and cognitive impairments across multiple domains. Many of the brain regions impacted by prenatal alcohol exposure are also linked with olfactory processing, and odor identification deficits have been documented in certain neurological disorders associated with these brain regions.

As odor identification following prenatal alcohol exposure is not well studied, we compared odor identification in children with prenatal exposure to alcohol (AE) to typically developing controls (CON) (N = 16/group). It was hypothesized that children in the AE group would perform more poorly than children in the CON group on the San Diego Odor Identification Test, an identification test of 8 common household odorants.

Children exposed to alcohol during prenatal development were significantly impaired in olfactory identification (M = 5.95, SE = 0.37) compared to typically developing controls (M = 7.24, SE = 0.37).

These findings confirmed the hypothesis that prenatal exposure to alcohol is associated with odor identification deficits, and suggest that further research is warranted to identify the mechanisms underlying these deficits, the integrity of brain areas that are involved, and to determine whether olfactory performance might contribute to better identification of children at risk for behavioral and cognitive deficits.

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Request Reprint E-Mail: cmurphy432000@yahoo.com

Monday, May 20, 2013

NIAAA Clinician's Guide Online Training

Contents
Clinician Support and Training

Free CME/CE Credits through Medscape®

VIDEO CASES:
Helping Patients Who
Drink Too Much
Interactive, engaging course with four 10-minute, realistic video cases

Patient Education

Alcohol News - 20/2013

Science Nordic (Sweden) - Sick Swedes keep on swigging

Even though alcohol consumption can delay a return to work, a new survey shows that Swedes like their liquor, particularly at sporting events, and even when they are on sick leave.

Addiction (Norway) - The collectivity of drinking cultures: is the theory applicable to African settings?

Skog's theory of collective drinking behaviour implies that countries with a strict informal social control of drinking alcohol would not exhibit ‘collective displacement’ of consumption (a linear association between population mean consumption and percentile values across the full range of the distribution), as do countries with less informal social control.

Postimees (Estonia) - Consumption of alcohol in Estonia did not change last year – study

The consumption of alcohol by residents of Estonia did not change in 2012 compared to the previous year, averaging 10.6 liters of pure alcohol per capita, it appears from the fresh alcohol market survey by the Estonian Institute of Economic Research (EKI).

Al-Arabiya (Egypt) - Egypt faces social pressure to end alcohol sales

Egypt’s liquor stores are under growing pressure to stop selling alcohol, they say, not from the country’s Islamist government, but from society itself.

Healio - Adolescents' first drink tied to alcohol-related problems in adulthood

Adolescents who have their first drink during puberty are more likely to develop frequent drinking habits later in life, results from a new study show.

Newstalk 106-108 fm (Ireland) - Irish Alcohol consumption drops by 20% in 12 years

The alcohol consumption in Ireland has fallen by 20% over 12 years, with the idea that all Irish people now drink to excess now believed to be far from the truth.

The Guardian (UK) - Parliament too alcohol fuelled, say MPs

One in four MPs thinks parliament, where the price of alcohol is subsidised, has an unhealthy drinking culture.

EurActiv (EU) - EU's alcohol strategy needs further push, MEPs say

Europeans are the heaviest drinkers in the world and in some EU member states, such as Luxembourg and the Czech Republic, the alcohol consumption is 2.5 times more than what an average person in the world drinks. The Commission's new strategy on alcohol, to be published later this year, has to better address the issue of alcohol-related harm, MEPs say.

TIME (USA) - Safety Board Recommends Defining Legally Drunk With Lower Blood Alcohol Level

The government wants to drop the blood alcohol limit for being legally drunk in order to avoid drunk driving fatalities.

TIME (USA) - Task Force Recommends Screening All Adults for Alcohol Misuse

Questions about alcohol use should be a part of regular physical checkups, according to a panel of experts.

News-Medical.net - Alcohol advertising pre-disposes young people to have favorable attitudes toward drinking

The alcohol industry has developed and regulates its own guidelines regarding advertising. A new study has investigated the ability of panels to find consensus around code violations.

FRANCE 24 (Turkey) - Turkish parliament considers bill limiting alcohol sales

Turkey's parliament is reviewing a bill that would restrict alcohol sales, including banning purchases at educational, sports and health institutions. The bill has the beverage industry worried, including Diageo, owner of Turkey’s leading raki brand.

Examiner.com (USA) - Study: Female college students abuse alcohol more than men

New research shows that female college student drinkers exceed National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for weekly drinking more frequently than their male counterparts.

WSYM-TV - New Study Finds Alcohol Increases Risk of Breast Cancer

A lot of us unwind after a tough day with a drink, but sobering new research says just a few of those a week, could put some women's health at risk.

Medical Daily - Mixing Excessive Alcohol And Smoking Can Make Your Brain Old Before Its Time

A new study found that heavy drinkers who smoke excessively develop problems with memory, thinking and problem solving skills earlier than those who do not.

Tribune-Review (USA) - Hagel believes alcohol is ‘a very big factor’ in many of military’s sexual assault and harassment cases

Defense Secretary Chuck Hagel on Friday ordered the military to recertify all 25,000 people involved in programs designed to prevent and respond to sexual assault, an acknowledgement that assaults have escalated beyond the Pentagon's control.

MADD - Get the Facts on Privatized Alcohol Sales-MADD Canada Releases Newly-Updated Alcohol Policy Paper

MADD Canada is pleased to share its newly-updated alcohol policy paper, "Provincial Liquor Boards: Meeting the Best Interests of Canadians." The paper supports the role of provincial liquor boards and outlines the negative health and public safety impacts associated with privatized alcohol sales.

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Acute Alcohol Intoxication Characteristics in Children

To describe clinical, mental and physical signs in children with different severity acute alcohol intoxication (AAI) determined either by serum alcohol concentration (SAC) or by blood alcohol concentration (BAC) to study the diagnostic performance characteristics of clinical assessment and to establish the ratio of SAC:BAC in children.

Data were analysed from 256 children aged 8.4–17.9 years who were hospitalized at Estonia's two children's hospitals over a 3-year period. In each case, the on-call paediatrician completed a special form about the clinical, mental (consciousness, balance and speech) and physical (muscle tone, blood pressure, pulse and body temperature) signs of AAI. Blood samples were drawn for measurements of SAC and BAC. Diagnostic performance characteristics (sensitivity, specificity, efficiency) of the clinical assessments and the SAC:BAC ratio were calculated.

The most correctly described signs in children in different SAC groups were consciousness (r_s = 0.16) and speech (r_s = 0.13) (P < 0.0001). The severity of alteration of consciousness and degrees of disturbance in balance and speech were positively correlated with SAC (P < 0.001). The clinical judgment matched better with AAI determined by SAC rather than by BAC with the mean efficiency. The mean ratio between SAC and BAC was 1.19 ± 0.13 (P < 0.001) in children.

The level of consciousness is the leading sign in the clinical evaluation of children with AAI and correlates well with SAC. The severity of AAI judged by clinical assessment matched better with AAI severity stages determined by SAC than by BAC. For legal cases where BAC is required, the SAC:BAC ratio of 1.19:1 should be used in children regardless of their gender or age.

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Request Reprint E-Mail:      mailis.tonisson@ut.ee

Relationship Between Blood Alcohol Concentration and Observable Symptoms of Intoxication in Patients Presenting to an Emergency Department

Clinical and medico-legal decisions often require knowledge of alcohol impairment that is not necessarily revealed by an individual's appearance, and in turn, may not necessarily reflect level of blood alcohol. This study compares clinical signs and symptoms with measured and estimated blood alcohol concentrations (BACs).

Individuals (n = 384) perceived to be under the influence of alcohol at presentation to an emergency department were assessed by physicians and nurses for clinical features of alcohol intoxication (alcohol symptom checklist, ASC), who were asked to estimate the patient's BAC. Relation to measured BACs was assessed by correlation.

BACs ranged from 0 to 418 mg/100 ml. The correlation between the estimated BAC and measured BAC was r = 0.513. Measured BAC correlated with ASC r = 0.250. In subjects without a history of chronic drinking (n = 134) there was a better (P < 0.05) correlation with the ASC score (r = 0.363) versus measured BAC compared with that for chronic drinkers (r = 0.154). The positive predictive value of estimating BAC at or above a particular BAC cut-off decreased from 93.2% at 100 mg/100 ml to 37.7% at 300 mg/100 ml (P < 0.05).

Measured BAC does not correlate well with the outward physical signs of intoxication, especially for chronic drinkers. There is a need for further education on how tolerance masks clinical signs of intoxication for the chronic drinker. BACs should be measured especially in the obtunded where no history (symptoms) can be given by the patient.

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Request Reprint E-Mail: apple004@umn.edu

Prevalence of Hepatitis C Virus Infection in Alcoholic Patients: Cohort Study and Systematic Review

Prevalence of chronic hepatitis C virus (HCV) infection among alcoholics is thought to be higher than in the general population, although prevalence rates reported are quite variable. Our study is aimed to analyze HCV prevalence in a cohort of alcoholics and to perform a systematic review on this topic.

A total of 396 alcoholic patients consecutively referred to our Alcoholism Unit were included. HCV infection status and other clinical variables were recorded for each patient. Variables associated with HCV infection were analyzed by means of logistic regression. Additionally, we performed a systematic review focused on previous studies on this topic.

Among our alcoholic patients, 14 of them (3.53%) had chronic HCV infection. Variables independently associated with HCV infection were female gender, injection drug use (IDU) and the presence of alcoholic liver disease (ALD). Twenty-four studies analyzing HCV prevalence in alcoholic patients were included in our systematic review, showing prevalence rates of HCV infection ranging from 2.1 to 51% and an average weighted prevalence of 16.32%.

In our series, the prevalence rate of chronic HCV infection among alcoholic patients is lower than previously reported, which is probably explained by the relatively low number of patients with ALD or IDU in our sample. Prevalence rates previously published are quite different and the presence of ALD and/or IDU can act as confounding factors for HCV prevalence among alcoholics.

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Request Reprint E-Mail: mmarcos@usal.es

Effect of Transferrin Glycation on the Use of Carbohydrate-Deficient Transferrin as an Alcohol Biomarker

Measurement of an alcohol-induced shift in the serum transferrin glycosylation pattern, termed carbohydrate-deficient transferrin (CDT), is used as a biomarker for sustained high alcohol consumption. The present work examined whether non-enzymatic reaction of transferrin with glucose (glycation) might interfere with the use of CDT as an alcohol biomarker.

The blood specimens were leftover volumes from the routine sample pool. Plasma and serum were collected among samples submitted for hemoglobin A1c (HbA1c) and CDT testing. Quantification of individual transferrin glycoforms in percentage of total transferrin was performed by an HPLC candidate CDT reference method.

Incubating serum spiked with 20 or 200 mmol/l glucose caused time- and dose-dependent changes in the chromatographic profile of transferrin glycoforms, resulting in gradually wider peaks and reduced relative amounts of disialo- and trisialotransferrin. No similar chromatographic effects were seen in samples collected from diabetic patients with elevated HbA1c (>68 mmol/mol) values. These samples instead showed slightly higher mean %disialotransferrin levels (1.21%) compared with low HbA1c samples, pointing at a higher alcohol consumption level in the former group. Altogether ∼5% of the CDT values exceeded the cutoff. There was no significant difference in phosphatidylethanol (PEth) levels between the high and low HbA1c samples, but several (∼14%) showed elevated PEth concentrations.

Glycation of serum transferrin in vivo was indicated to differ from that in vitro, and suggested not to interfere with %CDT testing by the HPLC method. The results indicated that CDT and PEth are useful as objective, complementary alcohol biomarkers to identify risky drinking also in diabetic subjects.

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Request Reprint E-Mail: anders.helander@ki.se

A report into the effectiveness of civil commitment in the treatment of alcoholism, and its suitability for implementation the Northern Territory

Long-term harmful use of alcohol remains a large problem in the Northern Territory and a model of civil commitment for ‘problem drinkers’ has been proposed. This planned system has been strongly criticised on a number of ethical, moral and legal grounds.
This report explores existing evidence from studies on both civil and forensic mandatory rehabilitation, in order to evaluate if it would be an effective form of treatment for alcohol dependent persons, and appropriate to implement such a system in the Northern Territory.
The report concludes that given the lack of evidence for the effectiveness of civil commitment and the potentially significant impact upon the freedoms of individuals, families and the communities, it could be difficult to justify the
proposal.

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Characterization of Two Mutations, M287L and Q266I, in the α1 Glycine Receptor Subunit That Modify Sensitivity to Alcohols

Glycine receptors (GlyRs) are inhibitory ligand-gated ion channels. Ethanol potentiates glycine activation of the GlyR, and putative binding sites for alcohol are located in the transmembrane (TM) domains between and within subunits.

To alter alcohol sensitivity of GlyR, we introduced two mutations in the GlyR α1 subunit, M287L (TM3) and Q266I (TM2). After expression in Xenopus laevis oocytes, both mutants showed a reduction in glycine sensitivity and glycine-induced maximal currents. Activation by taurine, another endogenous agonist, was almost abolished in the M287L GlyR. The ethanol potentiation of glycine currents was reduced in the M287L GlyR and eliminated in Q266I. Physiological levels of zinc (100 nM) potentiate glycine responses in wild-type GlyR and also enhance the ethanol potentiation of glycine responses. Although zinc potentiation of glycine responses was unchanged in both mutants, zinc enhancement of ethanol potentiation of glycine responses was absent in M287L GlyRs. The Q266I mutation decreased conductance but increased mean open time (effects not seen in M287L).

Two lines of knockin mice bearing these mutations were developed. Survival of homozygous knockin mice was impaired, probably as a consequence of impaired glycinergic transmission. Glycine showed a decreased capacity for displacing strychnine binding in heterozygous knockin mice. Electrophysiology in isolated neurons of brain stem showed decreased glycine-mediated currents and decreased ethanol potentiation in homozygous knockin mice.

Molecular models of the wild-type and mutant GlyRs show a smaller water-filled cavity within the TM domains of the Q266I α1 subunit. The behavioral characterization of these knockin mice is presented in a companion article (J Pharmacol Exp Ther 340:317–329, 2012).

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The Basic Property of Lys385 Is Important for Potentiation of the Human α1 Glycine Receptor by Ethanol

Ethanol alters the function of several members of the Cys-loop ligand-gated ion channel superfamily. Recent studies have shown that the sensitivity of the α1 glycine receptor (GlyR) to ethanol can be affected by the state of G protein activation mediated by the interaction of Gβγ with intracellular amino acids in the GlyR.

Here, we evaluated the physicochemical property of Lys385 that contributes to ethanol modulation by using mutagenesis, patch-clamp, and biochemical techniques.

A conserved substitution (K385R) did not affect either the apparent glycine EC₅₀ (40 ± 1 versus 41 ± 0.5 μM) or the ethanol-induced potentiation (53 ± 5 versus 46 ± 5%) of the human α1 GlyR. On the other hand, replacement of this residue with glutamic acid (K385E), an acidic amino acid, reduced the potentiation of the GlyR to 10 ± 1%. Furthermore, mutations with a hydrophobic leucine (K385L), a hydrogen bond donor glutamine (K385Q), or a neutral residue (K385A) also reduced ethanol modulation.

Finally, substitution by a large and hydrophobic residue (K385F) and deletion of 385 (Lys385_) reduced ethanol modulation to 10 ± 4 and 17 ± 0.4%, respectively.

Experiments using dynamic cysteine substitution with a methanethiosulfonate reagent and homology modeling indicate that the basic property and the position of Lys385, probably because of its interaction with Gβγ, is critical for ethanol potentiation of the receptor.

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The TM2 6′ Position of GABAA Receptors Mediates Alcohol Inhibition

Ionotropic GABA_A receptors (GABA_ARs), which mediate inhibitory neurotransmission in the central nervous system, are implicated in the behavioral effects of alcohol and alcoholism. Site-directed mutagenesis studies support the presence of discrete molecular sites involved in alcohol enhancement and, more recently, inhibition of GABA_ARs.

We used Xenopus laevis oocytes to investigate the 6′ position in the second transmembrane region of GABA_ARs as a site influencing alcohol inhibition. We asked whether modification of the 6′ position by substitution with larger residues or methanethiol labeling [using methyl methanethiosulfonate (MMTS)] of a substituted cysteine, reduced GABA action and/or blocked further inhibition by alcohols.

Labeling of the 6′ position in either α2 or β2 subunits reduced responses to GABA. In addition, methanol and ethanol potentiation increased after MMTS labeling or substitution with tryptophan or methionine, consistent with elimination of an inhibitory site for these alcohols. Specific alcohols, but not the anesthetic etomidate, competed with MMTS labeling at the 6′ position. We verified a role for the 6′ position in previously tested α2β2 as well as more physiologically relevant α2β2γ2s GABA_ARs.

Finally, we built a novel molecular model based on the invertebrate glutamate-gated chloride channel receptor, a GABA_AR homolog, revealing that the 6′ position residue faces the channel pore, and modification of this residue alters volume and polarity of the pore-facing cavity in this region.

These results indicate that the 6′ positions in both α2 and β2 GABA_AR subunits mediate inhibition by short-chain alcohols, which is consistent with the presence of multiple counteracting sites of action for alcohols on ligand-gated ion channels.

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Saturday, May 18, 2013

RSA 36TH ANNUAL SCIENTIFIC MEETING

RSA 36TH ANNUAL SCIENTIFIC MEETING
JUNE 22–26, 2013 – ORLANDO, FLORIDA

RSA PROGRAM OUTLINE (PDF)

Neurocognition in 1-Month-Abstinent Treatment-Seeking Alcohol-Dependent Individuals: Interactive Effects of Age and Chronic Cigarette Smoking

Increasing age and chronic cigarette smoking are independently associated with adverse effects on multiple aspects of neurocognition in those seeking treatment for alcohol use disorders. However, the potential interactive effects of age and cigarette smoking on neurocognition in early abstinent alcohol-dependent individuals (ALC) have not investigated.

Cross-sectional performances of never-smoking healthy comparison participants (nvsCOM; n = 39) and 1-month-abstinent, treatment-seeking, never-smoking (nvsALC; n = 30), former-smoking (fsALC; n = 21), and actively smoking (asALC; n = 68) ALC were compared on a comprehensive neurocognitive battery. Domains of functioning evaluated were cognitive efficiency, executive functions, fine motor skills, general intelligence, learning and memory, processing speed, visuospatial functions and working memory. Participants were between 26 and 71 years of age at the time of assessment.

asALC showed steeper age-related effects than nvsCOM on the domains of visuospatial learning, auditory-verbal memory, cognitive efficiency, executive functions, processing speed, and fine motor skills. In pairwise comparisons, fsALC and asALC performed more poorly than both nvsCOM and nvsALC on multiple domains; nvsCOM and nvsALC showed no significant differences. Domain scores for the ALC groups generally fell in the low-to-high-average range of functioning. A clinically significant level of impairment was apparent in only 25% of ALC participants on visuospatial learning, visuospatial memory, and fine motor skills domains. Measures of alcohol use or consumption were not significantly related to neurocognition in the ALC cohorts.

The age-related findings suggest that the combination of active chronic smoking and alcohol dependence in this 1-month-abstinent ALC cohort was associated with greater than normal age-related effects in multiple domains. In general, a low level of clinically significant impairment was observed in the alcohol-dependent participants. The findings from this study, in conjunction with previous research, strongly support smoking cessation interventions for those seeking treatment for alcohol and substance use disorders.

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Request Reprint E-Mail: timothy.durazzo@ucsf.edu

A New Method for Evaluating Compliance with Industry Self-Regulation Codes Governing the Content of Alcohol Advertising

This study evaluated the use of a modified Delphi technique in combination with a previously developed alcohol advertising rating procedure to detect content violations in the U.S. Beer Institute Code. A related aim was to estimate the minimum number of raters needed to obtain reliable evaluations of code violations in television commercials.

Six alcohol ads selected for their likelihood of having code violations were rated by community and expert participants (N = 286). Quantitative rating scales were used to measure the content of alcohol advertisements based on alcohol industry self-regulatory guidelines. The community group participants represented vulnerability characteristics that industry codes were designed to protect; experts represented various health-related professions, including public health, human development, alcohol research, and mental health. Alcohol ads were rated on 2 occasions separated by 1 month. After completing Time 1 ratings, participants were randomized to receive feedback from 1 group or the other.

Findings indicate that (i) ratings at Time 2 had generally reduced variance, suggesting greater consensus after feedback, (ii) feedback from the expert group was more influential than that of the community group in developing group consensus, (iii) the expert group found significantly fewer violations than the community group, (iv) experts representing different professional backgrounds did not differ among themselves in the number of violations identified, and (v) a rating panel composed of at least 15 raters is sufficient to obtain reliable estimates of code violations.

The Delphi technique facilitates consensus development around code violations in alcohol ad content and may enhance the ability of regulatory agencies to monitor the content of alcoholic beverage advertising when combined with psychometric-based rating procedures.

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Request Rerprint E-Mail: babor@nso.uchc.edu

Sex Differences in College Student Adherence to NIAAA Drinking Guidelines

Exceeding nationally recommended drinking limits puts individuals at increased risk of experiencing harmful effects due to alcohol consumption. Both weekly and daily limits exist to prevent harm due to toxicity and intoxication, respectively. It remains unclear how well college students adhere to recommended limits, and whether their drinking is sensitive to the wider sex difference in weekly versus daily drinking limits.

This study used a daily-level, academic-year-long, multisite sample to describe adherence to NIAAA daily (no more than 4 drinks per day for men, 3 drinks per day for women) and weekly (no more than 14 drinks per week for men, 7 drinks per week for women) drinking guidelines, and to test for sex differences and time effects. College students (n = 992; 58% female) reported daily drinking on a biweekly basis using web-based surveys throughout their first year of college.

Women exceeded weekly limits more frequently (15% of weeks [14 to 17%]) than men (12% [10 to 14%]). Women and men exceeded daily drinking limits similarly often (25 and 27%, respectively). In a generalized estimating equations analysis across all 18 biweekly assessments, adjusted for covariates and a linear trend over time, women were more likely to exceed weekly guidelines compared to men. Sex differences in exceeding daily limits were not significant. Over time, rates of exceeding limits declined for daily limits but only for men for weekly limits.

Female college students are more likely to exceed weekly alcohol intake limits than men. Furthermore, trends over time suggest that college students may be maturing out of heavy episodic drinking, but women may not mature out of harmful levels of weekly drinking. The observed disparity in risk for long-term health consequences may represent a missed opportunity for education and intervention.

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Request Reprint E-Mail: bhoeppner@partners.org

Impact of Pubertal Stage at First Drink on Adult Drinking Behavior

Early alcohol use is one of the strongest predictors of later alcohol use disorders, with early use usually taking place during puberty. Many researchers have suggested drinking during puberty as a potential biological basis of the age at first drink (AFD) effect. However, the influence of the pubertal phase at alcohol use initiation on subsequent drinking in later life has not been examined so far.

Pubertal stage at first drink (PSFD) was determined in N = 283 young adults (131 males, 152 females) from an epidemiological cohort study. At ages 19, 22, and 23 years, drinking behavior (number of drinking days, amount of alcohol consumed, hazardous drinking) was assessed using interview and questionnaire methods. Additionally, an animal study examined the effects of pubertal or adult ethanol (EtOH) exposure on voluntary EtOH consumption in later life in 20 male Wistar rats.

PSFD predicted drinking behavior in humans in early adulthood, indicating that individuals who had their first drink during puberty displayed elevated drinking levels compared to those with postpubertal drinking onset. These findings were corroborated by the animal study, in which rats that received free access to alcohol during the pubertal period were found to consume more alcohol as adults, compared to the control animals that first came into contact with alcohol during adulthood.

The results point to a significant role of stage of pubertal development at first contact with alcohol for the development of later drinking habits. Possible biological mechanisms and implications for prevention are discussed.

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Request Reprint E-Mail: miriam.schneider@zi-mannheim.de

Impacts of the minimum legal drinking age legislation on in-patient morbidity in Canada, 1997–2007: a regression-discontinuity approach

To provide novel, population-based estimates of the influence of minimum legal drinking age (MLDA) legislation on target in-patient hospital events in Canada.

Regression–discontinuity analyses on rates of Canadian in-patient admissions.

All in-patient hospitalizations in Canada (except Québec) between 1 April 1997 and 31 March 2007.

Individuals aged 15–22 years admitted to hospital.

International Classification of Diseases-9/10 codes for alcohol-use disorders/poisoning, injury, suicide, assault and motor vehicle accidents were considered as target morbidity conditions.

Compared with the baseline hospitalization rate just prior to the MLDA, admissions at the MLDA rose significantly (P ≤ 0.001) for alcohol-use disorders/poisoning for males (17.3%) and females (21.1%), as well as for suicide events for the combined sample (9.6%, P = 0.029). Among males, there was a significant 4.4% increase (P = 0.001) in a broad class of injuries, including a 9.2% jump (P = 0.020) in admissions for motor vehicle accidents compared with the baseline hospitalization rate just prior to the MLDA.

Removal of minimum legal drinking age restrictions is associated with significant population-level increases in hospital admissions among young adults in Canada for alcohol-use disorders/poisoning, as well as for other serious injuries, especially among males. Current international minimum legal drinking age policy discussions should account for the impact of the minimum legal drinking age on severe morbidity outcomes.

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Request Reprint E-Mail: russ.callaghan@unbc.ca

Friday, May 17, 2013

Framing the alcohol policy debate

A new open access article by Benjamin Hawkins and Chris Holden is available online. ‘Framing the alcohol debate: industry actors and the regulation of the UK beverage alcohol market’ (Critical Policy Studies) is based on an Alcohol Research UK-funded project which analysed the role of alcohol industry in the formulation of British alcohol policy. The full report is available here.

Experts speak about the need for a renewed and strong alcohol strategy

Several experts have been interviewed during the first Alcohol Awareness week organized in Brussels

In their interviews experts express their support to the awareness week and talk about the need for enhanced action at EU level to reduce the burden of alcohol harm in Europe.

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