SAMHSA's 10 Strategic Initiatives

10 Strategic Initiatives

Through continued improvement in the delivery and financing of prevention, treatment, and recovery support services SAMHSA with its partners can advance and protect the Nation’s health. In order to achieve this goal SAMHSA has identified 10 Strategic Initiatives to focus the Agency’s work on improving lives and capitalizing on emerging opportunities. The 10 Initiatives are briefly described below with the Agency lead identified along with some background on the issue.

1. Abuse and Mental Illness

Goal—Create prevention prepared communities where individuals, families, schools, workplaces, and communities take action to promote emotional health and prevent and reduce mental illness, substance abuse including tobacco, and suicide across the lifespan

2. Trauma and Justice

Goal—Reduce the pervasive, harmful, and costly health impact of violence and trauma by integrating trauma-informed approaches throughout health and behavioral healthcare systems and to divert people with substance use and mental disorders from criminal and juvenile justice systems into trauma-informed treatment and recovery.

3 . Military Families—Active, Guard, Reserve, and Veteran

Goal—Support of our service men and women and their families and communities by leading efforts to ensure needed behavioral health services are accessible and outcomes are successful.

4. Health Reform

Goal—Broaden health coverage and the use of evidence based practices to increase access to appropriate and high quality care, and to reduce disparities that currently exist between the availability of services for substance use and mental disorders and other medical conditions.

5. Housing and Homelessness

Goal—Provide housing and reduce the barriers that homeless persons with mental and substance use disorders and their families experience to accessing effective programs that sustain recovery.

6. Jobs and Economy

Goal—Promote the behavioral health of individuals, families, and communities affected by the economic downturn; the employment of people with mental and substance use disorders, and policies for employers that support behavioral health in the workplace.

7. Health Information Technology for Behavioral Health Providers

Goal—Ensure the behavioral health provider network, including prevention specialists and consumer providers, fully participates with the general health care delivery system in the adoption of health information technology.

8. Behavioral Health Workforce—In Primary and Specialty Care Settings

Goal—Provide a coordinated approach to address workforce development issues affecting the behavioral health and general health service delivery community to promote the integration of services and the training and use of behavioral health screening, brief intervention and referral for treatment in primary care settings.

9. Data, Outcomes, and Quality—Demonstrating Results

Goal— Realize an integrated data strategy that informs policy, measures program impact, and results in improved quality of services and outcomes for individuals, families, and communities.

10. Public Awareness and Support

Goal—Increase understanding of mental and substance use disorder prevention and treatment services to achieve the full potential of prevention and help people recognize and seek assistance for these health conditions with the same urgency as any other health condition.

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Naltrexone Selectively Elevates GABAergic Neuroactive Steroid Levels in Heavy Drinkers With the ASP40 Allele of the OPRM1 Gene: A Pilot Investigation

Preclinical studies have implicated GABAergic neurosteroids in behavioral responses to alcohol. Naltrexone is thought to blunt the reinforcing effects of alcohol, and a few studies have found that the effects of naltrexone are moderated by the Asn40Asp polymorphisms of the OPRM1 gene.

The present study seeks to integrate these lines of research by testing (i) the moderating role of the functional Asn40Asp polymorphism of the OPRM1 gene on naltrexone-induced alternations in GABAergic neurosteroid levels, namely (3α,5α)-3-hydroxypregnan-20-one (allopregnanolone, ALLO); and (ii) the combined effects of naltrexone or genotype with alcohol administration on neurosteroid levels in a sample of at-risk drinkers.

Participants were 32 (9 females) nontreatment-seeking heavy drinkers who completed a placebo-controlled laboratory study of naltrexone (50 mg/d for 3 days) and provided complete sets of serum samples for ALLO assays before and after alcohol administration under both naltrexone and placebo conditions.

Naltrexone treatment raised ALLO levels among carriers of the Asp40 allele, but not homozygotes for the Asn40 allele. The Asn40Asp polymorphism did not moderate effects of naltrexone on cortisol levels. Ethanol infusion modestly reduced ALLO levels in all subjects, independent of genotype or naltrexone exposure.

Naltrexone increased ALLO levels among individuals with the Asn40Asp allele suggesting a potential neurosteroid contribution to the neuropharmacological effects of naltrexone among Asp40 carriers.

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Rerquest Reprint E-Mail: lararay@psych.ucla.edu

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An fMRI Study of Number Processing in Children With Fetal Alcohol Syndrome

Number processing deficits are frequently seen in children exposed to alcohol in utero.

Functional magnetic resonance imaging was used to examine the neural correlates of number processing in 15 right-handed, 8- to 12-year-old children diagnosed with fetal alcohol syndrome (FAS) or partial FAS (PFAS) and 18 right-handed, age- and gender-matched controls from the Cape Coloured (mixed ancestry) community in Cape Town, South Africa, using Proximity Judgment and Exact Addition tasks.

Control children activated the expected fronto-parietal network during both tasks, including the anterior horizontal intraparietal sulcus (HIPS), left posterior HIPS, left precentral sulcus, and posterior medial frontal cortex. By contrast, on the Proximity Judgment task, the exposed children recruited additional parietal pathways involving the right and left angular gyrus and posterior cingulate/precuneus, which may entail verbally mediated recitation of numbers and/or subtraction to assess relative numerical distances. During Exact Addition, the exposed children exhibited more diffuse and widespread activations, including the cerebellar vermis and cortex, which have been found to be activated in adults engaged in particularly challenging number processing problems.

The data suggest that, whereas control children rely primarily on the fronto-parietal network identified in previous studies to mediate number processing, children with FAS/PFAS recruit a broader range of brain regions to perform these relatively simple number processing tasks. Our results are consistent with structural neuroimaging findings indicating that the parietal lobe is relatively more affected by prenatal alcohol exposure and provide the first evidence for brain activation abnormalities during number processing in children with FAS/PFAS, effects that persist even after controlling statistically for group differences in total intracranial volume and IQ.

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Request Reprint E-Mail: ernesta.meintjes@uct.ac.za

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Recent Research on Impulsivity in Individuals With Drug Use and Mental Health Disorders: Implications for Alcoholism

Alcohol misuse and dependence, and many of its accompanying psychological problems, are associated with heightened levels of impulsivity that both accelerate the development of clinically significant illness and complicate clinical outcome.

This article reviews recent developments in our understanding of impulsivity as they relate to brain circuitry that might underlie these comorbid factors, focusing upon the clinical features of substance use (and dependence), bipolar disorder, and pathological gambling.

Individuals who are affected by these disorders exhibit problems in several domains of impulsive behavior including deficient response or "motor" control, and the tolerance of prolonged delays prior to larger rewards at the expense of smaller rewards ("delay-discounting"). These populations, like alcoholic dependents, also exhibit impairments in risky decision-making that may reflect dysfunction of monoamine and catecholamine pathways.

However, several areas of uncertainty exist including the specificity of impairments across disorders and the relationship between impulse control problems and altered evaluation of reward outcomes underlying observed impairments in action selection.


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Request Reprint E-Mail: robert.rogers@psych.ox.ac.uk


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Alcohol self-administration in rats: Modulation by temporal parameters related to repeated mild social defeat stress

Clinical evidence often points to stress as a cause or an antecedent to the development of drinking problems. Yet, animal models of alcohol drinking have yielded inconsistent evidence for a direct contribution of stress, and many studies have shown that stress suppresses alcohol consumption.

The aim of the present study was to examine alcohol reward in animals exposed to repeated, mild social stress, and to determine whether alcohol drinking changes as a function of the temporal parameters of alcohol access relative to the stressor.

Male Long-Evans rats, trained to self-administer a 6% (wt/vol) alcohol solution using a sucrose-fading procedure, were exposed to five brief (5min) episodes of contact with an aggressive male. Full contact with the resident was limited to a single episode of defeat, whereas the following four encounters occurred with the subjects behind a protective wire mesh cage. Alcohol self-administration was measured 1 week prior to stress (baseline), on each day of stress exposure, and 1 week following stress. Separate groups of animals were randomly assigned to self-administer alcohol immediately prior, immediately following, or 2h following defeat stress.

Stress preferentially increased alcohol drinking on stress-exposure days, and further elevated the amount consumed 1 week following stress. Temporal parameters of alcohol access relative to the stressor were found to be important. Average alcohol consumption was greatest for animals drinking 2h postdefeat, whereas animals drinking immediately prior to or following the stressor did not show a significant increase in alcohol consumption.

Results suggest that mild social defeat stress is sufficient to elicit increases in alcohol consumption in nonpreferring strains of rodents, provided alcohol access occurs at an optimal time interval after the social defeat experience.

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Request Reprint E-Mail: beth.caldwell@mcphs.edu

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Limited access to ethanol increases the number of spontaneously active dopamine neurons in the posterior ventral tegmental area of nondependent P rats

Microdialysis experiments in alcohol-preferring (P) rats have shown that chronic ethanol exposure increases extracellular levels of dopamine (DA) in the nucleus accumbens.

Because DA neuronal activity contributes to the regulation of DA overflow in terminal regions, we hypothesized that posterior ventral tegmental area (VTA) DA neuronal activity (firing frequency, burst activity, and/or the number of spontaneously active DA neurons) would be increased in P rats consuming ethanol compared with P rats consuming only water. I

n vivo electrophysiological techniques were used to evaluate the activity of single DA neurons in the posterior VTA.

Our findings show that voluntary ethanol intake by nondependent P rats significantly increased the number of spontaneously active DA neurons in the posterior VTA compared with P rats that consumed only water. Firing frequency and burst activity did not differ between the two groups.

These results suggest that adaptive changes occur in the mesolimbic DA system of nondependent P rats to increase the excitability of posterior VTA DA neurons and enhance DA release from nerve terminals in the nucleus accumbens.


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Request Reprint E-Mail: smorzora@iupui.edu

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Serotonin-3 receptors in the posterior ventral tegmental area regulate ethanol self-administration of alcohol-preferring (P) rats

Several studies indicated the involvement of serotonin-3 ([5-hydroxy tryptamine] 5-HT3) receptors in regulating alcohol-drinking behavior.

The objective of this study was to determine the involvement of 5-HT3 receptors within the ventral tegmental area (VTA) in regulating ethanol self-administration by alcohol-preferring (P) rats.

Standard two-lever operant chambers (Coulbourn Instruments, Allentown, PA) were used to examine the effects of seven consecutive bilateral microinfusions of ICS 205-930 (ICS), a 5-HT3 receptor antagonist, directly into the posterior VTA on the acquisition and maintenance of 15% (vol/vol) ethanol self-administration.

P rats readily acquired ethanol self-administration by the fourth session. The three highest doses (0.125, 0.25, and 1.25μg) of ICS prevented acquisition of ethanol self-administration.

During the acquisition postinjection period, all rats treated with ICS demonstrated higher responding on the ethanol lever, with the highest dose producing the greatest effect. In contrast, during the maintenance phase, the three highest doses (0.75, 1.0, and 1.25μg) of ICS significantly increased responding on the ethanol lever; after the 7-day dosing regimen, responding on the ethanol lever returned to control levels.

Microinfusion of ICS into the posterior VTA did not alter the low responding on the water lever and did not alter saccharin (0.0125% wt/v) self-administration. Microinfusion of ICS into the anterior VTA did not alter ethanol self-administration.

Overall, the results of this study suggest that 5-HT3 receptors in the posterior VTA of the P rat may be involved in regulating ethanol self-administration. In addition, chronic operant ethanol self-administration and/or repeated treatments with a 5-HT3 receptor antagonist may alter neuronal circuitry within the posterior VTA.

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Request Reprint E-Mail: zrodd@iupui.edu


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RAYPRO, a Resource on Alcohol and Youth Projects

The on-line database RAYPRO, a Resource on Alcohol and Youth Projects, enables to share information on projects and activities to reduce alcohol-related harm among children and young people, and promotes good practice based on sound evaluation of effectiveness.

Projects and activities are grouped according to themes:

• Curbing under-age drinking
• Curbing drink-driving by young people
• Educating and empowering young people on alcohol issues
• Promoting responsible selling and serving of alcohol to young people
• Protecting young people from the consequences of alcohol abuse by others.

The age range extends from children – for example reducing harm from alcohol use disorders in the family - to young adults, as late teenage and early adulthood affect drinking habits for life.

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Pattern of alcohol consumption and its effect on gastrointestinal symptoms in inflammatory bowel disease

Alcohol consumption is a potential trigger for flare in inflammatory bowel disease (IBD) flare because of alcohol's pro-oxidant effects and its deleterious effects on gut barrier function. The association with alcohol consumption and IBD flare is unclear.

To test this hypothesis, we evaluated the pattern of alcohol consumption and its self-reported effect on gastrointestinal (GI) symptoms in patients with IBD.

We recruited 129 consecutive patients: 52 patients with Crohn's disease, 38 patients with ulcerative colitis, and 39 patients with irritable bowel syndrome (IBS). All the participants completed a validated questionnaire on disease activity (the Crohn's disease activity index or ulcerative colitis clinical activity index, respectively) validated questionnaires to quantify alcohol consumption by National Institute of Alcohol Abuse and Alcoholism criteria, and two structured questionnaires we designed to access patients' perception of the effect of alcohol on their GI symptoms and on overall GI symptom severity.

The pattern of current, light, moderate, and heavy alcohol consumption in inactive IBD was similar to the general U.S. population. Specifically, of the 90 inactive IBD patients, 56 (62%) were current drinkers, compared with 61% in the general U.S. population. Of current drinkers, 75% of IBD (N=42) and 43% of IBS (N=9) reported a worsening of GI symptoms with alcohol consumption (P=.01); however, overall GI symptom severity did not differ when compared with quantity of alcohol consumed. Patients with inactive IBD drink alcohol in quantities similar to the general population.

Current drinkers with inactive IBD are more likely to report worsening of GI symptoms with alcohol than current drinkers with IBS.

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Request Reprint E-Mail: garth_r_swanson@rush.edu


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Cortical perfusion in alcohol-dependent individuals during short-term abstinence: relationships to resumption of hazardous drinking after treatment

Relapse to hazardous levels of alcohol consumption after treatment for alcohol use disorders is common. Investigation of the neurobiological correlates of resumption of hazardous drinking is necessary to clarify the mechanisms contributing to relapse

. Fifty-seven treatment-seeking alcohol-dependent participants (ALC) completed arterial spin labeling perfusion MRI of the frontal and parietal gray matter (GM) at 7±3 days of abstinence (baseline). ALC participants were restudied after 35±11 days of abstinence (assessment point 2: AP2). Twenty-eight nonsmoking, light-drinking control participants (nsLD) from the community were studied with perfusion MRI. ALC participants were followed over 12 months after baseline study and were classified as abstainers (no alcohol consumption; n=19) and resumers (any alcohol consumption; n=38) at follow-up. Cross-sectional and longitudinal perfusion was compared in abstainers, resumers, and nsLD.

At baseline, resumers demonstrated significantly lower frontal and parietal GM perfusion than nsLD and abstainers. Abstainers and nsLD were not different on frontal or parietal GM perfusion. No significant longitudinal perfusion changes were observed in abstainers and resumers. At AP2, resumers showed significantly lower frontal GM perfusion than nsLD and abstainers, whereas no group differences were observed for parietal GM. Abstainers and nsLD were not different on frontal GM perfusion.

The significantly decreased frontal GM perfusion in resumers compared with both abstainers and nsLD across the assessment interval suggests premorbid and/or acquired neurobiological abnormalities of the frontal GM in resumers.


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


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News Release - International Center for Alcohol Policies (ICAP) Announces Launch of www.global-actions.org

The International Center for Alcohol Policies (ICAP) has announced the launch of www.global-actions.org, the inaugural website for Global Actions on Harmful Drinking.

The companies sponsoring Global Actions on Harmful Drinking have established three critical initiatives to address the harmful use of alcohol around the world.

The activities documented at www.global-actions.org are the result of a collective commitment made by the chief executives of major international beverage alcohol producers to make a significant effort in the 2010-2012 time frame to address harmful drinking through a combination of global and local actions, with an emphasis on low- and middle-income countries.

The website at www.global-actions.org offers user discussion pages, publications and other resources, and background information pertaining to three critical initiatives launched in the areas of self-regulation, drink driving, and noncommercial alcohol.


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Alcohol-induced facial dysmorphology in C57BL/6 mouse models of fetal alcohol spectrum disorder

Alcohol consumption during pregnancy causes fetal alcohol spectrum disorder (FASD), which includes a range of developmental deficits. Fetal alcohol syndrome is the most severe form of FASD and can be diagnosed with pathognomonic facial features such as a smooth philtrum, short palpebral fissure, and thin upper vermilion. However, many children with developmental damage because of prenatal alcohol exposure exhibit none, or only a subset, of the above features, making diagnosis difficult.

This study explored novel analyses to quantify the effect of a known dose of alcohol on specific facial measurements in substrains C57BL/B6J (B6J) and C57BL/6NHsd (B6N) mice. Mouse dams were provided alcohol (Alc) consisting of 4.8% (vol/vol) alcohol in a liquid diet for 16 days prepregnancy and chow and water diet during mating, and then the alcohol liquid diet was reinstated on gestational days 7 (E7) to gestational day 17 (E17). Treatment controls included a pair-fed (PF) group given matched volumes of an alcohol-free liquid diet made isocalorically and a group given ad lib access to lab chow and water (Chow). Maternal diet intake (Alc and PF), blood alcohol concentrations (BACs), embryo weights, and 15 morphometric facial measurements for E17 embryos were analyzed. B6N dams drank more alcohol during pregnancy and generated higher BAC than B6J dams.

Both the Alc and PF treatments induced significant reductions in embryo weights relative to Chow in both substrains. Alcohol treatments produced significant changes, relative to controls, in 4 of the 15 facial measures for the B6N substrain but only in two measures for the B6J substrain. Discriminant analysis demonstrated successful classification of the alcohol-exposed versus nonalcohol-exposed B6N embryos, with a high sensitivity of 86%, specificity 80%, and overall classification (total correct 83%), whereas B6J mice yielded sensitivity of 80%, specificity 78%, and overall correct classification in 79%.

In addition, B6N mice showed significantly more effects of pair feeding on these facial measures than did B6J mice, suggesting that the B6N substrain may be more vulnerable to nutritional stress during pregnancy.

Overall, these data indicate that both B6N and B6J mice were vulnerable to alcohol but show differences in the severity and location of alcohol-induced dysmorphic facial features and may parallel findings from human studies comparing different ethnic groups.

Furthermore, these findings suggest that discriminant analysis may be useful in predicting alcohol exposure in either mouse substrains.


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Request Reprint E-Mail: cbanthon@iupui.edu


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Silver Sub-nanoclusters Electrocatalyze Ethanol Oxidation and Provide Protection against Ethanol Toxicity in Cultured Mammalian Cells

Silver atomic quantum clusters (AgAQCs), with two or three silver atoms, show electrocatalytic activities that are not found in nanoparticles or in bulk silver.

AgAQCs supported on glassy carbon electrodes oxidize ethanol and other alcohols in macroscopic electrochemical cells in acidic and basic media. This electrocatalysis occurs at very low potentials (from +200 mV vs RHE), at physiological pH, and at ethanol concentrations that are found in alcoholic patients.

When mammalian cells are co-exposed to ethanol and AgAQCs, alcohol-induced alterations such as rounded cell morphology, disorganization of the actin cytoskeleton, and activation of caspase-3 are all prevented.

This cytoprotective effect of AgAQCs is also observed in primary cultures of newborn rat astrocytes exposed to ethanol, which is a cellular model of fetal alcohol syndrome.

AgAQCs oxidize ethanol from the culture medium only when ethanol and AgAQCs are added to cells simultaneously, which suggests that cytoprotection by AgAQCs is provided by the ethanol electro-oxidation meditated by the combined action of AgAQCs and cells.

Overall, these findings not only show that AgAQCs are efficient electrocatalysts at physiological pH and prevent ethanol toxicity in cultured mammalian cells, but also suggest that AgAQCs could be used to modify redox reactions and in this way promote or inhibit biological reactions.

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Request Reprint E-Mail: malopez.quintela@usc.es,

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BME National Workshop

***The Joseph Rowntree Foundation will now be launching the latest report from their Alcohol Programme - Ethnicity and Alcohol: a Review of the UK Literature at the BME National Workshop***

Often BME groups have difficulty accessing alcohol-harm reduction services and there is a need to develop services that are sensitive to cultural diversity. The Alcohol Improvement Programme will be holding a free BME National Workshop on Tuesday 6th July in Peterborough to examine the needs of BME groups in relation to alcohol-harm.

The workshop will launch two new reports - a BME scoping and consultation conducted by the Universities of Middlesex and York and a review of the UK literature on ethnicity and alcohol from the Joseph Rowntree. . . . . . .

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'Clarifying brief interventions' Academy briefing paper

A briefing paper Clarifying brief interventions' [pdf] has been released by the AERC Alcohol Academy. The paper aims to clarify key issues relating to the delivery of brief interventions and related practice, particularly distinctions in the types of interventions and their key characteristics.

The paper follows the Academy symposium 'Brief interventions: commissioning and delivery issues' - see here for presentations from the day. The seminar aimed to explore challenges in the delivery of brief interventions and responses for improving alcohol intervention approaches.

Findings from the online brief interventions survey conducted to inform the event are available in the report 'Results from the survey ‘Brief interventions (IBA): commissioning and delivery issues’ - download here [pdf]

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Does Acute Alcohol Exposure Modulate Aggressive Behaviors in the Zebrafish (Danio rerio), or is the Bark Worse than the Bite?

Previous research reports that acute alcohol exposure disrupts shoaling behavior in the zebrafish. The purpose of these studies is to better understand how acute alcohol exposure (0%, 0.125%, 0.25%, 0.5%, and 1.0%) alters zebrafish behavior.

The effects of alcohol on aggressive behaviors in humans have been widely researched. Previous research from this lab has shown a bimodal effect of alcohol on shoaling behavior in zebrafish, with 0.5% and 2.0% (v/v) disrupting shoaling while 1.0% and 1.5% showing no direct effect.

Because shoaling is a social behavior and is altered during acute alcohol exposure, aggressive behavior between fish should be addressed. In this series of experiments we explored alcohol’s effects on aggressive behaviors.

In order to address a possible role for alcohol induced aggression as it relates to shoaling we chose to examine the effects of acute alcohol exposure on zebrafish pairs. Fish were assessed during initial encounters occurring in our testing apparatus during acute alcohol exposure.

Results show a change in biting as a function of all doses. Acute alcohol exposure (0.5%) also decreases overall occurrences of chasing and retreating but may increase the duration of each bout.

Lastly in a separate experiment we looked at blood alcohol levels as a result of acute alcohol exposure.


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Alcohol-use disorders: physical complications

The advice in the NICE guideline covers:

The care of adults and young people (aged 10 years and older) who have any of the following physical health problems that are completely or partly caused by alcohol use:

• acute alcohol withdrawal (which occurs if a ‘dependent’ drinker suddenly stops drinking)
• lack of thiamine (also called vitamin B1) in the body, which can cause a condition called Wernicke’s encephalopathy
• liver disease
• inflammation of the pancreas (called pancreatitis).

Read Full Guidance (PDF)


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NICE considers QOF indicator on alcohol consumption

The QOF may include an indicator on alcohol consumption from 2013/14, after NICE decided to undertake further development work in this area.

At its meeting on Thursday, NICE's QOF review committee decided that there was merit in alcohol consumption indicator. But it thought that more evidence was needed on who should be included in the target group for any indicator. . . . . .

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Gene—environment interactions in 7610 women with breast cancer: prospective evidence from the Million Women Study

Information is scarce about the combined effects on breast cancer incidence of low-penetrance genetic susceptibility polymorphisms and environmental factors (reproductive, behavioural, and anthropometric risk factors for breast cancer).

To test for evidence of gene—environment interactions, we compared genotypic relative risks for breast cancer across the other risk factors in a large UK prospective study.

We tested gene—environment interactions in 7610 women who developed breast cancer and 10 196 controls without the disease, studying the effects of 12 polymorphisms (FGFR2-rs2981582, TNRC9-rs3803662, 2q35-rs13387042, MAP3K1-rs889312, 8q24-rs13281615, 2p-rs4666451, 5p12-rs981782, CASP8-rs1045485, LSP1-rs3817198, 5q-rs30099, TGFB1-rs1982073, and ATM-rs1800054)

in relation to prospectively collected information about ten established environmental risk factors (age at menarche, parity, age at first birth, breastfeeding, menopausal status, age at menopause, use of hormone replacement therapy, body-mass index, height, and alcohol consumption).

After allowance for multiple testing none of the 120 comparisons yielded significant evidence of a gene—environment interaction. By contrast with previous suggestions, there was little evidence that the genotypic relative risks were affected by use of hormone replacement therapy, either overall or for oestrogen-receptor-positive disease. Only one of the 12 polymorphisms was correlated with any of the ten other risk factors: carriers of the high-risk C allele of MAP3K1-rs889312 were significantly shorter than non-carriers (mean height 162·4 cm [95% CI 162·1—162·7] vs 163·1 cm [162·9—163·2]; p=0·01 after allowance for multiple testing).

Risks of breast cancer associated with low-penetrance susceptibility polymorphisms do not vary significantly with these ten established environmental risk factors.

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Bid to cut drink-drive limit by almost half

The Daily Telegraph has learned that Coalition ministers are studying proposals to cut the drink-drive limit for the first time in a generation.

Under the plans, the limit would fall from 80mg of alcohol per 100ml of blood to 50mg. Anyone caught above the new limit would face an automatic 12-month driving ban, even if they were only marginally over the threshold. . . . . .

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PREVALENCE OF DEPRESSION SYMPTOMS AMONG ADOLESCENTS AGED 12–17 YEARS IN CALIFORNIA AND THE ROLE OF OVERWEIGHT AS A RISK FACTOR

Literature documentation of the health consequences of obesity among adolescents continues to grow and includes the psychosocial consequences of obesity on this population.

The specific aim of this study was to identify prevalence of depression in adolescents, aged 12 to 17 years, and to identify the role of overweight as a risk factor for depression.

Secondary data analysis of the adolescent version of the 2005 California Health Interview Survey. Symptoms of depression were measured with a reduced version of he Center for Epidemiologic Studies Depression Scale. Weight status was determined using the Centers for Disease Control definitions and those recommended by the American Academy of Pediatrics.

The sample was nearly half male (50.6%). The majority of the adolescents in the sample were White (47.2%) followed by Latino (33.5%). Approximately 10% of the adolescents reported more than 10 depression symptoms. Based on BMI, 16.5% of the sample were at-risk of being overweight, and 14.7% were overweight. However, 24.4% of sample thought they were ‘slightly overweight or very overweight.

We did not find any statistically significant association between weight statu and symptoms of depression, but at the bivariate level we did find a statistically significant association between perception of one’s weight and depression, P,.001.

We also found that sex (OR 3.10; CI 2.07–4.51), perceived health (OR 2.25; CI 1.53–3.31), smoking (OR 1.8; CI 1.30–2.69), and alcohol use (OR 2.06; CI 1.44–2.95) were independently associated with depression symptoms.

Even though we were unable to prove the proposed association, our findings are noteworthy given that the association between these variables are less clear in the literature. Future studies that attempt to examine the relationship between these two variables may benefit from longitudinal design, inclusion of multi-item risk and protective predictors, inclusion of social-context related variables, perceived weight, and family history of obesity.

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THE SECOND SOUTH AFRICAN NAT I O N A L Y O U T H R I S K B E H AVIOUR SURVEY 2 0 0 8

While the world is home to 1.2 billion young people, South Africa is home to 9 million 747 thousand young people. This generation, the world over, are said to be the most educated youth generation in history.

As there are regional differences, South Africa will do well to see where it is pitched or better still to embark on a plan that gels together all the skills, attitude and knowledge that young people need to facilitate change at a personal, political, social and economic level.

Young people undisputedly are our future and ideally situated to change the ‘fabric of society’ through their own self-improvement and determination. Children and adolescents aged 19 years and younger account for almost half of the South African population of 48.8 million.(1)

The transition to democracy has made schooling compulsory, which means large numbers of young people are now engaged in the process of education.(2) At secondary school level the gross enrolment rate is over 90% with 4.5 million enrolled learners.
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Alcohol use: Learners reported alcohol consumption was 50% for ever having drunk alcohol and 35% for having drunk alcohol in the past month, and 29% for having engaged in binge drinking in the past month.


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Alcohol Consumption and Expectations of Its Effects in the Border Region of Pomerania: Comparison of German and Polish Adolescents

The study focused on expectations of alcohol effects and patterns of consumption in German and Polish adolescents in the border region of Pomerania.

In 2005/2006 a cross-sectional study was conducted in various schools. Adolescents with an average age of 14 from one German town (Greifswald) and two Polish towns (Szczecin and Kolobrzeg) were assessed using the ESPAD (European School Project on Alcohol and Other Drugs) questionnaire. Altogether 757 (444 Polish and 313 German) students in their 7th and 8th grades were assessed.

Differences between alcohol consumption patterns and expectations between Germany and Poland, and relationships between alcohol consumption and anticipated alcohol effects were tested.

There is a difference in patterns of consumption between the two countries. Among all adolescents, expectations of positive alcohol effects dominated, and the negative effects were estimated to be less likely. In a country-specific comparison,

German students estimated the occurrence of positive as well as negative effects to be likely.

Adolescents who consumed a lot of alcohol in both countries estimated the positive effects to be stronger. Adolescents are more focused on short-term experiences than the long-term consequences of alcohol consumption.

The results show potential targets for prevention and intervention of future risky consumption and alcohol use disorders.


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Request Reprint E-Mail:: ulrich.preuss@medizin.uni-halle.de


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Alcohol Consumption in Southern Sweden after Major Decreases in Danish Spirits Taxes and Increases in Swedish Travellers’ Quotas

In 2003, Denmark lowered its tax on spirits, and in 2004, Sweden increased its traveller import quotas.

The aim of the study was to determine whether these two changes increased self-reported alcohol consumption in southern Sweden, which is located near Denmark.

Data were collected through telephone interviews with the general population between 2003 and 2006. Individuals aged 16–80 years were interviewed. Some lived in southern Sweden, others in the northern region, which was assumed to be unaffected by the policy changes and was thus used as a control site. Analyses were performed for the total population as well as by sex, age, socio-economic group and consumption pattern.

The expected results were not found: alcohol consumption in southern Sweden had not changed. The few statistically significant changes found in southern Sweden indicated decreases. In the north, however, consumption seemed to have increased.

In addition to the two policy changes mentioned above, other changes seem to have affected alcohol consumption in Sweden. It is possible, however, that the policy changes have affected population groups not reached by the survey, and thus other types of data need to be analysed before drawing any far-reaching conclusions.


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Request Reprint E-Mail: nina-katri.gustafsson@sorad.su.se


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The Influence of Drinking Pattern, at Individual and Aggregate Levels, on Alcohol-Related Negative Consequences

To determine the extent drinking patterns (at the individual and country level) are associated with alcohol-related consequences over and above the total alcohol the person consumes.

Hierarchical linear models were estimated based on general population surveys conducted in 18 countries participating in the GENACIS project.

In general, the positive association between drinking pattern scores and alcohol-related consequences was found at both the individual and country levels, independent of volume of drinking. In addition, a significant interaction effect indicated that the more detrimental the country’s drinking pattern, the less steep the association between the volume of drinking and its consequences.

Drinking patterns have an independent impact on consequences over and above the relationship between volume and consequences.


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Request Reprint E-Mail;: mastudillo@sfa-ispa.ch


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An explanation for enhanced perceptions of attractiveness after alcohol consumption

Acute alcohol consumption increases ratings of attractiveness to faces. This may help to explain increased frequencies of sexual encounters during periods of alcohol intoxication. At least in part, such increased attraction may be the result of alcohol consumption decreasing ability to detect bilateral asymmetry, presumably because of the reductions in the levels of visual function.

We tested the hypotheses that acute alcohol consumption decreases ability to detect asymmetry in faces and reduces preference for symmetrical faces over asymmetrical faces.

Twenty images of a pair of faces and then 20 images of a single face were displayed on a computer, one at a time. Participants were instructed to state which face of each of the face pairs displayed was most attractive and then whether the single face being displayed was symmetrical or not. Data were collected near campus bars at Roehampton University. Sixty-four self-selecting students who undertook the study were classified as either sober (control) or intoxicated with alcohol. For each face pair or single face displayed, participant response was recorded and details of the alcohol consumption of participants that day were also obtained.

Sober participants had a greater preference for symmetrical faces and were better at detecting whether a face was symmetrical or otherwise, supporting the hypotheses. A further, unexpected finding was that males made fewer mistakes than did females when determining whether individual faces were asymmetrical.

The reduced ability of inebriated people to perceive asymmetry may be an important mechanism underlying the higher ratings of facial attractiveness they give for members of the opposite sex and hence their increased frequency of mate choice.

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The influence of the luteal and follicular phases on major pharmacokinetic parameters of blood and breath alcohol kinetics in women

Drink tests involving 14 women were carried out to determine the effects of the menstrual cycle phases on the pharmacokinetics of ethanol.

One experiment was carried out in the follicular phase of the cycle and another in the luteal phase, with the estradiol, progesterone, and testosterone levels being determined in both cases. The target concentration was a final blood alcohol concentration (BAC) of approximately 0.08g%. After drinking was completed, concurrent BAC and breath alcohol concentration (BrAC) measurements were carried out at intervals of 10–20min. The ethanol elimination rate was determined by calculating a linear function in the part of the slope that was clearly linear. In addition, the c0 and Widmark factors r were calculated.

In 10 of the volunteers, who had a normal increase in progesterone in the luteal phase, the average hourly elimination rate ß60 in the follicular phase amounted to 0.0194±0.0020g%/h (BAC) and 0.0975±0.0068mg/L/h (BrAC), and in the luteal phase to 0.0193±0.0031g%/h (BAC) and 0.1026±0.0101mg/L/h (BrAC).

There was no significant difference. Other pharmacokinetic parameters (c0 concentrations, Widmark factors r, distribution volumes, maximal BAC, mean absorption rate, time until the peak concentrations were reached) also revealed no significant differences between the blood and breath alcohol levels of the luteal and follicular phases.

In addition, no significant correlations were observed between the absolute progesterone level and the respective elimination rates ß60.

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Request Reprint E-Mail: andrea_dettling@med.uni-heidelberg.de

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