Educational inequalities in general and mental health: differential contribution of physical activity, smoking, alcohol consumption and diet

Behavioural, material and psychosocial risk factors may explain educational inequalities in general health. To what extent these risk factors have similar or different contributions to educational inequalities in mental health is unknown.

Data were derived from the Norwegian Survey of Level of Living from 2005, comprising 5791 respondents aged ≥25 years. The study objectives were addressed by means of a series of logistic regression analyses in which we examined: (i) educational inequalities in self-reported general and mental health; (ii) the associations between behavioural, material and psychosocial risk factors and general and mental health, controlled for sex, age and education; and (iii) the contribution of risk factors to the observed health gradients.

The lower educated were more likely to be in poor health [odds ratio (OR): 3.46 (95% confidence interval, CI: 2.84–4.21)] and to be in poor mental health [OR: 1.41 (95% CI: 1.12–1.78)] than the highest educated. The joint contribution of behavioural, material and psychosocial risk factors explained all the variations of mental health inequalities, whereas these were able to explain ∼40% of the inequalities in general health. Both behavioural and material risk factors contributed substantially to the explanation of general and mental health inequalities, whereas the psychosocial risk factor (i.e. having close persons to communicate with) only seemed to make a larger difference for the explanation of mental health inequalities.

Policies and interventions to reduce health inequalities should have a broad focus. Combined strategies should be applied to improve physical activity, decrease smoking and improve material and psychosocial conditions among lower educated groups, to achieve the true potential of reducing inequalities in both general and mental health.


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Request Reprint E-Mail: nku@nokc.no

Paternal alcohol consumption, family transition and child development in a former Soviet country

Although major societal changes have been observed in former Soviet countries, the child health consequences of these changes have rarely been studied.

We examined the associations of paternal alcohol consumption and family transitions with cognitive ability and behaviour problems among healthy, early school-age Belarusian children. Our study is based on follow-up of children aged 6.5 years participating in a cluster-randomized trial of a breastfeeding promotion intervention. Paternal alcohol consumption was measured at follow-up and classified into three categories: at least weekly consumption of heavy (≥6 standard units per occasion), moderate (4–5 units per occasion), or light (≤3 units per occasion) or infrequent drinking. Family transition from birth to age 6.5 years was categorized into living stably with an intact family, having transitioned into a stepfamily, having transitioned into a single-parent family and living stably with a single-parent family. Mean differences in intelligence quotient (IQ) measured with the Wechsler Abbreviated Scales of Intelligence and in behaviour problems measured with the Strengths and Difficulties Questionnaire were compared according to paternal alcohol and family transition, after controlling for a wide range of confounding factors.

Children whose fathers were moderate or heavy drinkers with at least weekly alcohol consumption showed 1.5–2.5 points lower mean IQ scores and greater behaviour problems (range 0.1–0.3 SD) compared with those whose fathers were light or infrequent drinkers. Compared with children from stable intact families, children who transitioned into stepfamilies had 1 point lower IQ and greater behaviour problems by 0.1–0.4 SD, and children from stable single-parent families or with transition into single-parent families showed no cognitive deficit but greater behaviour problems (range 0.1–0.3 SD).

The sharp rise in both alcohol consumption and divorce/re-marriage rates in former Soviet countries may have negative consequences for cognitive and behavioural development in children.

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Request Reprint E-Mail: seungmi.yang@mail.mcgill.ca

Alcohol drinking and overall and cause-specific mortality in China: nationally representative prospective study of 220 000 men with 15 years of follow

Regular alcohol drinking contributes both favourably and adversely to health in the Western populations, but its effects on overall and cause-specific mortality in China are still poorly understood.

A nationally representative prospective cohort study included 220 000 men aged 40–79 years from 45 areas in China in 1990–91, and >40 000 deaths occurred during 15 years of follow-up. Cox regression was used to relate alcohol drinking to overall and cause-specific mortality, adjusting for age, area, smoking and education.

Overall, 33% of the participants reported drinking alcohol regularly at baseline, consuming mainly distilled spirits, with an estimated mean amount consumed of 372 g/week (46.5 units per week). After excluding all men with prior disease at baseline and the first 3 years of follow-up, there was a 5% [95% confidence interval (CI) 2–8] excess risk of overall mortality among regular drinkers. Compared with non-drinkers, the adjusted hazard ratios among men who drank <140, 140–279, 280–419, 420–699 and ≥700 g/week were 0.97, 1.00, 1.02, 1.12 and 1.27, respectively (P < 0.0001 for trend). The strength of the relationship appeared to be greater in smokers than in non-smokers. There was a strong positive association of alcohol drinking with mortality from stroke, oesophageal cancer, liver cirrhosis or accidental causes, a weak J-shaped association with mortality from ischaemic heart disease, stomach cancer and lung cancer and no apparent relationship with respiratory disease mortality.

Among Chinese men aged 40–79 years, regular alcohol drinking was associated with a small but definite excess risk of overall mortality, especially among smokers.

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Request Reprint E-Mail: ling.yang@ctsu.ox.ac.uk

Recovery Characteristics and Practices of Alcoholics Anonymous Sponsors

Sponsoring another member of Alcoholics Anonymous (AA) is associated with improved substance use outcomes, but little research examines who is asked (and agrees) to sponsor another member. The objective of this exploratory study is to describe the recovery-related characteristics and practices associated with AA sponsors.

AA members (N=263) completed an anonymous online questionnaire about their background and recovery behaviors. On 9 characteristics and 4 practices, Pearson χ² and Student t tests were used to compare (a) current nonsponsors with sponsors; and (b) lifetime nonsponsors with those who had sponsored at some point.

How and when members entered AA had no association with the sponsor role. Sponsors, past and present, were characterized by having an AA home group, completing more steps, having longer sobriety, and reporting a greater degree of spiritual surrender. Current sponsors engaged more frequently than current nonsponsors in all 4 practices: performing AA service work, attending meetings, praying or meditating, and reading AA literature. Lifetime sponsors engaged more frequently than lifetime nonsponsors in all practices except praying or meditating. Tentative evidence suggested lifetime nonsponsors and former sponsors did not differ in AA practices, indicating the value of current/active sponsorship.

Similar to having a sponsor, being a sponsor is associated with characteristics and practices supportive of AA engagement.

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Request Reprint E-Mail: Lance.Young@va.gov

NIAAA NEWS Spring 2012 • Issue 24

• NIAAA at CADCA’s National Leadership Forum

• Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide

• Update for NIAAA’s Flagship Publication

• Alcohol Policy Information System Now Updated

• New NIH Web Site Sparks Interest in Clinical Trials

• NIAAA Chats With Kids About Alcohol

• NIH Seeks Input for Institute’s Scientific Strategic Plan

• New Publications

• Personnel

Binge Drinking Intensity: A Comparison of Two Measures

Binge drinking (≥4 drinks for women; ≥5 drinks for men, per occasion) is responsible for more than half of the estimated 80,000 U.S. deaths annually and three-quarters of the $223.5 billion in costs in 2006. Binge drinking prevalence is assessed more commonly than binge drinking intensity (i.e., number of drinks consumed per binge episode). Risk of binge drinking–related harm increases with intensity, and thus it is important to monitor. The largest number of drinks consumed is assessed in health surveys, but its usefulness for assessing binge intensity is unknown.

To assess the agreement between two potential measures of binge drinking intensity: the largest number of drinks consumed by binge drinkers (maximum-drinks) and the total number of drinks consumed during their most recent binge episode (drinks-per-binge).

Data were analyzed from 7909 adult binge drinkers from 14 states responding to the 2008 Behavioral Risk Factor Surveillance System (BRFSS) binge drinking module. Mean and median drinks-per-binge from that module were compared to mean and median maximum-drinks. Analyses were conducted in 2010–2011.

Mean (8.2) and median (5.9) maximum-drinks were strongly correlated with mean (7.4) and median (5.4) drinks-per-binge (r=0.57). These measures were also strongly correlated across most sociodemographic and drinking categories overall and within states.

The maximum-drinks consumed by binge drinkers is a practical method for assessing binge drinking intensity and thus can be used to plan and evaluate Community Guide–recommended strategies for preventing binge drinking (e.g., increasing the price of alcoholic beverages and regulating alcohol outlet density).

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Request Reprint E-Mail: dkanny@cdc.gov

Policy Dialogue - UK Cabinet seminar on alcohol pricing policy

In the context of growing policy interest in pricing policy as a tool to address alcohol harms, researchers from ALICE RAP and RAND Corporation organised an invitation-only saminar of policy-makers and researchers working on alcohol pricing and related issues.

The meeting aimed to address some of the specific questions policy-makers in the UK are confronting as they consider policy options, with a focus on excise taxation, minimum pricing, restrictions on promotions and discounts, and bans on below cost sales.

• Agenda
• Summary notes

Are Benzodiazepines Effective for Alcohol Withdrawal?

This Cochrane review evaluated the
effectiveness and safety of benzodiazepines
for the treatment of alcohol withdrawal symptoms.

The reviewed studies evaluated benzodiazepines
against placebos, benzodiazepines against other medications (including other anticonvulsants), and one benzodiazepine against a different benzo-diazepine. In general, the studies were small, had large heterogeneity, and had variable assessment outcomes, and most did not reach statistical
significance. Even with multiple studies, the only statistically significant finding in this review was that benzodiazepines were shown to be more effective than placebo for preventing withdrawal seizures; however, they were not shown to be superior to anticonvulsants or other medications

A parallel Cochrane review examining anticonvulsants for alcohol withdrawal symptoms
showed a trend toward a protective benefit against seizures compared with placebo, but this did not reach statistical significance.


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A Brief Intervention Reduces Hazardous and Harmful Drinking in Emergency Department Patients

Brief interventions have been shown to reduce alcohol use and improve outcomes in hazardous and harmful drinkers, but evidence to support their use in emergency department (ED) patients is limited. The use of research assessments in studies of brief interventions may contribute to uncertainty about their effectiveness. Therefore we seek to determine (1) if an emergency practitioner-performed Brief Negotiation Interview or a Brief Negotiation Interview with a booster reduces alcohol consumption compared with standard care; and (2) the impact of research assessments on drinking outcomes using a standard care-no-assessment group.

We randomized 889 adult ED patients with hazardous and harmful drinking. A total of 740 received an emergency practitioner–performed Brief Negotiation Interview (n=297), a Brief Negotiation Interview with a 1-month follow-up telephone booster (Brief Negotiation Interview with booster) (n=295), or standard care (n=148). We also included a standard care with no assessments (n=149) group to examine the effect of assessments on drinking outcomes. Primary outcomes analyzed with mixed-models procedures included past 7-day alcohol consumption and 28-day binge episodes at 6 and 12 months, collected by interactive voice response. Secondary outcomes included negative health behaviors and consequences collected by telephone surveys.

The reduction in mean number of drinks in the past 7 days from baseline to 6 and 12 months was significantly greater in the Brief Negotiation Interview with booster (from 20.4 [95% confidence interval {CI} 18.8 to 22.0] to 11.6 [95% CI 9.7 to 13.5] to 13.0 [95% CI 10.5 to 15.5]) and Brief Negotiation Interview (from 19.8 [95% CI 18.3 to 21.4] to 12.7 [95% CI 10.8 to 14.6] to 14.3 [95% CI 11.9 to 16.8]) than in standard care (from 20.9 [95% CI 18.7 to 23.2] to 14.2 [95% CI 11.2 to 17.1] to 17.6 [95% CI 14.1 to 21.2]). The reduction in 28-day binge episodes was also greater in the Brief Negotiation Interview with booster (from 7.5 [95% CI 6.8 to 8.2] to 4.4 [95% CI 3.6 to 5.2] to 4.7 [95% CI 3.9 to 5.6]) and Brief Negotiation Interview (from 7.2 [95% CI 6.5 to 7.9] to 4.8 [95% CI 4.0 to 5.6] to 5.1 [95% CI 4.2 to 5.9]) than in standard care (from 7.2 [95% CI 6.2 to 8.2] to 5.7 [95% CI 4.5 to 6.9] to 5.8 [95% CI 4.6 to 7.0]). The Brief Negotiation Interview with booster offered no significant benefit over the Brief Negotiation Interview alone. There were no differences in drinking outcomes between the standard care and standard care–no assessment groups. The reductions in rates of driving after drinking more than 3 drinks from baseline to 12 months were greater in the Brief Negotiation Interview (38% to 29%) and Brief Negotiation Interview with booster (39% to 31%) groups than in the standard care group (43% to 42%).

Emergency practitioner–performed brief interventions can reduce alcohol consumption and episodes of driving after drinking in hazardous and harmful drinkers. These results support the use of brief interventions in ED settings.

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Request Reprint E-Mail: gail.donofrio@yale.edu

Department of Health seek partners for social marketing acitivity with young people

The Department of Health (DH) has set out its business priorities for the year ahead in its 2012 Corporate Plan. It includes commitments to improve and promote health and wellbeing, including campaigns acitivity around alcohol and lifestyle choices.

As highlighted in the recent Government Alcohol Strategy it commits to social marketing activity with young people and is seeking services to work with the campaign. > > > > Read More

Persistent Dose-Dependent Changes in Brain Structure in Young Adults with Low-to-Moderate Alcohol Exposure In Utero

Many children with heavy exposure to alcohol in utero display characteristic alterations in brain size and structure. However, the long-term effects of low-to-moderate alcohol exposure on these outcomes are unknown.

Using voxel-based morphometry and region-of-interest analyses, we examined the influence of lower doses of alcohol on gray and white matter composition in a prospectively recruited, homogeneous, well-characterized cohort of alcohol-exposed (n = 11, age 19.5 ± 0.3 years) and control (n = 9, age 19.6 ± 0.5 years) young adults. A large proportion of the exposed individuals were born to mothers whose alcohol consumption during pregnancy was in the low-to-moderate range.

There were no differences in total brain volume or total gray or white matter volume between the exposed and control groups. However, gray matter volume was reduced in alcohol-exposed individuals in several areas previously reported to be affected by high levels of exposure, including the left cingulate gyrus, bilateral middle frontal gyri, right middle temporal gyrus, and right caudate nucleus. Notably, this gray matter loss was dose dependent, with higher exposure producing more substantial losses.

These results indicate that even at low doses, alcohol exposure during pregnancy impacts brain development and that these effects persist into young adulthood.

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Request Reprint E-Mail: sandra.jacobson@wayne.edu

Effects of Cross-Fostering on Alcohol Preference and Correlated Responses to Selection in High- and Low-Alcohol-Preferring Mice

Selectively bred rodent lines are valuable tools for investigating gene × environment interactions related to risk for alcoholism in humans. Early maternal environment is one particular factor known for critically influencing neural, hormonal, and behavioral outcomes in adulthood. Cross-fostering is a procedure that may be used to explore the role of genotype-dependent maternal influences on phenotypic variability in adulthood. The purpose of these experiments was to examine the effects of cross-fostering on free-choice alcohol drinking and correlated responses to selection for alcohol preference in mice selectively bred for high (HAP2) and low (LAP2) alcohol preference.

Mice were assigned to one of the following treatments: SHAM (pups that were fostered to their original biological mother), IN (pups that were fostered to a different mother of the same line), and CROSS (pups that were fostered to a mother of a different line). Mice were tested in adulthood for (i) free 24-hour access to alcohol for a period of 28 days; (ii) the expression of the acoustic startle response and fear-potentiated startle (FPS); and (iii) handling-induced convulsions (HICs) during acute alcohol withdrawal.

Overall, the expression of the alcohol preference selection phenotype was robust in all groups (HAP2 > LAP2). Cross-fostering produced a moderate but significant reduction in g/kg alcohol drinking and preference scores in HAP2 mice (CROSS < SHAM) but had no effect in LAP2 mice. Cross-fostering did not affect the expression of correlated responses to selection: acoustic startle response (HAP2 > LAP2), FPS (HAP2 > LAP2), HICs (LAP2 > HAP2).

It appears that maternal environment can modify the expression of the high-alcohol-preference phenotype in HAP2 selectively bred mice. These results suggest a gene × environment interaction with respect to the expression of the high-alcohol-preference selection phenotype but not correlated responses to selection.

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Request Reprint E-Mail: jchester@psych.purdue.edu

Association of the ALDH1A1*2 Promoter Polymorphism With Alcohol Phenotypes in Young Adults With or Without ALDH2*2

Prior studies suggest a possible association of a promoter polymorphism in the ALDH1A1 gene (ALDH1A1*2) with alcohol use or dependence. The aim of this study was to examine the association of ALDH1A1*2 with drinking behaviors in Asian young adults and to examine ALDH2 genotype as a potential moderator of these associations.

Asian young adults (n = 951) were recruited from 2 college sites for studies of genetic associations with alcohol use behavior. Participants completed comprehensive background questionnaires on demographics and drinking behavior. Fingertip blood samples were obtained for DNA extraction and analysis.

Participants with the ALDH2*1/*2 genotype reported significantly lower levels (frequency and quantity) of drinking within the last 90 days, fewer numbers of heavy drinking episodes within the last 90 days, and lower lifetime maximum consumption levels compared with ALDH2*1/*1 participants. There were no significant main effects of ALDH1A1*2 on any drinking variables, nor was there a significant interaction between ALDH2 and ALDH1A1 genotypes on drinking outcomes.

The association of ALDH2*2 with reduced alcohol consumption replicates previous findings across numerous studies. Although ALDH1A1*2 was not associated with drinking levels, the lack of an ALDH1A1*2 effect in ALDH2*2 individuals is consistent with the only other study that has examined these associations in East Asian populations.

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Request Reprint E-Mail: jmo5@u.washington.edu

Differential Effects of Moderate Alcohol Consumption on Performance Among Older and Younger Adults

Studies exploring differential effects of acute alcohol consumption on younger and older adults are lacking within the field of alcohol research, especially those using moderate doses. Previous studies addressing this question have tended to use complex behavioral tasks too broad to isolate specific neurocognitive processes affected by both alcohol and aging. Compromises in cognitive efficiency (i.e., the ability to respond both quickly and accurately) have previously been identified in both elderly and acutely intoxicated individuals.

The present study employed a visual–spatial, 2-choice reaction time (RT) task to evaluate the interactive effects of aging and alcohol on cognitive efficiency. Our primary outcome measure was an efficiency ratio derived from each participant's response accuracy (ACC) and mean RT (%correct/RT). Younger (25 to 35; n = 22) and older (55 to 74; n = 37) participants were randomly assigned to receive either a placebo or moderate alcohol dose intended to produce a peak breath alcohol concentration of 0.04%. Participants performed the task at peak alcohol levels.

A significant interaction between age group and dose assignment was observed, F(3, 55) = 4.86, p = 0.03, for the efficiency ratio. Younger participants who received alcohol performed significantly better than did their older counterparts regardless of alcohol condition and despite no differences in performance between the 2 age groups in the placebo condition. Additional correlation analyses between ACC and RT suggested that moderately intoxicated older adults become more accurate as response times increase. This relationship was not observed in older adults in the placebo condition.

These data suggest that healthy individuals exhibit a differential susceptibility to the effects of alcohol depending on their age. Unfortunately, because of the presumed safety of moderate alcohol doses and a lack of studies investigating the interactive effects of acute alcohol consumption and aging, most individuals are unlikely to be aware of this relationship between alcohol consumption and age.

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Request Reprint E-Mail: asklar@ufl.edu

Magnitude of the Problem of Drinking Alcohol on College Campuses, Commentary on “Structuring a College Alcohol Prevention Program on the Low Level of

The objective of this commentary is to discuss the significance of the study entitled, “Structuring a College Alcohol Prevention Program on the Low Level of Response to Alcohol Model: A Pilot Model” by Schuckit and colleagues (2012) published in this issue of the Alcoholism: Clinical and Experimental Research. The work by Schuckit and colleagues emphasizes the importance of personalizing an alcohol prevention program for college students.

This pilot model is the result of over 30 years of clinical translational research on an individual's level of response to alcohol. The prevention program is efficient, simple, safe, cost-effective and self-directed.

The results indicate the computerized intervention was associated with decreases in drinking overall and students with a low level of response to alcohol showed greater decreases when the prevention program is personalized to focus on how level of response is affected by peer influence, alcohol expectancies, and stress management. It concludes that college students with a low level of response to alcohol will benefit from a prevention program that is personalized to this well documented endophenotype.

The findings provide the foundation for developing future longitudinal studies of the proposed prevention program with a larger sample size on diverse campuses. In addition, as mentioned in the Discussion section, future studies could also evaluate the effectiveness of other easily measured clinical endophenotypes known to be associated with alcohol use such as impulsivity, negative effect, and maximum number of drinks per occasion.

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Request Reprint E-Mail: d_m_scott2@howard.edu

Ethanol Enhances Human Hyperpolarization-Activated Cyclic Nucleotide-Gated Currents

There is a clear association between excessive ethanol (EtOH) consumption and the risk of sudden cardiac death. The hyperpolarization-activated cyclic nucleotide-gated (HCN) current, I_f, is known to contribute to spontaneous pacemaker activity of sinoatrial (SA) node cells. However, the exact mechanisms of EtOH on arrhythmia induction are not well understood.

The preparations of SA node were excised from rabbit heart, transmembrane potentials were recorded by standard glass microelectrode technique, and a whole-cell patch clamp technique was used to record I_f in enzymatically isolated rabbit SA node pacemaker cells. Human HCN2 (hHCN2) and HCN4 channels were heterologously expressed in Xenopus oocytes and studied using 2-electrode voltage clamp technique.

Superfusion of EtOH increased the spontaneous firing frequency of SA node cells in a reversible fashion. Treatment with ivabradine irreversibly depressed basal firing frequency and markedly attenuated the enhancement effect of EtOH on firing. The stimulatory effects of EtOH on I_f were concentration-dependent in the range of 1 to 100 mM, with an average EC₅₀ value of 20.81 ± 6.71 mM and Hill coefficient of 1.19 ± 0.10. Furthermore, EtOH reversibly enhanced the HCN currents in a concentration-dependent fashion with an EC₅₀ value of 18.41 ± 2.75 mM for the HCN2 channel and 21.98 ± 3.54 mM for the HCN4 channel, which was accompanied by the acceleration of activation and deactivation kinetics. In addition, EtOH, at both moderate and high doses, caused a shift in the voltage dependence of hHCN4 channel activation to more depolarizing potentials. However, superfusion of high, not moderate, concentration of EtOH caused a shift in the voltage dependence of hHCN2 channel activation to more hyperpolarizing potentials.

This study provides insight into the molecular interaction of EtOH and the hHCN channels, which may shed light on elucidating the potentially proarrhythmic mechanism of EtOH.

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Request Reprint E-Mail: huangcongxing@yahoo.cn

Call for all alcohol industry activities to get in line with their Corporate Social Responsibilities

A new editorial in the scientific journal Addiction calls for alcohol producers to stop undermining their own Corporate Social Responsibility goals with their sophisticated marketing activities.

The editorial, written by Dr. Adrian Bonner of the Centre for Health Services Studies at the University of Kent and Prof. Ian Gilmore, Chairman of the Alcohol Health Alliance, primarily focuses on the 2010 UK Government’s Responsibility Deal Alcohol Network (RDAN) and the European Forum for Alcohol Health (EAHF) of the European commission. Both initiatives rely heavily on cooperation of the alcohol industry.

For RDAN the UK government had hoped to work together with the drinks industry as well as a number of health groups. However, acknowledging that the initiative does not advance public health objectives, the health groups withdrew from RDAN in 2011. The authors of the editorial argue that social responsibility deals as in RDAN and the EAHF will be ‘significantly undermined unless Corporate Social Responsibility is consistent in all activities across the whole sector'. > > > > Read More

Poly hosts HIV/AIDS awareness campaign

The Polytechnic of Namibia (PoN) last week held its two day 16th HIV/AIDS and Alcohol Awareness Campaign under the theme: No Youth No Future.

The two day event was aimed at addressing factors that are linked to HIV/AIDS, particularly that of alcohol abuse. Speaking at the launch, PoN Vice Rector: Academic Affairs and Research, Andrew Niikondo, stressed the need for young people to make the right decisions and change their behaviours towards HIV/AIDS.

“Young people have grown up in a world changed by AIDS, yet many still lack comprehensive and correct knowledge about how this pandemic is contracted and how to prevent its infection. This situation persists even though Namibia has programmes for young people to education, information and services that could protect them form harm,” he said. > > > > Read More

Global Actions May 16, 2012

Key Recent Milestones:

· China: Global Actions country coordinator James Yu met with the China Alcoholic Drinks Industry Association (CADIA) to discuss the corporate social responsibility (CSR) survey in China. The survey is expected to commence in late May.



Global Actions in Focus: Self-Regulation in the Philippines

The Ad Standards Council (ASC) and the Philippine Association of National Advertisers (PANA) will soon be launching an ambitious nationwide advertising monitoring exercise.

The comprehensive exercise will focus on beverage alcohol advertisements, but also look at advertisements from other key sectors and their compliance with existing self-regulatory rules in the Philippines. The monitoring proposal is tailored to include the Philippine self-regulatory system of pre-screening ads before they are broadcast or printed.

The beverage alcohol ad monitoring will be broken down in three parts, reflecting ASC’s screening process: (1) screening of initial creative materials (storyboards, scripts, etc.), (2) screening of finished materials (TV, radio ads, etc.), and (3) post-screening.

Each part will look at different elements, including: the volume of ads submitted for screening, whether they were approved or rejected for production, how many complaints a certain ad receives, the nature of these complaints, breakdowns of ASC’s Screening & Hearing Panel decisions, and company compliance with ASC decisions.

The aim of the monitoring is to identify areas in which industry needs to “improve” with regard to the Philippines’ general advertising code, as well as to draw conclusions about what works and what doesn’t in terms of creative materials.

Concrete deliverables for industry include three monitoring reports to be delivered in 2012 in addition to best practice workshops based on the monitoring results and aimed at marketers within PANA’s membership.

What’s Happening Next:

· Mexico: Global Actions Mexico will be attending the 3rd Mesoamerican Forum Good Practices in Road Safety from May 15 to 17, 2012 in Puebla. The event is hosted by the Ministry of Health and the Pan American Health Organization (PAHO).

Variation in regulator of G-Protein signaling 17 Gene (RGS17) is associated with multiple substance dependence diagnoses

RGS17 and RGS20 encode two members of the regulator of G-protein signaling RGS-Rz subfamily. Variation in these genes may alter their transcription and thereby influence the function of G protein-coupled receptors, including opioid receptors, and modify risk for substance dependence.

The association of 13 RGS17 and eight RGS20 tag single nucleotide polymorphisms (SNPs) was examined with four substance [dependence diagnoses (alcohol (AD), cocaine (CD), opioid (OD) or marijuana (MjD)) in 1,905 African Americans (AAs: 1,562 cases and 343 controls) and 1,332 European Americans (EAs: 981 cases and 351 controls). Analyses were performed using both chi2 tests and logistic regression analyses that covaried sex, age, and ancestry proportion. Correlation of genotypes and mRNA expression levels was assessed by linear regression analyses.

Seven RGS17 SNPs showed a significant association with at least one of the four dependence traits after a permutation-based correction for multiple testing (0.003<=Pempirical<=0.037). The G allele of SNP rs596359, in the RGS17 promoter region, was associated with AD, CD, OD, or MjD in both populations (0.005<=Pempirical<=0.019). This allele was also associated with significantly lower mRNA expression levels of RGS17 in YRI subjects (P=0.002) and non-significantly lower mRNA expression levels of RGS17in CEU subjects (P=0.185). No RGS20 SNPs were associated with any of the four dependence traits in either population.

This study demonstrated that variation in RGS17 was associated with risk for substance dependence diagnoses in both AA and EA populations.

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The impact of minimum unit pricing in the new UK alcohol strategy

In March this year the UK government released its Alcohol Strategy for England and Wales. Although weaknesses in sections on treatment and the promotion of alcohol have been criticised, the Strategy has been broadly welcomed by those concerned about alcohol misuse. In particular, the commitment to introduce a minimum unit price for alcohol has been hailed as a significant step forward in addressing the country’s alcohol problems. But how much impact will minimum pricing have?

Minimum unit pricing directly links the price of drinks to their alcohol content and sets a floor price below which a unit (10ml or 8g) of alcohol cannot be sold. For example, a 40 pence minimum price would mean a pint of beer containing two units could not be sold for less than 80 pence. The main evidence demonstrating minimum pricing’s potential effectiveness has been produced by researchers at the University of Sheffield. > > > > Read More

Drinking behaviors by stress level in Korean university students

The purposes of this study are to estimate the stress level of university students, and to verify the relationships between stress level and drinking behavior.

A questionnaire survey was administered to 430 university students in the Gangwon area in Korea from November 5 to November 28, 2008, and data from 391 students were used for the final statistical analysis.

The most stressful factor was "Worry about academic achievements" (2.86 by Likert-type 4 point scale). The subjects were divided into two groups, a low stress group (≤ 65.0) and a high stress group (≥ 66.0), by the mean value (65.1) and median value (66.0) of the stress levels.

The drinking frequency was not different between the two stress groups, but the amount of alcohol consumption was significantly different (P < 0.05). The portion of students reporting drinking "7 glasses or over" was higher in the lower stress group than in the higher stress group. In addition, factor 6, "Lack of learning ability", was negatively correlated with drinking frequency and the amount of alcohol consumption (P < 0.05), and factor 3, "Worry about academic achievements", was negatively correlated with the amount of drinking (P < 0.05).

The major motive for drinking was "When overjoyed or there is something to celebrate" (2.62), and the main expected effect of drinking was "Drinking enables me to get together with people and shape my sociability" (2.73).

The higher stress group showed significantly higher scores on several items in the categories of motives (P < 0.01), negative experience (P < 0.05), and expected effects (P < 0.05) of drinking than the lower stress group.

Our results imply that university students at the lower stress level may drink more from social motives in positive drinking environments, while those at the higher stress level may have more problematic-drinking despite their smaller amount of alcohol consumption.

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Associations of Alcohol, Nicotine, Cannabis, and Drug Use/Dependence with Educational Attainment: Evidence from Cotwin-Control Analyses

Although substance use is associated with reduced educational attainment, this association may be owing to common risk factors such as socioeconomic disadvantage. We tested whether alcohol, nicotine, and illicit drug use and dependence were associated with lifetime educational attainment after controlling for familial background characteristics.

Data were from a 1987 questionnaire and a 1992 telephone diagnostic interview of 6,242 male twins (n = 3,121 pairs; mean age = 41.9 years in 1992) who served in the U.S. military during the Vietnam era and therefore, were eligible for educational benefits after military service. Reduced educational attainment (<16 years) was examined in twin pairs discordant for substance use history. Substance use and dependence risk factors assessed were early alcohol and cannabis use, daily nicotine use, lifetime cannabis use, and alcohol, nicotine, cannabis, and any illicit drug dependence.

Three significant differences were observed between at-risk twins and their cotwins: Compared to their low-risk cotwins, likelihood of completing <16 years of education was significantly increased for the following: (i) twins who used alcohol before age 18 (adjusted OR = 1.44; 95% CI: 1.02 to 2.05), (ii) twins with a lifetime alcohol dependence diagnosis (adjusted OR = 1.76; 95% CI: 1.27 to 2.44), and (iii) twins who had used nicotine daily for 30 or more days (adjusted OR = 2.54, 95% CI: 1.55 to 4.17). However, no differences in education were observed among twin pairs discordant for cannabis initiation, early cannabis use, or cannabis, nicotine, or any illicit drug dependence.

Even in a veteran population with access to military educational benefits, early alcohol use, alcohol dependence, and daily nicotine use remained significantly associated with years of education after controlling for shared familial contributions to educational attainment. The association between other substances and educational attainment was explained by familial factors common to these substance use phenotypes and adult educational attainment.

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The Association Between Density of Alcohol Establishments and Violent Crime Within Urban Neighborhoods

Numerous studies have found that areas with higher alcohol establishment density are more likely to have higher violent crime rates, but many of these studies did not assess the differential effects of type of establishments or the effects on multiple categories of crime. In this study, we assess whether alcohol establishment density is associated with 4 categories of violent crime and whether the strength of the associations varies by type of violent crime and by on-premise establishments (e.g., bars, restaurants) versus off-premise establishments (e.g., liquor and convenience stores).

Data come from the city of Minneapolis, Minnesota in 2009 and were aggregated and analyzed at the neighborhood level. Across the 83 neighborhoods in Minneapolis, we examined 4 categories of violent crime: assault, rape, robbery, and total violent crime. We used a Bayesian hierarchical inference approach to model the data, accounting for spatial auto-correlation and controlling for relevant neighborhood demographics. Models were estimated for total alcohol establishment density as well as separately for on-premise establishments and off-premise establishments.

Positive, statistically significant associations were observed for total alcohol establishment density and each of the violent crime outcomes. We estimate that a 3.9 to 4.3% increase across crime categories would result from a 20% increase in neighborhood establishment density. The associations between on-premise density and each of the individual violent crime outcomes were also all positive and significant and similar in strength as for total establishment density. The relationships between off-premise density and the crime outcomes were all positive but not significant for rape or total violent crime, and the strength of the associations was weaker than those for total and on-premise density.

Results of this study, combined with earlier findings, provide more evidence that community leaders should be cautious about increasing the density of alcohol establishments within their neighborhoods.

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Executive Function Predicts Adaptive Behavior in Children with Histories of Heavy Prenatal Alcohol Exposure and Attention-Deficit/Hyperactivity Disord

Prenatal exposure to alcohol often results in disruption to discrete cognitive and behavioral domains, including executive function (EF) and adaptive functioning. In the current study, the relation between these 2 domains was examined in children with histories of heavy prenatal alcohol exposure, nonexposed children with a diagnosis of attention-deficit/hyperactivity disorder (ADHD), and typically developing controls.

As part of a multisite study, 3 groups of children (8 to 18 years, M = 12.10) were tested: children with histories of heavy prenatal alcohol exposure (ALC, n = 142), nonexposed children with ADHD (ADHD, n = 82), and typically developing controls (CON, n = 133) who did not have ADHD or a history of prenatal alcohol exposure. Children completed subtests of the Delis–Kaplan Executive Function System (D-KEFS), and their primary caregivers completed the Vineland Adaptive Behavior Scales-II. Data were analyzed using regression analyses.

Analyses showed that EF measures were predictive of adaptive abilities, and significant interactions between D-KEFS measures and group were present. For the ADHD group, the relation between adaptive abilities and EF was more general, with 3 of the 4 EF measures showing a significant relation with adaptive score. In contrast, for the ALC group, this relation was specific to the nonverbal EF measures. In the CON group, performance on EF tasks did not predict adaptive scores over the influence of age.

These results support prior research in ADHD, suggesting that EF deficits are predictive of poorer adaptive behavior and extend this finding to include children with heavy prenatal exposure to alcohol. However, the relation between EF and adaptive ability differed by group, suggesting unique patterns of abilities in these children. These results provide enhanced understanding of adaptive deficits in these populations, as well as demonstrate the ecological validity of laboratory measures of EF.

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Resiliency in Adolescents at High Risk for Substance Abuse: Flexible Adaptation via Subthalamic Nucleus and Linkage to Drinking and Drug Use in Early

The personality trait resiliency is the ability to flexibly adapt impulse control relative to contextual demand. Low resiliency has been linked to later alcohol/drug problems. The underlying psychological and neural mechanisms are unknown, but neurocomputational models suggested relations between resiliency and working memory. Cortical–striatal connectivity has been proposed to underlie adaptive switches between cautious and risky behaviors.

Working memory was probed in sixty-seven 18- to 22-year-olds from a larger community study of alcoholism, using the n-back task during functional magnetic resonance imaging. Functional connectivity between task-related regions was investigated with psychophysiological interaction analysis. Resiliency was measured in early teen years and related to early adulthood measures of drinking/drug use, task activation, and connectivity. Relationships with risk factors, including family history, age of drinking onset, and number of alcohol problems, were also investigated.

Higher resiliency was related to lower levels of substance use, fewer alcohol problems, and better working memory performance. Whole-brain regression revealed resiliency negatively correlated with activation of subthalamic nucleus (STN) and pallidum during the n-back. High and Low resiliency quartile groups (n = 17 each) differed in coupling strength between STN and median cingulate cortex, a region of reduced activation during working memory. The high resiliency group had later onset of drinking, fewer alcohol problems, had used fewer illicit drugs, and were less likely to smoke cigarettes than their low resiliency counterparts.

These findings suggest that resiliency in early adolescence may protect against alcohol problems and drug use, although the direction of this effect is currently unknown. This protective factor may relate to executive functioning as supported by the finding of a neural link shared between resiliency and working memory in basal ganglia structures. The STN, a key basal ganglia structure, may adaptively link flexible impulse control with cognitive processing, potentially modulating substance use outcomes.

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Substance Use during Pregnancy Varies by Race and Ethnicity

When pregnant women use alcohol, tobacco, or other drugs, they incur an increased risk for experiencing health problems themselves and poor birth outcomes for their infants. It is important for doctors, nurses, and midwives to discuss the risks of substance use with all pregnant women. Data from the National Survey on Drug Use and Health (NSDUH) indicate that substance use during pregnancy varies by race and ethnicity and suggest that health care providers may consider delivering targeted messages to make their discussions more effective.


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Levels of aggressiveness are higher among alcohol-related suicides: Results from a psychological autopsy study

Suicide is one of the major causes of deaths worldwide. Several studies have showed that alcohol use disorders (AUD) are associated with suicide ideation, suicide attempts, and suicide completion. The majority of the theoretical conceptualization and the bulk of evidence on suicidal behavior and AUD are based on investigations of nonfatal cases because data on nonfatal suicidal behaviors are more readily available.

This study aims to explore demographic, clinical, and behavioral dimensions in a large sample of alcohol-related suicides compared to an age-gender matched sample of non-AUD suicides to identify specific factors associated with AUD suicides. We conducted a psychological autopsy study with 158 pairs of AUD and non-AUD suicides. Findings showed that AUD suicides have lower educational level, more biological children and were more likely to be heavy smokers (OR=3.32). Cases were more likely to have family history of alcohol (OR=1.73) and drug abuse (OR=3.61).

Subjects had similar prevalences of depressive disorders, anxiety disorders or psychotic disorders. AUD suicides were more likely to meet criteria for current cocaine abuse/dependence (OR=6.64).

With respect to personality disorders, AUD suicides presented higher prevalence of Antisocial Personality Disorder (OR=4.68), and were less likely to meet criteria for Avoidant (OR=0.26) and Obsessive-Compulsive Personality Disorders (OR=0.35). Impulsivity scores were higher in AUD suicides (p=0.18), as well as aggression scores (p<0.001).

Results form the conditional logistic regression models showed that cocaine abuse/dependence (OR=4.20) and Antisocial Personality Disorder (OR=6.24) were associated with AUD suicide. After controlling for impulsive-aggressive behaviors, levels of aggression were the only psychopathological feature statistically different between AUD and non-AUD suicides (OR=1.28).

In conclusion, higher levels of aggressive behaviors are a specific characteristic of AUD suicides. Apart from substance-related diagnoses, AUD and non-AUD suicides have comparable Axis I psychiatric diagnoses and familial transmission of suicidal behavior.



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Request Reprint E-Mail: eduardo.chachamovich@mcgill.ca