Upside and Downside
Easing the Pain of an Economic Downturn: Macroeconomic Conditions and Excessive Alcohol Consumption
María Dávalos, Hai Fang & Michael French
Health Economics, forthcoming
Abstract:
Individuals can react to financial stress in a variety of ways, such as reducing discretionary spending or engaging in risky behaviors. This article investigates the effect of changing macroeconomic conditions (measured by the unemployment rate in the state of residence) on one type of risky behavior: excessive alcohol consumption. Using unique and recent panel data from waves 1 and 2 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) and estimating fixed-effects models, we find that changes in the unemployment rate are positively related to changes in binge drinking, alcohol-involved driving, and alcohol abuse and/or dependence. Some differences are present among demographic groups, primarily in the magnitude of the estimated effects. These results contradict previous studies and suggest that problematic drinking may be an indirect and unfortunate consequence of an economic downturn.
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Birth Cohort Effects and Gender Differences in Alcohol Epidemiology: A Review and Synthesis
Katherine Keyes, Guohua Li & Deborah Hasin
Alcoholism, forthcoming
Background: Alcohol consumption has demonstrated substantial temporal trends, with some evidence suggesting strong birth cohort effects. The identification of at-risk birth cohorts can inform the interpretation of alcohol trends across age, time, and demographic characteristics such as gender. The present literature review has 2 objectives. First, we conduct a cross-national review of the literature on birth cohort differences in alcohol consumption, disorder, and mortality. Second, we determine the consistency of evidence for birth cohort effects on gender differences.
Methods: A search was conducted and key data on population characteristics, presence and direction of cohort effects, and interactions with gender compiled. Thirty-one articles were included.
Results: Evidence suggests that younger birth cohorts in North America, especially those born after World War II, are more likely than older cohorts to engage in heavy episodic drinking and develop alcohol disorders, but this cohort effect is not found in Australia and western Europe. Cross-nationally, substantial evidence indicates that women in younger cohorts are at especially high risk for heavy episodic drinking and alcohol disorders.
Discussion: Younger birth cohorts in North America and Europe are engaging in more episodic and problem drinking. The gender gap in alcohol problems is narrowing in many countries, suggesting shifting social norms surrounding gender and alcohol consumption. These trends suggest that public health efforts to specifically target heavy drinking in women are necessary.
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Understanding High-Risk Behavior among Non-Dominant Minorities: A Social Resistance Framework
Roni Factor, Ichiro Kawachi & David Williams
Social Science & Medicine, forthcoming
Abstract:
Across different societies, non-dominant minority groups, compared to the dominant group, often exhibit higher rates of involvement in high-risk behaviors, such as smoking, drug and alcohol use, sexual risk behaviors, overeating, and unsafe driving habits. In turn, these behaviors have a well-documented impact on chronic disease, morbidity, and mortality. Previous studies have emphasized macro-structural or micro-agentic explanations for this phenomenon. Such explanations suffer from mirror-image shortcomings, such as, by emphasizing structural barriers, macro-level explanations leave out individual agency ("the over-socialized conception of the individual"), while micro-level theories give short shrift to structural constraints that prevent individuals from engaging in health-promoting behaviors ("the under-socialized conception of the individual"). Moreover, most current theories regard individuals as passive players who are influenced by the social environment or by psychological problems, or who make "bad" choices. The current paper develops an integrated theoretical framework that incorporates structural inequalities while leaving intact the role of individual agency. According to the social resistance framework, power relations in society encourage members of non-dominant minority groups to actively engage in everyday resistance practices that include various unhealthy behaviors. The paper develops propositions from which testable hypotheses can be generated, and discusses the implications and contributions of the social resistance framework.
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Anna Söderpalm Gordh, Sejla Brkic & Bo Söderpalm
Pharmacology Biochemistry and Behavior, October 2011, Pages 696-703
Background: This paper investigates how stress interacts with alcohol consumption in subjects with a family history of alcoholism. One mechanism for increases in alcohol intake may be that stress alters the subjective effects produced by the drug.
Methods: 58 healthy volunteers, divided into two groups of family history positive (FHP) and two groups of family history negative (FHN) participated in two laboratory sessions, in which they performed in one out of two sessions a stress task. Then subjects were allowed to choose up to six additional drinks of ethanol or placebo depending on which session they were randomly assigned to start with.
Results: It was found that FHP subjects increased their consumption of alcohol after stress.
Conclusions: It is possible that both stress and alcohol specifically exaggerate the feelings of the reward in the FHP individuals in such way that it may increase the likelihood of consuming more alcohol.
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The impact of retail practices on violence: The case of single serve alcohol beverage containers
Robert Nash Parker, Kevin McCaffree & Daniel Skiles
Drug and Alcohol Review, September 2011, Pages 496-504
Introduction and Aims: This paper examines the role that sales of single serve alcoholic beverages plays in violent crime in surrounding areas. Increasingly a target of regulatory measures, this is the first study to systematically assess the impact of single serve containers on neighbourhood violence.
Design and Methods: The relative proportion of shelf space in each liquor establishment in San Bernardino, CA devoted to single serve alcohol containers was surveyed. Assuming that this is a rough indicator of the amount of sales derived from single serve containers, we use this indicator as a measure of the impact of specific retail practice on violence around the outlet.
Results: Results show that the average proportion of shelf space devoted to single serve containers in the unit of analysis, the US Census Bureau block group, was positively related to violent crime, net of overall retail availability of alcohol and relevant social and economic indicators often used to predict violent crime rates in such units.
Discussion and Conclusions: These findings suggest that if the city were to make the voluntary ban on single serve container sales mandatory, violence in the surrounding areas would decline, all other things being equal. This study provides a much more grounded and specific justification for enacting such policy changes and once again shows the utility of alcohol policy for the reduction of crime and violence.[Parker RN, McCaffree KJ, Skiles D. The impact of retail practices on violence: The case of single serve alcohol beverage containers.
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Melissa Lewis et al.
Journal of Studies on Alcohol and Drugs, September 2011, Pages 844-853
Objective: Prior research has shown that normative perceptions of others' drinking behavior strongly relates to one's own drinking behavior. Most research examining the perceived drinking of others has generally focused on specificity of the normative referent (i.e., gender, ethnicity). The present study expands the research literature on social norms by examining normative perceptions by various drinking contexts. Specifically, this research aimed to determine if college students overestimate peer drinking by several drinking contexts (i.e., bar, fraternity/sorority party, non-fraternity/sorority party, sporting event) and to examine whether normative perceptions for drinking by contexts relate to one's own drinking behavior specific to these contexts.
Method: Students (N = 1,468; 56.4% female) participated in a web-based survey by completing measures assessing drinking behavior and perceived descriptive drinking norms for various contexts.
Results: Findings demonstrated that students consistently overestimated the drinking behavior for the typical same-sex student in various drinking contexts, with the most prominent being fraternity/sorority parties. In addition, results indicated that same-sex normative perceptions for drinking by contexts were associated with personal drinking behavior within these contexts.
Conclusions: Results stress the importance of specificity of social norms beyond those related to the normative referent. Clinical implications are discussed in terms of preventions and intervention efforts as well as risks associated with drinking in a novel context.
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Dangerous Liaisons? Dating and Drinking Diffusion in Adolescent Peer Networks
Derek Kreager & Dana Haynie
American Sociological Review, October 2011, Pages 737-763
Abstract:
The onset and escalation of alcohol consumption and romantic relationships are hallmarks of adolescence. Yet only recently have these domains jointly been the focus of sociological inquiry. We extend this literature by connecting alcohol use, dating, and peers to understand the diffusion of drinking behavior in school-based friendship networks. Drawing on Granovetter's classic concept of weak ties, we argue that adolescent romantic partners are likely to be network bridges, or liaisons, connecting daters to new peer contexts that, in turn, promote changes in individual drinking behaviors and allow these behaviors to spread across peer networks. Using longitudinal data of 449 couples from the National Longitudinal Study of Adolescent Health, we estimate Actor-Partner Interdependence Models and identify unique contributions of partners' drinking, friends' drinking, and friends-of-partners' drinking to daters' own future binge drinking and drinking frequency. Findings support the liaison hypothesis and suggest that friends-of-partners' drinking have net associations with adolescent drinking patterns. Moreover, the coefficient for friends-of-partners' drinking is larger than the coefficient for one's own peers and generally immune to prior selection. Our findings suggest that romantic relationships are important mechanisms for understanding the diffusion of emergent problem behaviors in adolescent peer networks.
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The Impact of Peer Social Networks on Adolescent Alcohol Use Initiation
Marlon Mundt
Academic Pediatrics, September-October 2011, Pages 414-421
Objective: Early adolescent alcohol use is a major public health problem. Drinking before the 14th birthday is associated with a fourfold increase in risk of alcohol dependence in adulthood. The objective of this study is to evaluate the association between adolescent social network characteristics and alcohol initiation prospectively over time.
Methods: The study analyzes data from the National Longitudinal Study of Adolescent Health, a nationally representative survey of 7th- through 11th-grade students enrolled between 1995 and 1996. Generalized estimating equations are used to model the risk of alcohol use initiation at 1-year follow-up among nondrinkers at wave 1 of the study.
Results: Both an adolescent's friends' alcohol use and the adolescent's social network characteristics displayed an independent main effect on alcohol initiation. In comparison with abstainers, alcohol initiators had more popular friends as measured by more peer nominations as friends (indegree) and having more friends up to 3 steps removed (3-step reach), and more friends who drank. An adolescent's risk of alcohol use onset increased 13% (95% CI, 4%-22%) for every additional friend with high indegree, 3% (95% CI, 0.3%-6%) for every additional 10 friends within 3-step reach, and 34% (95% CI, 14%-58%) for each additional friend who drank alcohol, and after controlling for confounders.
Conclusion: The findings suggest that, in addition to well-established demographic risk factors, adolescents are at heightened risk of alcohol use onset because of their position in the social network in relationship to their friends and the friends of their friends.
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Positive income shocks and accidental deaths among Cherokee Indians: A natural experiment
Tim Bruckner, Ryan Brown & Claire Margerison-Zilko
International Journal of Epidemiology, August 2011, Pages 1083-1090
Background: Several studies in low-income populations report the somewhat counterintuitive finding that positive income gains adversely affect adult health. The literature posits that receipt of a large portion of annual income increases, in the short term, risk-taking behaviour and/or the consumption of health-damaging goods. This work implies the hypothesis that persons with an unexpected gain in income will exhibit an elevated risk of accidental death-the fifth leading cause of death in the USA. We test this hypothesis directly by capitalizing on a natural experiment in which Cherokee Indians in rural North Carolina received discrete lump sum payments from a new casino.
Methods: We applied Poisson regression to the monthly count of accidental deaths among Cherokee Indians over 204 months spanning 1990-2006. We controlled for temporal patterns in accidental deaths (e.g. seasonality and trend) as well as changes in population size.
Results: As hypothesized, the risk of accidental death rises above expected levels during months of the large casino payments (relative risk = 2.62; 95% confidence interval = 1.54-4.47). Exploratory analyses of ethnographic interviews and behavioural surveys support that increased vehicular travel and consumption of health-damaging goods may account for the rise in accident proneness.
Conclusions: Although long-term income gains may improve health in this population, our findings indicate that acute responses to large income gains, in the short term, increase risk-taking and accident proneness. We encourage further investigation of natural experiments to identify causal economic antecedents of population health.
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Christopher Armitage, Peter Harris & Madelynne Arden
Health Psychology, September 2011, Pages 633-641
Objective: To test the ability of a new, brief means of affirming the self (the "self-affirming implementation intention") to decrease alcohol consumption against a standard means of self-affirmation (the self-affirming "kindness" questionnaire) and an active control condition; to test whether self-affirmation effects can be sustained beyond the experimental session; and to examine potential moderators of the effects.
Method: Two hundred seventy-eight participants were randomly allocated to one of three conditions: control questionnaire, self-affirming questionnaire, and self-affirming implementation intention. All participants were exposed to a threatening health message, designed to inform them about the health risks associated with consuming alcohol.
Main Outcome Measures: The main outcome measure was subsequent alcohol intake.
Results: There were significant public health gains and statistically significant decreases (>1 unit/day) in alcohol consumption in the two experimental conditions but not in the control condition. At the end of the study, participants in the control condition were consuming 2.31 units of alcohol per day; people in the self-affirming questionnaire condition were consuming 1.52 units of alcohol per day; and people in the self-affirming implementation intention condition were consuming 1.53 units of alcohol per day. There were no significant differences between the self-affirming questionnaire and self-affirming implementation intention, and adherence did not moderate the effects. Self-affirmation also improved message processing, increased perceived threat, and led to lower message derogation.
Conclusions: The findings support the efficacy of a new, brief self-affirmation manipulation to enhance the effectiveness of health risk information over time. Further research is needed to identify mediators of the effects of self-affirmation on health behavior change.
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Alcohol availability and youth homicide in the 91 largest US cities, 1984-2006
Robert Parker et al.
Drug and Alcohol Review, September 2011, Pages 505-514
Abstract:
The aggregate relationship between homicide and alcohol availability is well established across a number of national and sub-national settings in North America, Europe and some parts of Asia. However, results linking youth homicide and alcohol availability at the retail level are largely absent from the literature, especially at the city level and across longer time periods. In a multivariate, pooled time series and cross-section study, youth homicide offending rates for two age groups, 13-17 and 18-24, were analysed for the 91 largest cities in the USA between 1984 and 2006. Data for social and economic characteristics, drug use, street gang activity and gun availability were also used as time series measures. Data on the availability of alcohol for each city were gathered from the US Census of Economic Activity, which is conducted every 5 years. These data were used to construct an annual time series for the density of retail alcohol outlets in each city. Results indicated that net of other variables, several of which had significant impacts on youth homicide, the density of alcohol outlets had a significant positive effect on youth homicide for those aged 13-17 and 18-24. Such positive effects have been found for adults in national and neighbourhood level studies, but this is the first study to report such evidence for teenagers and young adults. An important policy implication of these findings is that the reduction of the density of retail alcohol outlets in a city may be an effective tool for violent crime reduction among such youth.
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Determinants of Tobacco Control Funding: Evidence from U.S. States
Craig Gallet
Forum for Health Economics & Policy, 2011
Abstract:
The literature on tobacco control funding has focused on its impact on the demand for tobacco products. This paper turns the issue around by utilizing state-level panel data to address the determinants of per capita tobacco control funding. Tobacco control funding is found to be increasing with per capita income, cigarette consumption, and cigarette taxes, but decreasing with population density and neighbor-state tobacco control funding. Political affiliation, cancer and heart attack mortalities, as well as the extent of smoke-free air laws, have little impact on tobacco control funding. Results are robust to addressing the endogeneity of cigarette consumption and cigarette taxes.
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Diminishing Willingness to Pay per Quality-Adjusted Life Year: Valuing Acute Foodborne Illness
Kevin Haninger & James Hammitt
Risk Analysis, September 2011, Pages 1363-1380
Abstract:
We design and conduct a stated-preference survey to estimate willingness to pay (WTP) to reduce foodborne risk of acute illness and to test whether WTP is proportional to the corresponding gain in expected quality-adjusted life years (QALYs). If QALYs measure utility for health, then economic theory requires WTP to be nearly proportional to changes in both health quality and duration of illness and WTP could be estimated by multiplying the expected change in QALYs by an appropriate monetary value. WTP is elicited using double-bounded, dichotomous-choice questions in which respondents (randomly selected from the U.S. general adult population, n = 2,858) decide whether to purchase a more expensive food to reduce the risk of foodborne illness. Health risks vary by baseline probability of illness, reduction in probability, duration and severity of illness, and conditional probability of mortality. The expected gain in QALYs is calculated using respondent-assessed decrements in health-related quality of life if ill combined with the duration of illness and reduction in probability specified in the survey. We find sharply diminishing marginal WTP for severity and duration of illness prevented. Our results suggest that individuals do not have a constant rate of WTP per QALY, which implies that WTP cannot be accurately estimated by multiplying the change in QALYs by an appropriate monetary value.
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Concurrent drinking and smoking among college students: An event-level analysis
Katie Witkiewitz et al.
Psychology of Addictive Behaviors, forthcoming
Abstract:
Cigarette smoking and drinking commonly co-occur among college students, a population that is at high risk for developing alcohol and nicotine use disorders. Several studies have been conducted that have examined predictors of drinking or smoking to gain a better understanding of the antecedents of engaging in these behaviors. Yet, few studies have examined specific factors that influence concurrent smoking and drinking in this population. The current study used data from a 21-day electronic diary-based study of college students (n = 86) who engaged in concurrent drinking and smoking to examine event-level associations between alcohol use and cigarette smoking in the student's natural environment. We specifically focused on within-person analyses of contexts in which students reported smoking and drinking simultaneously in comparison to contexts in which students reporting drinking without smoking. Situational contexts included environmental setting, whether s/he was alone or with others, and changes in stress and urges to smoke before initiating drinking. Results indicated that students drank more while smoking and smoked three times as many cigarettes, on average, during drinking episodes. Being with others at a party or a bar was associated with increased odds of smoking while drinking. Likewise, increased stress since the prior assessment predicted a greater likelihood of smoking while drinking. Based on the findings from the present study, it is important for future prevention and intervention efforts to consider social settings and heightened stress among students as potential risk factors for engaging in concurrent drinking and smoking.
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Marleen van Gelder et al.
Perspectives on Sexual and Reproductive Health, September 2011, Pages 164-172
Context: Illicit drug use is associated with risky sexual behaviors in adolescents and young adults. However, few studies have examined these associations among drug users of all reproductive ages, using a control group of nonusers.
Methods: Associations between marijuana and cocaine use, and outcomes related to sexual behaviors and reproductive health, were assessed using data from the 2002 National Survey of Family Growth. Overall, 4,928 men and 7,643 women aged 15-44 were interviewed. Chi-square tests, t tests and multivariable logistic regression analyses were used; in supplementary analyses, men and women were stratified by age-group (25 or younger, and older than 25), to capture the understudied older adults who use drugs.
Results: Twenty-seven percent of men and 16% of women reported use of marijuana or cocaine in the last year. Drug users were younger than nonusers at first vaginal sex (mean, 15.2-16.1 vs. 17.3-17.5 years) and were more likely to have engaged in risky sexual behaviors in the last year, including having had sex with a nonmonogamous partner (odds ratios, 3.3-5.2 for men and 2.9-6.5 for women), while high on alcohol or drugs (10.1-18.0 and 8.1-24.2), or in exchange for money or drugs (2.7-2.8 and 2.3-9.2). They also were more likely to have undergone STD testing or treatment. Drug use was associated with risky sexual behaviors in both age-groups.
Conclusion: Programs aimed at reducing sexual risks among drug users should address the behaviors of men and women of all reproductive ages.
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Alcohol and Homicide in Russia and the United States: A Comparative Analysis
Jonas Landberg & Thor Norström
Journal of Studies on Alcohol and Drugs, September 2011, Pages 723-730
Objective: The object of this study was to perform a comparative analysis of the aggregate relationship between alcohol and homicide in Russia and in the United States. The comparison was based on the magnitude of the alcohol effect, the alcohol attributable fraction (AAF), and the degree to which total consumption could account for trends in homicide.
Method: We analyzed total and sex-specific homicide rates for the age groups 15-64 years, 15-34 years, and 35-64 years. The study period was 1959-1998 for Russia and 1950-2002 for the United States. For the United States, alcohol consumption was gauged by sales of alcohol; for Russia, estimated unrecorded consumption was included as well. The data were analyzed through autoregressive integrated moving average (ARIMA) modeling.
Results: The results show that, for Russia as well as for the United States, a 1-L increase in consumption was associated with an increase in homicides of about 10%, although the absolute effect was markedly larger in Russia because of differences in homicide rates. The AAF estimates suggested that 73% and 57% of the homicides would be attributable to alcohol in Russia and in the United States, respectively. Most of the temporal variation in the Russian homicide rate could be accounted for by the trend in drinking, whereas the U.S. trend in total alcohol consumption had a more limited ability to predict the trend in homicides.
Conclusions: We conclude that the role of alcohol in homicide seems to be larger in Russia than in the United States.
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J. Gold et al.
Health Education Research, October 2011, Pages 782-794
Abstract:
Mobile phone text messages (SMS) are a promising method of health promotion, but a simple and low cost way to obtain phone numbers is required to reach a wide population. We conducted a randomised controlled trial with simultaneous brief interventions to (i) evaluate effectiveness of messages related to safer sex and sun safety and (ii) pilot the use of mobile advertising for health promotion. Mobile advertising subscribers aged 16-29 years residing in Victoria, Australia (n = 7606) were randomised to the ‘sex' or ‘sun' group and received eight messages during the 2008-2009 summer period. Changes in sex- and sun-related knowledge and behaviour were measured by questionnaires completed on mobile phones. At follow-up, the sex group had significantly higher sexual health knowledge and fewer sexual partners than the sun group. The sun group had no change in hat-wearing frequency compared with a significant decline in hat-wearing frequency in the sex group. This is the first study of mobile advertising for health promotion, which can successfully reach most young people. Challenges experienced with project implementation and evaluation should be considered as new technological approaches to health promotion continue to be expanded.
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Kurt Dermen & Sherilyn Thomas
Psychology of Addictive Behaviors, forthcoming
Abstract:
The present study tested the proposition that an intervention to reduce alcohol use among college students will also reduce their risky sexual behavior. In a randomized controlled trial, 154 heavy-drinking, predominantly White, heterosexual college students at behavioral risk for infection with HIV and other sexually transmitted diseases were assigned to receive no intervention or a two-session, in-person, motivational interviewing-based intervention focused on (a) reducing alcohol risk behavior, (b) reducing HIV risk behavior, or (c) reducing both alcohol and HIV risk behavior. Three-month retrospective assessments of alcohol use and sexual behavior were conducted at intake and at 3-, 6-, 9-, 12-, and 15-month follow-up appointments. During follow-up, participants who received the single-focus alcohol risk-reduction intervention drank less frequently and consumed fewer drinks per drinking day as compared with no-intervention control participants, but did not differ from control participants in their frequency of intercourse without a condom or number of sexual partners. Participants who received the single-focus HIV risk-reduction intervention evidenced fewer unprotected sex events during follow-up, as compared with control participants. The number of sexual partners reported during follow-up did not differ by condition. Effects of the interventions did not vary significantly over time and were not moderated by participant gender. Results suggest that intervening to reduce alcohol use may not reduce risky sexual behavior among nonminority college students, but that a brief motivational intervention targeting HIV risk behavior may have utility for reducing the frequency of unprotected sex in this population.