The relationship of early-onset regular smoking to alcohol use, depression, illicit drug use, and other risky behaviors during early adolescence: results from the youth supplement to the third national health and nutrition examination survey.

PURPOSE: Recently we found that the early onset of regular tobacco use is as predictive of lifetime drug use and depressive disorders as it is of alcohol use disorders [Alcohol.: Clin. Exp. Res. 23 (1999) 513.]. This finding, which paralleled findings regarding early onset of alcohol use [J. Subst. Abuse 10 (1998) 59.], suggested that early regular use of any drug might simply be an indicator of risk for a constellation of problem behaviors. The purpose of the present study is to test this hypothesis as well as to study the strength and patterns of associations among these problem behaviors already present among youth. The results will permit description of more precise profiles to identify groups of children at risk. METHODS: Using data for respondents aged 12-16 from the Third National Health and Nutrition Examination Survey (NHANES III), descriptive statistics were calculated and logistic regression models were estimated. RESULTS: Descriptive analyses indicated that in comparison with those who never smoked, or who simply experimented, early-onset regular smokers, both those who began at age 13 or younger and those who did so between 14 and 16, were those most likely to use alcohol and other drugs as well as have school problems and early sexual experiences culminating in pregnancy. Multivariate logistic regression analyses were conducted to assess the associations among these high-risk behaviors. IMPLICATIONS: These results support the hypothesis that early onset of smoking is but an indicator of a syndrome of problem behaviors already in place during childhood. They also suggest that the significance of an age onset variable may differ depending on the age of the sample used. As follow-up data are collected, we expect to learn much about the natural course of the distinct risk groups identified in the analyses by studying longitudinally this nationally representative group of early adolescents.

Effects of alcohol on the heart.

Some evidence suggests that light to moderate alcohol consumption protects against cardiovascular diseases. However, this cardioprotective effect of alcohol consumption in adults is absent at the population level. Approximately 20 to 30% of patients admitted to a hospital are alcohol abusers. In medical practice, it is essential that patients' levels of consumption are known because of the many adverse effects that might result in the course of routine care. Ethanol damage to the heart is evident if alcohol consumption exceeds 90 to 100 g/d. Heavy ethanol consumption leads to increased risk for sudden cardiac death and cardiac arrhythmias. In patients with coronary heart disease, alcohol use was associated with increased mortality. An early response to drinking was an increased ventricular wall thickness to diameter ratio, possibly proceeding with continuous drinking to alcoholic cardiomyopathy, which had a worse outcome compared with idiopathic dilative cardiomyopathy if drinking was not stopped or at least reduced (< 60 g/d). In the ICU, patients with chronic alcoholism have more cardiac complications postoperatively. These complications probably are caused by biventricular dysfunction, particularly with the occurrence of severe infections or septic shock, events that are three to four times more frequent among chronic alcoholics than occasional drinkers or nondrinkers. To prevent further complications from drinking and for long-term management of drinking, patients with alcohol abuse and heart failure should be treated in brief intervention and follow-up programs. Prognosis is good even in patients with New York Heart Association class IV heart failure caused by cardiomyopathy if complete abstinence is accomplished. Noncompliance to smoking and alcohol restrictions, which are amenable to change, dramatically increases the risk for hospital readmissions among patients with heart failure.

Alcohol consumption and divorce rates in the United States.

OBJECTIVE: The objective of the present study is to analyze time series data on alcohol consumption and divorce rates and assess the directionality of this relationship using alternative aggregate measures of alcohol consumption rates. METHOD: Granger's causality test and Box-Jenkins time series analysis are used to examine aggregate data on divorce rates and two indicators of alcohol consumption: a per capita consumption measure based on sales and shipments, and an expenditure-based measure for U.S. data from 1934 to 1987. RESULTS: A consumption increase of 1 liter of alcohol per capita brings about an increase in the divorce rate of about 20%. This finding contrasts with results, using expenditures as the aggregate alcohol measure, that show that an increase of 1/1,000 in the divorce rate leads to a 10% increase in alcohol expenditures. (These latter findings confirm earlier published results.) CONCLUSIONS: The results from the present study provide support both for the effects of heavy drinking on divorce rates and the effects of divorce rates on expenditures for alcoholic beverages. While both aggregate measures of alcohol consumption are highly correlated, they may tap different aspects of consumption. The relationship between marital instability and alcohol consumption is far from a simple one, and more complete conceptual models need to be developed. Aggregate-level findings indicate that it is reasonable to assume that a bidirectional influence exists between divorce rates and alcohol consumption.

Parallels to early onset alcohol use in the relationship of early onset smoking with drug use and DSM-IV drug and depressive disorders: findings from the National Longitudinal Epidemiologic Survey.

This paper endeavored to determine (1) if early onset of regular tobacco use is as predictive of drug use and depressive disorders as it is of alcohol use disorders; and (2) if a biological commonality, as measured by a family history of alcoholism and both early onset and severity of disease, among all three disorders can be evidenced in a large nationally representative sample. Prevalences of lifetime drug use, drug abuse and dependence, and major depressive disorders, as well as indices of their severity, were compared among smoking groups defined by age at onset of regular tobacco use and among nonsmokers. Linear logistic regression analyses, controlling for important covariates, including a family history positive for alcoholism, were conducted to assess the relationship between age at smoking onset and drug use, abuse and dependence, as well as depressive disorders. Both objectives were met. Moreover, results suggest that smoking may play an equally, if not even more, insidious role than drinking in the use and development of dependence on illicit substances and depression.

Gender differences in DSM-IV alcohol use disorders and major depression as distributed in the general population: clinical implications.

This study examined gender differences within and between five groups of subjects drawn from a large representative sample of the United States population and classified as having either major depression (MDD) only, alcohol use disorder (AUD) only, or primary, secondary, or concurrent depression to determine if these diagnostic profiles (1) were consistent with those drawn on clinical samples and (2) might suggest potential clinical implications. Respondents (N = 9,985) from a nationally representative survey of the United States population met DSM-IV criteria for classification into these five mutually exclusive groups that were compared within and between groups by gender on the characteristics of each disorder. The results were consistent with those of other studies: (1) gender distributions of AUD and depressive disorder remain almost mirror opposites, and (2) comorbid disorders are more severe than either of the conditions appearing singly. Findings of particular interest were that the synergistic effects of an alcohol and a depressive condition operate equally for both men and women with concurrent depression. This points to the necessity of attending carefully to gender biases when dealing with comorbid conditions, last we fail to take alcoholism in the presence of depression seriously enough in women and vice versa in men. Additionally, women with primary depression are at high risk for suicide and thus may require special attention in the evaluative phase of treatment.

The relationship between drinking and heart disease morbidity in the United States: results from the National Health Interview Survey.

This study, based on data drawn from the responses of 18,323 males and 25,440 females to the 1988 National Health Interview Survey, a nationally representative, multistage probability sample of the United States, attempts to define more precisely the level of drinking at which the relationship between heart disease and alcohol consumption is a protective one. Its attempt at precision derives from (1) using drinking categories that represent various points within the range of moderate drinking (1-6 drinks) defined in the literature as protective; (2) adjusting for underreporting that commonly occurs in population surveys by using consumption at time of heaviest drinking; and (3) controlling for age, body mass, smoking, former drinker, and former smoker status, duration of drinking, and sociodemographic factors. It also examines whether the relationship derived from these levels conforms to the U-shaped curve that demonstrates the protective effect of moderate drinking when abstainers are not used as the reference group. Relative to infrequent drinkers (less than 1 drink per day), men report more heart disease at the level of more than five drinks per day. However, black men also report more heart disease, relative to infrequent drinkers, at the greater than two drinks per day level; and women report more heart disease at the level of more than two drinks per day at the time of their heaviest drinking. Former drinkers of both genders, considered as an independent variable in the regression analysis, were more likely to report having heart disease. Abstainers, light drinkers, and infrequent drinkers were not significantly different in their reports of heart disease. Our results are consistent with studies that suggest protection from heart disease occurs only at lower levels of drinking.

The effects of substance use during gestation on birth outcome, infant and maternal health.

This study examines the relationship of substance use to birth outcome, infant, and maternal health in a large, nationally representative sample. Multiple regression analyses, accommodating the nature of the survey data using the SUDAAN software package, indicated that drinking and smoking independently and/or interactively with depression account for poor health and serious medical conditions among pregnant women as well as negative birth outcomes or adverse health consequences in those infants who are live births. In addition, African American women and their infants are more likely than those of other racial groups to suffer these adverse outcomes. Given the risk profiles of individual illnesses, this study suggests the need for developing and targeting health education and preventive efforts specific to those groups that are clearly at greater risk.

The motivational correlates of drinking, smoking, and illicit drug use during pregnancy.

Despite attempts to eliminate the consumption of alcohol, tobacco, and other substances of abuse by women of childbearing age, especially during gestation, apparently many do not curtail these negative lifestyle behaviors, as evidenced by the number of poor birth outcomes and developmentally disabled children born each year. This study examined the relationship of depression, attitude toward pregnancy, a number of sociodemographic variables, and substance use by women of child-bearing age prior to and after learning of their pregnancies. Results indicated that attitude independently, and depression independently and in interaction with socio-demographic factors are associated with substance use at both time points. From this we conclude that preventive efforts should be designed and targeted at those women who are depressed, especially those who have the sociodemographic characteristics associated with heavier substance use.

The long- and short-term effects of marriage on drinking.

Descriptive and multiple regression analyses of data from the National Longitudinal Survey of Youth (NLSY), a longitudinal survey conducted annually since 1979, offer support for the many studies that demonstrate a relationship between marital status and alcohol consumption. Race, gender, history of heavy drinking, and alcoholic relatives were additional key variables utilized in the analysis. Data from this ongoing survey indicate that long-term marriage is associated with decreased drinking, except among women with a history of heavy drinking. Separation and divorce are not associated with long-term effects on current drinking. Divorce is associated with decreased drinking, at least in the short term, for men and women with a family history of alcoholism.

Marriage: does it protect young women from alcoholism?

The literature is replete with conflicting articles about the relationship of marital status and drinking in women. This study is an analysis of the drinking practices of women, 24 through 32 years old, who were respondents in the National Longitudinal Survey of Youth (NLSY). Variations in drinking patterns for the years 1982 through 1988 as a function of changes in marital status are detailed. Findings indicated that women who married or remarried decreased drinking, whereas those who became separated or divorced increased drinking. In the present study, women with alcoholic spouses exhibited similar changes in drinking as did other young women. Our conclusion was that the instability created by a change in social position, namely marital status, led to changes in drinking patterns during the study interval in the direction of those associated with the new social position.

Attitudes toward problem drinkers, revisited: patient-therapist factors contributing to the differential treatment of patients with alcohol problems.

Although there are many treatment alternative open to people with drinking problems, health professionals still exhibit negative attitudes towards alcoholics. In a previous study, the author demonstrated that those patients who were self-labelled alcoholics were treated in a less preferential manner than those who did not identify as such. This study used both overt and unobtrusive measures to determine whether negative attitudes of intake interviewers towards problem drinkers were elicited by the patients' self-label as an alcoholic or by other variables related to perceived treatment outcome. Pre- and postinterview data on patient likability, doctor's eagerness to work with the patient, interview content, treatment disposition, and patient compliance were collected from first-time patients, and from their interviewers, in the walk-in psychiatry and alcohol treatment units of a large, urban teaching hospital. The results elucidate how stereotypes interact with patient characteristics to influence both professional behavior and patient compliance.

Social opportunity and alcohol abuse in women: temporal and structural differences in drinking contexts of nonclinic and clinic female drinkers.

This study examined the contextual drinking patterns of two groups of women drawn from larger samples of nonclinic (from a survey of drinking practices in metropolitan Boston) and alcoholic (from a Boston hospital outpatient alcoholism clinic) women. Clinic women, although reporting an equal number of drinking events as nonclinic women, consume more alcohol in settings outside the normative sphere of influence, thus maximizing the likelihood of drinking in response to internal demands or those of a heavy drinking social intimate. Differences obtained between lighter and heavier drinker categories within the nonclinic group suggest that those women who drink in contexts where heavy drinking is encouraged may be at risk for alcohol abuse. The data are discussed relative to the assumption that increased exposure to and participation in heavy drinking contexts may lead to an increase in alcohol abuse among those nonclinic women who respond to the structural demands of drinking contexts.