Alcoholic beverage preference and characteristics of drinkers and nondrinkers in western New York (United States).

BACKGROUND AND AIM: Dietary and lifestyle characteristics may differ for drinkers of specific alcoholic beverages and nondrinkers which would have important implications for studies of alcohol and disease. Our aim in this study was to describe differences in dietary and lifestyle characteristics associated with alcoholic beverage preference in a population-based sample of healthy study participants. METHODS AND RESULTS: Data were collected as part of a series of case-control studies of alcohol use, myocardial infarction, and lung, breast and prostate cancer in western New York from 1846 men and 1910 women aged 35 to 79, randomly selected from the general population of Erie and Niagara Counties. Beverage preference was defined for noncurrent vs current drinkers, and drinkers of beer, wine, liquor, and mixed beverages. Generalized linear models for continuous variables and Cochran-Mantel-Haenszel statistics for categorical variables were computed for the entire sample and stratified by gender. Participant characteristics differed by alcoholic beverage preference and drinking status. In general, wine drinkers had higher education and household incomes, lower prevalence of current smoking, higher intakes of dietary fiber, potassium, vitamin E, and total carotenoids, lower total fat intakes and higher amounts of fruits, vegetables, and grain products than consumers of other beverages. Conversely, beer and liquor drinkers had somewhat lower education and household incomes, higher rates of current smoking, higher energy and total fat intakes and consumed lower amounts of fruits, vegetables, and grain products. Finally, current nondrinkers were more likely to be older, less educated, have lower household incomes, and consume diets less consistent with dietary guidelines than current drinkers. CONCLUSIONS: These results suggest that usual beverage preference may encompass other health-related behaviors and underline the importance of accurate exposure measurement and use of statistical methods to accommodate these interrelationships.

Natural recovery in a community-based sample of alcoholics: study design and descriptive data.

The majority of alcoholics who recover do so without the benefit of treatment, yet little is known about these individuals and the factors associated with their success. A better understanding is needed of the self-initiated and maintained change processes ("natural recovery") associated with such recoveries. In the current study, initiated in 1997, we followed up alcoholics identified in four previous community surveys and conducted a brief physical examination and an in-depth interview assessing factors thought to be associated with "natural recovery" or entry into treatment. Here we present the study model, describe our sample of 83 "naturally recovered" and 138 "hazardous problem drinkers," and report factors associated with "natural recovery." During the period when their drinking was at its most problematic, those who naturally recovered had discussed their alcohol-use associated problems with fewer network members and had been advised to stop drinking or to drink less by fewer network members. In addition to older age, "natural recovery" was associated with marriage, lower levels of avoidant coping, higher self-esteem, social networks with members who drank less, and a history of less frequent drug use and lower frequencies of intoxication. Rates of "natural recovery'' may be increased by encouraging the development of these attributes in hazardous problem drinkers who do not already have them.

Relations among alcohol consumption measures derived from the Cognitive Lifetime Drinking History.

Few studies have been conducted of chronic alcohol effects on health and social outcomes. To evaluate the utility and feasibility of such studies, correlations between lifetime and current measures of total alcohol consumption (ounces) and times intoxicated were examined to determine whether these dimensions of drinking are distinct. Studies were conducted in 2142 respondents ages 35 to 70 selected from lists of licensed drivers and individuals eligible for Medicare. Lifetime measures of alcohol consumption and times intoxicated were derived from the Cognitive Lifetime Drinking History (CLDH). Depending on age and sex of the subgroups examined, current consumption accounted for only about 10-25% of the variability in lifetime alcohol consumption; current and lifetime times intoxicated were even less highly correlated. Lifetime and current measures of alcohol consumption accounted for approximately 40-50% of the variability in corresponding lifetime and current measures of times intoxicated in younger cohorts, but this fell to 25% and less in older cohorts. These findings support the use of lifetime measures of alcohol consumption and times intoxicated based on the CLDH together with current measures to investigate chronic and acute alcohol effects on health and social outcomes.

Assessing alcohol problems in female DWI offenders.

The severity of alcohol problems in a sample of 812 women driving while intoxicated (DWI) offenders enrolled in a Drinking Driver Program in New York State was assessed through the use of multiple measures. These women voluntarily provided information through a self-administered questionnaire completed at the beginning of the program. Classification of alcohol problems based on DSM-III-R criteria was compared with classification based on the use of alcohol-specific and nonalcohol-specific measures of alcohol-related problems. Greater hostility and a larger number of drinks ever consumed accounted for nearly 12% of the variance between no diagnosis and alcohol abuse women, whereas these two variables plus age, race, depression, and having a relative with alcohol problems accounted for nearly 41% of the variance between alcohol abuse and dependent women. A subsample of women within each DSM-III-R diagnostic group showed high risk for later, more severe alcohol problems. Multiple measures of alcohol problems help to elucidate subtle differences in alcohol problems within each of the broad categories specified by the DSM, and should facilitate more appropriate intervention and treatment plans for women DWI offenders with alcohol-related problems.

A comparison of effectiveness of biofeedback and pelvic muscle exercise treatment of stress incontinence in older community-dwelling women.

BACKGROUND: Research using biofeedback as a treatment for sphincteric incontinence began with Kegel's early studies using a perineometer and pelvic muscle exercises demonstrating a 90% improvement in urine loss symptoms. More recent studies using varying combinations of biofeedback and pelvic muscle exercises found symptom reduction rates of 78% to 90%, but these studies lacked the rigor of a "phase three," or randomized controlled clinical trial. METHODS: A randomized controlled trial assessed the efficacy of biofeedback for older women for treatment of sphincteric incompetence. One hundred thirty-five community-dwelling women were randomized in a single-blind trial to three groups: biofeedback, pelvic muscle exercise, or control. Incontinent episodes were monitored over 8 weeks of treatment and at 3 and 6 months thereafter. RESULTS: The number of incontinent episodes decreased significantly in the biofeedback and pelvic muscle exercise subjects but not in the control subjects for all severity of incontinence frequency subgroups. Improvement was maintained within the moderate and severe symptom subgroups for both treatments for at least 6 months but declined in subjects with mild incontinence frequency. Pelvic muscle activity (EMG) was significantly correlated with decreases in incontinent episodes, and only the biofeedback subjects showed significant improvement in EMGs. CONCLUSIONS: Biofeedback and pelvic muscle exercises are efficacious for sphincteric incompetence in older women. Benefits are maintained and improvement continues for at least 6 months postintervention. These therapies may be useful before considering invasive treatment.

Dimensions of urine loss among older women with genuine stress incontinence.

The specific maneuvers that cause women to be incontinent can become important diagnostic aids and major factors in differentiating the effectiveness of the current pharmacological, surgical, and behavioral treatments for urinary incontinence. The purpose of this study was to evaluate whether meaningful dimensions could be identified within the multiple movements that produce urine loss in stress-incontinent women. The Stress Incontinence Questionnaire (SIQ) was constructed from items derived from a compilation of studies and reports of urinary incontinence experts. An exploratory factor analysis using maximum likelihood method of extraction and a varimax rotation procedure identified four dimensions: active maneuvers, passive maneuvers, planned maneuvers, and unplanned maneuvers. The alpha coefficients for the four identified factors were acceptable and ranged from .71 to .79, with 8-week test-retest correlations for the active (r = .87), passive (r = .87), planned (r = .85), and the unplanned maneuvers (r = .60) all highly significant. The four factors also showed differential patterns of relationships with various gynecologic and urologic measures. These latter findings suggest that the factors identified in this study may be acknowledging different types or components of stress incontinence. In either case, the findings may have implications for treatment approaches to stress incontinence. Further research is needed to substantiate the various components of stress incontinence found in this study and the implications these findings may have for treatment of incontinence.

The limited utility of BAC for identifying alcohol-related problems among DWI offenders.

To see if blood alcohol concentration (BAC) is a significant indicator of problem drinking or an alcohol-related diagnosis, the relationships between BAC at arrest for drinking and driving, typical drinking, alcohol-related problems, problem drinking and an alcohol abuse or dependence diagnosis were examined for 235 drinking and driving offenders referred for alcoholism evaluation. BAC and typical drinking correlated weakly and no significant relationship between alcohol-related problems and BAC was found. Further, no significant relationship was found between BAC and alcohol abuse or dependence diagnoses, or between problem drinking and BAC. These findings cast doubt on the usefulness of a single report of BAC for diagnostic and screening purposes.

Resistance to alcohol impairment of visual-motor performance: does it help to pay attention?

In a 2 x 2 factorial design, moderately intoxicated (BAC = .05) college students (n = 40) were exposed to a cognitive set (to concentrate) and/or an auditory feedback signal while performing a modified pursuit-rotor task across five postbeverage trials. Self-reported "highness" was also assessed. A control group received placebo drinks and performed without aids. Hypothesized main effects for both set and signal revealed that intoxicated aided subjects outperformed their unaided counterparts. Moreover, subjects who received both aids outperformed all other intoxicated subjects and performed equivalently with unaided placebo subjects. Separate analyses of the first postbeverage trial and use of covariance analyses provided confidence that the obtained effects were not attributable to acute or chronic tolerance. Highness correlated negatively with performance; but set and signal effects on highness failed to reach significance. Although alcohol-induced motor impairment is not recognized in the research literature as being under volitional control, subjects in the present study exhibited clear resistance to alcohol impairment. Possible psychological mediators and moderators of the obtained effects are discussed, as well as the relevance of these findings for tolerance research. Practical implications are also considered.

Multiple and single location drinking among DWI offenders referred for alcoholism evaluation.

Problem-drinker drivers who drank at multiple locations differ substantially from those who drank at only one location. Persons who drank at more than one location prior to their DWI arrest exhibit the most severe alcohol problems. Multilocation drinkers consumed significantly greater amounts of alcohol--for nearly all alcohol measures including consumption per drinking day, consumption averaged over 30 days, and consumption on the day of the DWI arrest--than single location drinkers. The multilocation group experienced more alcohol problems in their lives, had higher Mortimer-Filkins test scores, were intoxicated more frequently, and had a greater probability of a DSM-III-R alcohol-dependence diagnosis. Compared to the single location drinkers, the multilocation group had more bad driving incidents, frequently (once a week) drove while drunk, and expressed the attitude that the DWI had less of an impact on their lives. The findings suggest that multilocation drinkers require intensive interventions.

Factors discriminating between genuine stress and mixed incontinence.

Nurse practitioners (NP) are often confronted with female clients who describe various types of urine loss symptoms. To establish an accurate diagnosis and therapeutic intervention, it is important for the NP to identify the etiology of the urine loss complaint. The purpose of the study is to compare symptoms and physical findings that differentiate between the urodynamic diagnoses of genuine stress incontinence (GSI) and mixed incontinence (MI) in 135 clinical trial subjects: 123 diagnosed as GSI and 12 as MI. These subjects participated in a randomized controlled clinical trial to investigate the efficacy of biofeedback and pelvic floor exercises for incontinence treatment. Data were analyzed for significant differences between these two groups on urologic and gynecologic symptoms, pelvic muscle relaxation, vaginal mucosa, vaginal electromyograph readings, urodynamic parameters, and quantified measure of urine loss. One-way analysis of variance (ANOVA) showed significant difference in nocturnal and diurnal voidings and urine loss immediately after sensing the urge to void in the MI and GSI subjects. Chi-square analyses found a significantly decreased incidence of poor vaginal tone and atrophic vaginal mucosa in the MI group as compared to the GSI group. The MI group also lost significantly more urine than did the GSI group on the hand wash maneuver of the perineal pad test. Although the sample size of MI subjects was small, these results show that a noninvasive history and physical examination can differentiate between urologic diagnoses. This approach provides a cost-effective expedient protocol to aid the NP in establishing a differential diagnosis between genuine stress and mixed incontinence.

Psychiatric symptoms and DWI offenders.

The utility of psychiatric symptoms for identifying potential DWI recidivists was examined. Results indicated that psychiatric symptoms were more related to whether the individual would have qualified for a DSM-III-R alcohol dependent diagnosis than to offender status. A second finding of importance was the high rate of alcohol dependence found for the first-time offenders. The implications for these findings are discussed in this report.

Communicative competence in sons of alcoholics.

Sons of alcoholic (SA), depressive (SD), and social drinking (SN) fathers gave 3-min speeches under low- and high-stress conditions. Trained raters, unaware of group membership, scored each speech on a variety of communicative competence dimensions. The results gave evidence that the SA group, relative to the SN group, showed deficits in all six speech variables. Further results suggested that the SA group was unaffected by level of stress, while the SD group showed a decrease in communicative clarity from speech 1 (low stress) to speech 2 (high stress). The results suggest lower levels of communicative competence among adult sons of alcoholics. The implication of this finding with regard to the psychosocial functioning of children of alcoholics is discussed.

Resistance to alcohol impairment of visual-motor performance. II: Effects for attentional set and self-reported concentration.

There has been little or no direct inquiry into the feasibility of nonbiological processes for attenuating alcohol effects. In an initial study, we found that an instructional Set (to concentrate) presented at each trial facilitated visual-motor performance among moderately intoxicated subjects. We extended this work in the present study by varying density of the Set presentation across trials, by varying Set onset and offset, and by assessing self-reported concentration levels. After dosing, subjects participated in two pairs of performance trials separated by a rest period. Six groups of subjects differed with respect to the number and sequence of Set presentations received across the postbeverage trials. We found that more Set presentations yielded better performance. Also, onset of Set presentation led to improved or sustained performance, whereas offset led to diminished performance. Finally, consistent with the possibility that concentration serves as a mediating variable, self-reported concentration correlated with performance. Implications of the obtained effects are discussed in the context of tolerance research and practical considerations.

Expectancy set, self-reported expectancies and predispositional traits: predicting interest in violence and erotica.

To investigate the role of alcohol expectancies in predicting postdrinking behavior, two studies were conducted. In Study 1, an instrument assessing alcohol expectancies was devised for later use in prediction. Factor analyses with split-sample validation confirmed 3 factors (11 total items): disinhibition, aggression and sexuality. In Study 2, expectancies, Buss-Durkee hostility and Mosher sex-guilt were assessed in a preexperimental questionnaire session. In a subsequent drink administration session, an expectancy set manipulation led subjects to expect alcohol or to expect tonic. To assess postdrinking behavior, interest in violent, erotic and violent-erotic materials was measured unobtrusively using an ad lib slide-viewing task. Consistent with the hypotheses, expectancies in conjunction with trait hostility significantly predicted violence viewing and violent-erotica viewing for expect alcohol, but not expect tonic controls. Moreover, after variance due to hostility was accounted for, expectancies predicted violence viewing significantly and violent-erotica viewing marginally. These findings provide modest support for the proposition that preexisting alcohol expectancies mediate between the effects of expectancy set and postdrinking behaviors. Once activated by perceived alcohol ingestion, these expectancies can shape postdrinking behaviors. The findings also underscore the need for further experimentation aimed at clarifying the interrelationships between alcohol expectancies and expectancy set.