Relationships Between Problem-Gambling Severity and Psychopathology as Moderated by Income.

Background and aims Problem and pathological gambling have been associated with elevated rates of both Axis-I and Axis-II psychiatric disorders. Although both problem gambling and psychiatric disorders have been reported as being more prevalent among lower income vs. middle/higher income groups, how income might moderate the relationship between problem-gambling severity and psychopathology is incompletely understood. To examine the associations between problem-gambling severity and psychopathology in lower income and middle/higher income groups. Methods Data from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093) were analyzed in adjusted logistic regression models to investigate the relationships between problem-gambling severity and psychiatric disorders within and across income groups. Results Greater problem-gambling severity was associated with increased odds of multiple psychiatric disorders for both lower income and middle/higher income groups. Income moderated the association between problem/pathological gambling and alcohol abuse/dependence, with a stronger association seen among middle/higher income respondents than among lower income respondents. Discussion and conclusions The findings that problem-gambling severity is related to psychopathology across income groups suggest a need for public health initiatives across social strata to reduce the impact that problem/pathological gambling may have in relation to psychopathology. Middle/higher income populations, perhaps owing to the availability of more "disposable income," may be at greater risk for co-occurring gambling and alcohol-use psychopathology and may benefit preferentially from interventions targeting both gambling and alcohol use.

Correlates of gambling on high-school grounds.

OBJECTIVE: This study examined adolescent gambling on school grounds (GS+) and how such behavior was associated with gambling-related attitudes. Further, we examined whether GS+ moderated associations between at-risk problem-gambling (ARPG) and gambling behaviors related to gambling partners. METHOD: Participants were 1988 high-school students who completed survey materials. Demographic, perceptions, attitudes, and gambling variables were stratified by problem-gambling severity (ARPG versus recreational gambling) and GS+ status. Chi-square and adjusted logistic regression models were used to examine relationships among study variables. RESULTS: Nearly 40% (39.58%) of students reported past-year GS+, with 12.91% of GS+ students, relative to 2.63% of those who did not report gambling on school grounds (GS-), meeting DSM-IV criteria for pathological gambling (p<0.0001). In comparison to GS- students, GS+ students were more likely to report poorer academic achievement and more permissive attitudes towards gambling behaviors. Weaker links in GS+ students, in comparison with GS-, students, were observed between problem-gambling severity and gambling with family members (interaction odds ratio (IOR)=0.60; 95% CI=0.39-0.92) and gambling with friends (IOR=0.21; 95% CI=0.11-0.39). CONCLUSIONS: GS+ is common and associated with pathological gambling and more permissive attitudes towards gambling. The finding that GS+ (relative to GS-) youth show differences in how problem-gambling is related to gambling partners (friends and family) warrants further investigation regarding whether and how peer and familial interactions might be improved to diminish youth problem-gambling severity. The high frequency of GS+ and its relationship with ARPG highlights a need for school administrators and personnel to consider interventions that target school-based gambling.

Gambling behaviors and attitudes in adolescent high-school students: Relationships with problem-gambling severity and smoking status.

BACKGROUND AND AIMS: Smoking is associated with more severe/extensive gambling in adults. The purpose of this study was to examine relationships between smoking and gambling in adolescents. METHODS: Analyses utilized survey data from 1591 Connecticut high-school students. Adolescents were classified by gambling (Low-Risk Gambling [LRG], At Risk/Problem Gambling [ARPG]) and smoking (current smoker, non-smoker). The main effects of smoking and the smoking-by-gambling interactions were examined for gambling behaviors (e.g., type, location), and gambling attitudes. Data were analyzed using chi-square and logistic regression; the latter controlled for gender, race/ethnicity, grade, and family structure. RESULTS: For APRG adolescents, smoking was associated with greater online, school, and casino gambling; gambling due to anxiety and pressure; greater time spent gambling; early gambling onset; perceived parental approval of gambling; and decreased importance of measures to prevent teen gambling. For LRG adolescents, smoking was associated with non-strategic gambling (e.g., lottery gambling); school gambling; gambling in response to anxiety; gambling for financial reasons; greater time spent gambling; and decreased importance of measures to prevent teen gambling. Stronger relationships were found between smoking and casino gambling, gambling due to pressure, earlier onset of gambling, and parental perceptions of gambling for ARPG versus LRG adolescents. DISCUSSION: Smoking is associated with more extensive gambling for both low- and high-risk adolescent gamblers. CONCLUSION: Smoking may be a marker of more severe gambling behaviors in adolescents and important to consider in gambling prevention and intervention efforts with youth.

At-Risk/Problematic Shopping and Gambling in Adolescence.

Elevated levels of both pathological gambling (PG) and problem shopping (PS) have been reported among adolescents, and each is associated with a range of other negative health/functioning measures. However, relationships between PS and PG, particularly during adolescence, are not well understood. In this study, we explored the relationship between different levels of problem-gambling severity and health/functioning characteristics, gambling-related social experiences, gambling behaviors and motivations among adolescents with and without at-risk/problematic shopping (ARPS). Survey data from Connecticut high school students (n = 2,100) were analyzed using bivariate analyses and logistic regression modeling. Although at-risk/problematic gambling (ARPG) was not increased among adolescents with ARPS, adolescents with ARPG (vs non-gamblers) were more likely to report having experienced a growing tension or anxiety that could only be relieved by shopping and missing other obligations due to shopping. In comparison to the non-ARPS group, a smaller proportion of respondents in the ARPS group reported paid part-time employment, whereas a greater proportion of respondents reported excessive gambling by peers and feeling concerned over the gambling of a close family member. In general, similar associations between problem-gambling severity and measures of health/functioning and gambling-related behaviors and motivations were observed across ARPS and non-ARPS adolescents. However, associations were weaker among ARPS adolescents for several variables: engagement in extracurricular activities, alcohol and caffeine use and gambling for financial reasons. These findings suggest a complex relationship between problem-gambling severity and ARPS. They highlight the importance of considering co-occurring risk behaviors such as ARPS when treating adolescents with at-risk/problem gambling.

Potential mental health needs of US adult residents under different provisions of the Affordable Care Act.

OBJECTIVE: This study examined different groups of the US population who may be affected by the expansion of Medicaid and creation of health insurance exchanges under the Affordable Care Act (ACA). METHOD: Data were based on structured interviews with a nationally representative sample of 34,587 adults from the 2004-2005 Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Psychiatric diagnoses were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV. RESULTS: Of the total sample, 6.4% were currently on Medicaid; 3.9% were uninsured and likely eligible for the Medicaid expansion (LEME); 8.6% were uninsured and not LEME but likely to participate in the health insurance exchanges; 4.6% were insured and LEME; and 76.6% were insured and not LEME. Among those uninsured, those LEME had a significantly higher prevalence of mood and anxiety disorders than those not LEME (odds ratios = 1.26-1.41). Among those insured, those LEME had a higher prevalence of mood, anxiety, substance use, and personality disorders than those not LEME (odds ratios = 1.78-2.41). Although there were few clinical differences between those currently on Medicaid and those LEME, those currently on Medicaid were more likely to use all types of services for mood, anxiety, and substance use disorders. CONCLUSIONS: The ACA may directly affect the 12.5% of the US adult population who are uninsured by requiring them to obtain insurance coverage. Given the high prevalence for various psychiatric disorders among those uninsured, state plans to expand Medicaid and create health insurance exchanges have potential to offer coverage to many adults with mental health needs, and states should carefully plan for comprehensive services.

Lower prevalence of psychiatric conditions when negative age stereotypes are resisted.

Older military veterans are at greater risk for psychiatric disorders than same-aged non-veterans. However, little is known about factors that may protect older veterans from developing these disorders. We considered whether an association exists between the potentially stress-reducing factor of resistance to negative age stereotypes and lower prevalence of the following outcomes among older veterans: suicidal ideation, anxiety, and posttraumatic stress disorder (PTSD). Participants consisted of 2031 veterans, aged 55 or older, who were drawn from the National Health and Resilience in Veterans Study, a nationally representative survey of American veterans. The prevalence of all three outcomes was found to be significantly lower among participants who fully resisted negative age stereotypes, compared to those who fully accepted them: suicidal ideation, 5.0% vs. 30.1%; anxiety, 3.6% vs. 34.9%; and PTSD, 2.0% vs. 18.5%, respectively. The associations followed a graded linear pattern and persisted after adjustment for relevant covariates, including age, combat experience, personality, and physical health. These findings suggest that developing resistance to negative age stereotypes could provide older individuals with a path to greater mental health.

An exploratory examination of marijuana use, problem-gambling severity, and health correlates among adolescents.

BACKGROUND AND AIMS: Gambling is common in adolescents and at-risk and problem/pathological gambling (ARPG) is associated with adverse measures of health and functioning in this population. Although ARPG commonly co-occurs with marijuana use, little is known how marijuana use influences the relationship between problem-gambling severity and health- and gambling-related measures. METHODS: Survey data from 2,252 Connecticut high school students were analyzed using chi-square and logistic regression analyses. RESULTS: ARPG was found more frequently in adolescents with lifetime marijuana use than in adolescents denying marijuana use. Marijuana use was associated with more severe and a higher frequency of gambling-related behaviors and different motivations for gambling. Multiple health/functioning impairments were differentially associated with problem-gambling severity amongst adolescents with and without marijuana use. Significant marijuana-use-by-problem-gambling-severity-group interactions were observed for low-average grades (OR = 0.39, 95% CI = [0.20, 0.77]), cigarette smoking (OR = 0.38, 95% CI = [0.17, 0.83]), current alcohol use (OR = 0.36, 95% CI = [0.14, 0.91]), and gambling with friends (OR = 0.47, 95% CI = [0.28, 0.77]). In all cases, weaker associations between problem-gambling severity and health/functioning correlates were observed in the marijuana-use group as compared to the marijuana-non-use group. CONCLUSIONS: Some academic, substance use, and social factors related to problem-gambling severity may be partially accounted for by a relationship with marijuana use. Identifying specific factors that underlie the relationships between specific attitudes and behaviors with gambling problems and marijuana use may help improve intervention strategies.

Adolescent alcohol-drinking frequency and problem-gambling severity: adolescent perceptions regarding problem-gambling prevention and parental/adult behaviors and attitudes.

BACKGROUND: The study examined in adolescents how alcohol-drinking frequency relates to gambling-related attitudes and behaviors and perceptions of both problem-gambling prevention strategies and adult (including parental) behaviors/attitudes. METHODS: A survey assessing alcohol, gambling, and health and functioning measures in 1609 high school students. Students were stratified into low-frequency/nondrinking and high-frequency-drinking groups, and into low-risk and at-risk/problematic gambling groups. RESULTS: High-frequency drinking was associated with at-risk/problematic gambling (χ(2)(1,N = 1842) = 49.22, P < .0001). High-frequency-drinking versus low-frequency/nondrinking adolescents exhibited more permissive attitudes towards gambling (e.g., less likely to report multiple problem-gambling prevention efforts to be important). At-risk problematic gamblers exhibited more severe drinking patterns and greater likelihood of acknowledging parental approval of drinking (χ(2)(1, N = 1842) = 31.58, P < .0001). Problem-gambling severity was more strongly related to gambling with adults among high-frequency-drinking adolescents (odds ratio [OR] = 3.17, 95% confidence interval [95% CI] = [1.97, 5.09]) versus low-frequency/nondrinking (OR = 1.86, 95% CI = [0.61, 2.68]) adolescents (interaction OR = 1.78, 95% CI = [1.05, 3.02]). CONCLUSIONS: Interrelationships between problematic drinking and gambling in youth may relate to more permissive attitudes across these domains. Stronger links between at-risk/problem gambling and gambling with adults in the high-frequency-drinking group raises the possibility that interventions targeting adults may help mitigate youth gambling and drinking.

Cigarette smoking among intimate partner violence perpetrators and victims: findings from the National Epidemiologic Survey on Alcohol and Related Conditions.

BACKGROUND AND OBJECTIVES: Cigarette smoking and intimate partner violence (IPV) are preventable, major public health issues that result in severe physical and psychological consequences. The primary aim of the current study was to examine the consistency and strength of the association between these highly variable behaviors using a nationally representative sample. METHODS: Self-reported IPV perpetration, victimization, and smoking data were collected from 25,515 adults (54% female) through the National Epidemiologic Survey on Alcohol and Related Conditions. Multinomial logistic regression models were constructed to determine the relationships among smoking status (current daily, intermittent, former, and never smoker) and IPV (minor and sever victimization as well as perpetration). RESULTS: Results indicated a robust relationship between IPV and smoking among both victims and perpetrators. The odds for current daily and intermittent smoking were significantly elevated among those who reported both minor and severe IPV relative to their non-violent counterparts. Mood and anxiety disorders were significant comorbid conditions in the interpretation of the relationship between severe IPV and smoking. CONCLUSIONS: The current study provides strong evidence for a robust relationship between IPV and smoking across current smoking patterns, IPV severity levels, and IPV experience patterns. SCIENTIFIC SIGNIFICANCE: Findings emphasize the need to better understand the mechanisms by which smoking and IPV are associated and how this interdependence may impact approaches to treatment. Specifically, research is required to assess the efficacy of integrated smoking cessation and IPV treatment or recovery programs over more traditional, exclusive approaches.

Stability of smoking status in the US population: a longitudinal investigation.

AIMS: To determine smoking transitions in a representative sample of US adults. DESIGN: Longitudinal study using data from the National Epidemiologic Survey on Alcohol and Related Conditions (wave 1, 2001-02; wave 2, 2004-05). SETTING: The general US adult population. PARTICIPANTS: A total of 33 309 adults (53.6% female) classified as wave 1 current daily, current non-daily, former daily, former non-daily or never smokers. MEASUREMENTS: Smoking transitions were determined from waves 1 and 2 data. FINDINGS: Smoking status remained stable for the majority of current daily (79.8%), former daily (95.8%), former non-daily (96.3%) and never (97.1%) smokers. Among current non-daily smokers, 54.5% quit smoking while 22.5% increased to daily smoking. Current daily smokers who were older [30-44, odds ratio (OR) = 0.62; 95% confidence interval (CI) = 0.49-0.78; 45+, OR = 0.75; 95% CI = 0.61-0.93] and unmarried (OR = 0.80, 95% CI = 0.66-0.96) were less likely to report smoking cessation. Current daily smokers who were Hispanic (OR = 2.15, 95% CI = 1.65-2.81) and college educated (OR = 1.27, 95% CI = 1.05-1.53) were more likely to report smoking cessation. Relapse in former daily smokers was greater in women (OR = 1.44, 95% CI = 1.01-2.06) and lower in older adults (OR = 0.44; 95% CI = 0.27-0.74). Smoking initiation occurred less in women (OR = 0.65; 95% CI = 0.49-0.87) and Hispanic adults (OR = 0.57; 95% CI = 0.36-0.91) and more in unmarried adults (OR = 1.84; 95% CI = 1.37-2.47) and adults with less education (OR = 1.63; 95% CI = 1.09-2.44). CONCLUSIONS: From 2001 to 2005, smoking status was extremely stable in the US population. Specific gender, race and educational groups need increased prevention and intervention efforts.

Trauma, PTSD, and binge and hazardous drinking among women and men: findings from a national study.

OBJECTIVE: To examine whether trauma and posttraumatic stress disorder (PTSD) are differentially associated with binge and hazardous patterns of drinking among women and men. METHODS: Secondary analysis of the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); the analytic sample included 31,487 respondents (54.6% female) without past-year alcohol abuse/dependence. Participants' trauma-exposure/PTSD status was characterized as: no exposure to trauma in lifetime (reference), lifetime trauma exposure, PTSD before past-year, or past-year PTSD. Past-year binge and hazardous drinking were examined with multinomial logistic regression models (past-year abstinence was modeled as the non-event); models included the main effects of trauma-exposure/PTSD status and gender, the trauma-exposure/PTSD status-by-gender interaction, psychiatric comorbidity, and socio-demographic covariates. RESULTS: The gender-specific effects of trauma, before past-year PTSD, and past-year PTSD were significantly elevated for all drinking behaviors in women (range of odds ratios (ORs) = 1.8-4.8), and for some drinking behaviors in men (range of ORs = 1.3-2.0), relative to no trauma exposure. Trauma exposure was more strongly associated with high-frequency binge drinking, low-frequency binge drinking, and non-binge drinking among women as compared to men. Past-year PTSD was also more strongly associated with low-frequency binge drinking and non-binge drinking among women compared to men. Findings for hazardous drinking followed a similar pattern, with significant gender-related differences in ORs for hazardous drinking and non-hazardous drinking observed with respect to trauma exposure and past-year PTSD.. CONCLUSION: Mental health practitioners should be mindful of the extent to which trauma-exposed individuals both with and without PTSD engage in binge and hazardous drinking, given the negative consequences associated with these patterns of drinking..

Gender-related differences in the associations between sexual impulsivity and psychiatric disorders.

OBJECTIVE: Sexual impulsivity (SI) has been associated with conditions that have substantial public health costs, such as sexually transmitted infections and unintended pregnancies. However, SI has not been examined systematically with respect to its relationships to psychopathology. We aimed to investigate associations between SI and psychopathology, including gender-related differences. METHOD: We performed a secondary data analysis of Wave-2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national sample of 34,653 adults in the United States. DSM-IV-based diagnoses of mood, anxiety, drug and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Scheduled DSM-IV Version. RESULTS: The prevalence of SI was considerable (14.7%), with greater acknowledgment by men than women (18.9% versus 10.9%; p < 0.0001). For both women and men, SI was positively associated with most Axis-I and Axis-II psychiatric disorders (OR range: Women, Axis-I:1.89-6.14, Axis-II:2.10-10.02; Men, Axis-I:1.92-6.21, Axis-II:1.63-6.05). Significant gender-related differences were observed. Among women as compared to men, SI was more strongly associated with social phobia, alcohol abuse/dependence, and paranoid, schizotypal, antisocial, borderline, narcissistic, avoidant and obsessive-compulsive personality disorders. CONCLUSION: The robust associations between SI and psychopathology across genders suggest the need for screening and interventions related to SI for individuals with psychiatric concerns. The stronger associations between SI and psychopathology among women as compared to men emphasize the importance of a gender-oriented perspective in targeting SI. Longitudinal studies are needed to determine the extent to SI predates, postdates or co-occurs with specific psychiatric conditions.

Relationships between problematic internet use and problem-gambling severity: findings from a high-school survey.

With the popularity of Internet use among adolescents, there is concern that some youth may display problematic or addictive patterns of Internet use. Although excessive patterns of Internet use was considered for inclusion in the DSM-5 with pathological gambling and substance-use disorders in a category of addictive disorders, it was determined that more research was needed on Internet-use behaviors before such actions be further considered and possibly undertaken. The present study is the first to investigate whether at-risk/problematic Internet use (ARPIU) may moderate the strength of association between problem-gambling severity and gambling-related characteristics and health and well-being measures in adolescents. Survey data from 1884 Connecticut high-school student stratified by Internet use (ARPIU vs. non-ARPIU) were examined in bivariate analyses and logistic regression models. Gambling-related characteristics and health and well-being measures were mostly positively associated with problem-gambling severity in both Internet use groups. Interaction odds ratio revealed that the strength of the associations between problem-gambling severity and marijuana, alcohol and caffeine use were stronger amongst the non-ARPIU compared to the ARPIU group, suggesting that the relationships between these substance use behaviors and problem gambling may be partially accounted for by ARPIU. Future studies should examine the extent to which preventative interventions targeting both problematic Internet use and problem gambling may synergistically benefit measures of health and reduce risk-taking behaviors in adolescence.

Latent class analysis of personality disorders in adults with posttraumatic stress disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: To characterize predominant typologies of co-occurring personality disorders among adults with posttraumatic stress disorder (PTSD) and examine their relation to Axis I comorbidities, health-related quality of life, and course and treatment of PTSD. METHOD: Latent class analysis was conducted on the 10 DSM-IV personality disorders in a nationally representative sample of 2,463 adults with a lifetime diagnosis of PTSD from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS: Three latent classes of personality disorders were identified: a borderline-dysregulated class (11.4%), an obsessive-paranoid class (13.1%), and a no/low personality disorders class (75.5%). The borderline-dysregulated and obsessive-paranoid classes were more likely than the no/low personality disorder class to have a broad range of comorbid Axis I diagnoses and to have ever attempted suicide (ORs = 1.50-8.01), and they reported lower mental health-related quality of life. The borderline-dysregulated class was less likely than the no/low personality disorder class to have experienced remission of their most recent episode of PTSD (OR = 0.54; 95% CI, 0.38-0.75) and was more likely to have been prescribed medication for PTSD (OR = 1.65; 95% CI, 1.20-2.28) and to have used alcohol and drugs to mitigate their PTSD symptoms (OR = 2.77; 95% CI, 1.62-4.74). The obsessive-paranoid class was more likely than the no/low personality disorders class to report sexual assault as their worst trauma (OR = 2.22; 95% CI, 1.36-3.61) and had an earlier age at onset of PTSD symptoms compared to the other 2 classes. CONCLUSIONS: Among US adults with PTSD, the 10 DSM-IV personality disorders can be classified into 3 "person-based" typologies, which are differentially associated with comorbid Axis I disorders, mental health-related quality of life, and clinical and treatment characteristics of this disorder. These results suggest that comprehensive assessment of personality disorders may help inform etiologic models and treatment approaches for PTSD.

Serious Physical Fighting and Gambling-Related Attitudes and Behaviors in Adolescents.

BACKGROUND AND AIMS: Physical fighting and gambling are common risk behaviors among adolescents. Prior studies have found associations among these behaviors in adolescents but have not examined systematically the health and gambling correlates of problem-gambling severity amongst youth stratified by fight involvement. METHODS: Survey data were used from 2,276 Connecticut high-school adolescents regarding their physical fight involvement, gambling behaviors and perceptions, and health and functioning. Gambling perceptions and correlates of problem-gambling severity were examined in fighting and non-fighting adolescents. RESULTS: Gambling perceptions were more permissive and at-risk/problem gambling was more frequent amongst adolescents reporting serious fights versus those denying serious fights. A stronger relationship between problem-gambling severity and regular smoking was observed for adolescents involved in fights. DISCUSSION AND CONCLUSIONS: The more permissive gambling attitudes and heavier gambling associated with serious fights in high-school students suggest that youth who engage in physical fights warrant enhanced prevention efforts related to gambling. The stronger relationship between tobacco smoking and problem-gambling severity amongst youth engaging in serious fights suggest that fighting youth who smoke might warrant particular screening for gambling problems and subsequent interventions.

Differences in gambling problem severity and gambling and health/functioning characteristics among Asian-American and Caucasian high-school students.

Studies of Asian-American adults have found high estimates of problematic gambling. However, little is known about gambling behaviors and associated measures among Asian-American adolescents. This study examined gambling perceptions and behaviors and health/functioning characteristics stratified by problem-gambling severity and Asian-American and Caucasian race using cross-sectional survey data of 121 Asian-American and 1659 Caucasian high-school students. Asian-American and Caucasian adolescents significantly differed on problem-gambling severity, with Asian-American adolescents more often reporting not gambling (24.8% vs. 16.4%), but when they did report gambling, they showed higher levels of at-risk/problem gambling (30.6% vs. 26.4%). Parental approval or disapproval of adolescent gambling also significantly differed between races, with Asian-American adolescents more likely to perceive both parental disapproval (50.0% vs. 38.2%) and approval (19.3% vs. 9.6%) of gambling. Asian-American adolescents were also more likely to express concern about gambling among close family members (25.2% vs. 11.6%). Among Asian-American adolescents, stronger associations were observed between at-risk/problem gambling and smoking cigarettes (interaction odds ratio=12.6). In summary, differences in problem-gambling severity and gambling perceptions indicate possible cultural differences in familial attitudes towards gambling. Stronger links between cigarette smoking and risky/problematic gambling amongst Asian-American adolescents suggest that prevention and treatment efforts targeting youth addictions consider cultural differences.

Increased incidence of cardiovascular conditions among older adults with pathological gambling features in a prospective study.

OBJECTIVES: To evaluate the prospective associations between at-risk/problem/pathological gambling (ARPG) and incident medical conditions among older adults. METHODS: Secondary data analysis of the National Epidemiologic Survey on Alcohol and Related Conditions, waves 1 and 2, collected from 2001 to 2002 and 2004 to 2005, respectively. Participants are adults aged 55 years and older (n = 10,231) who were selected from a nationally representative community sample of adults residing in the United States. Past-year diagnostic criteria for pathological gambling at wave 1 were evaluated with the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. Physical health conditions were assessed at wave 1 and wave 2. Logistic regression modeling was conducted on groups categorized as ARPG (participants endorsing 1 or more inclusionary criteria for pathological gambling) and non-ARPG (nongambling/low-frequency gambling or gambling without endorsement of pathological gambling criteria). RESULTS: Relative to non-ARPG, ARPG is prospectively associated with elevated incidences of arteriosclerosis and any heart condition, independently of wave-1 sociodemographic characteristics, psychiatric comorbidity, substance use, and body mass index. CONCLUSIONS: Older adults who demonstrate risky or problematic levels of gambling may be at particular risk for the onset of some physical health conditions. Individuals with at-risk/problem/pathological gambling features should be monitored more closely for the development of these conditions and encouraged to adopt activities that confer health benefits. Efforts should be made to educate older adults and their caretakers on the adverse incident physical health conditions associated with ARPG.

Pain interference and incident mood, anxiety, and substance-use disorders: findings from a representative sample of men and women in the general population.

To examine gender differences in the longitudinal relationship between past-month pain interference and incident mood, anxiety, and substance-use disorders, chi-square tests and binomial logistic regression analyses were performed on data obtained from the National Epidemiologic Survey on Alcohol and Related Conditions from 34,465 adult respondents (47.9% men; 52.1% women) who completed waves 1 (2000-2001) and 2 (2004-2005) data collection. Models were adjusted for potentially confounding factors (i.e., age, race, marital status, educational level, employment, household income, number of stressful life events, number of general medical conditions, and wave-1 psychopathology). Respondents were categorized at wave 1 according to their past-month level of pain interference (i.e., no or low pain interference, moderate pain interference, severe pain interference). Moderate and severe pain interference (as compared to no or low pain interference) in male and female respondents was associated with the incidence of several psychiatric disorders. A stronger relationship was observed in male respondents as compared to female ones between past-month moderate pain interference and a new onset of any mood disorder (OR=1.57, p=0.03) and major depressive disorder (OR=1.60, p=0.03), and between past-month severe pain interference and a new onset of alcohol abuse or dependence (OR=1.69, p=0.045) and nicotine dependence (OR=1.48, p=0.04). These findings suggest that providers should consider screening patients with past-month moderate or severe pain interference for mood, anxiety, and substance-use problems and monitor the possible development of subsequent comorbid psychiatric disorders.

Gender differences in the relationship between gambling problems and the incidence of substance-use disorders in a nationally representative population sample.

BACKGROUND: Cross-sectional studies have demonstrated gender-related differences in the associations between problem-gambling severity and substance-use disorders; however, these associations have not been examined longitudinally. We aimed to examine the prospective associations between problem-gambling severity and incident substance-use disorders in women versus men. METHODS: Analyses were conducted using Wave-1 and Wave-2 NESARC data focusing on psychiatric diagnoses from 34,006 non-institutionalized US adults. Inclusionary criteria for pathological gambling were used to categorize Wave-1 participants as at-risk/problem gambling (ARPG) and non-ARPG (i.e. non-gambling/low-frequency gambling/low-risk gambling). Dependent variables included the three-year incidence of any substance-use disorder, alcohol-use disorders, nicotine dependence, drug-use disorders, prescription drug-use disorders, and illicit drug-use disorders. RESULTS: Significant gender-by-ARPG status interactions were observed with respect to the three-year incidence of nicotine dependence and prescription drug-use disorders, and approached significance with respect to incident alcohol-use disorders. ARPG (relative to non-ARPG) was positively associated with nicotine dependence among women (OR=2.00; 95% CI=1.24-3.00). ARPG was negatively associated with incident prescription drug-use disorders among men (OR=0.30; 95% CI=0.10-0.88)). Finally, ARPG was positively associated with incident alcohol-use disorders among men (OR=2.20; 95% CI=1.39-3.48). CONCLUSIONS: Gambling problems were associated with an increased 3-year incidence of nicotine dependence in women and alcohol dependence in men. These findings highlight the importance of considering gender in prevention and treatment initiatives for adults who are experiencing gambling problems. Moreover, the specific factors underlying the differential progressions of specific substance-use disorders in women and men with ARPG warrant identification.

Changes in smoking for adults with and without alcohol and drug use disorders: longitudinal evaluation in the US population.

BACKGROUND: Little is known about the smoking cessation and smoking relapse behavior of adults with alcohol use disorders (AUDs) and drug use disorders (DUDs). OBJECTIVE: The current study used longitudinal data from a representative sample of the US adult population to examine changes in smoking over 3 years for men and women with and without AUD and DUD diagnoses. METHODS: Participants were current or former daily cigarette smokers at Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions who completed the Wave 2 assessment 3 years later (n = 11,973; 46% female). Analyses examined the main and gender-specific effects of AUD and DUD diagnoses on smoking cessation and smoking relapse. RESULTS: Wave 1 current daily smokers with a current AUD (OR = .70, 95% CI = .55, .89), past AUD (OR = .73, 95% CI = .60, .89), current DUD (OR = .48, 95% CI = .31, .76), and past DUD (OR = .62, 95% CI = .49, .79) were less likely to have quit smoking at Wave 2 than those with no AUD or DUD diagnosis. Wave 1 former daily smokers with a current AUD (OR = 2.26, 95% CI = 1.36, 3.73), current DUD (OR = 7.97, 95% CI = 2.51, 25.34), and past DUD (OR = 2.69, 95% CI = 1.84, 3.95) were more likely to have relapsed to smoking at Wave 2 than those with no AUD or DUD diagnosis. The gender by diagnosis interactions were not significant. CONCLUSION: Current and past AUDs and DUDs were associated with a decreased likelihood of quitting smoking, while current AUDs, current DUDs, and past DUDs were associated with an increased likelihood of smoking relapse.