Alcohol Use Amongst Rural Adolescents and Young Adults: A Brief Review of the Literature.

The sociodevelopmental periods of adolescence and young adulthood are rife with alcohol use. However, much of the literature demonstrating this comes from 'traditional' settings and college campuses (i.e., large suburban/urban campuses, or those containing their own infrastructure). Alcohol culture in rural areas has largely been understudied, which may be problematic given the unique stressors they face (e.g., economic hardship, lack of social activities, healthcare inequality). There has also been difficulty both within and across fields classifying rural versus urban geographical locations; no distinct system used broadly, making ittrea difficult to generalize and accurately collect data. The geographic categorizations are often viewed as homogenous identifiers; however, diversity occurs both within and outside of these classification systems. It appears that rurality may be a risk factor for increased drinking both earlier and later in life, but the research has failed to extend to the formative college years. This short review has two main focuses: attempting to disentangle the definition of rurality and reviewing the literature regarding alcohol use in rural areas, with a specific focus on adolescents and young adults. Identifying the mechanisms responsible for substance use in rural areas is a crucial component of prevention and treatment programs.

Comparison of Concurrent and Same-Day Balance Measurement Approaches in a Large Sample of Uninjured Collegiate Athletes.

BACKGROUND: Measures of postural stability are useful in assisting the diagnosing and managing of athlete concussion. Error counting using the Balance Error Scoring System (BESS) is the clinical standard, but has notable limitations. New technologies offer the potential to increase precision and optimize testing protocols; however, whether these devices enhance clinical assessment remains unclear. PURPOSE: To examine the relationships between metrics of balance performance using different measurement systems in uninjured, healthy collegiate athletes. STUDY DESIGN: Cross-sectional. METHODS: Five hundred and thirty uninjured collegiate athletes were tested using the C3Logix app, which computes ellipsoid volume as a measure of postural stability during the six standard BESS conditions, while concurrently, errors were manually counted during each condition per standard BESS protocols. The association between concurrently measured ellipsoid volumes and error counts were examined with Spearman's correlations. From this sample, 177 participants also performed two double-leg conditions on the Biodex BioSway force plate system on the same day. This system computes Sway Index as a measure of postural stability. The association of ellipsoid volume (C3Logix) and Sway Index (Biodex) was examined with Spearman's correlations. Individual-level data were plotted to visually depict the relationships. RESULTS: C3Logix ellipsoid volume and concurrently recorded error counts were significantly correlated in five of the six BESS conditions (rs:.22-.62; p< 0.0001). C3Logix ellipsoid volume and Biodex Sway Index were significantly correlated in both conditions (rs=.22-.27, p< 0.004). However, substantial variability was shown in postural stability across all three measurement approaches. CONCLUSION: Modest correlation coefficients between simultaneous and same-day balance assessments in uninjured collegiate athletes suggest a need to further optimize clinical protocols for concussion diagnosis. LEVEL OF EVIDENCE: 2b.

Digital neuropsychological test performance in a large sample of uninjured collegiate athletes.

Digital neuropsychological test batteries are popular in college athletics; however, well-validated digital tests that are short and portable are needed to expand the feasibility of performing cognitive testing quickly, reliably, and outside standard clinical settings. This study assessed performance on digital versions of Trail Making Test (dTMT) and a modified Symbol Digit Modalities Test (dSDMT) in uninjured collegiate athletes (n = 537; 47% female) using the C3Logix baseline assessment module. Time to complete (dTMT) and the number of correct responses (dSDMT) were computed, transformed into z scores, and compared to age-matched normative data from analogous paper-and-pencil tests. Overall sample performance was compared to normative sample performance using Cohen's d. Sample averages on the dTMT, Part A, and dSDMT were similar to published norms; 97 and 92% of z scores fell within 2 standard deviations of normative means, respectively. The sample averaged faster completion times on dTMT, Part B than published norms, although 98% of z scores were within 2 standard deviations of the normative means. Brief, digitized tests may be useful in populations and testing environments when longer cognitive test batteries are impractical. Future studies should assess the ability of these tests to detect clinically relevant changes following a suspected head injury.

Fos activation patterns related to acute ethanol and conditioned taste aversion in adolescent and adult rats.

Studies in rats have revealed marked age differences in sensitivity to the aversive properties of ethanol, with a developmental insensitivity to ethanol aversion that is most pronounced during pre- and early adolescence, declining thereafter to reach the enhanced aversive sensitivity of adults. The adolescent brain undergoes significant transitions throughout adolescence, including in regions linked with drug reward and aversion; however, it is unknown how ontogenetic changes within this reward/aversion circuitry contribute to developmental differences in aversive sensitivity. The current study examined early adolescent (postnatal day [P]28-30) and adult (P72-74) Sprague-Dawley male rats for conditioned taste aversion (CTA) after doses of 0, 1.0, or 2.5 g/kg ethanol, and patterns of neuronal activation in response to ethanol using Fos-like immunohistochemistry (Fos+) to uncover regions where age differences in activation are associated with ethanol aversion. An adolescent-specific ethanol-induced increase in Fos+ staining was seen within the nucleus accumbens shell and core. An age difference was also noted within the Edinger-Westphal nucleus (EW) following administration of the lower dose of ethanol, with 1 g/kg ethanol producing CTA in adults but not in adolescents and inducing a greater EW Fos response in adults than adolescents. Regression analysis revealed that greater numbers of Fos+ neurons within the EW and insula (Ins) were related to lower consumption of the conditioned stimulus (CS) on test day (reflecting greater CTA). Some regionally specific age differences in Fos+ were noted under baseline conditions, with adolescents displaying fewer Fos+ neurons than adults within the prelimbic (PrL) cortex, but more than adults in the bed nucleus of the stria terminalis (BNST). In the BNST (but not PrL), ethanol-induced increases in Fos-immunoreactivity (IR) were evident at both ages. Increased ethanol-induced activity within critical appetitive brain regions (NAc core and shell) supports a role for greater reward-related activation during adolescence, possibly along with attenuated responsiveness to ethanol in EW and Ins in the age-typical resistance of adolescents to the aversive properties of ethanol.

Oxytocin and vasopressin modulation of social anxiety following adolescent intermittent ethanol exposure.

RATIONALE: Adolescent intermittent ethanol exposure (AIE) produces lasting, sex-specific social anxiety-like alterations in male, but not female rats. Oxytocin (OXT) and vasopressin (AVP) brain systems play opposite roles in regulating social preference/avoidance, with OXT increasing approach to, and AVP increasing avoidance of social stimuli. OBJECTIVES: To test the hypothesis that social anxiety-like alterations seen in adult males after AIE are associated with a shift in the balance between OXT and AVP toward AVP, effectiveness of pharmacological activation of the OXT system and blockade of endogenous activity at AVP receptors for reversing AIE-induced social anxiety-like alterations was assessed, along with examination of the effects of AIE on OXT, vasopressin V1a, and V1b receptor (OXT-R, V1a-R, and V1b-R) surface expression in the hypothalamus. METHODS: Sprague-Dawley male and female rats were given 4 g/kg ethanol (AIE) or water intragastrically every 48 h for a total of 11 exposures during postnatal days (P) 25-45. On P70-72, animals were given a social interaction test following administration of a selective OXT-R agonist WAY-267464, selective V1a-R antagonist SR-49059, or V1b-R antagonist SSR-149415, and hypothalamic tissue was collected. RESULTS: Social anxiety-like behavior was induced by AIE in males but not females, and was selectively reversed by the selective OXT-R agonist and V1b-R antagonist, but not V1a-R antagonist. AIE was also found to decrease OXT-R, but increase V1b-R neuronal surface expression relative to water-exposed controls in the hypothalamus of males, but not females. CONCLUSIONS: These findings demonstrate that AIE induces changes in OXT-R and AVP-R surface expression in the hypothalamus along with social anxiety-like alterations in male rats. These social anxiety-like alterations can be reversed either by activation of the OXT system or by suppression of the AVP system, data that support the hypothesis that social anxiety-like alterations induced by adolescent alcohol exposure in male rats are associated at least in part with an OXT/AVP imbalance.

The ontogeny of ethanol aversion.

Recent work has suggested separate developmental periods within the broader framework of adolescence, with data suggesting distinct alterations and vulnerabilities within these intervals. While previous research has suggested reduced sensitivity to the aversive effects of alcohol in adolescence relative to adults, a more detailed ontogeny of this effect has yet to be conducted. The adolescent brain undergoes significant transitions throughout adolescence, including in regions linked with drug reward and aversion. The current study aimed to determine the ontogeny of ethanol aversion by utilizing a conditioned taste aversion procedure at six different ages to test the hypothesis that the transitions into, through, and out of adolescence are associated with ontogenetic alterations in sensitivity to the aversive properties of ethanol. Non-deprived animals given Boost® as the conditioned stimulus (CS) were used in Experiment 1, whereas Experiment 2 used water-restricted animals provided with a saccharin/sucrose solution as the CS. In both experiments, an attenuated sensitivity to the aversive properties of ethanol was evident in adolescents compared to adults, although more age differences were apparent in water deprived animals than when a highly palatable CS was given to ad libitum animals. Overall, the data suggest an attenuated sensitivity to the aversive properties of ethanol that is most pronounced during pre- and early adolescence, declining thereafter to reach the enhanced aversive sensitivity of adults.

Consequences of repeated ethanol exposure during early or late adolescence on conditioned taste aversions in rats.

Alcohol use is prevalent during adolescence, yet little is known about possible long-lasting consequences. Recent evidence suggests that adolescents are less sensitive than adults to ethanol's aversive effects, an insensitivity that may be retained into adulthood after repeated adolescent ethanol exposure. This study assessed whether intermittent ethanol exposure during early or late adolescence (early-AIE or late-AIE, respectively) would affect ethanol conditioned taste aversions 2 days (CTA1) and >3 weeks (CTA2) post-exposure using supersaccharin and saline as conditioning stimuli (CS), respectively. Pair-housed male Sprague-Dawley rats received 4g/kg i.g. ethanol (25%) or water every 48 h from postnatal day (P) 25-45 (early AIE) or P45-65 (late AIE), or were left non-manipulated (NM). During conditioning, 30 min home cage access to the CS was followed by 0, 1, 1.5, 2 or 2.5g/kg ethanol i.p., with testing 2 days later. Attenuated CTA relative to controls was seen among early and late AIE animals at both CTA1 and CTA2, an effect particularly pronounced at CTA1 after late AIE. Thus, adolescent exposure to ethanol was found to induce an insensitivity to ethanol CTA seen soon after exposure and lasting into adulthood, and evident with ethanol exposures not only early but also later in adolescence.

Developmental differences in the effects of alcohol and stress on heart rate variability.

Adolescent rats differ in their responses to stress and ethanol from their adult counterparts, although not much is known about the contribution of the autonomic nervous system (ANS) to these differences. This study assessed the impact of stress, ethanol, and their combination on parameters of heart rate variability (HRV) in adolescent and adult male Sprague-Dawley rats. Animals were habituated to the testing box and neck sensors (MouseOX, STARR Life Sciences Corp.) used for recording heart rate (HR). After 8-10min of baseline recording, animals were restrained for 90min or returned home, followed by intraperitoneal injection of 0, 0.5, 1.0, or 1.5g/kg ethanol. The 8-10min test recording occurred 30min post-injection. Ethanol-related decreases in LF (an index of sympathetic activity) were evident under non-stressed conditions in adolescents but only after stress in adults, perhaps in part due to apparent ethanol-induced sympathetic deactivation in adolescents. Parasympathetic tone, indexed by HF, was unaffected by both ethanol and stress in adolescents, while again both the 1.0 and 1.5g/kg ethanol doses decreased HF in adults following stress. Ethanol also decreased low frequency/high frequency tone (LF/HF), an index of sympathovagal balance, only in adolescents, with no decrease evident in adults. Further, stressed adults, and not adolescents, had significantly lower CORT and PROG values than their non-stressed counterparts. Taken together, these results demonstrate notable age differences in the ANS response to ethanol under stressful vs. non-stressful circumstances, reflected by ethanol-mediated autonomic effects that were more pronounced following stressor exposure in adults but under non-stressed conditions in adolescents.