Parental alcoholism as a risk factor for DSM-IV-defined alcohol abuse and dependence in American women: the protective benefits of dyadic cohesion in marital communication.

Important trends in research over the past decade indicate that women are as greatly affected by familial alcoholism as are men. Although it is increasingly recognized that the adverse drinking outcomes predicted for adult children of alcoholics (COAs) are not inevitable, and only a small percentage develop alcohol dependence or grow up to be alcoholic, relatively little knowledge exists regarding moderating factors that reduce their vulnerability. This study identifies a multiple mediator latent structural model of the intergenerational transmission of risk for DSM-IV-assessed alcohol abuse and dependence among women COAs in adulthood. The effects of both parental alcoholism and family environment are estimated at three time points spanning 10 years across 5-year intervals (1984, 1989, and 1994) using data from a subsample of 4,449 women in the National Longitudinal Survey of Youth (NLSY). Dyadic cohesion in marital communication (greater marital cohesion, harmony, and less verbal disagreement, discord, and conflict) is a proposed moderating factor that may operate in adulthood to lower the risk of female COAs developing alcohol abuse and dependence. Maximum likelihood standardized estimates of the effects of alcohol mediators measured over time indicate that direct parental effects for adverse outcomes decline when COAs are in their late 20s and early 30s. Indirect parental effects through environmental influences dramatically increase the risk of abuse and dependence among COAs at this time if they have one or more alcoholic siblings, especially an alcoholic sister. Dyadic cohesion and positive interpersonal communication patterns were found to moderate effectively the relationship that existed among parental alcoholism, environmental influences, and adverse alcohol consequences. COAs with satisfactory marital communication also evidenced higher levels of intimacy with their partners, perceived the division of housework to be fairer, shared more responsibilities and burdens of the household, and had less conflict over critical domestic issues than other women COAs. The protective benefits of a good marriage against the risks of alcoholism remained when applied to younger and older subjects, across diverse backgrounds, and after adjusting for other factors such as employment status.

Alcohol dependence in adult children of alcoholics: longitudinal evidence of early risk.

This study investigates familial alcoholism effects and the comparative probability of risk for alcohol dependence in adult children of alcoholics (ACAs) with a control group of non-ACAs. A cohort of 12,686 young adults from the National Longitudinal Survey of Youth (NLSY) is examined over a five-year period and conventional and lineal intergenerational models of alcoholism transmission are assessed. The results of multivariate logistic regression analyses indicate that the risk is relatively greater for male ACAs; sons of alcoholics drink significantly more heavily, experience problems earlier, and develop alcohol dependence more extensively than female ACAs or non-ACAs of either gender. The extent of dependence found in subjects with a lineal history of alcoholism on the father's side of the family, as well as heavy drinking, cigarette smoking and drinking onset in adolescence should be considered as critical predisposing factors of high risk for dependence at later ages. These observations corroborate clinical studies and support a growing body of biopsychosocial research literature.

Resilience to drinking vulnerability in women with alcoholic parents: the moderating effects of dyadic cohesion in marital communication.

Data from a subsample of women (N = 4,235) in two waves of the National Longitudinal Surveys of Youth (NLSY) are used to examine the relationship between parental alcoholism and alcohol use in adult life. Dyadic cohesion in marital communication (frequency of interaction and agreement on substantive issues that affect couples) is investigated as a resilience factor that could potentially mitigate adverse drinking outcomes in adult children of alcoholics (ACAs). A moderated mediation model is estimated using a Two-Stage Least Squares (2SLS) regression analysis. The results indicated that an imputed transmission of risk for drinking vulnerability in women ACAs, controlling for nonACA status, was effectively moderated by positive dyadic interaction.

Drinking-induced blackouts among young adults: results from a national longitudinal study.

Amnesia drinking episodes among a national probability sample of 12,686 young adults are examined at two points in their lives: when they were ages 19 to 26 in 1984 and 23 through 30 in 1988. Prospective blackout patterns of early onset, late onset, chronicity, and remission were analyzed using logistic regression statistical models. Results indicate that the relative risk of short-term memory loss while drinking is significantly associated with increased alcohol consumption, age of drinking onset, the number of alcoholic relatives, and, principally, with the individual's capacity to control drinking behavior. It is concluded that the blackout remission rate observed among a substantial proportion (68%) of young adults may not fit the progressive, irreversible model of alcoholism.

The drinking-smoking syndrome and social context.

Drinking and smoking concurrence is examined in a national sample of 6,072 respondents. Results indicate that the two addictive behaviors are synergistically associated in the general population: persons who both drink and smoke tend to drink to a greater extent than nonsmokers; drinkers smoke more than nondrinkers and smokers drink more than nonsmokers. As predicted, a multivariate analysis of drinking and smoking covariance was significantly correlated with social group affiliation, both across the life span and proportionately among men and women. The social context of interpersonal relationships may therefore be a critical factor in the process of pharmacological conditioning and environmental reinforcement of the drinking and smoking habits. This report confirms the strong drinking and smoking covariation found among social drinkers and heavy alcohol consumers in clinical and experimental studies, suggesting that drinking and smoking may also be interrelated in the rehabilitative process. Finally, it is suggested that the present investigation extends the research literature on the drinking and smoking syndrome in several important respects. Various implications of the study are discussed.

The impact of stressful life events and social support on drinking among older adults: a general population survey.

This article is an analysis of stressful life events, the buffering hypothesis, and alcohol use in a national sample of 1,418 respondents 60 years of age and over. The results indicate that older adults who experience stressful losses are significantly more likely to drink excessively than those who have not experienced such losses or who have experienced them to a lesser extent. Increased drinking among older adults may therefore be a reaction to life circumstances in which alcohol represents an attempt to cope with traumatic loss, personal as well as within the kinship network. Supportive resources of spouse, family, friends, and church appear to have a stress-buffering effects that reduces the excessive-drinking response to life crisis. Data suggest, however, that older persons are vulnerable to the magnitude of losses experienced as they grow older and lose more of their family, friends, and peers. These stressors appear to seriously impact their drinking behavior and are not effectively buffered. Respondents report that drinking may increase during periods of prolonged exposure to emotionally depleting life change and loss, when supportive needs may exceed the capacities of personal and social support resources.

Comparison of the quality of ambulatory care for fee-for-service and prepaid patients.

OBJECTIVE: To determine whether the quality of care for common ambulatory conditions is adversely affected when physicians are provided with incentives to limit the use of health services. DESIGN: Retrospective cohort study over a 2-year period. SETTING: Four group practices that cared for both fee-for-service patients and prepaid patients within a network model health maintenance organization (HMO). PATIENTS: Equal numbers of prepaid (HMO) and fee-for-service patients were selected by randomly choosing medical records from each group practice: 246 patients with chronic uncomplicated hypertension and 250 women without chronic diseases who received preventive care. MAIN OUTCOME MEASURES: Adequate hypertension control was defined as a mean blood pressure of less than 150/90. Adequate preventive care was defined as the provision of blood pressure screening, colon cancer screening, breast cancer screening, and cervical cancer screening within guidelines recommended by the 1989 U.S. Preventive Services Task Force. Resource use was measured by the annual number of visits and tests. MAIN RESULTS: The adjusted relative odds of HMO patients having controlled hypertension, compared with fee-for-service patients, were 1.82 (95% CI, 1.02 to 3.27). The relative risks of HMO patients receiving preventive care within established guidelines were 1.19 (CI, 0.93 to 1.51) for colon cancer screening, 1.78 (CI, 1.11 to 2.84) for annual breast examinations, 1.75 (CI, 1.08 to 2.84) for biannual mammography, and 1.35 (CI, 1.13 to 1.60) for Papanicolaou smears every 3 years. Prepaid patients had visit rates that were 18% to 22% higher than those of fee-for-service patients. CONCLUSIONS: In the type of network model HMO we studied, the quality and quantity of ambulatory care for HMO patients was equal to or better than that for fee-for-service patients. In this setting, the incentives for physicians to limit resource use may be offset by lack of disincentives for HMO patients to seek care.

Cost savings and economic considerations using home intravenous antibiotic therapy for cystic fibrosis patients.

Our Cystic Fibrosis (CF) Center made an effort to utilize home intravenous antibiotic therapy (HIVAT) as an alternative to continued hospitalization during a 1-year study. After thorough individual clinical and financial evaluation, 27 of 41 CF patients admitted for treatment, including antibiotic therapy, were selected for HIVAT to complete a 14- to 21-day treatment course (mean 15.1 days). The 27 patients (6-28 years old, mean 16 years) incurred a total of $698,587 in hospital charges and physician fees during 96 admissions. The average charge for 974 inpatient days was $717/day ($7,280 per admission). After an average of 10.2 days of inpatient care, the 27 patients underwent 79 courses of HIVAT for an additional 8 days; 21 additional HIVAT courses in six of these patients were initiated on an outpatient basis between frequent readmissions. The 811 days of HIVAT resulted in $85,027 total charges by two home care companies. The charges per day of HIVAT by one company were almost twice that of the other. The average daily cost of HIVAT was $108/day. If the HIVAT patients had remained hospitalized to complete the course of intravenous antibiotic therapy, the projected inpatient costs would have been $589,271. Therefore, the 811 days of HIVAT over a 1-year period resulted in total estimated direct cost savings of $501,770. The average savings per course of HIVAT was $5,017, or $618/day.(ABSTRACT TRUNCATED AT 250 WORDS)

A possible method for the detection of ovulation and the determination of the duration of the fertile period.

PIP: In attempt to find a more reliable and earlier predictor of ovulation, radioimmunoassay methods were investigated which could measure the levels of steroid glucuronides (follicular estrogens), varying levels of which would warn of approaching ovulation well before (up to 96 hours) its occurrence so that abstinence can be practiced during the period of sperm viability before the egg is released. To this end, daily urine collections were made on 9 subjects and the steroid glucuronides were totalled. In addition, the excretion of 5 beta-pregnanediol-3 alpha-glucuronide was measured throughout the menstrual cycle. Measurement of this parameter seemed of more practical value since the ratio of estrone-3-glucuronide/pregnanediol-3 alpha-glucuronide rises during the periovulatory period and falls sharply after the formation of the corpus lutuem. This parameter, unlike measurement of total steroid glucuronides, is not dependent on the rate of excretion or on concentration. In all 9 subjects, a significant increase in this ratio (P .05) was detected 48-120 hours before the plasma lutropin maximum. For assay, this ratio value is easier to assess because the assay kit would be applicable to early morning urine samples and would not involve any measurement of urine volume or time. A short discussion follows the experimental presentation.^ieng

The direct radioimmunoassay of oestrogen glucuronides in human female urine.

Radioimmunoassays for five oestrogen metabolites in urine are described; they are oestrone 3-glucuronide, oestradiol 3-glucuronide, oestradiol 17 beta-glucuronide, oestriol 3-glucuronide and oestriol 16 alpha-glucuronide. These assays have proved accurate and reliable and can be performed rapidly; they have been carried out directly in diluted menstrual cycle urine and pregnancy urine. No sample pretreatment was required. Preliminary results suggest that clinically useful information can be obtained by performing these assays on random urine specimens.