More than a Quarter of U.S. Adults, Roughly 9 Percent of U.S. Youth Use Tobacco

Roswell Park scientists report findings from first wave of PATH Study in New England Journal of Medicine

Newswise, February 10, 2017. — More than 1 in 4 adults and nearly 1 in 10 youth use tobacco, according to findings from the Population Assessment of Tobacco and Health (PATH) Study, published online ahead of print in the New England Journal of Medicine.

The PATH Study, established in 2011 through collaboration between the National Institutes of Health’s National Institute on Drug Abuse and the U.S. Food and Drug Administration’s Center for Tobacco Products, is a uniquely large, nationally representative longitudinal study designed to examine tobacco use behaviors and health among the U.S. population over multiple years of follow-up.

The PATH Study is being conducted by Westat of Rockville, Md., with Roswell Park Cancer Institute as the scientific lead.

“Tobacco use continues to be an overwhelming economic and personal burden in this country. This research provides a unique and much-needed long-term approach to understanding tobacco use and the impact those behaviors have on individuals and on society as a whole,” says Andrew Hyland, PhD, Chair of the Department of Health Behavior at Roswell Park Cancer Institute and principal investigator of the PATH Study.

The present study reports findings from the baseline wave of data collection, conducted from September 2013 to December 2014.

As part of that first wave of the PATH Study data collection, 32,320 adults and 13,651 youths (ages 12-17) were asked about their use of 12 types of tobacco products, including cigarettes, e-cigarettes, cigars, pipe tobacco, hookah, smokeless tobacco and snus. 

The research team found that 27.6% of American adults are current tobacco users and 8.9% of youth reported using tobacco in the previous 30 days. Use of multiple tobacco products was common among both adult and youth users, with cigarettes and e-cigarettes being the most common combination. 

“These findings will serve as the baseline for comparison to future waves of PATH Study data in our effort to understand changes in use of tobacco products over time, including switching among types of products, quitting tobacco, and trajectories of use of multiple products,” says Karin Kasza, MA, Senior Research Specialist in the Department of Health Behavior at Roswell Park and lead author of the study published today.

“The study documents that tobacco use is about much more than just cigarettes,” adds study co-author Wilson M. Compton, MD, Deputy Director of the National Institute on Drug Abuse. “Both youth and adults use a remarkably broad variety of tobacco products.”

“The findings from the PATH Study will help inform the FDA’s efforts to regulate tobacco products in such a way that reduces harm and protects public health.

“We look forward to findings from future study waves that will help us better understand patterns of tobacco use in the U.S. and, ultimately, how such behaviors influence health,” says David L. Ashley, PhD, Director of the Center for Tobacco Products’ Office of Science.

Additional PATH Study partners are the Truth Initiative, the University of California at San Diego, University of Waterloo, Geisel School of Medicine at Dartmouth, Medical University of South Carolina, Rutgers University and University of Minnesota.

This manuscript is supported with federal funds from the National Institute on Drug Abuse, National Institutes of Health, and the Food and Drug Administration, Department of Health and Human Services, under a contract to Westat (Contract No. HHSN271201100027C). The study, “Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014,” is available at nejm.org.

For an online version of this release, please visit:
https://www.roswellpark.org/media/news/more-quarter-us-adults-roughly-9-percent-us-youth-use-tobacco

Police Sobriety Checkpoints Can Reduce Drunk Driving Better Than Increased Penalties

Newswise, February 3, 2017 — Driving while impaired (DWI) causes more than 10,000 deaths per year in the United States. Although enforcing criminal sanctions for DWI is the traditional response, the success of these measures has been inconsistent.

This study looked at risk perceptions as a method of reducing the frequency of DWI - in other words, whether the threat of being apprehended for DWI can deter people from engaging in this behavior.

Researchers examined survey data collected from individual drivers, police, and defense attorneys specializing in DWI in eight U.S. cities.

They compared two measures to determine which was a better deterrent of alcohol-impaired driving: the threat of being apprehended for DWI or harsher penalties for DWI.

Individuals reported that a greater perceived chance of being pulled over for DWI corresponded to less alcohol-impaired driving on their part.

Conversely, individual perceptions of DWI penalties were unrelated to their self-reports of current or future alcohol-impaired driving. The authors suggested that increasing the certainty of apprehension by increasing police staffing and/or conducting more sobriety checks would likely be more effective in reducing alcohol-impaired driving than legislating increased penalties.

Problem Drinking in Older Adults

Newswise, January 14, 2017 – Older adults suffering from multiple chronic health conditions and depression are nearly five times as likely to be problem drinkers as older adults with the same conditions and no depression, according to researchers at the University of Georgia. Their study is the first to document the connection between multiple chronic illnesses, depression and alcohol use in seniors.

This information could help health care providers identify which older adults are most likely to experience problem drinking and lead to better preventive care for this segment of society.

The study, conducted by researchers from the UGA School of Social Work, utilized data from the National Social Life, Health and Aging Project, a nationwide survey of older adults that is funded by the National Institutes of Health. Researchers looked at more than 1,600 individuals aged 57 to 85 who identified as active alcohol consumers.

Among problem drinkers, or individuals who reported a high amount of negative consequences associated with alcohol use, the researchers found that more than half—66 percent—reported having multiple chronic health conditions, or MCC, and 28 percent reported having symptoms of depression.

The researchers also found that older adults who experienced MCC combined with depression were those who experienced the highest likelihood of problem drinking.

“These findings suggest that effective training in screening and referral for mental health and alcohol use issues for health care providers of older adults may better serve the approximate 4 million older adults who currently experience problem drinking in the U.S.,” said Orion Mowbray, assistant professor at the UGA School of Social Work and lead author of the study.

Previous efforts to prevent and manage disease in older adults have focused on a single disease at a time, said Mowbray. Few physicians consider the combination of multiple chronic conditions in connection with depression as a potential sign for increased alcohol misuse, although screening and follow-up counseling for behavioral problems is known to help.

“There is sufficient evidence that even brief interventions delivered in medical-related settings can have a positive influence on reducing problem drinking among most older adults,” said Mowbray.

“These interventions can include screening for signs of depression in individuals with long-term health problems, engaging the individual in a conversation about the risks of problem drinking, and providing a referral for brief alcohol-related treatment.”

Other contributors to the paper include Tiffany Washington, assistant professor of social work, social work doctoral student Greg Purser and Jay O’Shields.

The study, “Problem drinking and depression in older adults with multiple chronic health conditions,” was published in the October issue of the Journal of the American Geriatrics Society, and will be presented this month at the Society for Social Work and Research’s annual conference in New Orleans. It is available online at http://onlinelibrary.wiley.com/doi/10.1111/jgs.14479/full 

Older Adults with Long-Term Alcohol Dependence Lose Neurocognitive Abilities

Newswise, October 9, 2016— Heavy drinking can lead to neurophysiological and cognitive changes ranging from disrupted sleep to more serious neurotoxic effects. Aging can also contribute to cognitive decline. Several studies on the interaction of current heavy drinking and aging have had varied results.

This study sought to elucidate the relations among age, heavy drinking, and neurocognitive function.

Researchers had 66 participants (35 women, 31 men), recruited from the Brown University Center for AIDS Research, undergo a comprehensive neurocognitive battery of testing.

 Current heavy drinkers (n=21) were classified using National Institute on Alcohol Abuse and Alcoholism criteria and structured clinical interviews and, further, were compared to non-drinkers and moderate drinkers (n=45).

About 53 percent of the total population had a lifetime history of alcohol dependence (AD). Neurocognitive data were grouped according to global cognitive function, attention/executive function, learning, memory, motor function, verbal function, and speed of processing.

Results showed that current heavy drinking in older adults was associated with poorer global cognitive function, learning, memory, and motor function.

Furthermore, a lifetime history of AD was associated with poorer function in the same neurocognitive domains, as well as the attention/executive domain, notwithstanding age.

In summary, although current heavy drinking is associated with significant impairment in a number of neurocognitive domains, it appears that a history of AD is associated with lasting negative consequences for neurocognitive function.

Specific Trauma Experiences Contribute to Women’s Alcohol Use, Differs by Race

 Newswise, October 9, 2016 — Trauma exposure has consistently been reported as a risk factor for alcohol use and related problems. Further, racial differences in alcohol use, alcohol use disorder (AUD), and trauma exposure between European American (EA) and African American (AA) women have been reported previously.

This study sought to identify racial differences in alcohol involvement, and to examine the risk conferred by specific trauma exposures and PTSD for different stages of alcohol involvement in EA and AA women.

Researchers examined data from the Missouri Adolescent Female Twins Study: the mean age of the 3,787 women at time of interview was 24.5 years; 85.4 percent were EA, 14.6 percent AA.

Trauma exposures were defined as sexual abuse (SA), physical abuse (PA), witnessing another person being killed or injured, experiencing an accident, or experiencing a disaster. Trauma exposure was examined as a predictor of alcohol initiation, transition to the first AUD symptom, and transition to an AUD diagnosis – while also considering other substance involvement, parental characteristics, and commonly co-occurring psychiatric disorders.

Results showed that trauma experiences were important contributors to all stages of alcohol involvement in EA women only, with different trauma types conferring risk for each stage of alcohol involvement.

For example, in EA women SA was associated with alcohol initiation prior to the age of 14; PA predicted the transition from initiation to the first AUD symptom; and PA, witnessing injury or death, and SA predicted the transition to an AUD diagnosis.

There were no such findings in AA women. Further, PTSD was not revealed as a significant predictor of AUD in either EA or AA women. The findings suggest that trauma, independent of PTSD, directly contributes to alcohol involvement.

Further, they highlight the importance of considering racial differences when looking at linkages between traumatic experiences and alcohol involvement.

STRONG ALCOHOL POLICIES CAN HELP PREVENT SUICIDE

Newswise, September 13, 2016— Suicide was the tenth leading cause of death in the United States in 2013. There is clear evidence that intoxication and chronic, heavy drinking are often associated with suicide. While alcohol policies are known to be effective in reducing excessive drinking, this review undertakes a critical look at the literature on the relationship between alcohol policies and suicide.

The authors summarize the associations between various types of alcohol policies and suicide, both in the U.S. and internationally, as found in English-language literature published between 1999 and 2014. Overall, a number of studies suggest that restrictive alcohol policies have a protective effect on reducing suicide at a general population level. Due to substantial between-states variation in alcohol policies, U.S.-based studies contributed substantially to the literature.

The findings highlight the importance of population-based alcohol policies in suicide prevention. Better implementation of effective alcohol policies can reduce alcohol availability at a population level, which in turn, reduces the average risk of suicide, especially in those cases where alcohol is involved.

This is consistent with the prevention paradox, which posits that the majority of cases of a health condition arise from members at low or moderate risk of the disease, while members at high risk only contribute a minority of cases.

This population-based approach is likely to maximize public health benefits and have a long-lasting influence on reducing suicide. This is because this population-based approach is likely to shift the distribution of population suicide risk in a favorable (lower) direction.

The authors point out that the literature has a number of methodological limitations, such as measurement and selection bias, and a restricted focus, in which the effects of a limited number of alcohol policies are considered without accounting for other alcohol policies. 

Loyola Study Finds That Excessive Alcohol Consumption Impacts Breathing

Newswise, August 3, 2016-- A study led by researchers from Loyola Medicine and Loyola University Chicago has discovered a potential new health concern related to excessive alcohol consumption.

Adults who drink excessively were found to have less nitric oxide in their exhaled breath than adults who don’t drink. The finding, published in the journal Chest, is significant because nitric oxide helps protect against certain harmful bacteria.

“Alcohol appears to disrupt the healthy balance in the lung,” said lead author Majid Afshar, MD, MSCR. Dr. Afshar is a Loyola Medicine pulmonologist and an assistant professor in the division of pulmonary and critical care medicine and department of public health sciences of Loyola University Chicago Stritch School of Medicine.

This is the first study to report such a link between excessive alcohol consumption and nitric oxide.

Dr. Afshar is among the 50 researchers in Loyola’s Alcohol Research Program who are studying the effects of alcohol on multiple organ systems. They are researching the molecular, cellular and physiological responses to acute, binge and chronic alcohol consumption. Studies center on endocrine, gastrointestinal, immune, nervous and skeletal systems.

Dr. Afshar and colleagues examined data from the U.S. Centers for Disease Control and Prevention’s National Health and Examination Survey (NHANES). NHANES conducts interviews and physical examinations to assess the health and nutritional status of Americans.

The Loyola researchers examined data from 12,059 adults who participated in NHANES between 2007 and 2012. Excessive drinkers were defined as heavy drinkers (more than one drink per day on average for women and more than two drinks per day for men) and people who binge drink at least once per month (four or more drinks per occasion for women and five or more drinks for men).

In the sample population researchers examined, 26.9 percent of the participants were excessive drinkers. After controlling for asthma, smoking, diet, demographics and other factors, researchers found that exhaled nitric oxide levels were lower in excessive drinkers than in adults who never drink, and the more alcohol an excessive drinker consumed, the lower the level of nitric oxide.

Nitric oxide is a colorless gas produced by the body during respiration. A nitric oxide molecule consists of one nitrogen atom and one oxygen atom. Nitric oxide and similar molecules play an important role in killing bacteria that cause respiratory infections.

In an asthma patient, the amount of exhaled nitric oxide in a breath test provides a good indication of how well the patient’s medication is working. Excessive alcohol consumption might complicate the results of such tests. 

“Lung doctors may need to take this into consideration,” Dr. Afshar said.

Dr. Afshar and colleagues concluded: “Accounting for alcohol use in the interpretation of [exhaled nitric oxide] levels should be an additional consideration, and further investigations are warranted to explore the complex interaction between alcohol and nitric oxide in the airways.”

The study is titled “Exhaled nitric oxide levels among adults with excessive alcohol consumption.” The study was funded in part by the National Institutes of Health.

Dr. Afshar’s co-authors are Guichan Cao, MS, Ramon Durazo, PhD and Richard C. Cooper, MD of Loyola’s department of public health sciences; Jill A. Poole, MD and Joseph H. Sisson, MD of the University of Nebraska and Elizabeth J. Kovacs, PhD, who was at Loyola at the time of the study and now is at the University of Colorado