Risky Bingeing: Women in Appalachian Ohio Report Higher Rates of Alcohol Misuse

How much alcohol women drink may depend on where they live. A new study finds one-fifth of women in Appalachian Ohio imbibe at alarming levels

Newswise, June 27, 2017 — Appalachia — stretching from the southern tier of New York state to northern Alabama, Mississippi and Georgia — has long experienced deep economic distress and deprivation, and the gamut of accompanying social problems.

Compared with women living in urban areas, women who reside in these rural areas face multiple health concerns, including substance abuse issues, and often at greater rates. While the opioid epidemic in rural areas has gained attention, the rampant alcohol use has not.

“Alcohol continues to be the most prevalent and widely used and abused substance among Appalachian adults and is reported to be the primary reason for seeking substance use treatment in the region, surpassing drug abuse,” says Golfo K. Tzilos, Ph.D.

Tzilos is an assistant professor in the University of Michigan’s Departments of Family Medicine and Psychiatry and the U-M Addiction Center. She and Mack T. Ruffin IV, M.D., MPH, professor emeritus and chair of the Department of Family and Community Medicine at Penn State Hershey Medical Center, studied excessive drinking behavior in women from rural Appalachian Ohio because of a surprising lack of empirical data.

Tzilos and Ruffin analyzed data from the Community Awareness, Resources, and Education (CARE) Project, which investigated determinants of abnormal cervical cytology.

More than 6,000 women older than 18 and representing 14 counties in Appalachian Ohio, 95 percent of whom were non-Hispanic whites, participated in the original study.

Approximately 2,300 of those women supplied relevant information about their alcohol use and other possible predictive alcohol abuse variables. Of these, one-fifth (19.9 percent) reported recent, heavy episodic drinking.

Heavy episodic drinking, or binge drinking, is defined as consuming four or more alcoholic beverages — beer, wine, wine coolers, mixed drinks and liquor — in one sitting for women.

Younger women (under age 26) were five times more likely to binge drink than women older than 50, researchers found. Those who identified themselves as current smokers, single and with four or more lifetime sexual partners also had an increased adjusted risk of binge drinking.

“One interpretation of the findings is that these women are a vulnerable population,” says Tzilos.

“Typically, these women face a number of disadvantages in their environment, including chronic stressors such as limited resources and living in poverty, as well as acute stressors such as exposure to violence and abuse, which can all play a role in the likelihood of higher rates of alcohol use.”

Their results are published in the Journal of Rural Mental Health.

Clinical takeaways and broader implications

Binge drinking is associated with a broad range of hazardous behaviors, including tobacco use, risky sexual activity, higher risks of unintended pregnancy and sexually transmitted infections. These behaviors can lead to harmful consequences that can negatively affect society as a whole.

Tzilos says primary care physicians have an opportunity to act as a conduit between their patients and critical health resources.

“Clinicians have the opportunity to inquire about risky alcohol use among their patients,” says Tzilos. “In rural settings, there are often barriers to health services that women face, including stigma, cultural concerns of confidentiality and trust, lack of anonymity, and lack of access and providers.”

This gap is particularly important to address given that rural women, including those from Appalachian regions, report a higher rate of health concerns that may be associated with, or a consequence of, unaddressed or undertreated alcohol misuse.

Tzilos and Ruffin’s findings also reflect what is happening at the national level. Women are increasingly participating in risky alcohol use at younger ages.

They suggest increasing sensitivity to this fact and work to address the obstacles to improving health outcomes for women from Appalachian communities. This could include leveraging technology to increase reach and access to screening, treatment and referrals.

“My future work will explore the relationship between stress and alcohol use among women in this region,” says Tzilos. “It may shed light on opportunities for prevention.”

Tzilos also plans to help adapt integrative strategies to identify and reduce health risk behaviors and to enhance protective factors among these women.

Social Rejection by Those Closest to You Can Lead to Subsequent Drinking

Newswise, June 6, 2017 — The need to belong and experience social connections is a fundamental human characteristic. Prior research has shown that social rejection is linked to increases in negative emotions, distress, and hostility.

This study examined the impact of social rejection on alcohol use, and whether the impact differed when the social rejection was by close others, such as friends, spouses or family members, or by strangers or acquaintances.

Researchers gathered data from 77 community participants (41 women, 36 men) who used their smartphones to record their social interactions and alcohol use for 14 consecutive days. The analysis examined associations between rejection experiences and daily alcohol use.

Findings indicated that the type of relationship may be a key factor in whether or not social rejection leads to drinking. More specifically, on days characterized by rejection by close others, the likelihood of drinking significantly increased.

In contrast, on days characterized by rejection by acquaintances, there was no increase in the likelihood of drinking. This finding contrasts with laboratory studies of rejection that emphasize rejection and ostracism by strangers rather than known others.

An Increasing Proportion of Women Who Are 60 Years of Age and Older Are Drinking

Newswise, June 6, 2017 — Most older Americans drink alcohol. Given that this segment of the population is projected to almost double by 2050, reaching 112 million, in the future, there will likely be many more older drinkers in the United States than currently.

Importantly, older individuals are more sensitive to alcohol’s effects than their younger counterparts, and are also more likely to take prescription medications that can interact negatively with alcohol, potentially leading to falls and other injuries. This study examined trends in drinking status among U.S. adults 60 years of age and older.

Researchers analyzed data from the 1997-2014 National Health Interview Surveys: 65,303 respondents 60 years of age and older (31,803 men, 33,500 women) were current drinkers; 6,570 men and 1,737 women were binge drinkers. Analysis of respondents by sex, age group, and birth cohort showed differing trends over time.

The observed upward trends in drinking among adults 60 years of age and older, particularly women, are of public health concern. Among older men, the prevalence of current drinking trended upward an average of 0.7% per year, while average volume and the prevalence of binge drinking remained stable.

Among older women, the prevalence of current drinking trended upward an average of 1.6% per year, while average volume remained stable; moreover, the prevalence of binge drinking increased an average of 3.7% per year. These findings indicate a need for alcohol-related public-health education, screening, and treatment for the growing older population.

Social Smoking Carries Same Heart-Disease Risks as Everyday Habit

One in 10 Americans screened said they sometimes smoked, study found

Newswise, May 4, 2017 – Social smokers’ risk for high blood pressure and high cholesterol is identical to those who light up every day, new research has found.

This large, nationally representative study is the first to look at blood pressure and cholesterol in social smokers. More than 10 percent of 39,555 people surveyed said they were social smokers, meaning they didn’t smoke every day. That’s on top of the 17 percent who called themselves current smokers.

Among current and social smokers (after researchers adjusted for differences in factors including demographics and obesity), about 75 percent had high blood pressure and roughly 54 percent had high cholesterol.

“Not smoking at all is the best way to go. Even smoking in a social situation is detrimental to your cardiovascular health,” said lead author Kate Gawlik, assistant professor of clinical nursing at The Ohio State University.

“One in 10 people in this study said they sometimes smoke, and many of them are young and already on the path to heart disease,” she said. 

Smoking is a risk factor for unhealthy blood pressure and cholesterol and both are significant contributors to cardiovascular disease, the leading killer of men and women worldwide. 

The study appears in the American Journal of Health Promotion

“These are striking findings and they have such significance for clinical practice and for population health,” said study senior author Bernadette Melnyk, dean of Ohio State’s College of Nursing and chief wellness officer for the university.

Melnyk said doctors and nurses should strive to identify social smokers and offer them advice and tools to quit smoking.

“This has been a fairly neglected part of the population. We know that regular smoking is an addiction, but providers don’t usually ask about social smoking,” Melnyk said.

“The typical question is ‘Do you smoke or use tobacco?’ And social smokers will usually say ‘No’.”

Participants in the study were screened from February 2012 to February 2016 as part of Ohio State’s Million Hearts educational program.  The U.S. Department of Health and Human Services in 2012 launched Million Hearts, a five-year initiative to improve cardiovascular health co-led by the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services. Ohio State was the first university-wide partner. 

During the screenings, participants identified themselves as nonsmokers, current smokers or social smokers. The screenings also included measures of blood pressure and total cholesterol.

Social smokers in the study were more likely to be younger (between 21 and 40 years old), male and Hispanic. After the researchers took into account demographic and biometric differences between the smokers and social smokers in the study, they found no difference in the risk of hypertension or high cholesterol.

Social smokers were defined as those who do not smoke cigarettes daily, but who smoke in certain social situations regularly. 

The good news about this study is there’s plenty of room for intervention and prevention of future death and disease, the researchers said. 

“Simple healthy lifestyle behavior changes including appropriate aspirin therapy, blood pressure control, cholesterol management, stress management and – very importantly – smoking cessation can do away with much of the risk of chronic disease,” Melnyk said. 

The percentage of participants who called themselves “current smokers” was in line with estimates from the CDC, which reports that 17.8 percent of U.S. adults identify as smokers.

Gawlik and Melnyk said those who consider themselves social smokers should be aware that the toll on their cardiovascular health could be just as great as if they smoked every day.

And this study should prompt clinicians to rethink how they ask patients about smoking, they said.

“Are you a smoker?” isn’t likely to work with social smokers, because they don’t think of themselves as addicted, Gawlik said.

In the study, the researchers advise asking “Do you ever smoke cigarettes or use tobacco in social situations such as at bars, parties, work events or family gatherings?”

Another option: “When was the last time you had a cigarette or used tobacco with friends?” 

Furthermore, clinicians working with smokers should be aware that cutting back on smoking isn’t a good answer from a heart-health perspective.

“Doctors and nurses need to educate patients that social smoking is still a major health risk and is not a long-term healthy choice,” Gawlik said.

Limitations of the study include the fact that the researchers don’t have information about prior smoking behavior, just what the participants reported at the screenings. In addition, the screenings were open to people who chose to participate, meaning the study subjects were self-selected.

Gawlik said she’d like to know more about how many of those who smoke socially go on to become everyday smokers.

“That’s a huge area for clinical intervention because you might be able to reach them before they’re completely and totally addicted,” she said.

Ohio State has led a national effort through Million Hearts, which now has over 150 participating organizations and universities, to provide free education and support to health care providers, students and community members looking to reduce cardiovascular death and disease. More information is available at https://millionhearts.osu.edu/ 

Aggression Disorder Linked to Greater Risk of Substance Abuse

 People with intermittent explosive disorder at five times greater risk for substance abuse than those who don’t display frequent aggressive behavior

Newswise, May 2, 2017 — People with intermittent explosive disorder (IED)—a condition marked by frequent physical or verbal outbursts—are at five times greater risk for abusing substances such as alcohol, tobacco and marijuana than those who don’t display frequent aggressive behavior, according to a new study by researchers from the University of Chicago.\

In the study, published Feb. 28, 2017 in the Journal of Clinical Psychiatry, Emil Coccaro, MD, and colleagues analyzed data from more than 9,200 subjects in the National Comorbidity Survey, a national survey of mental health in the United States.

They found that as the severity of aggressive behavior increased, so did levels of daily and weekly substance use. The findings suggest that a history of frequent, aggressive behavior is a risk factor for later substance abuse, and effective treatment of aggression could delay or even prevent substance abuse in young people.

IED affects as many as 16 million Americans, more than bipolar disorder and schizophrenia combined. It is often first diagnosed in adolescents, some of whom are as young as 11, years before substance abuse problems usually develop.

 IED runs in families and is thought to have a significant genetic component, although Coccaro said people tend to treat it as a social-behavioral issue instead of as a true neurobiological disorder.

“People don’t see this as a medical problem. They think of it as simply bad behavior they have developed over the course of their lives, but it isn’t. It has significant biology and neuroscience behind it,” said Coccaro, who is the Ellen C. Manning Professor of Psychiatry and Behavioral Neuroscience at UChicago.

Previous research has implied that aggressive behavior in IED is due to the presence of other psychiatric disorders, such as anxiety or depression. But the new UChicago study found no such relationship.

While substance abuse, like excessive drinking, can clearly make aggressive behavior worse, the onset of IED almost always precedes the development of chronic substance abuse. Coccaro and his team found that IED preceded substance abuse in 92.5 percent of the cases where subjects developed both disorders.

Coccaro emphasized that early psychological intervention, medication and cognitive therapy are the most effective treatments to prevent, or at least delay, substance abuse problems in adolescents diagnosed with IED.

“What you’re really treating is the emotional dysregulation that leads to aggression,” Coccaro said. “The earlier you treat this dysregulation, the more likely you are to offset other disorders that come later down the road.”

The study, “Intermittent Explosive Disorder and Substance Use Disorder: Analysis of the National Comorbidity Survey Replication Sample,” was supported by the National Institute of Mental Health. Additional authors include Jennifer Fanning, PhD, and Royce Lee, MD, both from the University of Chicago.

Study Confirms Link Between Alcohol Consumption, Breast Cancer Risk in Black Women

Newswise, May 2, 2017– Alcohol consumption is known to be a risk factor for breast cancer based on studies predominantly done in white women. Now a University of North Carolina Lineberger Comprehensive Cancer Center study has found the same risk exists for black women, an understudied group.

Researchers found in the new study that black women who drank more than 14 alcoholic drinks per week had a significantly higher risk of invasive breast cancer than those who drank less.

The findings, published in the journal Cancer, Epidemiology, Biomarkers & Prevention, confirmed the link between alcohol consumption and breast cancer risk, which has been seen in other studies drawn from majority white populations.

And while some breast cancer risk factors - like age or genetics -- aren’t easily modified, alcohol consumption is one risk factor that women, regardless of race, can change to potentially lower their cancer risk.

“Minority groups are often understudied because they represent a smaller proportion of study populations. This work avoided that limitation by working with a consortium of many different studies, including more than 20,000 black women,” said Melissa Troester, PhD, a member of UNC Lineberger and professor of epidemiology in the UNC Gillings School of Global Public Health.

“We found that the patterns observed in other studies examining alcohol and breast cancer risk hold in black women, too.”

The researchers analyzed data for 22,338 women from the African American Breast Cancer Epidemiology and Risk (AMBER) consortium, which combines data from four large breast cancer studies.

Researchers evaluated alcohol as a risk factor for invasive breast cancer as well as for specific breast cancer subtypes, such as estrogen receptor positive or negative cancer.

“Our study demonstrated there is benefit in creating consortia to focus on understudied groups,” said the study’s first author Lindsay Williams, a graduate research assistant at UNC Gillings.

When they studied the data across all breast cancer subtypes, they found consuming seven or more alcoholic drinks per week was linked to increased risk of breast cancer across all subtypes.

Women who previously drank alcohol, and later stopped, had lower risk than women who reported recent use – indicating that women may be able to reduce their risk by drinking less.

However, they did find significantly higher risk for some women who have never drank alcohol.

The researchers said that the group of women that avoids alcohol also sometimes includes women who have other health conditions, and some of these health conditions can increase risk for breast cancer. The finding may direct additional research.

“In the future, it may be worth-while to better characterize women who identify as never drinkers to understand reasons for abstaining from alcohol,” Williams said.

The researchers underscored that the study is important as alcohol consumption can be changed or addressed.

“Overall, our findings among African American women mirror those reported in the literature for white women, namely that high levels of alcohol intake – more than one drink per day – are associated with increased breast cancer risk,” Troester said.

“Alcohol is an important modifiable exposure, and women who are concerned about their risk of breast cancer could consider reducing levels of exposure.”

In addition to Troester and Williams, other authors include: Andrew F. Olshan, Chi-Chen Hong, Elisa V. Bandera, Lynn Rosenberg, Ting-Yuan David Cheng, Kathryn L. Lunetta, Susan E. McCann, Charles Poole, Laurence N. Kolonel, Julie R. Palmer, and Christine B. Ambrosone.

Anxiety Is a Stronger Harbinger of Alcohol Problems Than Stress

Newswise, March 20, 2017 — Stress and anxiety are widely believed to contribute to drinking. Alcohol is thought to reduce tension caused by stress (the “flight or fight” response) as well as alleviate the unpleasant symptoms of anxiety (anticipation of the unpredictable, impending threats).

Prior research, however, has yielded inconsistent findings as to the unique relations between stress and anxiety, on the one hand, and alcohol consumption and alcohol use disorders, on the other hand.

This study was designed to examine how differences in self-reported levels of anxiety, anxiety sensitivity, and perceived stress impact the frequency and intensity of drinking, alcohol craving during early withdrawal, and alcohol craving and stress reactivity.

Recent drinking was assessed in 87 individuals (70 men, 17 women) with alcohol use disorders (AUDs). Three distinct measures were used to evaluate anxiety, anxiety sensitivity, and perceived stress.

A subset of 30 subjects was admitted to a medical center to ensure alcohol abstinence for one week: measures of alcohol craving were collected twice daily. On day 4, subjects participated in a public speaking/math challenge, before and after which measures of cortisol and alcohol craving were collected.

In these heavy drinkers, measures of anxiety as compared with perceived stress were more strongly associated with a variety of alcohol-related measures.

While alcohol studies often use the terms anxiety, anxiety sensitivity, and stress interchangeably, this study showed the importance of differentiating among the three terms given their unique relationships with drinking, craving, and stress reactivity among individuals with AUDs.