Alcohol to-go sales policies at on-premise drinking establishments near large public US universities during the COVID-19 pandemic.

AIMS: Sweeping policy changes during the COVID-19 pandemic increased alcohol availability through permitted to-go sales, potentially posing unique risks to college students. While to-go sales may make binge drinking more convenient, little remains known about these practices. Therefore, this study aimed to assess whether drinking establishments' to-go sales practices are associated with their other operational practices and state policy. METHOD: This cross-sectional analysis included 221 randomly selected bars, nightclubs, and restaurants within two miles of a large public university. Telephone interviews assessed establishment practices, and the Alcohol Policy Information System provided state alcohol to-go laws. Regression models tested whether establishment to-go sales practices were associated with their business practices (logistic regression) and state policy (generalized estimating equations). RESULTS: Nearly one-half (44.8%) of drinking establishments sold alcohol to-go. Establishments with higher vodka prices had nearly 30% higher odds of selling spirits to-go (aOR = 1.29) and establishments offering happy hours specials had more than twice the odds of selling beer (aOR = 2.22), wine (aOR = 2.53), and spirits to-go (aOR = 2.60). Additionally, establishments that implemented physical distance requirements had higher odds of selling wine to-go (aOR = 3.00). State to-go laws were associated with higher odds of selling wine (aOR = 3.99) and spirits to-go (aOR = 5.43) in the full sample and beer to-go (aOR = 4.92) in urban counties. CONCLUSIONS: Establishments that sell alcohol to-go tend to engage in other practices designed to drive sales. Evaluations of alcohol to-go sales laws on risky consumption among priority populations, including college students, are urgently needed to inform decisions about how to appropriately regulate sales.

Characterizing Twitter chatter about temporary alcohol abstinence during "Dry January".

With roots as a public health campaign in the United Kingdom, "Dry January" is a temporary alcohol abstinence initiative encouraging participants to abstain from alcohol use during the month of January. Dry January has become a cultural phenomenon, gaining increasing news media attention and social media engagement. Given the utility of capturing naturalistic discussions around health topics on social media, we examined Twitter chatter about Dry January and associated temporary abstinence experiences. Public tweets were collected containing the search terms "dry january" or "dryjanuary" posted between 15 December and 15 February across 3 years (2020-2). A random subsample stratified by year (n = 3145) was pulled for manual content analysis by trained coders. Final codebook accounted for user sentiment toward Dry January, user account type, and themes related to Dry January participation. Engagement metadata (e.g. likes) were also collected. Though user sentiment was mixed, most tweets expressed positive or neutral sentiment toward Dry January (74.7%). Common themes included encouragement and support for Dry January participation (14.1%), experimentation with and promotion of nonalcoholic drinks (14.0%), and benefits derived from Dry January participation (10.4%). While there is promise in the movement to promote positive alcohol-related behavior change, increased efforts to deliver the campaign within a public health context are needed. Health communication campaigns designed to inform participants about evidence-based treatment and recovery support services proven to help people quit or cut down on their drinking are likely to maximize benefits.

Alcohol Use Disorder Narratives in U.S. Digital News Coverage and Engagement on Social Media.

Social media regularly serves as a source of news and health-related information subsequently shaping public opinion and behavior. We examined mainstream digital news narratives about alcohol use disorder (AUD), including coverage of solutions to AUD, and associations between narratives and engagement on social media. AUD-related articles (N = 339) published in top U.S. newspapers and digital native news sources in 2019 were analyzed by trained coders with a structured codebook (κ = 0.75), examining characteristics of stories highlighting specific individuals affected by AUD and solution-framing of AUD. Facebook shares were used as a proxy measure for an article's potential "reach" on social media. Of articles focused on individuals (72.0%), most (62.7%) depicted individuals affected by AUD as criminals, as opposed to engaging with alcohol treatment or being in recovery (31.1%). These criminal depictions received over eight times as many FB shares, compared to alcohol use treatment or recovery depictions. Law enforcement solutions (63.9%) were depicted most often, followed by AUD-treatment oriented solutions (40.1%), and prevention-oriented solutions (15.8%). Law enforcement solutions received more than five times as much social media engagement than AUD-treatment oriented solutions and over twenty-nine times more engagement than prevention-oriented solutions. There is a need to increase news coverage featuring depictions of individuals who have successfully engaged with alcohol treatment and recovery, reflecting the millions of Americans who have resolved a significant past alcohol problem. News coverage of AUD should also incorporate more depictions of evidence-based prevention-oriented and treatment-oriented solutions to AUD.

The Alcohol and Polysubstance Behaviors of Mandated College Students Prior to Collegiate Sporting Events: An Assessment of Pregaming.

Background: Despite a litany of education and prevention efforts seeking to curtail alcohol and other drug (AOD) use behaviors of United States (U.S.) college students, AOD use remains pervasive among the American college student population. Socio-cultural reinforcement of AOD behaviors, such as pregaming (PG), are often considered normative aspects of the collegiate experience, potentially introducing, and/or exacerbating, AOD use among U.S. college students. Objective: Due to the unique relationship PG has with the U.S. college experience and sports culture, this study explored the relationship between PG prior to a live sporting event and frequency of alcohol use, and the likelihood of persons who pregame also engaging in polysubstance use (>1 substance during drinking/use event). Methods: This study was conducted with college students (n = 816) attending a large public university in the Southeastern Conference (SEC) who violated campus alcohol use policies. Results: Beyond the influence of important demographic covariates, PG (p < .001) was significantly associated with a greater frequency of alcohol use. Moreover, students who participated in PG festivities were nearly 2.5 times more likely to participate in polysubstance use. Discussion: PG prior to live collegiate sporting events has clear public health and policy implications. Future efforts should institute and enforce risk-management policies on college campuses and employ event-specific alcohol and polysubstance use prevention and intervention strategies.

Stealth Vaping Among College Students on Four Geographically Distinct Tobacco-Free College Campuses: Prevalence and Practices.

INTRODUCTION: To offset tobacco use among college students, many universities have implemented tobacco-free campus policies. Given how easily e-cigarette users can discreetly vape in places where it is prohibited without being detected (ie, stealth vape), it is important to assess whether students are subverting these policies. This study examined the prevalence of stealth vaping on-campus among students at multiple universities, including frequency and methods for stealth vaping. AIMS AND METHODS: A convenience sample of college students was obtained from four geographically distinct, large, public universities with established policies prohibiting all forms of tobacco use on campus. Participants (N = 863 current e-cigarette users) reported on demographics and e-cigarette use. Those who previously stealth vaped on-campus (n = 422) completed additional questions, including common locations, techniques, and devices/e-liquids used for stealth vaping. RESULTS: Nearly half (48.9%) of past 30-day e-cigarette users reported previously stealth vaping on-campus. Among stealth vapers, 48.1% owned a smaller device for stealth vaping and 38.9% used e-liquids with low visibility vapors. Common on-campus stealth vaping locations included bathrooms, libraries, parking garages, and classrooms. Techniques used for stealth vaping included deep inhale, blowing a hit into one's clothes, and swallowing a hit. CONCLUSIONS: A large percentage of respondents commonly violated campus tobacco-free policies by stealth vaping. For such policies to be effective at reducing on-campus e-cigarette use, there is a need for enhanced monitoring and enforcement. More research is needed to better understand factors influencing stealth vaping behaviors and public health implications. IMPLICATIONS: This sample of college student e-cigarette users commonly violated campus smoke- and tobacco-free policies by stealth vaping on campus. Respondents used a range of methods (eg, smaller device and low visibility e-liquids) and locations (eg, bathrooms, libraries, and parking garages) for stealth vaping. If campus policies are to be effective at reducing on-campus e-cigarette use, there is a need for enhanced monitoring and enforcement. E-cigarette devices specifically designed and marketed to facilitate stealth vaping (eg, resembling USB flash drives and pens) may require regulatory action. More research is needed to better understand factors influencing stealth vaping behaviors and public health implications.

Analyzing Twitter Chatter About Tobacco Use Within Intoxication-related Contexts of Alcohol Use: "Can Someone Tell Me Why Nicotine is So Fire When You're Drunk?"

INTRODUCTION: Alcohol and tobacco are commonly used together. Social influences within online social networking platforms contribute to youth and young adult substance use behaviors. This study used a sample of alcohol- and tobacco-related tweets to evaluate: (1) sentiment toward co-use of alcohol and tobacco, (2) increased susceptibility to tobacco use when consuming alcohol, and (3) the role of alcohol in contributing to a failed attempt to quit tobacco use. METHODS: Data were collected from the Twitter API from January 1, 2019 through December 31, 2019 using tobacco-related keywords (e.g., vape, ecig, smoking, juul*) and alcohol-related filters (e.g., drunk, blackout*). A total of 78,235 tweets were collected, from which a random subsample (n = 1,564) was drawn for coding. Cohen's Kappa values ranged from 0.66 to 0.99. RESULTS: Most tweets were pro co-use of alcohol and tobacco (75%). One of every ten tweets reported increased susceptibility to tobacco use when intoxicated. Non-regular tobacco users reported cravings for and tobacco use when consuming alcohol despite disliking tobacco use factors such as the taste, smell, and/or negative health effects. Regular tobacco users reported using markedly higher quantities of tobacco when intoxicated. Individuals discussed the role of alcohol undermining tobacco cessation attempts less often (2.0%), though some who had quit smoking for prolonged periods of time reported reinitiating tobacco use during acute intoxication episodes. CONCLUSIONS: Tobacco cessation interventions may benefit from including alcohol-focused components designed to educate participants about the association between increased susceptibility to tobacco use when consuming alcohol and the role of alcohol in undermining tobacco cessation attempts. IMPLICATIONS: Sentiment toward co-use of alcohol and tobacco on Twitter is largely positive. Individuals reported regret about using tobacco, or using more than intended, when intoxicated. Those who had quit smoking or vaping for prolonged periods of time reported reinitiating tobacco use when consuming alcohol. While social media-based tobacco cessation interventions like the Truth Initiative's "Ditch the Juul" campaign demonstrate potential to change tobacco use behaviors, these campaigns may benefit from including alcohol-focused components designed to educate participants about the association between increased susceptibility to tobacco use when consuming alcohol and the role of alcohol in undermining tobacco cessation attempts.

Using Natural Language Processing to Explore "Dry January" Posts on Twitter: Longitudinal Infodemiology Study.

BACKGROUND: Dry January, a temporary alcohol abstinence campaign, encourages individuals to reflect on their relationship with alcohol by temporarily abstaining from consumption during the month of January. Though Dry January has become a global phenomenon, there has been limited investigation into Dry January participants' experiences. One means through which to gain insights into individuals' Dry January-related experiences is by leveraging large-scale social media data (eg, Twitter chatter) to explore and characterize public discourse concerning Dry January. OBJECTIVE: We sought to answer the following questions: (1) What themes are present within a corpus of tweets about Dry January, and is there consistency in the language used to discuss Dry January across multiple years of tweets (2020-2022)? (2) Do unique themes or patterns emerge in Dry January 2021 tweets after the onset of the COVID-19 pandemic? and (3) What is the association with tweet composition (ie, sentiment and human-authored vs bot-authored) and engagement with Dry January tweets? METHODS: We applied natural language processing techniques to a large sample of tweets (n=222,917) containing the term "dry january" or "dryjanuary" posted from December 15 to February 15 across three separate years of participation (2020-2022). Term frequency inverse document frequency, k-means clustering, and principal component analysis were used for data visualization to identify the optimal number of clusters per year. Once data were visualized, we ran interpretation models to afford within-year (or within-cluster) comparisons. Latent Dirichlet allocation topic modeling was used to examine content within each cluster per given year. Valence Aware Dictionary and Sentiment Reasoner sentiment analysis was used to examine affect per cluster per year. The Botometer automated account check was used to determine average bot score per cluster per year. Last, to assess user engagement with Dry January content, we took the average number of likes and retweets per cluster and ran correlations with other outcome variables of interest. RESULTS: We observed several similar topics per year (eg, Dry January resources, Dry January health benefits, updates related to Dry January progress), suggesting relative consistency in Dry January content over time. Although there was overlap in themes across multiple years of tweets, unique themes related to individuals' experiences with alcohol during the midst of the COVID-19 global pandemic were detected in the corpus of tweets from 2021. Also, tweet composition was associated with engagement, including number of likes, retweets, and quote-tweets per post. Bot-dominant clusters had fewer likes, retweets, or quote tweets compared with human-authored clusters. CONCLUSIONS: The findings underscore the utility for using large-scale social media, such as discussions on Twitter, to study drinking reduction attempts and to monitor the ongoing dynamic needs of persons contemplating, preparing for, or actively pursuing attempts to quit or cut down on their drinking.

Characteristics and Effectiveness of Alcohol Website Age Gates Preventing Underage User Access.

AIMS: Examine and evaluate the overall effectiveness of age gates preventing access of underage users to alcohol websites. METHODS: Assess the characteristics of digital age gates among the top 25 alcohol brands among American adolescents, including type of age gate employed and resulting actions of repeated access requests indicating the user was under the legal drinking age. RESULTS: All official alcohol brand websites examined included an age gate, requiring either entering one's date of birth (DOB, 91%) or clicking a yes/no box indicating they were of legal drinking age (9%). Only one out of every five alcohol websites blocked futures attempts to gain access after entering a response indicating the user was under the legal drinking age. Users were allowed indefinite attempts to enter a DOB that was of legal drinking age, with the majority of websites subsequently granting access even after multiple underage entries. CONCLUSIONS: Alcohol website visitors with minimal arithmetic abilities, such as very young youth, are able to employ 'trial and error' to eventually enter an acceptable legal drinking DOB and gain access. Alcohol brand age gates are weak, at best, and likely an inconsequential barrier that someone with limited math abilities can easily overcome.

Alcohol messages disseminated to pregnant women by midwives.

BACKGROUND: Pregnant women frequently report inconsistent messages regarding alcohol consumption from their healthcare providers. Midwives play a major role in prenatal care. However, little research has examined alcohol-related information provided by midwives. OBJECTIVE: To examine alcohol-related messages disseminated to pregnant women by midwives. METHODS: In 2018, 61 certified professional midwives (CPMs) and certified nurse-midwives (CNMs) were recruited from professional organizations in a southwestern state. Midwives responded to an online cross-sectional survey containing the prompt: "A pregnant patient confides in you that she drinks alcohol. She then asks you to tell her a "safe" level of alcohol consumption that won't cause harm to her unborn fetus. How would you respond?" Open-ended responses were analyzed through content analysis and categorized using an inductive approach. RESULTS: Responses were grouped into five non-exclusive themes: "harmful effects and unknown safe limits" (77.0%); "abstaining is best" (50.8%); "light drinking is acceptable" (16.4%); "describe your drinking" (21.3%); "I will refer you" (16.4%). The most frequently shared messages were "safe levels of prenatal alcohol use are unknown" (68.9%) and "discontinue alcohol during pregnancy" (45.9%). However, some messages contradicted US dietary guidelines, including "a little bit of alcohol unlikely to cause harm" (11.5%); "cut-down if having more than 1-2 drinks per occasion" (4.9%); and "if you must drink, wine is best" (1.6%). CPMs were less likely to share abstinence messages (p = .003) and more likely to suggest referrals (p = .024), compared to CNMs. CONCLUSION: Concerted efforts are needed to ensure information disseminated aligns with health guidelines and encourages abstinence during pregnancy.

College Students' Perceptions of Peer Alcohol Use: A Social Network Analytic Approach.

BACKGROUND: Traditional measures attempting to capture students' perceptions of peer drinking fail to capture the unique social influence of their most proximal peers. Purpose: This study presents egocentric social network data assessing the relationship between students' personal drinking behaviors and those of their closest social ties. Methods: 697 college students participated in the study by reporting on demographic information, alcohol use (AUDIT scores), and egocentric networks. Hierarchical linear regression assessed whether egocentric network variables uniquely predicted personal alcohol use, controlling for age, gender, race/ethnicity, and Greek-life affiliation. Results: Students with higher AUDIT scores were more likely to nominate persons close to them that engaged in more frequent, higher quantity drinking, and were also likely to mirror drinking behaviors to that of their close ties. Conclusion: Future studies should utilize SNA to capture the nuance associated with individuals' perceptions of close others' alcohol use and their own drinking behaviors. Interventions aimed at reducing collegiate drinking should consider the interpersonal nature of drinking behaviors among college student networks.

Self-Perceptions and Factors Associated With Being Put Down at School Among Middle and High School Students.

This study assessed the prevalence of verbally being put down by others and intrapersonal and normative factors associated with being put down by others among middle and high school students. Students (N = 1,027) completed the Adolescent Health Risk Behavior Survey. Over 16% of participants reported being put down at school. Students who identified with the negative words confused, unattractive, dull, and careless and identified less with the positive words popular, smart, considerate, cool, and self-confident reported being put down by others. High school students were less likely to be put down. As students scored higher on the Negative Self-Description Scale, their odds of being put down increased. As students scored higher on the Positive Self-Description Scale, their odds of being put down decreased. Students who perceived their friends drinking alcohol regularly were less likely to be put down. Strategies to enhance self-perceptions to raise self-awareness and form healthy/positive identities are needed.

Underage drinkers' first experience consuming a popular brand of supersized alcopop.

BACKGROUND: Supersized alcopops are sugar sweetened beverages with high alcohol concentration; Four Loko is the most commonly consumed brand among underage drinkers. OBJECTIVES: The current study examined the prevalence and correlates of Four Loko consumption, as well as drinking location, beverage source, quantity consumed, and alcohol-related consequences among students who consumed the product before age 21. METHODS: Undergraduate drinkers (n = 1,019; 53.5% female) attending public universities in Florida, Montana, and Virginia completed a classroom survey. Multivariable logistic regression models examined first-time Four Loko experiences among students under age 21 at the time of the drinking episode (n = 336). RESULTS: Among drinkers, 46% had consumed Four Loko. The vast majority (93%) drank the product before age 21. During their first Four Loko drinking episode, 57% consumed at least one can and 10% drank two or more cans. Among underage drinkers, being male (AOR = 6.8), paying for the Four Loko (AOR = 3.1), and earlier age of alcohol initiation (AOR = 0.8) were associated with greater odds of drinking at least one can. Among underage drinkers who finished at least one can, 36% blacked out and 21% vomited. The odds of blacking out and vomiting were greater if the participant drank at least one can (AOR = 6.0, AOR = 4.0). Students in states that sold Four Loko with higher alcohol-by-volume were more likely to blackout (AOR = 2.0) and vomit (AOR = 2.5). CONCLUSIONS: Delaying the age of first alcohol use may have protective effects on supersized alcopop consumption. Increased enforcement of existing laws is needed to prevent underage access to Four Loko. Further, laws that reduce the alcohol content of Four Loko may reduce negative consequences associated with its consumption.

The Federal Trade Commission's mandated Four Loko labeling fails to facilitate accurate estimation of alcohol content by college students.

BACKGROUND: Four Loko, the leading supersized alcopop brand, is a pre-mixed alcoholic beverage containing up to 5.5 standard alcoholic drinks in a can. In 2013, the Federal Trade Commission (FTC) mandated the addition to Four Loko cans of a label indicating its alcohol content in standard drinks, presented as "alcohol per serving" and "servings per container." OBJECTIVE: The current study investigated whether college students accurately estimate the alcohol content in cans of Four Loko bearing the FTC mandated labels. METHOD: Undergraduate student drinkers (n = 833; 51.6% women) in three states (Florida, Montana, and Virginia) were provided an empty Watermelon Four Loko can and asked to determine the number of standard drinks it contained, using 12-ounce regular beer (Budweiser) equivalents. In Florida and Virginia, Watermelon Four Loko contains 4.70 standard alcoholic drinks; in Montana, it contains 3.13. RESULTS: More than 60% of Florida students and more than 70% of Virginia students underestimated Four Loko's alcohol content by one or more standard drinks, compared to 45% of Montana students. Multivariable logistic regression analysis found the following variables were associated with greater odds of underestimating Four Loko's alcohol content by one or more standard alcoholic drinks: being female (AOR = 2.2), having never seen nor heard of Four Loko (AOR = 1.9), and residing in Florida (AOR = 1.7) or Virginia (AOR = 2.8) versus Montana. CONCLUSIONS: Students were far less likely to underestimate alcohol content for 8% alcohol-by-volume (abv) cans compared to those with higher alcohol concentrations. Thus, policies restricting supersized alcopops' abv may help consumers better estimate their alcohol content.

Assessing the Associations between Religiosity and Alcohol Use Stages in a Representative U.S. Sample.

Background: Problematic alcohol drinking has been a public health concern in the United States. Studies showed that religiosity serves as a protective factor, delaying the onset of alcohol use, and reducing the frequency of drinking. Few studies, however, have examined these associations with large, nationally representative samples, and even fewer have assessed the impact of religiosity on drinking behavior transitions/changes. Objectives: This study examined a national adult sample to investigate the associations between religiosity and alcohol use stages including initiation, reinitiation, and persistence of alcohol use. Methods: Data from the National Epidemiologic Survey of Alcohol and Related Conditions Waves 1-2 were used. Wave 1 sample included 6113 nondrinkers, 6189 prior drinkers, and 21,950 current drinkers who were at risk for initiation, reinitiation, and persistent use of alcohol, respectively. Religiosity constructs included importance of religious and frequency of practice. Three logistic regressions examined the aforementioned associations. Results: Compared to those not attending religious services, the most frequent attenders exhibited lower odds of initiating alcohol use, reinitiation after prior use, and persistent drinking (ORs = 0.23, 0.51, 0.55, respectively; ps < .01). Those identifying religious beliefs as very important exhibited lower odds of initiation and reinitiation of alcohol use (both ORs = 0.63, ps < .05). Conclusions: Religiosity plays an important role in preventing/delaying alcohol use initiation, reinitiation, and persistence. Incorporating religiosity aspects (e.g. meditation) into alcohol prevention and control programs may serve to increase protective effects. Future studies should seek to delineate what religiosity factors can be leveraged and embedded into secular prevention programs delivered to youth and adolescents.

Does Religiosity Delay Adolescent Alcohol Initiation? A Long-Term Analysis (2008-2015) of Nationally Representatives Sample of 12th Graders.

Objective: Underage alcohol consumption is associated with deleterious consequences, with earlier initiation leading to increased likelihood of alcohol misuse and dependence later in life. Religiosity represents a protective factor, such that those with increased religiosity delay alcohol initiation. Herein, we test the association between religiosity and alcohol initiation across several distinct national samples of high school seniors in the United States. Method: To assess long-term associations between alcohol initiation and religiosity, we utilized latent growth curve modeling and simple mean plots to conduct a secondary data analysis on 8 years (2008-2015) of the Monitoring the Future Survey (n = 20,099). Results: When compared with the baseline model, which posited a consistent age of initiation of approximately 9th grade χ2 (n = 18,224, df = 31) = 33.70, p <.34, CFI = .000, TLI = 1.00, RMSEA = .006 (90% CI: .00, .017), religiosity plays an equally consistent role in delaying age of initiation by two grade levels, or three calendar years χ2 (n = 17,978, df = 159.116) = 159.17, p<.0001, CFI = .848, TLI = .834, RMSEA = .017 (90% CI: .00, .03). When means were parsed out by religiosity level and gender, religion was a stronger protector against alcohol age of initiation for females than males. These associations were constant over the 8-year period and across multiple nationally representative samples of adolescents. Conclusions: Religiosity delays alcohol initiation for adolescents. Prevention programs should seek to identify which components of religiosity are most impactful, and subsequently develop and incorporate programmatic aspects that leverage these factors.

Pregaming: A Field-Based Investigation of Alcohol Quantities Consumed Prior to Visiting a Bar and Restaurant District.

BACKGROUND: Investigations examining the association between pregaming, or the consumption of alcohol prior to attending a social gathering or drinking establishment, and blood alcohol concentrations have primarily relied on estimations (i.e., Widmark equation), rather than objective biologic samples, such as breath alcohol concentration (BrAC). OBJECTIVES: The current study assessed: (1) pregaming, using quantity-based measures, among a sample of college and non-college affiliated bar patrons, (2) associations between pregaming intensity/status and participant intoxication (BrAC), and (3) whether participants who pregamed were more likely to identify as a hazardous drinker. METHODS: 548 bar patrons provided data on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and a single pregaming item assessing quantity of alcohol consumed prior to visiting a bar/restaurant district in 2015. BrAC samples were collected post interview. We used hierarchical linear regression models, respectively, to assess whether pregaming significantly impacted BrAC and whether presence of hazardous drinking predicted pregaming behavior. RESULTS: After controlling for sex, race/ethnicity, age, student status, and Greek affiliation, the linear regression model explained 32.3% (R2 = .323) of the variance of BrAC levels (F(12) = 21.162, p < .001), with 4.30% of the variance explained solely by pregaming (ß = 0.014; p < .001). The linear regression model to assess if harzardous drinking behavior (AUDIT-C) significantly predicted pregaming explained 31.2% (R2 = .312) of the variance of pregaming behavior (F(18) = 13.276, p < .001), with 4.2% of the variance explained solely by AUDIT-C scores (ß = 0.280; p < .001). CONCLUSION: Findings further highlight pregaming as a harmful risk behavior linked to elevated levels of hazardous drinking and intoxication.

Food Label Literacy and Use among US Adults Diagnosed with Cancer: Results from a National Representative Study.

For those diagnosed with cancer, lifestyle factors including diet can be more important than ever. However, lack of nutrition-related knowledge can pose a significant barrier to healthy eating. Food labels guide consumers in selecting appropriate portion sizes-that is, caloric content-and ensuring adequate intake of nutrients. Data from the 2013-2014 HINTS were used to examine (a) differences in food label use and food label literacy between respondents ever had a cancer diagnosis and those never had a diagnosis; (b) sociodemographic correlates and health-related correlates of food label use and literacy, in a context of cancer diagnosis; and (c) potential association between food label use/literacy and each of two dietary choices, eating vegetables and fruits and limiting intake of sugary drinks, again, in a context of cancer diagnosis. Data was analyzed via SPSS version 24.0, and cross tabulations using Pearson's Chi-square test and logistic regressions. Income, gender and non-participation in support groups were associated with food label literacy (p<.05). Confidence to take care of self was associated with food label use (p<.05). Relationships were observed between using food labels and curtailing soda intake (b = -.368, p<.05), eating relatively more fruits (b = .558, p<.05), and eating relatively more vegetables (b = .558, p<.05). The overall models predicting consumption of soda [x2 (2) = 13.70, p = .001, Nagelkerke R-square = .059], of fruits [x2 (2) = 33.87, p < .001, Nagelkerke R-square = .136], and of vegetables [x2 (2) = 36.08, p < .001, Nagelkerke R-square = .144] was statistically significant. Implications for research and practice can be found in results linking food label use to better quality diets. They include the usefulness of nutrition education interventions targeting lower-income men with cancer diagnoses; one lesson should be the use of food labels.

Resources to Reduce Underage Drinking Risks and Associated Harms: Social Ecological Perspectives.

Underage college student alcohol consumption results in adverse consequences for students, colleges, and communities. Unfortunately, college health practitioners have invested time and effort implementing interventions that either fail to account for the complexity of this public health problem or are not evidence-based. Consequently, in September 2015, the National Institute on Alcohol Abuse and Alcoholism published CollegeAIM, which was developed to support higher education administrators and campus health/wellness professionals in selecting appropriate interventions for reducing harmful and underage drinking. CollegeAIM is a user-friendly, matrix-based tool that evaluates and synthesizes the peer-reviewed literature associated with nearly 60 campus and community interventions. This review uses the social ecological model to highlight individual- and environmental-level strategies evaluated in CollegeAIM matrices and is intended to be a tool in determining how best to implement resources to reduce college student alcohol use and associated harms. While CollegeAIM outlines strategies to be implemented among currently enrolled college students, it is important to note drinking behaviors for some students are established prior to entering college. Thus, interventions prior to enrolling in higher education are needed. As a resource for parents and for practitioners to use and share, the "Talk. They Hear You." mobile health (mHealth) app is also discussed and recommended.

Examining characteristics of recorded and unrecorded alcohol consumers in Kenya.

BACKGROUND: Due to media reports of several deaths, consumption of unrecorded alcohol (i.e., alcohol brewed at home) has emerged as a public health threat in developing countries like Kenya. Empirical data on this issue, however, is scarce. This investigation compared demographic characteristics of Kenyans who drank recorded (regulated) and unrecorded alcohol. METHODS: We examined all respondents who consumed alcohol in the past month (N = 718) on the 2015 nationally representative Kenya STEPwise survey. Descriptive statistics and bivariate logistic regression examined proportion of respondents consuming unrecorded alcohol, and social demographic factors associated with unrecorded alcohol consumption, respectively. RESULTS: The sample was primarily male (86%), married (64%), middle class or higher (64%), with an average age of 37 years. Participants reported an average of 2.5 drinking events and 4.3 binge-drinking occasions per month. Overall, 37% of our sample consumed unrecorded alcohol. Compared to those with incomplete primary education or lower, individuals who completed primary education or above were less likely to report consuming unrecorded alcohol (OR = 0.22, 95% CI: 0.12-0.43). Compared to poorest and poor respondents, those identifying as middle class or above were less likely to consume unrecorded alcohol (OR = 0.47, 95% CI: 0.29-.78). Current smokers (OR = 2.19, 95% CI: 1.34-3.60) and those with higher binge drinking occasions in the past month (OR = 1.03, 95% CI: 1.004-1.07) were significantly more likely to consume unrecorded alcohol. CONCLUSION: Kenyan adults who consume unrecorded alcohol engage in more binge drinking occasions, smoke, and have lower levels of education and socioeconomic status. It is vital that health promotion interventions aimed at reducing unrecorded alcohol consumption be tailored and targeted to individuals with low socio-economic status in Kenya.

Alcohol Advertising on Social Media: Examining the Content of Popular Alcohol Brands on Instagram.

BACKGROUND: There is considerable evidence that exposure to alcohol marketing increases the likelihood of adolescents initiating and engaging in alcohol consumption. There is a paucity of research, however, specifically examining industry generated alcohol marketing occurring on social media/networking platforms. OBJECTIVE: The purpose of this investigation was to analyze the content of promotional advertisements by alcohol brands on Instagram. METHODS: For a 30-day period, Instagram profiles of 15 distinct alcohol brands were examined. Pictorial posts/updates from each profile were screen captured and individually documented. Approximately 184 distinct posts constituted our final sample. The Content Appealing to Youth Index was independently employed by two raters to assess each post. For each characteristic, Cohen's Kappa measures, and associated 95% confidence intervals, were calculated. Descriptive statistics were performed. RESULTS: Posts increased throughout the week and peaked on Thursday and Friday. The production value of the posts examined was generally high, frequently featuring color, texture, shine, contrast, faces, and action. Character appeals and use of youth-oriented genres were uncommon. Many of the posts used product appeals and physical benefits to consumption. The posts also emphasized the following rewarding appeal characteristics: positive emotional experiences, achievement, individuality, and camaraderie. The most commonly coded risk-related feature was inappropriate use. Conclusions/Importance: This investigation represents an initial attempt to provide insights into the content alcohol brands are including in their promotional materials on social networking sites.