Strong and weak cross-inheritance of substance use disorders in a nationally representative sample.

Substance use disorders (SUDs) are moderately to highly heritable and are in part cross-transmitted genetically, as observed in twin and family studies. We performed exome-focused genotyping to examine the cross-transmission of four SUDs: alcohol use disorder (AUD, n = 4487); nicotine use disorder (NUD, n = 4394); cannabis use disorder (CUD, n = 954); and nonmedical prescription opioid use disorder (NMPOUD, n = 346) within a large nationally representative sample (n = 36,309), the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). All diagnoses were based on in-person structured psychiatric interview (AUDADIS-5). SUD cases were compared alone and together to 3959 "super controls" who had neither a SUD nor a psychiatric disorder using an exome-focused array assaying 363,496 SNPs, yielding a representative view of within-disorder and cross-disorder genetic influences on SUDs. The 29 top susceptibility genes for one or more SUDs overlapped highly with genes previously implicated by GWAS of SUD. Polygenic scores (PGS) were computed within the European ancestry (EA) component of the sample (n = 12,505) using summary statistics from each of four clinically distinct SUDs compared to the 3959 "super controls" but then used for two distinctly different purposes: to predict SUD severity (mild, moderate, or severe) and to predict each of the other 3 SUDs. Our findings based on PGS highlight shared and unshared genetic contributions to the pathogenesis of SUDs, confirming the strong cross-inheritance of AUD and NUD as well as the distinctiveness of inheritance of opioid use disorder.

Prevalence and Correlates of Past-Year Recovery From DSM-5 Alcohol Use Disorder: Results From National Epidemiologic Survey on Alcohol and Related Conditions-III.

BACKGROUND: Little is known about remission, recovery, and other outcomes of alcohol use disorder (AUD) as defined by the DSM-5. METHODS: Data from a large representative sample of the United States was used to examine correlates of past-year AUD status among individuals with prior-to-past-year AUD: persistent AUD, symptomatic high-risk drinking, asymptomatic high-risk drinking, symptomatic low-risk drinking, asymptomatic low-risk drinking (nonabstinent recovery, NAR), and abstainer (abstinent recovery, AR). Multiple logistic regression analyses were conducted to compare: (i) AR and NAR with persistent AUD, (ii) AR with NAR, and (iii) asymptomatic and symptomatic high-risk drinking with AR and NAR. RESULTS: Among individuals with AUD prior to past year (n = 7,785), 34.2% were classified with persistent AUD, 8.8 and 1.6% were symptomatic high-risk and symptomatic low-risk drinkers, respectively, 21.5% were asymptomatic high-risk drinkers, 17.9% were asymptomatic low-risk drinkers, and 16.0% were abstainers. One-quarter of individuals with AUD prior to past year achieved AR or NAR without the benefit of treatment, while a much greater percentage of individuals achieving AR (43.2%) reported receiving treatment relative to those with NAR (12.3%). The number of lifetime AUD symptoms was greater among those achieving AR (among the treated) and lower among those achieving NAR relative to persistent AUD. The number of AUD symptoms was also greater among those achieving AR than NAR and lower among asymptomatic and symptomatic risk drinkers relative to those achieving AR and NAR. Consumption was greater among those achieving AR relative to those achieving NAR and greater among asymptomatic and symptomatic risk drinkers relative to AR and NAR. Odds of achieving AR or NAR relative to persistent AUD were generally lower among non-Hispanic Blacks and those with higher education, greater among women and married individuals, and lower among illicit drug users and individuals with histories of a personality disorder or mood/anxiety disorder. CONCLUSIONS: There appears to be a substantial level of recovery from AUD. Information on specific factors associated with AUD outcomes can be useful in targeting appropriate treatment efforts.

Lifetime Drinking Trajectories and Nonfatal Acute Myocardial Infarction.

BACKGROUND: The relation of lifetime drinking trajectories to coronary heart disease is not well understood. METHODS: Cases hospitalized for a nonfatal acute myocardial infarction (AMI) and healthy population-based controls matched on age and sex completed a physical examination and an interview covering known AMI risk factors and a detailed lifetime drinking history. Distinct lifetime drinking trajectories based on ounces of ethanol consumed per decade between ages 10 and 59 years were derived and characterized according to lifetime drinking patterns associated with each. Sex-specific multiple logistic regression analyses were conducted to estimate AMI risk among participants who never drank regularly compared to lifetime drinking trajectories and risk associated with distinct trajectories among former and current drinkers. RESULTS: Two lifetime drinking trajectories were derived, early peak and stable. Early peak trajectories were characterized by earlier onset of regular drinking, less frequent drinking, more drinks per drinking day, fewer total drinks, more frequent drunkenness per drinking year, and reduced alcohol intake or abstention by middle age. Never drinking regularly, reported by significantly more women than men, was associated with significantly higher AMI risk than stable lifetime drinking trajectories among men and in the sex-combined analysis of former drinkers only. Compared to stable lifetime drinking trajectories, early peak trajectories were associated with significantly higher AMI risk among male former drinkers, among sex-combined former drinkers, and among female current drinkers. CONCLUSIONS: Epidemiological studies of alcohol and health in populations over age 35 may have underestimated the impact of heavy episodic drinking during adolescence and emerging adulthood on the cardiovascular system.

Re-examining the relationship between alcohol consumption and coronary heart disease with a new lens.

Moderate alcohol consumption has been related to lower risk of coronary heart disease (CHD) in the literature. To examine whether alcohol drinking during the past 12 months and heaviest drinking period were differentially associated with the risk of CHD, we designed a case-control study using a population-based health survey of U.S. adults conducted from 2012 to 2013. Respondents who reported to have doctor-ascertained CHD served as cases (n = 1671), and those free of CHD and other alcohol-related health conditions served as controls (n = 17,629) in logistic regressions. Sex-specific quartiles of average daily ethanol intake were ascertained and calculated for the past 12 months and during the period of heaviest lifetime drinking. We further split current drinkers into reducers and non-reducers (past 12 months relative to the heaviest drinking period) to examine CHD risk profiles in association with the 12-month drinking level. Current-drinker reducers (AOR, 95% CI = 1.57 [1.10-2.27] for men; AOR, 95% CI = 1.33 [1.02-1.72] for women) and former drinkers (AOR, 95% CI = 2.06 [1.43-2.97] for men; AOR, 95% CI = 1.51 [1.19-1.92] for women) more often had CHD than lifetime abstainers. Male heavy drinkers during the heaviest drinking period (AOR, 95% CI = 2.25 [1.52-3.32]) were more likely to manifest CHD than lifetime abstainers. In addition, individuals with diagnosed CHD were significantly more likely to have reduced drinking in the past. A change in alcohol consumption over the life course among former and current drinkers may distort the true alcohol-CHD relationship.

Assessment of age-related differences in smoking status and health-related quality of life (HRQoL): Findings from the 2016 Behavioral Risk Factor Surveillance System.

Despite significant declines in the use of cigarettes, a significant proportion of adults smoke. This study explores the association between smoking and health-related quality of life (HRQoL) by age. The 2016 Behavioral Risk Factor Surveillance System survey was administered to adults in 50 states and District of Columbia (n = 437,195). Physically unhealthy days (PUDs) and mentally unhealthy days (MUDs)) were regressed on age strata (18-24, 25-34, 35-44, 45-54, 55-64, ≥ 65 years) and smoking status (never, former, someday, and everyday) using negative binomial regression models with adjustment for sociodemographic covariates. For each age group, everyday smoking highly predicted PUDs and MUDs. Predicted PUDs increased with age; predicted MUDs decreased with age. Among adults aged 45-54 and 55-64 years, 3-day difference in PUDs was observed between never smokers and everyday smokers. Among young adults (18-24 years), a 4.3-day difference in MUDs was observed between everyday and never smokers. The discrepancies were nonlinear with age. The observed relationship between smoking and HRQoL provides novel information about the need to consider age when designing community-based interventions. Additional research can provide needed depth to understanding the relationship between smoking and HRQoL in specific age groups.

State socioeconomic indicators and self-reported hypertension among US adults, 2011 behavioral risk factor surveillance system.

INTRODUCTION: Hypertension is the leading cause of chronic disease and premature death in the United States. To date, most risk factors for hypertension have been identified at the individual (micro) level. The association of macro-level (area) socioeconomic factors and hypertension prevalence rates in the population has not been studied extensively. METHODS: We used the 2011 Behavioral Risk Factor Surveillance System to examine whether state socioeconomic status (SES) indicators predict the prevalence of self-reported hypertension. Quintiles of state median household income, unemployment rate among the population aged 16 to 64 years, and the proportion of the population under the national poverty line were used as the proxy for state SES. Hypertension status was determined by the question "Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?" Logistic regression was used to assess the relationship between state SES and hypertension with adjustment for individual covariates (demographic and socioeconomic factors and lifestyle behaviors). RESULTS: States with a median household income of $43,225 or less (odds ratio [95% confidence interval] = 1.16 [1.08-1.25]) and states with 18.7% or more of residents living below the poverty line (odds ratio [95% confidence interval] = 1.14 [1.04-1.24]) had a higher prevalence of hypertension than states with the most residents in the most advantageous quintile of the indicators. CONCLUSION: The observed state SES-hypertension association indicates that area SES may contribute to the burden of hypertension in community-dwelling adults.

Exploring patterns of alcohol use and alcohol use disorder among Asian Americans with a finer lens.

BACKGROUND: National survey data suggest Asian Americans (AA) are less likely to consume alcohol and develop AUD than Americans in other groups. However, it is common for AA to be born outside of the US and carry gene variants that alter alcohol metabolism, both of which can lead to lower levels of alcohol involvement. The current study examined differences in alcohol use and AUD between AA and other groups before and after controlling for birth location and gene variants. DESIGN: Past year alcohol measures were examined from adults 18+ (N=22,848) in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III before and after controlling for birth location (inside or outside of the US) and gene variants (ALDH2*2 and ADH1B*2/ADH1B*3). Gender gaps in alcohol measures also were assessed. RESULTS: Before adjustments, AA were less likely than White Americans to drink in the previous year (OR=0.50, 95% CI 0.41-0.62), binge (OR=0.68, 95% CI 0.52-0.88), engage in frequent heavy drinking (OR=0.55, 95% CI 0.42-0.73), and reach criteria for AUD (OR=0.71, 95% CI 0.53-0.94). After controlling for birth location and gene variants, AA remained less likely to drink in the past year (OR=0.54, 95% CI 0.41-0.70) but all other differences disappeared. Gender gaps were only observed for AA born outside of the US, highlighting the importance of experience rather than racial category per se. CONCLUSIONS: Findings indicate that heterogeneity among AA leads to spurious generalizations regarding alcohol use and AUD and challenge the model minority myth.

Trends in cigarette smoking rates and quit attempts among adults with and without diagnosed diabetes, United States, 2001-2010.

INTRODUCTION: Quitting smoking is a critical step toward diabetes control. It is not known whether smoking rates in adults with diabetes are similar to rates among adults who do not have the disease or whether people with diabetes have increased motivation to quit. We examined prevalence trends of current smoking and quit attempts among US adults with and without diagnosed diabetes from 2001 through 2010. METHODS: We used data from the 2001 through 2010 Behavioral Risk Factor Surveillance System, a state-based telephone survey of noninstitutionalized US adults, and conducted linear trend analysis and log linear regression. RESULTS: The adjusted prevalence of cigarette smoking among adults with diagnosed diabetes was 9% less than adults without diagnosed diabetes (adjusted prevalence ratio [APR], 0.91; 99% confidence interval [CI], 0.89-0.93). Declines in smoking prevalence were greater among adults without diabetes than adults with diagnosed diabetes (P < .001). Among smokers, the adjusted prevalence of quit attempts among adults with diagnosed diabetes was 13% higher than among adults without diagnosed diabetes (APR, 1.13; 99% CI, 1.11-1.15). Among adult smokers with diagnosed diabetes, quit attempts were stable over time for those aged 18 to 44 years and those with a high school education or less. Quit attempts were also stable for older smokers, non-Hispanic African Americans, and Hispanic smokers, regardless of diagnosed diabetes status. CONCLUSION: A large proportion of smokers with diagnosed diabetes seemed to have quit smoking, but more research is needed to confirm success and how difficult it was to achieve.

Visual impairment and health-related quality of life among elderly adults with age-related eye diseases.

PURPOSE: To examine the association between age-related eye disease (ARED), visual impairment, and health-related quality of life (HRQOL). METHODS: We used data from the 2006 and 2008 Behavioral Risk Factor Surveillance System to examine self-reported visual impairment and two HRQOL domains-physical impairment (including poor general health, physical unhealthy days, activity-limitation days, and disability) and mental distress (including mental unhealthy days, life dissatisfaction, major depression, lifetime depression, and anxiety) for people aged 65 years or older, by ARED status. RESULTS: People with any ARED were more likely than those without to report visual impairment as well as physical impairment and mental distress. The prevalence of visual impairment (P trend <0.001) and physical impairment (P trend <0.001) increased with increasing number of eye diseases after controlling for all covariates. There was no significant linear trend, however, in mental distress among people with one or more eye diseases. CONCLUSION: ARED was found to be associated with visual impairment and poorer HRQOL. Increasing numbers of AREDs were associated with increased levels of visual impairment and physical impairment, but were not associated with levels of mental distress.

Trends in selected chronic conditions and behavioral risk factors among women of reproductive age, behavioral risk factor surveillance system, 2001-2009.

INTRODUCTION: Some potentially modifiable risk factors and chronic conditions cause significant disease and death during pregnancy and promote the development of chronic disease. This study describes recent trends of modifiable risk factors and controllable chronic conditions among reproductive-aged women. METHODS: Data from the 2001 to 2009 Behavioral Risk Factor Surveillance System, a representative state-based telephone survey of health behavior in US adults, was analyzed for 327,917 women of reproductive age, 18 to 44 years. We calculated prevalence ratios over time to assess trends for 4 selected risk factors and 4 chronic conditions, accounting for age, race/ethnicity, education, health care coverage, and individual states. RESULTS: From 2001 to 2009, estimates of 2 risk factors improved: smoking declined from 25.9% to 18.8%, and physical inactivity declined from 25.0% to 23.0%. One risk factor, heavy drinking, did not change. From 2003 to 2009, the estimates for 1 risk factor and 4 chronic conditions worsened: obesity increased from 18.3% to 24.7%, diabetes increased from 2.1% to 2.9%, high cholesterol increased from 10.3% to 13.6%, asthma increased from 13.5% to 16.2%, and high blood pressure increased from 9.0% to 10.1%. All trends were significant after adjustment, except that for heavy drinking. CONCLUSION: Among women of reproductive age, prevalence of smoking and physical inactivity improved, but prevalence of obesity and all 4 chronic conditions worsened. Understanding reasons for the improvements in smoking and physical activity may support the development of targeted interventions to reverse the trends and help prevent chronic disease and adverse reproductive outcomes among women in this age group.

Smoking and visual impairment among older adults with age-related eye diseases.

INTRODUCTION: Tobacco use is the leading preventable cause of death in the United States. Visual impairment, a common cause of disability in the United States, is associated with shorter life expectancy and lower quality of life. The relationship between smoking and visual impairment is not clearly understood. We assessed the association between smoking and visual impairment among older adults with age-related eye diseases. METHODS: We analyzed Behavioral Risk Factor Surveillance System data from 2005 through 2008 on older adults with age-related eye diseases (cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy; age ≥50 y, N = 36,522). Visual impairment was defined by self-reported difficulty in recognizing a friend across the street or difficulty in reading print or numbers. Current smokers were respondents who reported having smoked at least 100 cigarettes ever and still smoked at the time of interview. Former smokers were respondents who reported having ever smoked at least 100 cigarettes but currently did not smoke. We used multivariate logistic regressions to examine the association and to adjust for potential confounders. RESULTS: Among respondents with age-related eye diseases, the estimated prevalence of visual impairment was higher among current smokers (48%) than among former smokers (41%, P < .05) and respondents who had never smoked (42%, P < .05). After adjustment for age, sex, race/ethnicity, education, and general health status, current smokers with age-related eye diseases were more likely to have visual impairment than respondents with age-related eye diseases who had never smoked (odds ratio, 1.16, P < .05). Furthermore, respondents with cataract who were current smokers were more likely to have visual impairment than respondents with cataract who had never smoked (predictive margin, 44% vs 40%, P = .03), and the same was true for respondents with age-related macular degeneration (65% of current smokers vs 57% of never smokers, P = .02). This association did not hold true among respondents with glaucoma or diabetic retinopathy. CONCLUSION: Smoking is linked to self-reported visual impairment among older adults with age-related eye diseases, particularly cataract and age-related macular degeneration. Longitudinal evaluation is needed to assess smoking cessation's effect on vision preservation.

Applying Structural Equation Modeling to Measure Violence Exposure and Its Impact on Mental Health: Malawi Violence Against Children and Young Women Survey, 2013.

This study examines exposure to multiple forms of violence among Malawian children and youth and their association with mental health outcomes. The Malawi Violence Against Children and Young Women Survey was conducted among a nationally representative sample of males and females aged 13 to 24 years (n = 2,162) in Malawi in 2013. The experience of sexual, physical, and emotional violence prior to age 18 and during the past 12 months and associated health outcomes were ascertained using a comprehensive interview. Latent factors of sexual violence, physical violence, and emotional violence as well as psychological distress were constructed. We examined whether the experience of violence was related to psychological distress after controlling for age and gender. Violence exposure prior to age 18 (early life) and during the past 12 months (proximal) were valid indicators for a latent factor representing overall lifetime violence exposure. Females were more likely to experience sexual violence, whereas males were more likely to experience physical violence. Experience of any type of violence decreased with age whereas experience of psychological distress increased with age. Current psychological distress was directly associated with exposure to sexual and emotional violence recently or during childhood. Exposure to multiple forms of violence during lifetime was related to two to seven folds higher odds of experiencing psychological distress compared with those who had never experienced violence. Future intervention strategies should address three forms of violence against children simultaneously in light of the associated adverse mental health outcomes.

Gene polymorphisms in association with emerging cardiovascular risk markers in adult women.

BACKGROUND: Evidence on the associations of emerging cardiovascular disease risk factors/markers with genes may help identify intermediate pathways of disease susceptibility in the general population. This population-based study is aimed to determine the presence of associations between a wide array of genetic variants and emerging cardiovascular risk markers among adult US women. METHODS: The current analysis was performed among the National Health and Nutrition Examination Survey (NHANES) III phase 2 samples of adult women aged 17 years and older (sample size n = 3409). Fourteen candidate genes within ADRB2, ADRB3, CAT, CRP, F2, F5, FGB, ITGB3, MTHFR, NOS3, PON1, PPARG, TLR4, and TNF were examined for associations with emerging cardiovascular risk markers such as serum C-reactive protein, homocysteine, uric acid, and plasma fibrinogen. Linear regression models were performed using SAS-callable SUDAAN 9.0. The covariates included age, race/ethnicity, education, menopausal status, female hormone use, aspirin use, and lifestyle factors. RESULTS: In covariate-adjusted models, serum C-reactive protein concentrations were significantly (P value controlling for false-discovery rate < or = 0.05) associated with polymorphisms in CRP (rs3093058, rs1205), MTHFR (rs1801131), and ADRB3 (rs4994). Serum homocysteine levels were significantly associated with MTHFR (rs1801133). CONCLUSION: The significant associations between certain gene variants with concentration variations in serum C-reactive protein and homocysteine among adult women need to be confirmed in further genetic association studies.

Lifestyle behaviors and receipt of preventive health care services among hypertensive Americans aged 45 years or older in 2007.

OBJECTIVE.: The aim of the study was to explore opportunities for more effective interventions on lifestyle modifications among hypertensives. METHODS.: Using 2007 data from the Behavioral Risk Factor Surveillance System from the United States, we assessed the prevalence of various lifestyle behaviors and receipt of preventive health care services among US adults aged 45 years or older based on hypertension and treatment status (n=218,228). RESULTS.: Compared with nonhypertensives, hypertensives were significantly less likely to engage in recommended levels of physical activity and to be more obese regardless of treatment status. Compared to nonhypertensives, hypertensives on medical treatment were less likely to consume five or more servings of fruit and vegetables per day, be current smokers, and binge drinkers. Hypertensives not on medical treatment were more likely to be current smokers, binge and heavy drinkers. Hypertensives on medical treatment were more likely to have routine health checkup, have blood cholesterol checkup within previous 5 years and have a flu shot within the previous year than hypertensives not on treatment. CONCLUSION.: Different patterns of lifestyle behaviors and use of preventive health care services were found based on treatment status among hypertensives. Intervention programs should be tailored accordingly to achieve optimal outcome on lifestyle modification.

Drinking patterns and myocardial infarction: a linear dose-response model.

BACKGROUND: The relation of alcohol intake to cardiovascular health is complex, involving both protective and harmful effects, depending on the amount and pattern of consumption. Interpretation of data available on the nature of these relations is limited by lack of well-specified, mathematical models relating drinking patterns to alcohol-related consequences. Here we present such a model and apply it to data on myocardial infarction (MI). METHODS: The dose-response model derived assumes: (1) each instance of alcohol use has an effect that either increases or decreases the likelihood of an alcohol-related consequence, and (2) greater quantities of alcohol consumed on any drinking day add linearly to these increases or decreases in risk. Risk was reduced algebraically to a function of drinking frequency and dosage (volume minus frequency, a measure of the extent to which drinkers have more than 1 drink on days when they drink). In addition to estimating the joint impact of frequency and dosage, the model provides a method for calculating the point at which risk related to alcohol consumption is equal to background risk from other causes. A bootstrapped logistic regression based on the dose-response model was conducted using data from a case-control study to obtain the predicted probability of MI associated with current drinking patterns, controlling for covariates. RESULTS: MI risk decreased with increasing frequency of drinking, but increased as drinking dosage increased. Rates of increasing MI risk associated with drinking dosage were twice as high among women as they were among men. Relative to controls, lower MI risk was associated with consuming < 4.55 drinks per drinking day for men (95% CI: 2.77 to 7.18) and < 3.08 drinks per drinking day for women (95% CI: 1.35 to 5.16), increasing after these cross-over points were exceeded. CONCLUSIONS: Use of a well-specified mathematical dose-response model provided precise estimates for the first time of how drinking frequency and dosage each contribute linearly to the overall impact of a given drinking pattern on MI risk in men and women.

Self-rated depression and physician-diagnosed depression and anxiety in Florida adults: Behavioral Risk Factor Surveillance System, 2006.

INTRODUCTION: Our purpose was to determine the prevalence and correlates of self-reported symptoms of depression and physician-diagnosed depression and anxiety in Florida adults by using the 2006 Florida Behavioral Risk Factor Surveillance System (BRFSS). METHODS: The BRFSS is an ongoing, state-based telephone health survey of noninstitutionalized adults that uses random-digit dialing. In 2006, an Anxiety and Depression Module was administered in Florida. Eight questions were used to examine current depression. Two additional questions assessed health care provider diagnosis of depressive and anxiety disorders. We used SUDAAN version 9.0 to evaluate the data to accommodate the complex sampling design. RESULTS: Approximately 9% of Florida adults experienced current depression; about 13% had had a diagnosis of depression in their lifetime and 11% had a diagnosis of anxiety in their lifetime. Approximately 44% of respondents with current depression had not had a diagnosis of depression. Current depression and lifetime diagnosis of depression and anxiety were independently associated with sociodemographic variables (being a woman, young, previously married or never married, or unemployed or unable to work), adverse health behaviors (current or former smoking, physical inactivity, or obesity), and chronic health conditions (history of a stroke, diabetes, or asthma). Although the prevalence of depression among non-Hispanic blacks and people with low education levels is higher, members of these groups are less likely than members of other sociodemographic groups to have had depression diagnosed by a physician. CONCLUSION: Depression and anxiety are associated with sociodemographic disadvantages and chronic conditions and risk factors. Knowing the prevalence of depression and anxiety, both self-rated and physician-diagnosed, is useful in identifying unmet mental health needs among subpopulations.

Drinking and driving among adults in the United States: Results from the 2012-2013 national epidemiologic survey on alcohol and related conditions-III.

Despite the seriousness of alcohol-impaired driving (A-ID) very few national surveys on reported A-ID have been conducted since the early 2000s. This study examined 12-month prevalences of driver-based A-ID and passenger-based alcohol-related practices in a large representative sample of the U.S. population. Twelve-month prevalences of drinking while driving and driving after drinking too much were 5.7% and 3.9%, respectively. Corresponding prevalences of having an accident while intoxicated and having an accident with an injury while intoxicated were 0.6% and 0.2%, respectively. Twelve-month prevalences of riding as a passenger with a drinking driver and riding as a passenger while drinking were 7.0% and 10.7%, respectively. In general, sociodemographic characteristics of individuals more vulnerable to all of these A-ID practices were similar: men, Whites, Blacks and Native Americans, younger and middle-aged adults, upper socioeconomic status, being never or previously married, and residing in the Midwest. Results of this study underscore the importance of assessing driver-based A-ID and passenger-based alcohol-related practices and the need to target prevention and intervention programs to reduce these practices among those subgroups of the U.S. population most vulnerable to them.

Changes in the prevalence and correlates of cocaine use and cocaine use disorder in the United States, 2001-2002 and 2012-2013.

To present nationally representative data on changes in the prevalences of 12-month cocaine use, cocaine use disorder (CocUD) and 12-month CocUD among 12-month cocaine users between 2001 and 2002 and 2012-2013. Data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012-2013 NESARC-III. Between 2001 and 2002 and 2012-2013, prevalences of 12-month cocaine use and DSM-IV CocUD significantly increased and 12-month CocUD among 12-month users significantly decreased. Increases in risk of cocaine use were seen across nearly all sociodemographic subgroups while increases in CocUD were observed among women, those in the oldest age group, Whites, individuals with the lowest incomes and highest education, and those residing in urban areas. Prevalence of CocUD among users significantly declined overall and among men, individuals aged 30-44 years old, the never-married, respondents with incomes between $20,000 and $34,000, and those residing in the Midwest. Increases in coca cultivation in Colombia in recent years together with increases in the purity of cocaine entering the U.S. portend more significant increases in the rates of cocaine use and CocUD in the U.S. along with increases in cocaine-related morbidity and mortality. The results of this study support the continued monitoring of cocaine use and CocUD in the U.S., especially in view of the narrowing of the gender gap and shifts in race-ethnic, age and socioeconomic differentials seen between 2001 and 2002 and 2012-2013.

Association of lifetime alcohol drinking trajectories with cardiometabolic risk.

CONTEXT AND OBJECTIVE: Alcohol intakes may vary considerably over a drinker's lifetime. This study was designed to examine whether lifetime drinking trajectories are associated with cardiovascular risk factors that are used to define the metabolic syndrome (MetS). DESIGN, SETTING, PARTICIPANTS, AND OUTCOMES: This is a population-based cross-sectional study. Participants were ever-regular drinkers (n = 2818) selected from healthy controls for the Western New York Health Study (1996-2001) in which lifetime lifestyle was ascertained retrospectively. Prevalence of the MetS and its individual components, including obesity, high triglycerides, low high-density lipoprotein cholesterol, elevated blood pressure, and high fasting glucose, were the main outcomes. RESULTS: Trajectory analyses were based on estimates of total kilograms of ethanol for each age decade between 10 and 59 yr. Two groups of drinkers with distinct lifetime drinking trajectories were obtained, an early peak and a stable trajectory group. Compared with stable trajectory drinkers, early-peak drinkers were 10 yr younger on average, had earlier onset of regular drinking, drank heavily in late adolescence and early adulthood tapering off in middle age, averaged more drinks per drinking day in lifetime, and were more likely to abstain when interviewed. After controlling for age, sex, and other potential confounders, early-peak trajectories were modestly associated with high odds of the MetS [1.31; 95% confidence interval (CI) 1.00, 1.71] overall, low high-density lipoprotein cholesterol (1.62; 95% CI 1.27, 2.08), abdominal obesity (1.48; 95% CI 1.23, 1.78), and overweight (1.32; 95% CI 1.10, 1.60). CONCLUSION: Early initiation of alcohol drinking and heavy drinking in adolescence and early adulthood may be associated with an adverse cardiometabolic profile.

Patterns of alcohol consumption and the metabolic syndrome.

CONTEXT AND OBJECTIVE: Protective and detrimental associations have been reported between alcohol consumption and the metabolic syndrome. This may be due to variations in drinking patterns and different alcohol effects on the metabolic syndrome components. This study is designed to examine the relationship between alcohol consumption patterns and the metabolic syndrome. DESIGN, SETTING, PARTICIPANTS, AND MEASURES: The 1999-2002 National Health and Nutrition Examination Survey is a population-based survey of noninstitutionalized U.S. adults. Current drinkers aged 20-84 yr without cardiovascular disease who had complete data on the metabolic syndrome and drinking patterns were included in the analysis (n = 1529). The metabolic abnormalities comprising the metabolic syndrome included having three of the following: impaired fasting glucose/diabetes mellitus, high triglycerides, abdominal obesity, high blood pressure, and low high-density-lipoprotein cholesterol. Measures of alcohol consumption included usual quantity consumed, drinking frequency, and frequency of binge drinking. RESULTS: In multinomial logistic regression models controlling for demographics, family history of cardiovascular disease and diabetes, and lifestyle factors, increased risk of the metabolic syndrome was associated with daily consumption that exceeded U.S. dietary guideline recommendations (more than one drink per drinking day for women and more than two drinks per drinking day for men (odds ratio 1.60, 95% confidence interval 1.22-2.11) and binge drinking once per week or more [odds ratio (95% confidence interval) 1.51 (1.01-2.29]. By individual metabolic abnormality, drinking in excess of the dietary guidelines was associated with an increased risk of impaired fasting glucose/diabetes mellitus, hypertriglyceridemia, abdominal obesity, and high blood pressure. CONCLUSION: Public health messages should emphasize the potential cardiometabolic risk associated with drinking in excess of national guidelines and binge drinking.