The dimensionality of DSM-IV alcohol use disorders among adolescent and adult drinkers and symptom patterns by age, gender, and race/ethnicity.

BACKGROUND: There is limited information on the validity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol use disorders (AUD) symptom criteria among adolescents in the general population. The purpose of this study is to assess the DSM-IV AUD symptom criteria as reported by adolescent and adult drinkers in a single representative sample of the U.S. population aged 12 years and older. This design avoids potential confounding due to differences in survey methodology when comparing adolescents and adults from different surveys. METHODS: A total of 133,231 current drinkers (had at least 1 drink in the past year) aged 12 years and older were drawn from respondents to the 2002 to 2005 National Surveys on Drug Use and Health. DSM-IV AUD criteria were assessed by questions related to specific symptoms occurring during the past 12 months. Factor analytic and item response theory models were applied to the 11 AUD symptom criteria to assess the probabilities of symptom item endorsements across different values of the underlying trait. RESULTS: A 1-factor model provided an adequate and parsimonious interpretation for the 11 AUD criteria for the total sample and for each of the gender-age groups. The MIMIC model exhibited significant indication for item bias among some criteria by gender, age, and race/ethnicity. Symptom criteria for "tolerance,""time spent," and "hazardous use" had lower item thresholds (i.e., lower severity) and low item discrimination, and they were well separated from the other symptoms, especially in the 2 younger age groups (12 to 17 and 18 to 25). "Larger amounts,""cut down,""withdrawal," and "legal problems" had higher item thresholds but generally lower item discrimination, and they tend to exhibit greater dispersion at higher AUD severity, particularly in the youngest age group (12 to 17). CONCLUSIONS: Findings from the present study do not provide support for the 2 separate DSM-IV diagnoses of alcohol abuse and dependence among either adolescents or adults. Variations in criteria severity for both abuse and dependence offer support for a dimensional approach to diagnosis which should be considered in the ongoing development of DSM-V.

Alcohol consumption by elderly Americans.

OBJECTIVE: The purpose of this study was to estimate the prevalence of alcohol consumption in Americans age 65 years and older using data from three nationally representative cross-sectional surveys: the National Health Interview Survey (NHIS-2000), the Behavioral Risk Factor Surveillance System (BRFSS-2001) and the National Household Survey on Drug Abuse (NHSDA-2000). METHOD: Alcohol consumption levels were defined as none, moderate (< or = 1 drink a day) and heavier (> 1 drink a day). The NHIS assessed alcohol consumption in the past year, and the BRFSS and NHSDA assessed alcohol consumption in the past 30 days. Differences between the BRFSS and NHSDA were tested using multinomial logistic regression. Age trends in alcohol consumption (between age 65 and 84 years) were tested using logistic regression. All analyses were weighted to produce national estimates. RESULTS: In men, the prevalence of moderate drinking was 37.6% (95% confidence interval [CI]: 35.2-40.0) in the NHIS, 38.7% (CI: 37.3-40.1) in the BRFSS and 27.2% (CI: 23.6-30.8) in the NHSDA. The prevalence of heavier drinking among men was 10.1% (CI: 8.7-11.5), 10.1% (CI: 9.3-10.9) and 9.2% (CI: 7.2-11.3), respectively. In women, the prevalence of moderate drinking was 32.3% (CI: 30.4-34.2) in the NHIS, 27.7% (CI: 26.7-28.6) in the BRFSS and 21.5% (CI: 18.9-24.2) in the NHSDA. The prevalence of heavier drinking among women was 2.2% (CI: 1.6-2.7), 2.6% (CI: 2.3-2.9) and 2.4% (CI: 1.4-3.3), respectively. In increasingly older groups of men, moderate drinking remained stable (all surveys, p for age trend [p trend] = NS), while heavier drinking significantly decreased in two of three surveys (NHIS and BRFSS, p trend < .05; NHSDA, p = NS). Conversely, in increasingly older groups of women, moderate drinking significantly decreased (all surveys, p trend = .001), while heavier drinking remained stable (all surveys, p trend = NS). CONCLUSIONS: In the years 2000 to 2001 approximately one third of the U.S. elderly population, about 11 million persons, consumed alcohol. The risks and benefits of drinking by elderly Americans will become an increasingly important public health issue as this segment of the population expands over the coming decades.

An evaluation of college online alcohol-policy information.

Excessive and underage drinking by US college and university students continues to be a significant problem. Curtailing the misuse of alcohol on college campuses is an important goal of college and university administrators because of the many negative consequences resulting from alcohol misuse. As part of their prevention programs, US colleges and universities are required by law to make information about their alcohol policies available to students. Often the source of this information is the school's Web site. The authors evaluated the alcohol-policy information that is available on the Web sites of the 52 top national universities listed in the 2002 rankings of US News and World Report. In general, they found that the information was difficult to find, was located in many areas of the Web site, and did not provide complete information about the school's alcohol policy.

Drinking frequency as a brief screen for adolescent alcohol problems.

OBJECTIVE: Routine alcohol screening of adolescents in pediatric settings is recommended, and could be facilitated by a very brief empirically validated alcohol screen based on alcohol consumption. This study used national sample data to test the screening performance of 3 alcohol consumption items (ie, frequency of use in the past year, quantity per occasion, frequency of heavy episodic drinking) in identifying youth with alcohol-related problems. METHODS: Data were from youth aged 12 to 18 participating in the annual National Survey on Drug Use and Health from 2000 to 2007. The screening performance of 3 alcohol consumption items was tested, by age and gender, against 2 outcomes: any Diagnostic and Statistical Manual, Fourth Edition alcohol use disorder symptom ("moderate"-risk outcome), and a diagnosis of Diagnostic and Statistical Manual, Fourth Edition alcohol dependence ("high"-risk outcome). RESULTS: Prevalence of the 2 outcomes increased with age: any alcohol use disorder symptom ranged from 1.4% to 29.2%; alcohol dependence ranged from 0.2% to 5.3%. Frequency of drinking had higher sensitivity and specificity in identifying both outcomes, compared with quantity per occasion and heavy episodic drinking frequency. For both outcomes, results indicate the utility of similar cut points for drinking frequency for males and females at each age. Age-specific frequency cut points, however, are recommended for both moderate- and high-risk outcomes to maximize screening performance. CONCLUSIONS: Drinking frequency provides an empirically supported brief screen to efficiently identify youth with alcohol-related problems.

An evaluation of college online alcohol-policy information: 2007 compared with 2002.

OBJECTIVE: To receive federal funds, colleges and universities are required to provide information to students about their alcohol policies as part of their alcohol-abuse prevention efforts. This study investigated whether and how the availability and completeness of alcohol-policy information on college Web sites changed between 2002 and 2007. METHOD: The Web sites of the top 52 national universities listed in the 2002 rankings of U.S. News and World Report, which were reviewed for alcohol-policy information in 2002, were reviewed again in 2007 using the same Web search methodology. RESULTS: Much more information regarding college alcohol policies was available on the Web sites of the 52 universities in 2007 than in 2002. Substantial increases were seen in the areas of (1) rules, restrictions, requirements; and (2) consequences for infractions, especially for student groups. In addition, information on university Web sites regarding their alcohol policies was easier to access in 2007 than in 2002. CONCLUSIONS: These findings indicate that colleges have made online alcohol-policy information more available and accessible to their students and other interested parties, including parents. This may reflect a greater engagement of colleges and universities in the issue of drinking on campus in general.

A developmental perspective on underage alcohol use.

Underage alcohol use can be viewed as a developmental phenomenon because many kinds of developmental changes and expectations appear to influence this behavior and also because it has consequences for development. Data on alcohol use, abuse, and dependence show clear age-related patterns. Moreover, many of the effects that alcohol use has on the drinker, in both the short and long term, depend on the developmental timing of alcohol use or exposure. Finally, many developmental connections have been observed in the risk and protective factors that predict the likelihood of problem alcohol use in young people. Therefore, efforts to understand and address underage drinking would benefit from a developmental perspective, and the general principles of developmental psychopathology offer a useful conceptual framework for research and prevention concerned with underage drinking.

Underage drinking: a developmental framework.

A developmental framework for understanding and addressing the problem of underage alcohol consumption is presented. The first section presents the rationale for a developmental approach, including striking age-related data on patterns of onset, prevalence, and course of alcohol use and disorders in young people. The second section examines the fundamental meaning of a developmental approach to conceptualizing underage drinking. The third section delineates contemporary principles of developmental psychopathology as a guide to future research and intervention efforts. Strategic, sensitive, and effective efforts to address the problem of underage drinking will require a developmentally informed approach to research, prevention, and treatment.

Trends in initiation of alcohol use in the United States 1975 to 2003.

INTRODUCTION: Alcohol is the drug of choice for youth in the United States. By 8th grade, more than 40% of youth have used alcohol; by 12th grade, almost 80% have done so (MTF, 2003). And many of these young people begin drinking at relatively early ages. On average, boys start drinking earlier than girls, and whites and Native Americans start drinking earlier than youth of other race/ethnicities. As alcohol consumption is such a high prevalence behavior among young people, it is crucial to understand the initiation of drinking as well as possible, so as to facilitate and inform interventions to delay this behavior. One facet of this involves investigating trends in the initiation of drinking. METHODS: Multiple years of data from 3 national surveys, Monitoring the Future (MTF)-1975 to 2003 for 12th graders, 1993 to 2003 for 8th and 10th graders; the National Household Survey on Drug Abuse (NHSDA) [now called the National Survey on Drug Use and Health (NSDUH)]-1991 to 1998; and the Youth Risk Behavior Surveillance System (YRBSS)-1991 to 2003, were analyzed using joinpoint analysis to further understanding of trends in the initiation of drinking by youth. The present analysis examines whether the age of drinking initiation has changed over time and evaluates trends in the percentages of youth who start drinking by various grades. RESULTS: Simultaneous examination of data from the 3 surveys indicates that 7th and 8th grades (when most youth are 13-14) are peak years for the initiation of drinking. Further, the present analysis shows that although the percentage of youth who start drinking early (before age 13) has declined (YRBSS, MTF), the average age of initiation of drinking for these "very early starters" did not change over the period 1991 to 1998 (NHSDA/NSDUH). At the same time, an upward shift in the "normative" age of initiation has occurred (NHSDA/NSDUH, MTF). Results of analyses by gender and race/ethnicity indicate similar trends over time. CONCLUSION: A more nuanced understanding of the initiation of drinking can have important implications for prevention.

Trends in drinking among Americans age 18 and younger: 1975-2002.

BACKGROUND: Although changes over time in the prevalence of drinking by youth under 18 have been previously reported, we present results based on data from multiple surveys, using recently developed software for trend analyses. In this study, we applied joinpoint statistical methodology to three national data sets to analyze trends in drinking by youth, age 18 and under, for the period 1975 to 2002. METHODS: Information was obtained from three national data sets, Monitoring the Future for the years 1975 to 2002, the Youth Risk Behavior Survey for the years 1991 to 2001, and the National Household Survey on Drug Abuse for 1979, 1985, and 1991 to 2001. Approximately 80,000 persons between 12 and 18 were included in the most recent survey years. The alcohol consumption measures examined over time were any use of alcohol, consumption of five or more drinks on one occasion, and daily consumption. RESULTS: Alcohol consumption by 8th, 10th and 12th graders decreased substantially since the 1970s according to joinpoint trend analyses. It remains disturbingly high, however, according to data from three national surveys (e.g., 12.4% of 8 and 28.6% of 12th graders drinking five or more drinks in a row in the past 2 weeks), although prevalence rates have been relatively stable for the last 5 to 10 years. CONCLUSIONS: Since the early 1990s, rates of drinking by youth under 18 remained relatively stable according to the Youth Risk Behavior Survey and National Household Survey on Drug Abuse and moved up and then down according to Monitoring the Future, underscoring the need for continued surveillance and enhanced understanding of this long-standing problem.

Collecting longitudinal data through childhood, adolescence, and young adulthood: methodological challenges.

This article presents the proceedings of a workshop at the 2003 Research Society on Alcoholism meeting in Fort Lauderdale, Florida. The organizers and chairs were Vivian Faden and Nancy Day. The presentations were (1) Lessons Learned From the Lives Across Time Longitudinal Study, by Michael Windle and Rebecca Windle; (2) Methodological Issues in Longitudinal Surveys With Children and Adolescents, by Joel Grube; (3) The Pittsburgh ADHD Longitudinal Study: Methodological and Conceptual Challenges, by Brooke Molina, William Pelham, Elizabeth Gnagy, and Tracey Wilson; and (4) Lessons learned in Conducting Longitudinal Research on Alcohol Involvement: If Only I Had Known Before Hand! by Kristina Jackson and Kenneth Sher.