Socioeconomic position indicators and risk of alcohol-related medical conditions: A national cohort study from Sweden.

BACKGROUND: Alcohol consumption contributes to excess morbidity and mortality in part through the development of alcohol-related medical conditions (AMCs, including alcoholic cardiomyopathy, hepatitis, cirrhosis, etc.). The current study aimed to clarify the extent to which risk for these outcomes differs as a function of socioeconomic position (SEP), as discrepancies could lead to exacerbated health disparities. METHODS AND FINDINGS: We used longitudinal Swedish national registries to estimate the individual and joint associations between 2 SEP indicators, educational attainment and income level, and risk of AMC based on International Classification of Diseases codes, while controlling for other sociodemographic covariates and psychiatric illness. We conducted Cox proportional hazards models in sex-stratified analyses (N = 1,162,679 females and N = 1,196,659 males), beginning observation at age 40 with follow-up through December 2018, death, or emigration. By the end of follow-up, 4,253 (0.37%) females and 11,183 (0.93%) males had received an AMC registration, corresponding to overall AMC incidence rates among females and males of 2.01 and 5.20, respectively. In sex-stratified models adjusted for birth year, marital status, region of origin, internalizing and externalizing disorder registrations, and alcohol use disorder (AUD) registration, lower educational attainment was associated with higher risk of AMC in both females (hazard ratios [HRs] = 1.40 to 2.46 for low- and mid-level educational attainment across 0 to 15 years of observation) and males (HRs = 1.13 to 1.48). Likewise, risk of AMC was increased for those with lower income levels (females: HRs = 1.10 to 5.86; males: HRs = 1.07 to 6.41). In secondary analyses, we further adjusted for aggregate familial risk of AUD by including family genetic risk scores for AUD (FGRSAUD), estimated using medical, pharmacy, and criminal registries in extended families, as covariates. While FGRSAUD were associated with risk of AMC in adjusted models (HR = 1.17 for females and HR = 1.21 for males), estimates for education and income level remained largely unchanged. Furthermore, FGRSAUD interacted with income level, but not education level, such that those at higher familial liability to AUD were more susceptible to the adverse effect of low income. Limitations of these analyses include the possibility of false negatives for psychiatric illness registrations, changes in income after age 40 that were not accounted for due to modeling restrictions, restriction to residents of a high-income country, and the inability to account for individual-level alcohol consumption using registry data. CONCLUSIONS: Using comprehensive national registry data, these analyses demonstrate that individuals with lower levels of education and/or income are at higher risk of developing AMC. These associations persist even when accounting for a range of sociodemographic, psychiatric, and familial risk factors. Differences in risk could contribute to further health disparities, potentially warranting increased screening and prevention efforts in clinical and public health settings.

Effects of family history of alcohol problems on alcohol consumption: Stronger for medically underserved men.

Family history (FH), informed by genetics and family environment, can be used by practitioners for risk prediction. This study compares the associations of FH with alcohol outcomes for medically underserved (MUS) men and women with the associations for non-underserved individuals to assess the utility of FH as a screening tool for this high-priority group. Data were from 29,993 adult lifetime drinkers in the Wave 1 (2001-2002) and Wave 2 (2004-2005) National Epidemiologic Survey on Alcohol and Related Conditions. All variables except FH were measured at Wave 2. Dependent variables were 12-month alcohol consumption and alcohol use disorder (AUD). FH scores (FH-SCORE) measured the proportion of first- and second-degree biological relatives with alcohol problems. MUS status was defined by household income at or below 100% of the federal poverty line and participants reporting no usual source of health care. Multivariate linear and logistic regression models tested main and interaction effects. Models showed a significant interaction of FH-SCORE with MUS status (p < .01), with a stronger effect of FH on alcohol consumption for the MUS group. This moderating effect was weaker for women than for men (FH-SCORE x MUS x Sex three-way interaction: p < .01). AUD models showed a significant positive association with FH-SCORE (p < .001) but no association with MUS status and no significant interaction effects. In this sample of lifetime drinkers, FH was associated with higher alcohol consumption, especially for MUS men. These results encourage additional validation of FH scores to prioritize MUS adults at high risk for alcohol problems to receive preventive interventions.

Divergent changes: abstinence and higher-frequency substance use increase among racial/ethnic minority young adults during the COVID-19 global pandemic.

BACKGROUND: Identifying factors influencing substance use among racial/ethnic minorities (REM) is important given the disproportionate impact of the COVID-19 pandemic on this population. OBJECTIVES: We examined factors in four domains and hypothesized that poor mental health, negative coping behaviors, negative environmental aspects, and belonging to more vulnerable social groups would be associated with increased substance use during the pandemic. METHODS: Multiple regression was applied to longitudinal data from a college sample assessed prior (fall 2017 to spring 2019) and during (spring 2020) the pandemic (n= 323; 81.5% cisgender women; 34.5% African-American, 36.1% Asian-American, 15.5% Hispanic/Latinx, 11.8% multi-racial) to identify factors predicting current alcohol, cannabis, and nicotine use frequency (spring 2020) and change in frequency of use between springs 2019 and 2020. RESULTS: While infrequent substance use (monthly or less) decreased during the pandemic, abstinence rates increased (alcohol 39%; cannabis 18%; nicotine 18%) and higher-frequency alcohol use increased (207%-1600% 2-3 times+/week) compared to spring 2019. The strongest protective factor was change in living situation during the pandemic, associated with lower current alcohol and cannabis use. Risk factors included a history of trouble with police and impulsivity since the pandemic, both associated with higher current and increased alcohol and cannabis use. REM did not differ on most factors and the outcomes. However, a higher percentage of Asian-Americans than other REM reported living situation changes. CONCLUSION: Substance use rates diverged during the pandemic, with both increased abstinence and higher-frequency use, attributed mostly to mental health and environmental domain factors with few REM differences.

Adverse childhood experience patterns, major depressive disorder, and substance use disorder in older adults.

OBJECTIVES: This article investigates distinct patterns of adverse childhood experiences (ACEs) in a representative sample of US older adults, and how the ACEs patterns relate to major depression and substance use disorder (SUD). METHODS: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions III. The study sample consisted of older adults aged 55 or older (N = 11,386). The dependent variable was past-year SUD measuring any DSM-5 diagnosis for alcohol, tobacco, cannabis, and other illicit drugs. The independent variables were the classes of ACEs identified using 11 types of early adversities. The mediating variable was past-year major depressive disorder. We conducted a latent class analysis (LCA) to identify latent classes of ACEs, estimated the relationships between the ACEs classes, major depressive disorder, and SUD, and tested mediation by major depression. RESULTS: Results of the LCA identified four classes of ACEs: High Adversity (6%), Low Adversity (69%), Child Abuse (16%), and Parental Substance Use (8%). The three classes of High Adversity, Child Abuse, and Parental Substance Use showed significantly higher rates of SUD than the Low Adversity class. The High Adversity and Child Abuse classes were more likely to have major depression compared to the Low Adversity class. In addition, major depression mediated the association between ACEs and SUD for those two classes. CONCLUSION: The findings provide evidence for a long-term impact of ACEs on mental health and SUD later in life and emphasize trauma-informed care principles in interventions for older adults with SUD.

Exploring how Family and Neighborhood Stressors Influence Genetic Risk for Adolescent Conduct Problems and Alcohol Use.

Previous research suggests that genetic risk factors may predispose to conduct problems and alcohol use in adolescence. Whether genetic risk factors interact with social contexts has not been well characterized among African American adolescents. Data came from a subsample of the Genes, Environment, and Neighborhood Initiative study comprising 501 African American adolescents, including 151 lifetime drinkers (56% female, mean age = 16.3, SD = 1.4). Genetic risk was assessed with polygenic risk scores for alcohol dependence. Analyses explored interactions between genetic risk and self-reported alcohol use, conduct problems, life stressors, and other covariates. The effects of two gene-environment interactions (G × E) were tested in the sample of alcohol exposed adolescents; one on conduct problems and the other on alcohol use. There were significant associations between polygenic risk for alcohol dependence and conduct problems. A significant G × E interaction showed the impact of genetic risk on conduct problems was stronger under conditions of high exposure to family and neighborhood stressors. Among this sample of African American adolescents, genetic risk for alcohol dependence was not directly associated with alcohol use but was related to more conduct problems. Further, the effect of genetic risk interacted with stressors from the family and neighborhood, so that the effect of genetic risk on conduct problems was stronger for individuals who reported greater stressors.

Conclusion: Special issue on genetic and alcohol use disorder research with diverse racial/ethnic groups: Key findings and potential next steps.

BACKGROUND AND OBJECTIVES: This special issue brings together papers focusing on a wide range of topics relevant to the research and understanding of the role of race/ethnicity and genetic variation for the susceptibility of developing an alcohol use disorder (AUD). METHODS: The key findings from the issue's 10 articles are reviewed and organized here around three topics: I: addictive behaviors and potential environmental influences; II: a focus on four racial/ethnic groups; and III: special methodologies. RESULTS: Several potential next steps in improving effective research strategies are highlighted: (1) implementing best practices for outreach and community engagement may reduce reluctance to participate; (2) recruiting adequately sized and racially/ethnically diverse samples will require new collaborations with investigators who successfully work in diverse communities; (3) identifying and assessing environmental influences that are both unique to, and common among, racial/ethnic groups may inform preventions for AUD; (4) use of standardized measures will facilitate the generation of larger samples and meta-analysis of research findings; and (5) use of better analytic approaches and experimental methods will improve replication in gene finding research and help advance new areas of research. CONCLUSIONS: Genetic research of AUD in diverse racial/ethnic populations is advancing. The articles in this issue examined the general theme of including diverse population groups in genetic studies and offered potential strategies for addressing some common problems. SCIENTIFIC SIGNIFICANCE: Greater inclusion of diverse racial/ethnic populations in this research is important to ensure that the benefits of new knowledge and technology are equally shared. (Am J Addict 2017;26:532-537).

Introduction: Special issue on genetic research of alcohol use disorder in diverse racial/ethnic populations.

This special issue of The American Journal on Addictions is an extension of a workshop held at the Research Society on Alcoholism (2015) highlighting several important issues related to studies of the genetic bases of alcohol use disorder among racially/ethnically diverse populations. While not exhaustive in their coverage, the papers in this special issue focus on three important topics: (1) the importance of considering the social and environmental context in genetic analyses; (2) social and cultural considerations for engaging diverse communities in genetic research; and (3) methodologies related to phenotype development for use with racially/ethnically diverse populations. A brief overview of each paper included in these three sections is presented. The issue concludes with additional considerations for genetic research with racially/ethnically diverse population groups along with a commentary. (Am J Addict 2017;26:422-423).

Learning from Latino voices: Focus Groups' Insights on Participation in Genetic Research.

BACKGROUND AND OBJECTIVES: There is a paucity of genetics research examining alcohol use among Latinos. The purpose of this study is to examine Latino perceptions of participation in alcohol studies that collect biological samples, an important precursor to increasing their participation in genetics research. METHODS: A synthesis of the literature addressing participation of racial/ethnic minorities in alcohol genetics research was undertaken. We developed a framework of themes related to barriers and facilitators for participation, which we then used to analyze two focus groups held with 18 Latino participants. RESULTS: From the literature review, we identified nine themes related to facilitators of and barriers to participation. They are, on continua: curiosity to disinterest; trust to mistrust; understanding to confusion; safety to danger; inclusion to exclusion; sense of connection to disconnection; hope to despair; ease to hassle; and benefit to cost. Another theme emerged from the focus groups: previous experience to no previous experience with health research. CONCLUSIONS: Applying the themes from the literature review to Latino perspectives on providing biological samples for alcohol research helps expand their definition and applicability. Consideration of these themes when designing recruitment/retention materials and strategies may encourage Latino participation in alcohol genetics research. SCIENTIFIC SIGNIFICANCE: An understanding of these themes and their significance for Latinos is offered in the form of "guiding questions" for researchers to consider as we strive for more inclusive research. Focus group participants were Mexican American; future research should further explore perspectives of this heterogeneous demographic group by studying other Latino subgroups. (Am J Addict 2017;26:477-485).

Review: Environmental influences on alcohol use: Informing research on the joint effects of genes and the environment in diverse U.S. populations.

BACKGROUND AND OBJECTIVES: This review aimed to inform the current state of alcohol research on the joint effects of genes and the environment conducted in U.S. racial/ethnic minority populations, focusing on African Americans, Latinos/Hispanics, Asians, and American Indians. METHODS: A key-word and author-based search was conducted and supplemented with direct contact to researchers in this area to ensure a comprehensive inclusion of published, peer-reviewed studies. These studies were considered in terms of the racial/ethnic population groups, phenotypes, genetic variants, and environmental influences covered. Research findings from alcohol epidemiologic studies were highlighted to introduce some potential environmental variables for future studies of gene and environment (G-E) relationships. RESULTS: Twenty-six (N = 26) studies were reviewed. They predominantly involved African American and Asian samples and had a very limited focus on Latinos/Hispanics and American Indians. There was a wide range of alcohol-related phenotypes examined, and studies almost exclusively used a candidate gene approach. Environmental influences focused on the most proximate social network relationships with family and peers. There was far less examination of community- and societal-level environmental influences on drinking. Epidemiologic studies informing the selection of potential environmental factors at these higher order levels suggest inclusion of indicators of drinking norms, alcohol availability, socioeconomic disadvantage, and unfair treatment. CONCLUSIONS: The review of current literature identified a critical gap in the study of environments: There is the need to study exposures at community and societal levels. SCIENTIFIC SIGNIFICANCE: These initial studies provide an important foundation for evolving the dialogue and generating other investigations of G-E relationships in diverse racial/ethnic groups. (Am J Addict 2017;26:446-460).

ALDH2*2 and peer drinking in East Asian college students.

BACKGROUND: The ALDH2*2 allele (A-allele) at rs671 is more commonly carried by Asians and is associated with alcohol-related flushing, a strong adverse reaction to alcohol that is protective against drinking. Social factors, such as having friends who binge drink, also contribute to drinking in Asian youth. OBJECTIVES: This study examined the interplay between ALDH2*2, peer drinking, and alcohol consumption in college students. We hypothesized that the relationship between ALDH2*2 and standard grams of ethanol per month would vary based on the level of peer drinking. METHODS: Subjects (N = 318, 63.25% female) were East Asian college students in the United States who reported drinking alcohol. Data were from the freshman year of a university survey that included a saliva DNA sample. ALDH2*2 status was coded ALDH2*2(+) (A/G and A/A genotypes) and ALDH2*2(-) (G/G genotype). Peer drinking was students' perception of how many of their friends "got drunk". RESULTS: Main effects of ALDH2*2(-) and having more friends who got drunk were associated with greater alcohol consumption. The ALDH2*2 × peer drunkenness interaction showed a stronger positive association with alcohol consumption for ALDH2*2(-) versus ALDH2*2(+) at increasing levels of peer drunkenness. Follow-up comparisons within each peer drunkenness level identified significantly higher alcohol consumption for ALDH2*2(-) compared to ALDH2*2(+) at the all friends got drunk level. CONCLUSION: There was evidence of a stronger effect for ALDH2*2(-) compared to ALDH2*2(+) with greater alcohol use when students were more exposed to peer drinking. Findings contribute to a growing literature on the interrelationships between genetic influences and more permissive environments for alcohol consumption.

Men and women from the STRIDE clinical trial: An assessment of stimulant abstinence symptom severity at residential treatment entry.

BACKGROUND AND OBJECTIVES: Gender-specific factors associated with stimulant abstinence severity were examined in a stimulant abusing or dependent residential treatment sample (N = 302). METHOD: Bivariate statistics tested gender differences in stimulant abstinence symptoms, measured by participant-reported experiences of early withdrawal. Multivariate linear regression examined gender and other predictors of stimulant abstinence symptom severity. RESULTS: Women compared to men reported greater stimulant abstinence symptom severity. Anxiety disorders and individual anxiety-related abstinence symptoms accounted for this difference. African American race/ethnicity was predictive of lower stimulant abstinence severity. DISCUSSION AND CONCLUSIONS: Women were more sensitive to anxiety-related stimulant withdrawal symptoms. SCIENTIFIC SIGNIFICANCE: Clinics that address anxiety-related abstinence symptoms, which more commonly occur in women, may improve treatment outcome.

Comorbidities and race/ethnicity among adults with stimulant use disorders in residential treatment.

Comorbid physical and mental health problems are associated with poorer substance abuse treatment outcomes; however, little is known about these conditions among stimulant abusers at treatment entry. This study compared racial and ethnic groups on baseline measures of drug use patterns, comorbid physical and mental health disorders, quality of life, and daily functioning among cocaine and stimulant abusing/dependent patients. Baseline data from a multi-site randomized clinical trial of vigorous exercise as a treatment strategy for a diverse population of stimulant abusers (N=290) were analyzed. Significant differences between groups were found on drug use characteristics, stimulant use disorders, and comorbid mental and physical health conditions. Findings highlight the importance of integrating health and mental health services into substance abuse treatment and could help identify potential areas for intervention to improve treatment outcomes for racial and ethnic minority groups.

Framing ethnic variations in alcohol outcomes from biological pathways to neighborhood context.

BACKGROUND: Health disparities research seeks to eliminate disproportionate negative health outcomes experienced in some racial/ethnic minority groups. This brief review presents findings on factors associated with drinking and alcohol-related problems in racial/ethnic groups. METHODS: Those discussed are as follows: (i) biological pathways to alcohol problems, (ii) gene × stress interactions, (iii) neighborhood disadvantage, stress, and access to alcohol, and (iv) drinking cultures and contexts. RESULTS: These factors and their interrelationships are complex, requiring a multilevel perspective. CONCLUSIONS: The use of interdisciplinary teams and an epigenetic focus are suggested to move the research forward. The application of multilevel research to policy, prevention, and intervention programs may help prioritize combinations of the most promising intervention targets.

Characteristics of adults involved in alcohol-related intimate partner violence: results from a nationally representative sample.

BACKGROUND: More than 12 million women and men are victims of partner violence each year. Although the health outcomes of partner violence have been well documented, we know very little about specific event-level characteristics that may provide implications for prevention and intervention of partner violence situations. Therefore, the purpose of this study is to evaluate substance abuse and dependence as risk factors for event-level alcohol-related intimate partner violence (IPV). METHODS: Data were derived from Wave II of the National Epidemiological Survey on Alcohol and Related Conditions (2004-2005). Eligible participants (N = 2,255) reported IPV the year before the survey. Negative binomial and ordinal regression methods were used to assess risk factors for alcohol use during IPV. RESULTS: Respondent PTSD was the only mental health diagnosis related to alcohol use during IPV (OR = 1.45). Marijuana use was related to respondents' use of alcohol during IPV (OR = 2.68). Respondents' meeting the criteria for alcohol abuse/dependence was strongly associated with respondent drinking (OR = 10.74) and partner drinking (OR = 2.89) during IPV. CONCLUSION: Results indicate that PTSD, marijuana use disorders, alcohol abuse and dependence are associated with more frequent alcohol use during IPV. In addition, it is important to consider that the patient who presents in emergency settings (e.g., hospitals or urgent care facilities) may not be immediately identifiable as the victim or the perpetrator of partner violence. Therefore, screening and intervention programs should probe to further assess the event-level characteristics of partner violence situations to ensure the correct service referrals are made to prevent partner violence.

The longitudinal mediating role of sleep in associations between COVID-19 stressors predicting mental and physical health outcomes among emerging adult college students.

The current study tested a longitudinal mediation model throughout the COVID-19 pandemic focused on whether students' housing instability stress and food/financial instability stress at the beginning of the pandemic in spring 2020 (T1) informed sleep dissatisfaction and duration in fall 2020 (T2) and, in turn, physical and mental health in spring 2021 (T3). Further, we tested whether relations varied based on students' ethnic-racial backgrounds. Participants included 879 Asian, Black, Latine, Multiracial, and White emerging adult college students (Mage = 19.95, SD = 0.33) from a large public university in the mid-Atlantic region of the United States who attended college during the COVID-19 pandemic and completed surveys about their experiences. Findings indicated a significant mediation process, such that T1 housing instability stress predicted greater T2 sleep dissatisfaction and, in turn, less physical health, greater depressive symptoms, and greater anxiety symptoms at T3. Additionally, T1 food/financial instability stress was significantly associated with less T2 sleep duration but was not, in turn, associated with any T3 outcomes. Findings did not vary by students' ethnicity/race. Results highlight that sleep dissatisfaction is an important factor that accounts for relations between COVID-19 stressors predicting mental and physical health outcomes throughout the pandemic.

Ethnicity and gender comparisons of health consequences in adults with alcohol dependence.

The moderating effects of ethnicity and gender on factors associated with physical health consequences in adults manifesting alcohol dependence were examined using data from the 2001-2002 US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Black and white respondents with a lifetime diagnosis of DSM-IV alcohol dependence were selected for the study (n = 3,852). A multiple-group structural equation model tested ethnicity, gender, and intervening variables as predictors of physical health status in alcohol-dependent men and women. Study findings offer implications for clinical practice with alcohol-dependent individuals by identifying likely target groups and problems for intervention.

Adverse Childhood Experiences and Tobacco Use among Latinx Parents in the USA.

The current study aimed to understand the effects of adverse childhood experiences (ACEs) and cultural factors on Latinx parents' tobacco use. Tobacco use is the leading cause of death among Latinx individuals in the USA, and parental use has long-term secondary harm for children. Thus, it is important to examine cultural protective factors that could prevent Latinx parents and children from the negative health effects of tobacco use. Data came from 2813 18- to 50-year-old Latinx respondents who participated in the Wave 3 of the National Epidemiological Survey on Alcohol and Related Conditions. They reported having children living in their household and had complete data for the variables of interest. In this sample (mean age = 33.5 years, 53.7% female), 16.4% (95%CI = 14.7%, 18.4%) and 7.4% (95%CI = 6.4%, 8.6%) were current and former smokers, respectively. The multivariate multinomial logistic regression analysis showed that experiencing more ACEs categories was associated with increased likelihood of current and former tobacco use compared to never use. Past year discrimination experiences and being US born (2nd and 3rd-generation parents) also increased the likelihood of current use. Differences in risk of current and former tobacco use were found based on respondents' country of origin, with protection against tobacco use found for most countries compared to being from Puerto Rico. Stronger ethnic-racial identity was not protective against tobacco use. Findings show the importance of considering ACEs and cultural factors when designing and implementing tobacco cessation programs for Latinx parents and increasing awareness of the impact of parents' tobacco use on their children.

Triangulation of evidence on immigration and rates of alcohol use disorder in Sweden: Evidence of acculturation effects.

BACKGROUND: This study aimed to determine the robustness of the impact of immigration on risk for alcohol use disorder (AUD) using different measures, designs, and immigrant regional cohorts. METHODS: The analytic sample included all individuals born between 1950 and 1990 and registered in Sweden from 1973 to 2017. Using Cox regression models, we examined the risk for AUD from Swedish nationwide registries in immigrants to Sweden from seven geographical regions: Africa, Asia and Oceania, Eastern Europe, Finland, Latin America and the Caribbean, Middle East/North Africa, and Western countries. We assessed greater exposure to Swedish culture, which we interpreted as increasing acculturation, by (i) comparing first-generation immigrants and their children with no and one native Swedish parent and (ii) examining age at immigration. The baseline comparison group was the native Swedish population. We also examined AUD risk in first-generation sibling pairs discordant for their age at immigration. RESULTS: In nearly all immigrant cohorts in Sweden, increasing degrees of acculturation, as assessed by both our variables, were associated with rates of AUD that approached those of the Swedish population. These findings occurred in both men and women and both regional cohorts whose first-generation immigrants had lower and higher levels of AUD than native-born Swedes. For most cohorts, the rates of change with acculturation were greater in women than in men. In sibling pairs from most regions, the sibling who was younger at immigration had a higher rate of AUD. CONCLUSIONS: An examination of both sexes and two different proxies for acculturation provides consistent support for socio-cultural influences on AUD risk. Our co-sibling analyses suggest that a meaningful proportion of this effect is likely to be causal in nature.

Cardiorespiratory fitness and depression symptoms among adults during the COVID-19 Pandemic: Cooper Center Longitudinal Study.

This study examined the relation between cardiorespiratory fitness (fitness) and depression symptoms prior to and during COVID-19 among adults seeking preventive medical care. Participants consisted of 967 patients attending the Cooper Clinic (Dallas, TX) pre-pandemic (March 2018-December 2019) and during the pandemic (March-December 2020). The outcome, depression symptoms, was based on the Center for Epidemiological Studies-Depression (CES-D). Maximal metabolic equivalents task (MET) levels for fitness were determined from the final treadmill speed and grade. Multiple linear regression models were computed by sex. Analysis revealed that mean fitness decreased from 11.4 METs (SD = 2.1) prior to the pandemic to 10.9 METs (SD = 2.3) during the pandemic (p-value < 0.001). The mean CES-D score increased from 2.8 (SD = 3.1) before to pandemic to 3.1 (SD = 3.2) during the pandemic (p-value = 0.003). Results from multiple linear regression indicate that increased fitness was associated with a statistically significant decrease in depression scores in men (-0.17 per MET; 95% CI -0.33, -0.02) but not women. This modest decrease may have been tempered by high fitness levels and low depression scores at baseline in this well-educated sample.

Fit and Tipsy? The Interrelationship between Cardiorespiratory Fitness and Alcohol Consumption and Dependence.

PURPOSE: To examine whether higher levels of cardiorespiratory fitness are related to increased alcohol consumption and dependence among a large sample of adults attending a preventive medicine clinic. METHODS: A cross-sectional study of 38,653 apparently healthy patients who visited the Cooper Clinic (Dallas, TX) for preventive medical examinations (1988-2019) and enrolled in the Cooper Center Longitudinal Study. The primary independent variable was cardiorespiratory fitness, based on a maximal treadmill test, and the dependent variables were alcohol consumption and dependence (self-reported). The relations between fitness category (low, moderate, high) and alcohol consumption (low, moderate, heavy) and suggested alcohol dependence (Cut down, Annoyed, Guilty, Eye opener score ≥2) among women and men were estimated via multivariable regression while adjusting for covariates (e.g., age, birth year cohort, marital status, and body mass index). RESULTS: Women within the moderate and high fitness categories had 1.58 (95% confidence interval [CI], 1.32-1.91) and 2.14 (95% CI, 1.77-2.58) greater odds of moderate/heavy alcohol consumption, respectively, in comparison to their low fitness counterparts. Similarly, moderate and high fit men had 1.42 (95% CI, 1.30-1.55) and 1.63 (95% CI, 1.49-1.80) times greater odds of moderate-to-heavy alcohol consumption, respectively, in comparison to the low fitness group. In addition, among men who were heavy drinkers (but not women), higher fitness levels were related to lower rates of suggested alcohol dependence. Specifically, these men had 45.7%, 41.7%, and 34.9% proportions of clinically relevant alcohol problems across low, moderate, and high fitness categories (adjusted P for trend <0.001). CONCLUSIONS: Higher fitness levels are significantly related to greater alcohol consumption among a large cohort of adult patients. Interventions focusing on increasing fitness (via physical activity promotion) might consider concurrently aiming to reduce alcohol consumption.