Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.

The objective of this study was to present nationally representative findings on sociodemographic and psychopathologic predictors of first incidence of Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) substance, mood and anxiety disorders using the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. One-year incidence rates of DSM-IV substance, mood and anxiety disorders were highest for alcohol abuse (1.02), alcohol dependence (1.70), major depressive disorder (MDD; 1.51) and generalized anxiety disorder (GAD; 1.12). Incidence rates were significantly greater (P<0.01) among men for substance use disorders and greater among women for mood and anxiety disorders except bipolar disorders and social phobia. Age was inversely related to all disorders. Black individuals were at decreased risk of incident alcohol abuse and Hispanic individuals were at decreased risk of GAD. Anxiety disorders at baseline more often predicted incidence of other anxiety disorders than mood disorders. Reciprocal temporal relationships were found between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. Borderline and schizotypal personality disorders predicted most incident disorders. Incidence rates of substance, mood and anxiety disorders were comparable to or greater than rates of lung cancer, stroke and cardiovascular disease. The greater incidence of all disorders in the youngest cohort underscores the need for increased vigilance in identifying and treating these disorders among young adults. Strong common factors and unique factors appear to underlie associations between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. The major results of this study are discussed with regard to prevention and treatment implications.

A method for estimating alcohol-related liver cirrhosis mortality in Japan.

In Japan, per capita alcohol consumption increased sharply during the post World War II period followed by an increase in cirrhosis mortality. The prevalence of alcoholic cirrhosis among hospitalized patients also increased, from 11% in 1969 to 18% in 1985. Despite an increase in the percentage of drinkers among young women, over 80% of women in Japan are still abstainers or light drinkers. Thus, female cirrhosis mortality rates can be used as a proxy measure of non-alcohol-related cirrhosis mortality rates to estimate alcohol-related cirrhosis deaths among Japanese men. Employing this method, we conclude that two-thirds of cirrhosis deaths among men between 24 and 85 years of age and half of all cirrhosis deaths were attributable to alcohol. Two factors are probably responsible for the differences in proportional morbidity and proportional mortality of alcohol-related cirrhosis: differences in survival rates between alcoholic and non-alcoholic cirrhosis patients and detection bias toward post-hepatic cirrhosis. The synergistic effect of alcohol on viral hepatitis may in part explain excess cirrhosis deaths among Japanese men.

Prevalence of alcohol problems among selected AIDS risk groups: United States, 1988.

Estimates of the prevalence of various alcohol problems (DSM-III-R alcohol abuse/dependence, heavier drinking, and consuming 5 or more/9 or more drinks per occasion) were examined for a general population group of 29,155 persons age 18 years and older at self-reported risk for contracting AIDS by several definitions. All AIDS risk groups showed elevated risk for alcohol problems. Results are presented separately for males and females and for various demographic groups (age, marital status, family income, education, and race).

Alcohol involvement in fatal traffic crashes in the United States: 1979-90.

Trends in alcohol-related traffic crash fatalities for the United States were examined with data from the Fatal Accident Reporting System for the years 1979-90. Alcohol-related traffic crash fatalities have decreased 10% over the 12 years studied, from 20,245 in 1979 to 18,279 in 1990. Fatality rates per 100 million vehicles miles traveled, and per 100,000 population, registered vehicles and licensed drivers have decreased even more sharply. Rates of blood alcohol testing of fatally injured drivers rose substantially among the States, with the nationwide rate increasing from 44% in 1979 to 75% in 1990. Factors that may be affecting these trends are discussed.

Assessment of the potential for surveillance of alcohol-related casualties using National Hospital Discharge Survey data.

It is well known that alcohol abuse is significantly involved in the incidence of casualties (that is, accidents and injuries as they are defined for the purpose of coding diagnoses in the International Classification of Diseases). Thus, a study was conducted of the feasibility of using data from the National Hospital Discharge Survey (NHDS) for the surveillance of alcohol-related casualties. Trends were analyzed over 7 years (1979-85), and results were discussed from three aspects: number and rates for comorbidity of injuries and accidents with alcohol-related diagnoses, percent of alcohol involvement for injuries and accidents, and proportionate morbidity for alcohol-related and nonalcohol-related injuries and accidents. The incidence of comorbidity and percent of alcohol involvement were found to be relatively low for both accidents and injuries--underreporting being a likely cause. Comorbidity rates over the 7-year period showed no major trends in the rates for injuries that were associated with alcohol use, but the rates for accidents that were associated with alcohol use increased in all but one of the years. Proportionate morbidity as reflected in hospital discharge records with alcohol-related diagnoses showed only small differences by sex and age group (except the 14 to 25 years group) for either injuries or accidents. Only the 25- to 44-year-old group showed a time-trend increase, and that is only for the accident category. For these reasons, we have concluded that data from the NHDS are not currently adequate for use in the surveillance of alcohol-related injuries and accidents.

Cirrhosis hospitalization and mortality trends, 1970-87.

The decline in cirrhosis mortality in recent years in light of increases in cirrhosis morbidity, as reflected in hospital discharge data, is examined. Although there does not appear to be a single explanation for the decline in mortality, it is suggested that increased identification and treatment, as measured by substantial increases in the rates of hospitalization involving cirrhosis, may be a contributing factor. If, as suggested by hospitalization data that indicate a decreasing proportion of patients with cirrhosis die during their hospital stay, a major portion of the increase in cirrhosis admissions was for patients with less severe cases, these patients would be more responsive to treatment and would have a relatively better prognosis. The identification of contributing factors that may be responsible for the decline in cirrhosis mortality can provide support for the continuation of early diagnosis and treatment in already identified populations. The same kind of support can be extended to other population subgroups that have yet to show the same decline in cirrhosis mortality.

Trends in alcohol-related morbidity and mortality.

Two major trends regarding alcohol use and consequences of alcohol abuse in the United States are showing significant improvement. Continued declines are evident in age-adjusted rates of liver cirrhosis mortality, and per capita alcohol consumption is at its lowest level in 15 years. Two other trends, however, are less clear. After declining in 1982 and continuing through 1984, alcohol-related morbidity--as measured by principal diagnoses listed on short-stay, community hospital discharges--showed a slight increase in 1985. Similarly, after declining every year but one since 1981, alcohol-related motor vehicle fatalities showed a significant increase in 1986. The downward trends suggest that progress is being made in efforts to reduce alcohol-related deaths and morbidity, but there are no easy explanations for any of the trends. Reductions in liver cirrhosis death rates may reflect coding changes in liver disease categories, less chronic heavy drinking, or better medical care. Lower per capita alcohol consumption may indicate the public's increased awareness of drinking risks or the aging of the U.S. population. Ironically, the recent increase in alcohol-related motor vehicle fatalities may reflect stronger enforcement of drunk driving laws and increased BAC (blood alcohol content) testing.

Average daily alcohol consumption during adult life among decedents with and without cirrhosis: the 1986 National Mortality Followback Survey.

The relationship of alcohol consumption and cirrhosis mortality was examined by sampling 1% of deaths in the U.S. using the 1986 National Mortality Followback Survey. Quantity and frequency of decedent's alcohol consumption was obtained from next of kin through mailed questionnaire. The percentage of decedents with cirrhosis increased sharply with the increasing number of drinks per day. Three drinks per day was associated with a significantly higher percentage of cirrhosis deaths compared with lifetime abstainers for both whites and blacks. Although blacks had a significantly higher percentage of abstainers than whites, of those persons who were reported to drink every day, blacks were more likely to be heavier drinkers (5 or more drinks per day). Blacks did not have a higher risk of cirrhosis mortality than whites for each drinking category. Although Native Americans were oversampled, the number of deaths was too small for statistical comparisons.

The effect of acculturation on drinking attitudes among Japanese in Japan and Japanese Americans in Hawaii and California.

Data from a joint Japan-U.S. collaborative study were examined to determine the relationship of acculturation to drinking attitudes among Japanese in Japan and Japanese Americans in Hawaii and California. Drinking attitudes (i.e., self-reported acceptable or appropriate levels of drinking) among ethnic groups differed significantly for the nine situations studied: (1) at a bar with friends, (2) at a party at someone else's house, (3) as a parent, spending time with small children, (4) during working hours, (5) visiting in-laws, (6) with friends at home, (7) with friends after work, (8) with people at sports events and (9) before driving a car. Factor analysis was used to determine the differences in drinking attitudes among these ethnic groups. Japanese and Japanese Americans differentiated drinking situations into different categories. The major difference between the two groups was that the Japanese associated spending time with small children with a situation appropriate for drinking, such as being with friends at home, whereas Japanese Americans associated spending time with small children with a situation inappropriate for drinking, such as before driving.

Alcohol-related mortality in the United States, 1979-1988.

Using alcohol-attributable fractions derived from studies of alcohol's involvement in various causes of death, this report presents trends in overall alcohol-related mortality for each year from 1979 through 1988. Age-adjusted rates show decreases in alcohol-related mortality for both sexes and for whites and nonwhites. Decreases occur for causes of death directly attributable to alcohol and for other diseases and injuries and adverse effects indirectly attributable to alcohol. Issues surrounding the use of currently available alcohol-attributable fractions for estimating alcohol-related mortality are discussed.

The critical dimension of ethnicity in liver cirrhosis mortality statistics.

BACKGROUND: In 1997, liver cirrhosis was the 10th leading cause of death in the United States. Beginning in the 1950s, liver cirrhosis mortality rates have been consistently higher for black than for white men and women. There has been a gradual adoption of the recommendation that all death certificates include information on the Hispanic origin of decedents, with universal adoption in the 1997 data year. It is the purpose of this study to examine the extent to which relative risks for cirrhosis mortality might shift for different demographic groups when Hispanic origin is considered along with the race and sex of the decedent. METHODS: Age-adjusted death rates were calculated for liver cirrhosis by using public-use data files produced by the National Center for Health Statistics. Trends in cirrhosis mortality rates from 1991 through 1997 are shown for white Hispanic, white non-Hispanic, black Hispanic, and black non-Hispanic men and women. RESULTS: In 1997, white Hispanic men show the highest cirrhosis mortality rates over the period examined, followed by black non-Hispanic and white non-Hispanic men, white Hispanic women, and black non-Hispanic and white non-Hispanic women. Among Hispanic decedents, the largest group was of Mexican ancestry, with large numbers being born outside the United States and having low education levels. CONCLUSIONS: The findings of higher risk for cirrhosis mortality among white men and women of Hispanic origin serve to focus new attention on these demographic groups. Collateral analyses of other causes of death do not support alternate explanations of these findings as artifacts of demographic misclassification. Future studies of amounts and patterns of alcohol consumption should include Hispanic origin among demographic factors examined.

Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: a 12-year follow-up.

PURPOSE: The purpose of this study was to examine the relationship between age at drinking onset and the development of DSM-IV alcohol abuse and dependence in a 12-year prospective study of youth in the United States. METHODS: Logistic regression analyses were used to quantify the relationship between age at drinking onset and the development of alcohol abuse and dependence controlling for sociodemographic factors and problem indicators. RESULTS: The odds of alcohol dependence decreased by 5% in 1989 and 9.0% in 1994 for each year drinking onset was delayed. In 1994, the odds of alcohol abuse increased by 7.0% with each decreasing year of age at drinking onset, while age at drinking onset was not related to alcohol abuse in 1989. Several other risk factors were found to be strong and consistent predictors of abuse and dependence in 1989 and 1994, including being male, divorced, separated or never married, younger, and having an early history antisocial behaviors and marijuana use. IMPLICATIONS: Implications of the results of this study are discussed in terms of other factors that may impact on the onset-abuse and onset-dependence relationship and the need to focus future prevention efforts.

The 5-year course of alcohol abuse among young adults.

PURPOSE: This study describes the course of alcohol abuse among a nationally representative sample of young adults over a 5-year time period for the purpose of examining the validity of the DSM-IV alcohol abuse category. METHODS: DSM-IV diagnoses of alcohol abuse at baseline and follow-up were examined using logistic regression analyses. RESULTS: Alcohol abuse and dependence were shown to have different courses. Very few abusers at Time 1 became dependent at Time 2, suggesting that abuse is not merely prodromal to dependence. Females, Blacks, and high school dropouts were less likely to receive an abuse diagnosis at baseline. Marital status, family history, earlier onset of drinking, and heavy drinking were also related to abuse at baseline. Alcohol abuse at baseline, in addition to gender, marital status, family history, early onset drinking, and heavy drinking, predicted abuse at follow-up. Exclusion of the hazardous criterion item "driving after drinking too much" from the abuse diagnosis yielded similar results. DISCUSSION: The DSM-IV alcohol abuse category was shown to have some diagnostic utility.

Genetic or cultural determinants of drinking: a study of embarrassment at facial flushing among Japanese and Japanese-Americans.

Facial flushing after the ingestion of alcohol is common among Asians. Flushers are genetically less able to tolerate alcohol than nonflushers and are less likely to become alcoholics. This study examined whether lower consumption of alcohol among flushers was correlated with cultural factors such as embarrassment over flushing as well as with biological factors among Japanese in Japan and Japanese-Americans using data from a joint Japan-U.S. collaborative survey. Eight hundred forty-six Japanese and 737 Japanese-American current drinkers with known flushing status were studied. The mean alcohol intake differed significantly between groups: (1) habitat--Japanese versus Japanese-Americans, (2) flushing status--flushers versus nonflushers, and (3) embarrassment about flushing. Among men, ethnicity was the major determinant of alcohol consumption, followed by flushing status and embarrassment about flushing. Among women, differences were not significant. Lower alcohol consumption by flushers than by nonflushers has been attributed to differences in physiological reactions to alcohol. However, this study demonstrated that cultural factors such as embarrassment also contribute to lower alcohol consumption by flushers. The lack of interaction between habitat and flushing status and between habitat and embarrassment status suggests that flushing status and embarrassment status associated with drinking levels are independent of habitat.

The association of drinking levels and drinking attitudes among Japanese in Japan and Japanese-Americans in Hawaii and California.

This study examined cross-cultural differences in drinking attitudes and drinking levels and their correlation among Japanese in Japan and Japanese-Americans in Hawaii or California. In most situations, an increase in drinking levels was associated with more tolerant drinking attitudes in all three groups. Abstainers were less likely to say that getting drunk is sometimes all right, whereas the reverse was true for heavier drinkers. Drinking levels among Japanese, especially among Japanese women, were not highly associated with how much drinking was perceived as acceptable in each situation, whereas among Japanese-Americans, drinking levels were highly associated with drinking attitudes. Although the Japanese had generally tolerant attitudes toward drinking, they indicated higher abstention rates before driving than Japanese-Americans regardless of their drinking levels. This may reflect the impact of public education on drunken driving in Japan.