Secondhand harms from cannabis use: Findings from Washington State, United States.

OBJECTIVE: There are few studies on harms attributed to others' cannabis use. We assessed individual- and contextual-level correlates of secondhand harms from cannabis use and considered whether cannabis legalization support, along with cannabis user status, predicted such harms. METHOD: Data were from five repeated cross-sectional, state-representative telephone surveys of Washington State residents ages 18 and over, years 2014-2016. For four surveys, outcome variables were past 12-month reports of experiencing any of five harms (family, traffic-related, vandalism, physical or financial), and in 2016 only, three harm types separately: 1) harassment, 2) safety-related (traffic, vandalism, physical), 3) family or financial, attributed to another's cannabis use. All models included a three-category typology comprised of participants' own cannabis use and whether they supported cannabis use legalization (user supporter, non-user non-supporter, non-user supporter). We estimated logistic regression models for the full sample and by gender, adjusting for individual- and Census tract-level covariates. RESULTS: Compared to non-cannabis-users supporting legalization, nonusers who did not support legalization reported significantly greater odds of perceiving secondhand cannabis harms. Cannabis users supporting legalization did not differ from nonuser supporters. Predictors of reported harms also differed by gender. While current drinkers had lower odds of reporting any harm from others' cannabis use overall, heavy drinking women but not men reported greater odds of any cannabis secondhand harm. CONCLUSIONS: Augmenting research on individual harms associated with cannabis use by including secondhand impacts such as social and family problems, along with safety risks, provides a more comprehensive picture of the effects of cannabis use.

Long-term trends in beverage-specific drinking in the National Alcohol Surveys: Differences by sex, age, and race and ethnicity.

BACKGROUND: Despite substantial declines in underage drinking and binge drinking, alcohol consumption has increased in the past 30 years. This study examined how beverage-specific drinking patterns varied by sex, age, and race and ethnicity from 1979 to 2020. METHODS: Secondary data analysis was conducted on pooled data from the National Alcohol Survey series from 1979 to 2020 of a sample of U.S. adults ages 18 years or older. Total and beverage-specific volume were calculated from graduated frequency questions on reported beverage type, which included beer, wine, and spirits. Sex-stratified analyses focused on descriptive trends of each alcohol measure over time and by age and race and ethnicity. Time-varying effect models were also conducted to identify subgroups at higher risk for increased consumption over time. RESULTS: Women's drinking increased, with alcohol volume rising substantially from 2000 to 2020; the largest increase was among women 30 and older. Men's alcohol volume also rose over this period but remained below the levels of 1979 and 1984, with older adults increasing their consumption those 18-29 decreased their drinking. Beverage-specific trends showed some similarities by gender: in 2020, wine volume was at its highest level for both women and men, while spirits volume also was at its highest level for men and in women was tied with the 1979 peak in spirits consumption. Increases were also found among Black men and women and Latina women from 2000 to 2020. CONCLUSIONS: Given the increases in alcohol volume, particularly among women and older age groups, alcohol policy, interventions, and education should consider ways to reduce harms associated with alcohol use among these groups. Continued monitoring of beverage-specific drinking patterns is needed to track policy-relevant changes.

Associations between simultaneous use of alcohol and cannabis and cannabis-related problems in 2014-2016: evidence from the Washington panel survey.

BACKGROUND: To address the research question of how simultaneous users of alcohol and cannabis differ from concurrent users in risk of cannabis use problems after the recreational marijuana legalization in Washington State. METHODS: We used generalized estimating equations with a Poisson distribution to analyze the association between simultaneous use of alcohol and marijuana (SAM) and cannabis-related problems compared to concurrent use. The data is a longitudinal sample of drinkers and cannabis users (n = 257, 47% female) aged 18 years and older from Washington State in 2014-2016. We adjusted for survey weights to account for differential probability of selection and response rates. The primary outcome is the past-six-month CUDIT problem subscale (ranging from 0 to 28), which is the total score for seven CUDIT problem items, after excluding the three items that covered marijuana use frequency. Covariates include marijuana use frequency (daily/near daily use, regular use, or infrequent use), marijuana daily quantity, alcohol daily volume, panel survey cycle, medical marijuana recommendation, driving time to nearest marijuana outlet, age of marijuana use onset, and other demographics. RESULTS: After adjusting for covariates, we found that compared to concurrent use, SAM was significantly positively associated with CUDIT problem subscale (IRR = 1.68, 95% CI: 1.25-2.27, p < 0.001); daily/near daily use of marijuana was strongly significantly associated with CUDIT problem subscale compared with infrequent use (IRR = 5.1, 2.71-9.57, p < 0.001) or regular use (IRR = 3.05, 1.91-4.85, p < 0.001). Secondary analyses using CUDIT total score as the outcome also showed a significant positive association with SAM compared to concurrent use (IRR = 1.17, 1.02-1.34, p < 0.05). CONCLUSIONS: This study highlighted the importance of SAM, in addition to cannabis use frequency for predicting cannabis-related problems.

Life-course Accumulated Cannabis Use and Recent Cannabis-related Problems in the Washington Panel Survey.

BACKGROUND: Previous studies have only investigated the short-term association of recent cannabis use with cannabis-related problems, without accounting for the onset, duration, and variations in frequency of use in the life-course. METHODS: We obtained data from the Washington panel survey during 2014-2016. We constructed accumulated lifetime exposure to cannabis use, heavy drinking (5+ drinks on one occasion), and cigarette pack-years from age of onset based on a series of decades-based questions on cannabis use and heavy drinking, and tobacco use history. We used Generalized Estimating Equation with Poisson distribution to investigate the association between accumulated cannabis use and the past-6-month CUDIT score. We adjusted for accumulated heavy drinking and cigarette pack-years, substance co-use variables, demographics, and applied survey weights. RESULTS: We found strong and statistically significant correlations for the lifetime measures across the four panel surveys, indicating that the life-course measures of cannabis use and heavy drinking were largely reliable. We found a statistically significant relationship between the lifetime accumulated exposure to cannabis and CUDIT. The results were robust to the inconsistencies in reported frequencies and onset age across panel surveys. CONCLUSIONS: This study established the relationship between lifetime exposure to cannabis and cannabis-related problems in a representative sample of drinkers and marijuana users in Washington state. We have also provided test-retest validity and question details for the decades-based cannabis and heavy drinking measures to facilitate their use in future studies of cannabis and alcohol-related outcomes.

Estimating Web Survey Mode and Panel Effects in a Nationwide Survey of Alcohol Use.

Random-digit dialing (RDD) telephone surveys are challenged by declining response rates and increasing costs. Many surveys that were traditionally conducted via telephone are seeking cost-effective alternatives, such as address-based sampling (ABS) with self-administered web or mail questionnaires. At a fraction of the cost of both telephone and ABS surveys, opt-in web panels are an attractive alternative. The 2019-2020 National Alcohol Survey (NAS) employed three methods: (1) an RDD telephone survey (traditional NAS method); (2) an ABS push-to-web survey; and (3) an opt-in web panel. The study reported here evaluated differences in the three data-collection methods, which we will refer to as "mode effects," on alcohol consumption and health topics. To evaluate mode effects, multivariate regression models were developed predicting these characteristics, and the presence of a mode effect on each outcome was determined by the significance of the three-level effect (RDD-telephone, ABS-web, opt-in web panel) in each model. Those results were then used to adjust for mode effects and produce a "telephone-equivalent" estimate for the ABS and panel data sources. The study found that ABS-web and RDD were similar for most estimates but exhibited differences for sensitive questions including getting drunk and experiencing depression. The opt-in web panel exhibited more differences between it and the other two survey modes. One notable example is the reporting of drinking alcohol at least 3-4 times per week, which was 21 percent for RDD-phone, 24 percent for ABS-web, and 34 percent for opt-in web panel. The regression model adjusts for mode effects, improving comparability with past surveys conducted by telephone; however, the models result in higher variance of the estimates. This method of adjusting for mode effects has broad applications to mode and sample transitions throughout the survey research industry.

Designing Effective Alcohol Warnings: Consumer Reactions to Icons and Health Topics.

Introduction: New warning labels for alcohol could reduce alcohol-related health harms. This study examined consumer responses to alcohol warnings with different designs. Methods: A national sample of 3,051 U.S. adults completed an online survey in August 2021. Participants were randomized to 1 of 4 warning topics (addiction, liver damage, early death, or colon cancer). Participants viewed 3 labels, presented in random order: 2 types of warning labels (text-only and icon) showing a newly developed warning message about their assigned topic and a text-only control label showing a neutral message. Participants rated each label on effectiveness at discouraging alcohol consumption (primary outcome) and attention (secondary outcome) using 1 to 5 Likert-type scales. Participants also rated warnings with different causal language variants (e.g., "increases risk of," "contributes to") and marker words (e.g., "WARNING," "SURGEON GENERAL WARNING"). Results: Both the text-only and icon warnings were perceived as more effective (Average Differential Effects [ADEs]=0.79 and 0.86, respectively) and more attention-grabbing (ADEs=0.43 and 0.69, respectively) than control labels (all ps<0.001). The icon warnings were rated as more effective and attention-grabbing than the text-only warnings (ADEs=0.07 and 0.27, respectively, both ps<0.001). Although all warning topics outperformed the control messages, warnings about addiction were rated as less effective and attention-grabbing than the other topics. A majority (60%) of participants selected "increases risk of" as the most discouraging causal variant and a plurality (47%) selected "SURGEON GENERAL WARNING" as the most discouraging marker word. Conclusions: New alcohol warnings could discourage alcohol consumption, especially if warnings include icons.

Beverage- and Context-Specific Alcohol Consumption During COVID-19 in the United States: The Role of Alcohol To-Go and Delivery Purchases.

OBJECTIVE: Alcohol delivery and to-go sales may contribute to changes in drinking patterns, including where and what people drink. This study tested whether home delivery and to-go alcohol purchases were associated with context- and beverage-specific consumption volumes during the first year of the COVID-19 pandemic after adjusting for pre-pandemic consumption volumes. METHOD: Data from a pre-pandemic panel were compared to a during-pandemic panel of the National Alcohol Survey (n = 1,150 adult drinkers, 52.7% female). Outcomes were past-year alcohol consumption volumes in standard drinks (overall, by beverage type, and by location). Independent variables included past-year alcohol delivery and to-go purchases (separately). Covariates comprised baseline beverage- or context-specific volume, demographics, COVID-19 impacts, and drinking motivations. Negative binomial regression tested associations between alcohol purchases and change in overall, beverage-, and context-specific consumption. RESULTS: On average, respondents who had alcohol delivered (vs. not) reported consuming larger volumes overall (incidence rate ratio [IRR] = 1.58, 95% CI [1.07, 2.32], p = .02), of wine (IRR = 2.90, 95% CI [1.50, 5.63], p < .04), of spirits (IRR = 1.59, 95% CI [1.03, 2.44], p = .04), and at home (IRR = 1.59, 95% CI [1.10, 2.31], p = .01). People who bought alcohol to go (vs. not) reported larger volumes of wine (IRR = 1.41, 95% CI [1.02, 1.96], p = .04), at home (IRR = 1.60, 95% CI [1.10, 2.32], p = .01), and in bars (IRR = 4.55, 95% CI [2.55, 8.11], p < .001). Finally, people who had alcohol delivered reported drinking smaller volumes in bars (IRR = 0.49, 95% CI [0.24, 0.98], p = .04). CONCLUSIONS: During the first year of the pandemic, adults who had alcohol delivered or bought it to go reported larger volumes for several locations and beverage types.

Characteristics associated with buying alcohol to-go and for delivery during the first year of the COVID-19 pandemic among a national sample of US adults.

INTRODUCTION: This study: (i) determined the population coverage of alcohol delivery and to-go/carryout policies (i.e., policies permitting bars/restaurants to sell individual drinks for off-site consumption) in 2019 and 2020; and (ii) identified characteristics associated with alcohol delivery and to-go purchases. METHODS: Data are from the National Alcohol Survey and Alcohol Policy Information System (n = 1677 adults, 52.1% female). Population coverage models summed state populations across state-level bar/restaurant delivery and to-go/carryout policies by beverage. Regression outcomes were past-year alcohol delivery and to-go purchases. Independent variables included demographics, excessive drinking, COVID-19 impacts and state COVID-19 bar/restaurant alcohol laws. Chi-squared tests and logistic regression models tested associations between delivery/to-go purchases and independent variables. RESULTS: Overall, 7.5% of adults had alcohol delivered and 14.5% bought alcohol to-go. From December 2019 to December 2020, the number of people living in states allowing beer/wine/spirits delivery (284%) and to-go sales (627%) rose steeply. People who were Black (vs. White; adjusted odds ratio [aOR] 2.92, p < 0.001), excessive drinkers (vs. non-excessive drinkers; aOR 2.06, p < 0.001) or lived in states allowing beer/wine/spirits to-go sales (aOR 2.20, p = 0.01) had higher odds of buying alcohol to-go. Conversely, older people had lower odds of buying alcohol to-go (aOR 0.97, p < 0.001). People with some college or more (vs. high school degree or less, aOR 2.21, p < 0.001) and a higher economic burden (vs. fewer COVID-19 impacts, aOR 2.32, p = 0.05) had higher odds of alcohol delivery. DISCUSSION AND CONCLUSIONS: A select sub-population defined by socioeconomic status, race, excessive drinking and state policies bought alcohol for delivery or to-go in the Unites States.

Changes in sugar-sweetened beverage consumption in the first two years (2018 - 2020) of San Francisco's tax: A prospective longitudinal study.

BACKGROUND: Sugar sweetened beverage (SSB) taxes are a promising strategy to decrease SSB consumption, and their inequitable health impacts, while raising revenue to meet social objectives. In 2016, San Francisco passed a one cent per ounce tax on SSBs. This study compared SSB consumption in San Francisco to that in San José, before and after tax implementation in 2018. METHODS & FINDINGS: A longitudinal panel of adults (n = 1,443) was surveyed from zip codes in San Francisco and San José, CA with higher densities of Black and Latino residents, racial/ethnic groups with higher SSB consumption in California. SSB consumption was measured at baseline (11/17-1/18), one- (11/18-1/19), and two-years (11/19-1/20) after the SSB tax was implemented in January 2018. Average daily SSB consumption (in ounces) was ascertained using the BevQ-15 instrument and modeled as both continuous and binary (high consumption: ≥6 oz (178 ml) versus low consumption: <6 oz) daily beverage intake measures. Weighted generalized linear models (GLMs) estimated difference-in-differences of SSB consumption between cities by including variables for year, city, and their interaction, adjusting for demographics and sampling source. In San Francisco, average SSB consumption in the sample declined by 34.1% (-3.68 oz, p = 0.004) from baseline to 2 years post-tax, versus San José which declined 16.5% by 2 years post-tax (-1.29 oz, p = 0.157), a non-significant difference-in-differences (-17.6%, adjusted AMR = 0.79, p = 0.224). The probability of high SSB intake in San Francisco declined significantly more than in San José from baseline to 2-years post-tax (AOR[interaction] = 0.49, p = 0.031). The difference-in-differences of odds of high consumption, examining the interaction between cities, time and poverty, was far greater (AOR[city*year 2*federal poverty level] = 0.12, p = 0.010) among those living below 200% of the federal poverty level 2-years post-tax. CONCLUSIONS: Average SSB intake declined significantly in San Francisco post-tax, but the difference in differences between cities over time did not vary significantly. Likelihood of high SSB intake declined significantly more in San Francisco by year 2 and more so among low-income respondents.

High Intensity Drinking (HID) Assessed by Maximum Quantity Consumed Is an Important Pattern Measure Adding Predictive Value in Higher and Lower Income Societies for Modeling Alcohol-Related Problems.

Adjusting for demographics and standard drinking measures, High Intensity Drinking (HID), indexed by the maximum quantity consumed in a single day in the past 12 months, may be valuable in predicting alcohol dependence other harms across high and low income societies. The data consisted of 17 surveys of adult (15,460 current drinkers; 71% of total surveyed) in Europe (3), the Americas (8), Africa (2), and Asia/Australia (4). Gender-disaggregated country analyses used Poison regression to investigate whether HID (8-11, 12-23, 24+ drinks) was incrementally influential, beyond log drinking volume and HED (Heavy Episodic Drinking, or 5+ days), in predicting drinking problems, adjusting for age and marital status. In adjusted models predicting AUDIT-5 for men, adding HID improved the overall model fit for 11 of 15 countries. For women, 12 of 14 countries with available data showed an improved fit with HID included. The results for the five Life-Area Harms were similar for men. Considering the results by gender, each country showing improvements in model fit by adding HID had larger values of the average difference between high intensity and usual consumption, implying variations in amounts consumed on any given day. The amount consumed/day often greatly exceeded HED levels. In many societies of varying income levels, as hypothesized, HID provided important added information on drinking patterns for predicting harms, beyond the standard volume and binging indicators.

Inequitable access to general and behavioral healthcare in the US during the COVID-19 pandemic: A role for telehealth?

Wide-ranging effects of the COVID-19 pandemic have led to increased psychological distress and alcohol consumption, and disproportionate hardship for disadvantaged groups. Early in the pandemic, telehealth services were expanded to maintain healthcare access amidst lockdowns, medical office closures, and fear of infection. This study examines general and behavioral healthcare access and disparities during the first year of the pandemic. Data are from the 2019-2020 US National Alcohol Survey (collected February 2019 to April 2020) and its COVID follow-up survey conducted January 30 to March 28, 2021 (N = 1819). General and behavioral healthcare-related outcomes were assessed at follow-up, and included perceived need for and receipt of care, delayed care, and use of telehealth since April 1, 2020. Results indicate that the majority of respondents with perceived need for healthcare received some behavioral healthcare (reported by 63%) and particularly general healthcare (88%), but nearly half (48%) delayed needed care. Delays were mostly due to COVID-related reasons, but cost barriers also were common and significantly impeded care-seeking by uninsured persons, young adults, rural residents, and persons whose employment was reduced by the pandemic. Disparities in the receipt of healthcare were pronounced for Hispanic/Latinx (vs. White) and lower-income (vs. higher-income) groups (AORs <0.37, p's < 0.05). Notably, telehealth was commonly used by Hispanic/Latinx and lower-income groups for general and particularly behavioral healthcare. Results suggest that telehealth has provided an important bridge to healthcare for certain medically underserved groups during the pandemic, and may be vital to future efforts to increase equity in healthcare access.

Predictors of alcohol screening quality in a US general population sample and subgroups of heavy drinkers.

Alcohol screening is one of the most cost-effective clinical preventive services and important for intervening in the development of alcohol problems. We examine predictors of the quality of alcohol screening, approximated by alcohol quantity screening, which is a prerequisite for appropriate counseling, and compare conventional regression approach with Classification and Regression Trees (CART). Data come from the 2020 National Alcohol Survey, a population survey of US adults aged 18 years and over. Analyses focus on those reporting any alcohol screening at all (N = 989). The primary outcome was whether a healthcare profession had ever asked how much they drink, which is necessary to identify heavy drinking. We examined 12 potential predictors of alcohol quantity: gender, age, race and ethnicity, education, marital status, having a usual source of primary care, insurance, and health conditions. Analyses were replicated in heavy episodic drinking (HED) and high intensity drinking (HID) subgroups, both warranting alcohol counseling. Logistic regression results show that having diabetes and not having a college degree predict missed alcohol quantity screening in the sample overall, and younger age predicts missed alcohol quantity screening in the HED/HID subgroups. CART identified Black and Hispanic respondents who had not attended college at high risk of missed screening for heavy drinking in the overall sample, and those with public insurance at high risk of missed screening for heavy drinking in the HED/HID subgroups. The quality of alcohol screening needs improvement in general, and to avoid unintended disparities in alcohol-related health services.

Longitudinal assessment of drinking changes during the pandemic: The 2021 COVID-19 follow-up study to the 2019 to 2020 National Alcohol Survey.

BACKGROUND: Surveys of changes in drinking during the COVID-19 pandemic have primarily relied on retrospective self-report. Further, most such surveys have not included detailed measures of alcohol use patterns, such as beverage-specific consumption, nor measures of alcohol use disorder (AUD) symptoms that would allow a comprehensive understanding of changes in alcohol use. METHODS: Data from 1819 completed interviews from the N14C follow-up survey to the 2019 to 2020 National Alcohol Survey (N14) were conducted between January 30 and March 28, 2021. Questions on alcohol use from the Graduated Frequency series, beverage-specific quantity and frequency, and DSM-5 AUD items were asked in both surveys and used to estimate changes from pre-pandemic drinking to drinking during the pandemic. Analyses focus on changes in these measures over time and comparisons between key subgroups defined by gender, race/ethnicity, and age. RESULTS: Key findings include particularly large increases in drinking and AUD for African Americans and women, reduced drinking and heavy drinking prevalence among men and White respondents, and a concentration of increased drinking and AUD among respondents aged 35 to 49. Increases in alcohol use were found to be driven particularly by increases in drinking frequency and the consumption of spirits. CONCLUSIONS: Results confirm prior findings of overall increases and subgroup-specific changes, and importantly, provide detailed information on the patterns of change across major socio-demographic subgroups. Substantial increases in the prevalence of DSM-5 moderate to severe AUDs are a novel finding that is of particular concern.

Substance use and misuse patterns and disability status in the 2020 US National Alcohol Survey: A contributing role for chronic pain.

BACKGROUND: Evidence about substance use and misuse among adults with disabilities is still emerging, despite increased risk of chronic pain and mental health problems, which are in turn risk factors for substance use and misuse. OBJECTIVE: We examined substance use and misuse among adults with selected self-reported disability (versus without), controlling for sociodemographics, depression/anxiety, physical health, and chronic pain, and assessed whether associations could be attributed to chronic pain. METHODS: Data are from the nationally representative 2020 US National Alcohol Survey. Disability indicators included sensory or mobility impairment, receiving Medicare before age 65, and/or unemployment due to disability. Regression analyses determined associations of disability with past-year substance use and misuse. Mediation analyses examined the role of chronic pain. RESULTS: Approximately 18% met 1+ disability criterion, representing 42.8 million adults. Disability was associated with reduced odds of current drinking (OR = 0.77, p < 0.01), but greater odds of daily nicotine use (OR = 1.43, p < 0.01), any drug use (OR = 1.32 p < 0.01), prescription drug misuse (OR = 1.99, p < 0.001), and other drug use (OR = 2.02, p < 0.001). Disability was not associated with high-intensity drinking or marijuana use. Chronic pain accounted for 17-38% of the association between disability and nicotine use, any drug use, prescription drug misuse, and other drug use. CONCLUSIONS: Findings indicated higher rates of substance use and misuse among people with disabilities, accounting for depression/anxiety, physical health, and chronic pain, with pain being a significant mediator. Substance use screening, brief intervention, and treatment should include appropriate accommodations for disabilities, inclusive of comprehensive pain management options.

Mental health and drinking to cope in the early COVID period: Data from the 2019-2020 US National Alcohol Survey.

BACKGROUND: Studies show drinking to cope and mental health problems have increased during the COVID-19 pandemic, however, their samples have been limited by convenience sampling or lack of a pre-pandemic measure. We examined the early impact of the COVID-19 pandemic on mental health, drinking to cope and their association using a probability-based sample of the US adult population. METHODS: Data was drawn from the probability samples of the 2019-2020 National Alcohol Survey (N = 7,233) to examine differences in drinking to cope and symptoms of depression and anxiety. Analyses compared participants who responded to the survey just prior to the widespread onset of the pandemic to those who responded after March 2020, in the total sample and by sex. RESULTS: Respondents in the early- vs. pre-COVID-19 period had a 1.48 higher odds (p = 0.03) of higher agreement with drinking to forget one's worries and problems, with a significant association observed among women only. Respondents with symptoms of depression and anxiety had a 2.94 and 1.56 higher odds, respectively, of higher agreement with drinking to forget one's worries. We observed significant associations between early- vs. pre-COVID-19 period, depression and anxiety symptoms, and drinking to forget one's worries among women only; however, moderation by sex in the total sample was not statistically significant. CONCLUSIONS: We observed higher prevalence of depression and anxiety symptoms and greater drinking to forget worries in the early months of COVID restrictions relative to the period just prior, with some effects more prominent among women. These observations call for sustained monitoring of and support for the mental health of the general population, and of women in particular during the course of the pandemic.

An integrated dual process simulation model of alcohol use behaviours in individuals, with application to US population-level consumption, 1984-2012.

INTRODUCTION: The Theory of Planned Behaviour (TPB) describes how attitudes, norms and perceived behavioural control guide health behaviour, including alcohol consumption. Dual Process Theories (DPT) suggest that alongside these reasoned pathways, behaviour is influenced by automatic processes that are determined by the frequency of engagement in the health behaviour in the past. We present a computational model integrating TPB and DPT to determine drinking decisions for simulated individuals. We explore whether this model can reproduce historical patterns in US population alcohol use and simulate a hypothetical scenario, "Dry January", to demonstrate the utility of the model for appraising the impact of policy interventions on population alcohol use. METHOD: Constructs from the TPB pathway were computed using equations from an existing individual-level dynamic simulation model of alcohol use. The DPT pathway was initialised by simulating individuals' past drinking using data from a large US survey. Individuals in the model were from a US population microsimulation that accounts for births, deaths and migration (1984-2015). On each modelled day, for each individual, we calculated standard drinks consumed using the TPB or DPT pathway. In each year we computed total population alcohol use prevalence, frequency and quantity. The model was calibrated to alcohol use data from the Behavioral Risk Factor Surveillance System (1984-2004). RESULTS: The model was a good fit to prevalence and frequency but a poorer fit to quantity of alcohol consumption, particularly in males. Simulating Dry January in each year led to a small to moderate reduction in annual population drinking. CONCLUSION: This study provides further evidence, at the whole population level, that a combination of reasoned and implicit processes are important for alcohol use. Alcohol misuse interventions should target both processes. The integrated TPB-DPT simulation model is a useful tool for estimating changes in alcohol consumption following hypothetical population interventions.

Prospective Multicenter Comparison of Open and Robotic Radical Prostatectomy: The PROST-QA/RP2 Consortium.

PURPOSE: Our goal was to evaluate the comparative effectiveness of robot-assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) in a multicenter study. MATERIALS AND METHODS: We evaluated men with localized prostate cancer at 11 high-volume academic medical centers in the United States from the PROST-QA (2003-2006) and the PROST-QA/RP2 cohorts (2010-2013) with a pre-specified goal of comparing RALP (549) and ORP (545). We measured longitudinal patient-reported health-related quality of life (HRQOL) at pre-treatment and at 2, 6, 12, and 24 months, and pathological and perioperative outcomes/complications. RESULTS: Demographics, cancer characteristics, and margin status were similar between surgical approaches. ORP subjects were more likely to undergo lymphadenectomy (89% vs 47%; p <0.01) and nerve sparing (94% vs 89%; p <0.01). RALP vs ORP subjects experienced less mean intraoperative blood loss (192 vs 805 mL; p <0.01), shorter mean hospital stay (1.6 vs 2.1 days; p <0.01), and fewer blood transfusions (1% vs 4%; p <0.01), wound infections (2% vs 4%; p=0.02), other infections (1% vs 4%; p <0.01), deep venous thromboses (0.5% vs 2%; p=0.04), and bladder neck contractures requiring dilation (1.6% vs 8.3%; p <0.01). RALP subjects reported less pain (p=0.04), less activity interference (p <0.01) and higher incision satisfaction (p <0.01). Surgical approach (RALP vs ORP) was not a significant predictor of longitudinal HRQOL change in any HRQOL domain. CONCLUSIONS: In high-volume academic centers, RALP and ORP patients may expect similar long-term HRQOL outcomes. Overall, RALP patients have less pain, shorter hospital stays, and fewer post-surgical complications such as blood transfusions, infections, deep venous thromboses, and bladder neck contractures.

Childhood Experiences and High-Intensity Drinking Among American Indian and Alaska Native Adults: Findings From the 2000-2015 National Alcohol Surveys.

OBJECTIVE: The purpose of this study was to examine associations with high-intensity drinking (HID) in American Indian/Alaska Native (AI/AN) populations and compare them to White and other minority groups using four National Alcohol Surveys, 2000 to 2015 (total N = 29,571; AI/ANs = 434). METHOD: Current drinking and HID (8+ and 12+ drinks on any day) from maximum drinks in the prior 12 months were analyzed with independent variables and race/ethnicity (AI/AN, non-Hispanic White, and other racial/ethnic groups combined). Adjusted logistic regression models comprised gender, age, marital status, employment, education, survey year, rurality, and especially, childhood trauma (physical/sexual abuse), and biological family alcohol problem history (each dichotomous). RESULTS: In adjusted population models, Whites had twice the odds of current drinking as AI/ANs, with no difference between other racial/ethnic groups and AI/ANs. Descriptively, AI/AN drinkers consumed at higher intensity levels than other groups, with higher prevalence of childhood trauma and family problem drinking than others. However, on a population basis, adjusting for all factors, apparent differences between AI/AN and White HID were eliminated; other minority groups together, compared with AI/ANs, showed lower odds of consuming 8+ drinks. CONCLUSIONS: AI/ANs had a higher prevalence of childhood trauma and family alcohol problems as well as lower current drinking likelihood compared with Whites. In adjusted population models, the combined other minorities group was less likely to ever consume 8+ drinks than AI/ANs. In all populations, childhood trauma and family alcohol problems increased the risk of HID, strongly so in AI/ANs. Addressing childhood trauma and family problems is important among AI/ANs to break generational cycles of drinking extreme amounts per occasion.