Controlled observational study and economic evaluation of the effect of city-centre night-time alcohol intoxication management services on the emergency care system compared with usual care.

BACKGROUND: Alcohol intoxication management services (AIMS) provide an alternative care pathway for alcohol-intoxicated adults otherwise requiring emergency department (ED) services and at times of high incidence. We estimate the effectiveness and cost-effectiveness of AIMS on ED attendance rates with ED and ambulance service performance indicators as secondary outcomes. METHODS: A controlled longitudinal retrospective observational study in English and Welsh towns, six with AIMS and six without. Control and intervention cities were matched by sociodemographic characteristics. The primary outcome was ED attendance rate per night, secondary analyses explored hospital admission rates and ambulance response times. Interrupted time series analyses compared control and matched intervention sites pre-AIMS and post-AIMS. Cost-effectiveness analyses compared the component costs of AIMS to usual care before with results presented from the National Health Service and social care prospective. The number of diversions away from ED required for a service to be cost neutral was determined. RESULTS: Analyses found considerable variation across sites, only one service was associated with a significant reduction in ED attendances (-4.89, p<0.01). The services offered by AIMS varied. On average AIMS had 7.57 (mean minimum=1.33, SD=1.37 to mean maximum=24.66, SD=12.58) in attendance per session, below the 11.02 diversions away from ED at which services would be expected to be cost neutral. CONCLUSIONS: AIMSs have variable effects on the emergency care system, reflecting variable structures and processes, but may be associated with modest reductions in the burden on ED and ambulance services. The more expensive model, supported by the ED, was the only configuration likely to divert patients away from ED. AIMS should be regarded as fledgling services that require further work to realise benefit. TRIAL REGISTRATION NUMBER: ISRCTN63096364.

Risk factors and costs associated with 30-day readmissions following alcohol-related hospitalizations in the United States from 2010 to 2015.

Patients with alcohol-related diagnoses at initial hospitalization are at high risk of 30-day readmission. Understanding risk factors for 30-day readmission among these patients may help to identify those who would benefit from efforts to reduce risk of readmission. The Nationwide Readmissions Database was used to estimate 30-day all-cause readmissions among United States patients with an alcohol-related index hospitalization and to evaluate risk factors and costs associated with these readmissions. Included patients were 18 years of age or older at initial hospitalization, had an alcohol-related primary diagnosis (based on ICD-9-CM codes), and were discharged between 2010 and 2015. They were followed for 30 days after initial hospitalization within the calendar year to identify all-cause readmissions. A logistic regression analysis assessed the association between risk factors and 30-day readmission. Average costs of initial admissions and readmissions were estimated. Among 113,931,723 adult index hospitalizations, 1,124,228 had alcohol-related diagnoses. Patients had a mean age of 49 years, 73% were male, and 45% had public insurance coverage. The annual rate of 30-day readmissions among patients with index alcohol-related hospitalizations increased from 119 readmissions per 1000 admissions in 2010 to 140 per 1000 in 2015, while the rate of readmissions among patients with all-cause hospitalizations declined from 103 to 98 per 1000. The regression analysis suggested that age, male sex, comorbid conditions, discharge against medical advice, admission to large and teaching hospitals, and Medicaid vs. non-Medicaid payment were all risk factors for 30-day readmission. Mean costs of initial alcohol-related hospitalizations were greater among those with a 30-day readmission than without a 30-day readmission, and the mean cost of 30-day readmission was even greater. Mitigating the upward trend in rates of readmission following alcohol-related initial hospitalizations may be addressed through better identification of high-risk patients who are admitted with an alcohol-related diagnosis and greater use of existing evidence-based psychosocial and pharmacotherapy treatment methods.

'Just Right': Balance, tranquility, and drunkenness in rural Yucatán.

In one rural community in Yucatán, many residents express concerns about the disruption alcohol use poses to the calm of everyday life and the wellbeing of individuals, families, and society. At the same time, men who drink point to tangible ways in which alcohol consumption relieves them of suffering and brings pleasure. Aware of the often-negative effects of their drinking, these men root their desire to get drunk in structural inequalities and resultant stress. Through analysis of extended ethnographic research, this paper explores drinking as a practice through which the complex and sometimes contradictory nature of care in modern life in rural Yucatán is exposed. Care through and against alcohol consumption reveals a convergence of suffering and privilege, one that is, in some ways, uniquely local and, in other ways, reflective of working-class masculinity in many parts of the world.

The healthcare costs of intoxicated patients who survive ICU admission are higher than non-intoxicated ICU patients: a retrospective study combining healthcare insurance data and data from a Dutch national quality registry.

BACKGROUND: The aim of this study was to describe the healthcare costs of intoxicated ICU patients in the year before and the year after ICU admission, and to compare their healthcare costs with non-intoxicated ICU patients and a population based control group. METHODS: We conducted a retrospective cohort study, combining a national health insurance claims database and a national quality registry database for ICUs. Claims data in the timeframe 2012 until 2014 were combined with the clinical data of patients who had been admitted to an ICU during 2013. Three study populations were compared and matched according to socioeconomic status, type of admission, age and gender: an "ICU population", an "intoxication population" and a "control population" (who had never been on the ICU). RESULTS: 2591 individual "intoxicated ICU patients" were compared to 2577 general "ICU patients" and 2591 patients from the "control population". The median and interquartile ranges (IQR) healthcare costs per day alive for the "intoxicated ICU patients" were higher during the year before ICU admission (€20.3 (IQR €3.6-€76.4)) and the year after ICU admission (€23.9 (IQR €5.1-€82.4)) compared to the ICU population (€6.1 (IQR €0.9-€29.3) and €13.6 (IQR €3.3-€54.9) respectively) and a general control population (€1.1 (IQR €0.3-€4.6) and €1.1 (IQR €0.4-€4.9) respectively). The healthcare associated costs in intoxicated ICU patients were correlated with the number of chronic conditions present prior ICU admission (p < 0.0001). CONCLUSIONS: Intoxicated patients admitted to the ICU had in the year before and after ICU admission much higher median healthcare costs per day alive compared to other ICU patients and a general population control group. Healthcare costs are greatly influenced by the number of psychiatric and other chronic conditions of these intoxicated patients.

Brief Report: Trends in Social Inequality in Drunkenness Among Danish Adolescents, 1991-2014.

OBJECTIVE: This study examined whether social inequality in frequent drunkenness among Danish adolescents changed from 1991 to 2014. METHOD: We used data from the international Health Behaviour in School-aged Children (HBSC) study, which provided nationally representative samples of 15-year-olds from seven comparable cross-sectional studies in Denmark (N = 8,655). The students provided data about frequency of drunkenness and parents' occupation. RESULTS: In total, 38.6% reported to have been drunk at least four times, decreasing from 44.2% in 1991 to 21.2% in 2014. Most of the decrease took place in the latter part of the period. This decrease was found in all occupational social classes, but there was no change in absolute social inequality in drunkenness four or more times reported from 1991 to 2014. The sex- and yearadjusted odds ratio for frequent drunkenness was 0.80, 95% CI [0.70, 0.93] in low compared with high occupational social class. The statistical interaction between survey year and occupational social class was insignificant (p = .3601); that is, there was no change in relative social inequality in frequent drunkenness over time. CONCLUSIONS: Drunkenness was more prevalent among adolescents from the high occupational social class, and this social inequality did not change from 1991 to 2014.

Socio-economic disadvantage is associated with heavier drinking in high but not middle-income countries participating in the International Alcohol Control Study.

INTRODUCTION AND AIMS: To investigate if socio-economic disadvantage, at the individual- and country-level, is associated with heavier drinking in some middle- and high-income countries. DESIGN AND METHODS: Surveys of drinkers were undertaken in some high- and middle-income countries. Participating countries were Australia, England, New Zealand, Scotland (high-income) and Peru, Thailand and Vietnam (middle-income). Disadvantage at the country-level was defined as per World Bank (categorised as middle-or high-income); individual-level measures were (i) years of education and (ii) whether and individual was under or over the poverty line in each country. Measures of heavier drinking were (i) proportion of drinkers that consumed 8+ drinks and (ii) three drinking risk groups (lower, increasing and higher). Multi-level logistic regression models were used. RESULTS: Individual-level measures of disadvantage, lower education and living in poverty, were associated with heavier drinking, consuming 8+ drinks on a typical occasion or drinking at the higher risk level, when all countries were considered together. Drinkers in the middle-income countries had a higher probability of consuming 8+ drinks on a typical occasion relative to drinkers in the high-income countries. Interactions between country-level income and individual-level disadvantage were undertaken: disadvantaged drinkers in the middle-income countries were less likely to be heavier drinkers relative to those with less disadvantage in the high-income countries. DISCUSSION AND CONCLUSIONS: Associations between socio-economic disadvantage and heavier drinking vary depending on country-level income. These findings highlight the value of exploring cross-country differences in heavier drinking and disadvantage and the importance of including country-level measurements to better elucidate relationships.

Prevalence and socio-demographic correlates of alcohol consumption: Survey findings from five states in India.

AIM: To investigate the association between socio-demographic characteristics and alcohol consumption in India. METHODS: Analytical data were derived from household surveys conducted by the study team that included 6088 adults in five states of India (male = 3803, female = 2285). The sample was a cross-sectional selected through stratified multistage sampling design. The survey collected data on socio-demographic characteristics of the respondents as well as the pattern of alcohol consumption. Multivariate logistic regression models were fitted to investigate the socio-demographic association with both alcohol consumption and types of alcoholic beverages consumed (distilled spirits, country liquor, home-brewed). RESULTS: More than one-third of the sample respondents (38.6%, 95%CI = 29.2-48.8%) reported to be current drinkers and approximately one-fifth (21.7%, 95%CI = 4.2-31.7%) were heavy drinkers and 7.4% (95%CI = 4.6-11.6%) were heavy episodic drinkers. In multivariate analyses, age greater than 50 years (OR = 0.70, 95%CI = 0.56-0.86), being female (OR = 0.08, 95%CI = 0.06-0.09), schooling greater than 12 years (OR = 0.61, 95% CI = 0.50-0.75), owning land (OR = 0.74, 95%CI = 0.65-0.86), and living in pucca house (OR = 0.85, 95% CI = 0.74-0.98) were negatively associated with current drinking status. Higher income (OR = 1.30, 95%CI = 1.08-0.57) and living in urban areas (OR = 1.54, 95%CI = 1.33-1.78) were positively associated with current drinking status. CONCLUSIONS: Substantial differences in the socio-demographic correlates of alcohol consumption and types of alcoholic beverages exist in India. It is recommended that intervention and prevention strategies to curb alcohol consumption should include drinkers' characteristic.

Down the local: A qualitative case study of daytime drinking spaces in the London Borough of Islington.

BACKGROUND: Recognising the lack of research on daytime drinking practices in areas with managed night-time economies (NTEs), this qualitative study explores the phenomena in the London Borough of Islington; a rapidly gentrifying area with a highly regulated night-time economy (NTE). The objectives were to (i) Characterise the daytime drinking spaces of the local alcohol environment and (ii) Theorise the ways in which these spaces, and the practices and performativities within them, are situated within broader social and economic trends. METHODS: Adopting a legitimate peripheral participation approach to data collection, 39 licensed premises were visited in Islington and on-site observations carried out between the hours of 12 pm and 6 pm using a semi-structured observation guide. Observations were written-up into detailed fieldnotes, uploaded to NVivo and subject to a thematic analysis. FINDINGS: The daytime on-premises alcohol environment was characterised by two main trends: the decline of traditional pubs and a proliferation of hybrid establishments in which alcohol was framed as part of a suite of attractions. The consumption trends that the latter exemplify are implicated in processes of micro-cultural production and 'hipster capitalism'; and it is via this framing that we explore the way the diverse local drinking spaces were gendered and classed. Hybrid establishments have been regarded as positive in terms of public health, crime and safety. However, they could also help introduce drinking within times and contexts where it was not previously present. CONCLUSION: The intersection of an expanding hipster habitus with Local Authority efforts to tackle 'determined drunkenness' create very particular challenges. The operating practices of hybrid venues may feed into current alcohol industry strategies of promoting 'new moments' in which consumers can drink. They blur the divisions between work and play and produce temporal and classed divisions of drinking.

Heavy Drinkers and the Potential Impact of Minimum Unit Pricing-No Single or Simple Effect?

AIMS: To explore the potential impact of a minimum unit price (MUP: 50 pence per UK unit) on the alcohol consumption of ill Scottish heavy drinkers. METHODS: Participants were 639 patients attending alcohol treatment services or admitted to hospital with an alcohol-related condition. From their reported expenditure on alcohol in their index week, and assuming this remained unchanged, we estimated the impact of a MUP (50 ppu) on future consumption. (Around 15% purchased from both the more expensive on-sale outlets (hotels, pubs, bars) and from off-sales (shops and supermarkets). For them we estimated the change in consumption that might follow MUP if (i) they continued this proportion of 'on-sales' purchasing or (ii) their reported expenditure was moved entirely to off-sale purchasing (to maintain consumption levels)). RESULTS: Around 69% of drinkers purchased exclusively off-sale alcohol at <50 ppu. Their drinking, post MUP, may reduce by a mean of 33%. For this group, from a population of very heavy, ill consumers, we were unable to show a differential effect across multiple deprivation quintiles. For other drinkers there might be no reduction, especially if after MUP there were many products priced close to 50 ppu. Moving away from on-sales purchases could support, for some, an increase in consumption. CONCLUSIONS: While a proportion of our harmed, heavy drinkers might be able to mitigate the impact of MUP by changing purchasing habits, the majority are predicted to reduce purchasing. This analysis, focusing specifically on harmed drinkers, adds a unique dimension to the evidence base informing current pricing policy. SHORT SUMMARY: From drink purchasing data of heavy drinkers, we estimated the impact of legislating £0.50 minimum unit price. Over two thirds of drinkers, representing all multiple deprivation quintiles, were predicted to decrease alcohol purchasing; remainder, hypothetically, could maintain consumption. Our data address an important gap within the evidence base informing policy.

Relative deprivation and episodes of drunkenness among French and Canadian adolescents.

INTRODUCTION AND AIMS: Studies link socio-economic deprivation to alcohol consumption in adolescents, but the role of relative deprivation has been understudied and may be equally important. This study investigates the association between relative deprivation and episodes of drunkenness among adolescents in France and Canada. DESIGN AND METHODS: We used data from the 2014 Health Behaviours in School-aged Children study collected from 15-year-olds in Canada (n = 4276) and France (n = 1625). Students reported the number of times they had ever been drunk. The degree of relative deprivation was quantified through the student's rank in the deprivation distribution, measured through the Family Affluence Scale, within school and the extent of the inequality. Random intercept logistic regression models were used to examine the association between relative deprivation and drunkenness. RESULTS: Canadian adolescents were more likely to have experienced drunkenness more than once in their lifetime compared with French adolescents (21.6% vs. 16.2%). Adolescents with high relative deprivation were not more likely to report episodes of drunkenness in Canada and were less likely to report episodes of drunkenness in France compared with those with low relative deprivation. DISCUSSION AND CONCLUSIONS: Our findings do not support the hypothesis that adolescents who experienced greater relative deprivation are more likely to report drunkenness. They suggest that policies and interventions on alcohol use should target adolescents across all levels of deprivation in Canada and particularly those that are relatively more affluent in France. The context of countries appears to matter to the socio-economic distribution of drinking behaviour in youth. [Sentenac M, Ehlinger V, Napoletano A, Spilka S, Gariepy G, Godeau E, Elgar FJ. Relative deprivation and episodes of drunkenness among French and Canadian adolescents.

Purchases by heavier drinking young people concentrated in lower priced beverages: Implications for policy.

INTRODUCTION AND AIMS: Alcohol is an increasingly important risk factor in the global burden of disease. The acute harms experienced and persistence of drinking patterns established in adolescence motivate investigating influences on youth drinking. The aim is to examine association between heavier drinking in young people and their choice of beverage type, purchase outlet and price. DESIGN AND METHODS: A nationally representative sample of New Zealand drinkers (N = 1056) aged 16-19 years recruited using random digit dialling was surveyed in 2012 as part of the International Alcohol Control study. Typical quantities consumed and frequency of alcohol consumption categorised respondents into lower, medium and heavier consumption groups. Beverage choice, prices paid and on or off-premise purchase were related to consumption using univariate analysis. Logistic analysis was used to examine multivariate factors predicting membership of consumption groups. RESULTS: Twenty percent of the sample consumed six or more drinks at least once a week, increasing to 1 in 4 for those 18 years and older. Heavier drinkers consumed more alcohol in the form of ready to drinks (RTD) especially high-potency RTDs. Lower consumers drank greater proportion of wine. Heavier drinkers paid less than medium consumers who paid less than lower consumers. High-potency RTDs were cheaper per unit of alcohol than other beverages and chosen by heavier drinkers resulting in lower prices. DISCUSSION AND CONCLUSIONS: Heavy consumption of alcohol remains common in New Zealand young drinkers. Heavier drinkers paid less to purchase alcohol and consumed more alcohol in the form of high-potency RTDs. [Wall M, Casswell S, Yeh L-C. Purchases by heavier drinking young people concentrated in lower priced beverages: Implications for policy. Drug Alcohol Rev 2017;36:352-358].

The country-level effects of drinking, heavy drinking and drink prices on pre-drinking: An international comparison of 25 countries.

INTRODUCTION AND AIMS: The practice and adverse consequences of pre-drinking have been documented within a dozen countries, but little remains known about the differences between countries or the country-specific determinants of pre-drinking. This study aims to estimate the percentage of pre-drinkers in different countries and the impact of country-level indicators such as the price of alcohol and the prevalence of drinkers and of heavy drinkers. DESIGN AND METHODS: Using data from the Global Drug Survey, the percentage of pre-drinkers was estimated for 25 countries from 65 126 respondents. Bivariate and multivariate multilevel models were used to model the impact of the on-premise/off-premise drinks price ratio, the prevalence of current drinkers and of heavy drinkers on the percentage of pre-drinkers. RESULTS: The estimated percentage of pre-drinkers per country ranged from 17.7% (Greece) to 85.4% (Ireland). Across all countries, the higher the prevalence of current drinkers, the higher the percentage of pre-drinkers. In addition, an interaction between the prevalence of heavy drinkers and the price ratio was found. In countries with a low price ratio, the higher the prevalence of heavy drinkers, the higher the percentage of pre-drinkers. The opposite effect was observed in countries with high price ratios. DISCUSSION AND CONCLUSIONS: Pre-drinking appears to be a worldwide phenomenon. The significant effects of all three indicators demonstrate the role of country-level determinants underpinning the prevalence of pre-drinking across countries. Policy makers could use the reported findings for initiating campaigns to reduce pre-drinking behaviour. [Labhart F, Ferris J, Winstock A, Kuntsche E. The country-level effects of drinking, heavy drinking and drink prices on pre-drinking: An international comparison of 25 countries.

[Injuries under the influence of alcohol]. / Verletzungen unter Alkoholeinfluss.

BACKGROUND: In Germany, an average of 9.5 L of pure alcohol is consumed per capita per year. Alcohol is known to negatively influence psychomotor abilities. The aim of this study was to evaluate injuries that lead to hospital admission with and without prior intake of alcohol. PATIENTS AND METHODS: Over a 7-month period, all 1317 patients who were admitted to the hospital because of an injury were evaluated with respect to their blood-alcohol level. Patient data of both groups (139 injuries under alcohol influence and 1178 injuries without alcohol influence) were compared with respect to the mechanism and type of injury, patient demographics, and treatment costs. RESULTS: At the time of presentation, 11 % (n = 139) of all admitted patients had detectable blood-alcohol levels of more than 0.1 g/L with an average blood-alcohol level of 2.21 g/L. Female patients had an average of 1.96 g/L and males an average of 2.28 g/L (N.S.). Almost every fifth male patient (109 out of 570, 19 %) had a detectable blood-alcohol level, compared to only 4 % of all admitted female patients. Among the patients admitted between 11:00 p.m. and 5:00 a.m., 35 % had detectable blood-alcohol levels and among the 20- to 30-year-old patients, 24 % had detectable blood-alcohol levels. The leading mechanisms of injury among intoxicated patients were falls (50 %, n = 70) and physical violence (18 %, n = 25). The latter was recorded significantly (p = 0.01) less among sober patients (0.17 %, n = 2). The most frequent diagnosis was a mild concussion in both intoxicated (60%, n = 84) and sober (34 %, n = 402) patients (p = 0.04). The time to discharge averaged 4.3 days for intoxicated and 5.6 days for sober patients. CONCLUSIONS: Injuries that occur while under the influence of alcohol that lead to hospital admission are particularly frequent in male patients aged between 20 and 30 years. They do not necessarily lead to more severe injuries.

Reinforcer Pathology: The Behavioral Economics of Abuse Liability Testing.

Understanding the abuse liability of novel drugs is critical to understanding the risk these new compounds pose to society. Behavioral economics, the integration of psychology and economics, can be used to predict abuse liability of novel substances. Here, we describe the behavioral economic concept of reinforcer pathology and how it may predict the use of novel drugs in existing drug-users and initiation of use in the drug-naive.

The effect of alcohol consumption on household income in Ireland.

This paper presents a study of the effects of alcohol consumption on household income in Ireland using the Slán National Health and Lifestyle Survey 2007 dataset, accounting for endogeneity and selection bias. Drinkers are categorised into one of four categories based on the recommended weekly drinking levels by the Irish Health Promotion Unit; those who never drank, non-drinkers, moderate and heavy drinkers. A multinomial logit OLS Two Step Estimate is used to explain individual's choice of drinking status and to correct for selection bias which would result in the selection into a particular category of drinking being endogenous. Endogeneity which may arise through the simultaneity of drinking status and income either due to the reverse causation between the two variables, income affecting alcohol consumption or alcohol consumption affecting income, or due to unobserved heterogeneity, is addressed. This paper finds that the household income of drinkers is higher than that of non-drinkers and of those who never drank. There is very little difference between the household income of moderate and heavy drinkers, with heavy drinkers earning slightly more. Weekly household income for those who never drank is €454.20, non-drinkers is €506.26, compared with €683.36 per week for moderate drinkers and €694.18 for heavy drinkers.

Price elasticity of on- and off-premises demand for alcoholic drinks: A Tobit analysis.

BACKGROUND: Understanding how price policies will affect alcohol consumption requires estimates of the impact of price on consumption among different types of drinkers and across different consumption settings. This study aims to estimate how changes in price could affect alcohol demand across different beverages, different settings (on-premise, e.g., bars, restaurants and off-premise, e.g., liquor stores, supermarkets), and different levels of drinking and income. METHODS: Tobit analysis is employed to estimate own- and cross-price elasticities of alcohol demand among 11 subcategories of beverage based on beverage type and on- or off-premise supply, using cross-sectional data from the Australian arm of the International Alcohol Control Survey 2013. Further elasticity estimates were derived for sub-groups of drinkers based on their drinking and income levels. RESULTS: The results suggest that demand for nearly every subcategory of alcohol significantly responds to its own price change, except for on-premise spirits and ready-to-drink spirits. The estimated demand for off-premise beverages is more strongly affected by own price changes than the same beverages in on-premise settings. Demand for off-premise regular beer and off-premise cask wine is more price responsive than demand for other beverages. Harmful drinkers and lower income groups appear more price responsive than moderate drinkers and higher income groups. CONCLUSION: Our findings suggest that alcohol price policies, such as increasing alcohol taxes or introducing a minimum unit price, can reduce alcohol demand. Price appears to be particularly effective for reducing consumption and as well as alcohol-related harm among harmful drinkers and lower income drinkers.

Poor, persecuted, young, and alone: Toward explaining the elevated risk of alcohol problems among Black and Latino men who drink.

BACKGROUND: Even given equivalent drinking patterns, Black and Latino men experience substantially more dependence symptoms and other consequences than White men, particularly at low/no heavy drinking. No known studies have identified factors driving these disparities. The current study examines this question. METHODS: The 2005 and 2010 National Alcohol Surveys were pooled. Surveys are nationally representative, telephone interviews of the U.S. including Black and Latino oversamples; male drinkers were analyzed (N=4182). Preliminary analyses included negative binomial regressions of dependence symptom and consequence counts testing whether effects for race/ethnicity were diminished when entering potential explanatory factors individually. Additional analyses re-examined effects for race/ethnicity when using propensity score weighting to weight Blacks to Whites, and Latinos to Whites, first on heavy drinking alone, and then on heavy drinking and all explanatory factors supported by preliminary analyses. RESULTS: Preliminary regressions suggested roles for lower individual SES, greater prejudice and unfair treatment, and younger age in the elevated risk of alcohol problems among Black and Latino (vs. White) men at low heavy drinking levels; additional support emerged for single (vs. married) status among Blacks and neighborhood disadvantage among Latinos. When Blacks and Latinos were weighted to Whites on the above variables, effects for race/ethnicity on dependence counts were reduced to nonsignificance, while racial/ethnic disparities in consequence counts were attenuated (by >43% overall). CONCLUSIONS: Heavy drinking may be especially risky for those who are poor, exposed to prejudice and unfair treatment, young, and unmarried, and these factors may contribute to explaining racial/ethnic disparities in alcohol problems.

Effects of Economic Disruptions on Alcohol Use and Problems: Why Do African Americans Fare Worse?

OBJECTIVE: This study tested a model of the effects of recession-related job loss on alcohol use disorder (AUD) and examined why African Americans who lost their jobs during the 2008-2009 recession were at increased risk for AUD relative to Whites. We hypothesized that (a) job loss would be positively associated with psychological distress (i.e., higher levels of depressive symptoms) and increased drunkenness, and (b) low levels of family social support and experiences of racial stigma would exacerbate the effects of job loss on distress, especially among African Americans and Hispanics. METHOD: Data were drawn from the 2010 U.S. National Alcohol Survey (NAS), a cross-sectional survey of the U.S. general population. Using data from the 2010 NAS (telephone survey of 1,111 African American, 964 Hispanic, and 3,133 White adults), we conducted simultaneous path modeling in Mplus to test mediation and moderation hypotheses. Our key outcome was AUD as measured by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. RESULTS: Recession-related job loss was significantly associated with AUD through its effects on increased drunkenness, and the associations were positive for Whites, stronger for African Americans than Whites, and nonexistent for Hispanics. Job loss was associated with distress in the overall sample, and distress was positively associated with drunkenness among African Americans only, suggesting that distress is another pathway by which job loss affects AUD among African Americans. Higher levels of family social support mitigated the effects of job loss on psychological distress, and this relationship did not differ by race/ethnicity. CONCLUSIONS: During economic downturns, increased stress and heavy drinking are important pathways through which recession-related job loss can lead to greater AUD among African Americans relative to Whites.

Can Obviously Intoxicated Patrons Still Easily Buy Alcohol at On-Premise Establishments?

BACKGROUND: Excessive alcohol consumption at licensed alcohol establishments (i.e., bars and restaurants) has been directly linked to alcohol-related problems such as traffic crashes and violence. Historically, alcohol establishments have had a high likelihood of selling alcohol to obviously intoxicated patrons (also referred to as "overservice") despite laws prohibiting these sales. Given the risks associated with overservice and the need for up-to-date data, it is critical that we monitor the likelihood of sales to obviously intoxicated patrons. METHODS: To assess the current likelihood of a licensed alcohol establishment selling alcohol to an obviously intoxicated patron, we conducted pseudo-intoxicated purchase attempts (i.e., actors attempt to purchase alcohol while acting out obvious signs of intoxication) at 340 establishments in 1 Midwestern metropolitan area. We also measured characteristics of the establishments, the pseudo-intoxicated patrons, the servers, the managers, and the neighborhoods to assess whether these characteristics were associated with likelihood of sales of obviously intoxicated patrons. We assessed these associations with bivariate and multivariate regression models. RESULTS: Pseudo-intoxicated buyers were able to purchase alcohol at 82% of the establishments. In the fully adjusted multivariate regression model, only 1 of the characteristics we assessed was significantly associated with likelihood of selling to intoxicated patrons-establishments owned by a corporate entity had 3.6 greater odds of selling alcohol to a pseudo-intoxicated buyer compared to independently owned establishments. CONCLUSIONS: Given the risks associated with overservice of alcohol, more resources should be devoted first to identify effective interventions for decreasing overservice of alcohol and then to educate practitioners who are working in their communities to address this public health problem.