Associations between mental health and surgical outcomes among women undergoing mastectomy for cancer.

Following diagnosis of breast cancer, many women experience serious psychological distress, which can adversely affect their cancer care and outcomes. We conducted this study to examine the association between mental health conditions and hospital outcomes and costs among women undergoing mastectomy for invasive breast cancer. Using nationally representative data from the 2005 to 2008 Nationwide Inpatient Sample, we identified women aged ≥18 years with invasive breast cancer who underwent inpatient mastectomy (N = 40,202). Individuals with a psychiatric diagnosis (major depressive, posttraumatic stress, panic, adjustment, or generalized anxiety disorder) or substance abuse were compared with those without a mental health condition. Outcomes included risk of complications, prolonged hospitalization (>3 days), and direct costs of care. Multivariable logistic and linear regression analyses were performed to control for sociodemographic and clinical characteristics. Overall, 4.5% of patients had a mental health condition. Patients with substance abuse were more likely than those without to experience both complications (8.5% versus 4.8%; adjusted odds ratio [AOR] = 1.61 [1.30-2.00]) and prolonged hospitalization (26.4% versus 13.6%; AOR = 2.25 [1.95-2.59]), and to have higher average costs ($9,855 versus $9,128, p = 0.009). Presence of psychiatric diagnoses was also significantly associated with increased complications (5.9% versus 4.8%; AOR = 1.21 [1.10-1.34]), prolonged hospitalization (8.5% versus 4.8%; AOR = 1.40 [1.32-1.49]), and higher average costs ($9,723 versus $9,108, p < 0.001). Mental health conditions are associated with poorer outcomes and higher costs in breast cancer patients undergoing inpatient mastectomy. Greater efforts are needed to identify and manage these patients with psychiatric and substance use disorders during the perioperative period.

Measuring use of evidence based psychotherapy for posttraumatic stress disorder.

To improve methods of estimating use of evidence-based psychotherapy for posttraumatic stress disorder in the Veteran's health administration, we evaluated administrative data and note text for patients newly enrolling in six VHA outpatient PTSD clinics in New England during the 2010 fiscal year (n = 1,924). Using natural language processing, we developed machine learning algorithms that mimic human raters in classifying note text. We met our targets for algorithm performance as measured by precision, recall, and F-measure. We found that 6.3 % of our study population received at least one session of evidence-based psychotherapy during the initial 6 months of treatment. Evidence-based psychotherapies appear to be infrequently utilized in VHA outpatient PTSD clinics in New England. Our method could support efforts to improve use of these treatments.

The population level prevalence and correlates of appropriate and inappropriate imaging to stage incident prostate cancer in the medicare population.

PURPOSE: According to guidelines most men with incident prostate cancer do not require staging imaging. We determined the population level prevalence and correlates of appropriate and inappropriate imaging in this cohort. MATERIALS AND METHODS: We performed a cross-sectional study of men 66 to 85 years old who were diagnosed with prostate cancer in 2004 and 2005 from the SEER (Surveillance, Epidemiology and End Results)-Medicare database. Low risk (no prostate specific antigen greater than 10 ng/ml, Gleason score greater than 7 or clinical stage greater than T2) and high risk (1 or more of those features) groups were formed. Inappropriate imaging was defined as any imaging for men at low risk and appropriate imaging was defined as bone scan for men at high risk as well as pelvic imaging as appropriate. Logistic regression modeled imaging in each group. RESULTS: Of 18,491 men at low risk 45% received inappropriate imaging while only 66% of 10,562 at high risk received appropriate imaging. For patients at low risk inappropriate imaging was associated with increasing clinical stage (T2 vs T1 OR 1.35, 95% CI 1.27-1.44), higher Gleason score (7 vs less than 7 OR 1.80, 95% CI 1.69-1.92), increasing age and comorbidity as well as decreasing education. Appropriate imaging for men at high risk was associated with lower stage (T4, T3 and T2 vs T1 OR 0.63, 95% CI 0.48-0.82, OR 0.67, 95% CI 0.60-0.80 and OR 0.87, 95% CI 0.80-0.86) and with higher Gleason score (greater than 8 and 7 vs less than 7 OR 2.18, 95% CI 1.92-2.48 and 1.51, 95% CI 1.35-1.70, respectively) as well as with younger age, white race, higher income, lower stage and more comorbidity. CONCLUSIONS: We found poor adherence to imaging guidelines for men with incident prostate cancer. Understanding the patterns by which clinicians use imaging for prostate cancer should guide educational efforts as well as research to suggest evidence-based guideline improvements.

Gender and the use of Veterans Health Administration homeless services programs among Iraq/Afghanistan veterans.

BACKGROUND: Female Veterans comprise 12% of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, the largest proportion of women to serve of any prior cohort. We sought to determine the sex-specific risk of using a Veterans Health Administration (VHA) homeless program among OEF/OIF Veterans and to identify factors associated with increased risk of program use for women compared with men. METHODS: We included OEF/OIF Veterans with at least 1 VHA clinical visit between October 1, 2001, and September 30, 2009. The study's outcome was the time to first use of a VHA homeless program. Cox proportional-hazards regression was used to estimate the relative risk of using a homeless program by sex, adjusting for relevant sociodemographic and clinical variables. Exploratory analyses examined interactions between sex and all covariates. RESULTS: Of 445,319 Veterans, 7431 (1.7%) used a VHA homeless program, of which 961 were females (1.8%), and 6470 were males (1.7%) during a median follow-up period of 3.20 years. Women were as likely as men to use a homeless program (adjusted hazard ratio, 1.02; 95% confidence interval, 0.95-1.09); median time to first use was similar for female and male Veterans (1.88 vs. 1.88 y, respectively, P=0.53). In exploratory analyses, we found increased risk of program use for women compared with men for the following subgroups: ages 26-35 years, 100% service-connected disability rating, posttraumatic stress disorder diagnosis, and northeast location. CONCLUSIONS: Overall, there was no substantial difference in the sex-specific risk of using a VHA homeless program. In light of this finding, VHA homeless programs must be prepared to recognize and address the unique needs of female OEF/OIF Veterans.

Trauma experience among homeless female veterans: correlates and impact on housing, clinical, and psychosocial outcomes.

This study examined lifetime exposure to traumatic events as reported by 581 homeless female veterans enrolled in a Homeless Women Veterans Program across 11 sites to characterize the types of trauma they experienced; their correlation with baseline characteristics; and their association with housing, clinical outcomes, and psychosocial functioning over a 1-year treatment period. Almost all participants endorsed multiple types and episodes of traumatic events. Among the most common were having someone close experience a serious or life-threatening illness (82%) and rape (67%). Exploratory factor analysis revealed 6 potential trauma categories: being robbed, experiencing accident or disasters, illness or death of others, combat, sexual assault, and physical assault. At baseline, trauma from sexual assault was associated with more days homeless (ß = .18, p < .001), trauma from accidents or disasters was associated with poorer physical health (ß = -.23, p < .001), and trauma from being robbed was related to greater use of drugs (ß = .22, p < .001). Trauma reported at baseline, however, was not predictive of 1-year outcomes, suggesting type and frequency of trauma does not negatively affect the housing gains homeless women veterans can achieve through homeless services.

Veterans health administration information systems as a resource for rare disorders research: Creutzfeldt-Jakob disease as a paradigm.

OBJECTIVE: To illustrate the application of Veterans Health Administration (VHA) information systems in both clinical and epidemiologic investigations of a rare disease, our specific aims were: (1) to determine the number and incidence of Creutzfeldt-Jakob disease (CJD) diagnoses in the VHA from fiscal year (FY) 1997 through FY 2010 and (2) to describe the relevant clinical features associated with those diagnoses. METHODS: The VHA Medical SAS Datasets were queried for all unique, incident CJD diagnoses between FY 1997 and 2010. Electronic health records were then reviewed to validate diagnoses using modified criteria. RESULTS: During the study period, 115 CJD diagnoses (43 definite, 27 probable, 19 possible, and 26 suspected) were identified. Annual incidence ranged between 0.8 per million (95% CI, 0.3-1.7) in FY 2009 and 3.7 per million (95% CI, 2.1-6.4) in FY 1997. Dementia was documented in 111 cases (96.5%) and myoclonus in 73 (63.5%). Discharges consistent with CJD were noted in 31 of 78 patients (39.7%) with documented electroencephalography. CONCLUSIONS: For certain rare diseases, VHA information systems can be used to assemble a substantive case series for clinical study. However, the VHA's distinctive demographic characteristics and population dynamics may limit the external validity of epidemiologic investigations.

Access to VA services for returning veterans with PTSD.

OBJECTIVE: In order to understand access to treatment services for post-traumatic stress disorder (PTSD) in the Veterans Health Administration (VHA), we reviewed existing literature to estimate the proportion of Iraq and Afghanistan veterans who have used VHA services. METHODS: We reviewed studies regarding the prevalence of PTSD among Iraq and Afghanistan War veterans to estimate the need for treatment. We then compared need to Veterans Affairs utilization in order to estimate the proportion accessing care. RESULTS: Access to VHA services is high, with 58% of the estimated population of Iraq and Afghanistan veterans accessing some PTSD-related service. However, there is insufficient information about the quality of these services. CONCLUSIONS: The Veterans Affairs has been successful in providing access to treatment services for Iraq and Afghanistan Veterans with PTSD. Additional studies are needed to further characterize the quality of services provided.

Racial comparison of therapeutic support, service use, and satisfaction among male outpatients with severe mental illness.

This study examined racial differences among male outpatients with severe mental illness on therapeutic support, mental health service utilization, and service satisfaction. A total of 530 participants (289 white, 179 black, and 62 of another race) across three large mental health centers (two state funded and one federally funded) in Connecticut were examined cross-sectionally. No racial differences were found in therapeutic support, and there were essentially no racial differences in service satisfaction. Black clients reported greater use of substance abuse inpatient services than White clients and clients of other racial minorities reported greater use of mental health inpatient services than White clients, but differences were small. These findings suggest there are few racial differences in the reported quality of mental health care and service utilization among male outpatients with severe mental illness. More research is needed on where and under what circumstances health disparities exist.

Epidemiology and outcomes of fever burden among patients with acute ischemic stroke.

BACKGROUND AND PURPOSE: Although fever following ischemic stroke is common and has been associated with poor patient outcomes, little is known about which aspects of fever (eg, frequency, severity, or duration) are most associated with outcomes. METHODS: We used data from a retrospective cohort of acute ischemic stroke patients who were admitted to 1 of 5 hospitals (1998-2003). A fever event was defined as a period with a temperature≥100.0 °F (37.8 °C). Fever burden was defined as the maximum temperature (Tmax) minus 100.0 °F, multiplied by the number of days with a fever. Fever burden (in degree-days) was categorized as low (0.1-2.0), medium (2.1-4.0), or high (≥4.0). Logistic regression was used to evaluate the adjusted association of any fever episode and fever burden with the combined outcome of in-hospital mortality or discharge to hospice. RESULTS: Among 1361 stroke patients, 483 patients (35.5%) had ≥1 fever event. Among febrile patients, the median Tmax was 100.9 °F (range, 100.0-106.6 °F), 87% had ≤2 events and median total fever days was 2. Patients with any fever event had higher combined outcome rates after adjusting for demographics, stroke severity, and clinical characteristics: adjusted odds ratio (aOR), 2.7 (95% CI, 1.6-4.4). Higher fever burden was also associated with the combined outcome: high burden aOR, 6.7 (95% CI, 3.6-12.7); medium burden aOR, 3.9 (95% CI, 1.9-8.2); and low burden aOR, 1.2 (95%CI, 0.6-2.3) versus no fever. CONCLUSIONS: This study confirms that poststroke fever occurs commonly and demonstrates that patients with high fever burden have a 6-fold increased odds of death or discharge to hospice.

The association between diffusion of the surgical robot and radical prostatectomy rates.

BACKGROUND: Despite its expense and controversy surrounding its benefit, the surgical robot has been widely adopted for the treatment of prostate cancer. OBJECTIVES: To determine the relationship between surgical robot acquisition and changes in volume of radical prostatectomy (RP) at the regional and hospital levels. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: Men undergoing RP for prostate cancer at nonfederal, community hospitals located in the states of Arizona, Florida, Maryland, North Carolina, New York, New Jersey, and Washington. MEASURES: Change in number of RPs at the regional and hospital levels before (2001) and after (2005) dissemination of the surgical robot. RESULTS: Combining data from the Healthcare Cost and Utilization Project State Inpatient Databases 2001 and 2005 with the 2005 American Hospital Association Survey and publicly available data on robot acquisition, we identified 554 hospitals in 71 hospital referral regions (HRR). The total RPs decreased from 14,801 to 14,420 during the study period. Thirty six (51%) HRRs had at least 1 hospital with a surgical robot by 2005; 67 (12%) hospitals acquired at least 1 surgical robot. Adjusted, clustered generalized estimating equations analysis demonstrated that HRRs with greater numbers of hospitals acquiring robots had higher increases in RPs than HRRs acquiring none (mean changes in RPs for HRRs with 9, 4, 3, 2, 1, and 0 are 414.9, 189.6, 106.6, 14.7, -11.3, and -41.2; P<0.0001). Hospitals acquiring surgical robots increased RPs by a mean of 29.1 per year, while those without robots experienced a mean change of -4.8, P<0.0001. CONCLUSIONS: Surgical robot acquisition is associated with increased numbers of RPs at the regional and hospital levels. Policy makers must recognize the intimate association between technology diffusion and procedure utilization when approving costly new medical devices with unproven benefit.

Shopping problems among high school students.

BACKGROUND: Although shopping behavior among adolescents is normal, for some, the shopping becomes problematic. An assessment of adolescent shopping behavior along a continuum of severity and its relationship to other behaviors and health issues is incompletely understood. METHODS: A large sample of high school students (n = 3999) was examined using a self-report survey with 153 questions concerning demographic characteristics, shopping behaviors, other health behaviors including substance use, and functioning variables such as grades and violent behavior. RESULTS: The overall prevalence of problem shopping was 3.5% (95% CI, 2.93-4.07). Regular smoking, marijuana and other drug use, sadness and hopelessness, and antisocial behaviors (e.g., fighting, carrying weapons) were associated with problem shopping behavior in both boys and girls. Heavy alcohol use was significantly associated with problem shopping only in girls. CONCLUSION: Problem shopping appears fairly common among high school students and is associated with symptoms of depression and a range of potentially addictive and antisocial behaviors. Significant distress and diminished behavioral control suggest that excessive shopping may often have significant associated morbidity. Additional research is needed to develop specific prevention and treatment strategies for adolescents who report problems with shopping.

Differences in the associations between gambling problem severity and psychiatric disorders among black and white adults: findings from the National Epidemiologic Survey on Alcohol and Related Conditions.

We examined differences in the associations of gambling problem severity and psychiatric disorders among a nationally representative sample of 32,316 black and white adults. Black respondents were more likely than white ones to exhibit problem or pathological gambling (PPG) and a stronger relationship between subsyndromal gambling and any mood disorder, hypomania, and any substance use disorder. Differences in the patterns of co-occurring disorders between syndromal and particularly subsyndromal levels of gambling in black and white respondents indicate the importance of considering race-related factors in mental health prevention and treatment strategies.

Health/functioning characteristics, gambling behaviors, and gambling-related motivations in adolescents stratified by gambling problem severity: findings from a high school survey.

In adults, different levels of gambling problem severity are differentially associated with measures of health and general functioning, gambling behaviors, and gambling-related motivations. Here we present data from a survey of 2,484 Connecticut high school students, and investigate the data stratifying by gambling problem severity based on DSM-IV criteria for pathological gambling. Problem/pathological gambling was associated with a range of negative functions; for example, poor academic performance, substance use, dysphoria/depression, and aggression. These findings suggest a need for improved interventions related to adolescent gambling and a need for additional research into the relationship (eg, mediating factors) between gambling and risk and protective behaviors.

Posttraumatic stress disorder and trauma characteristics are correlates of premenstrual dysphoric disorder.

Posttraumatic stress disorder (PTSD) is often comorbid with premenstrual dysphoric disorder (PMDD) in women; however, it is unclear whether this relationship is driven by the trauma that may lead to PTSD or if PTSD is uniquely associated with PMDD. In this study, we examine trauma and PTSD as independent correlates of PMDD. Researchers conducted a cross-sectional, secondary data analysis of 3,968 female participants (aged 18-40) of the Collaborative Psychiatric Epidemiology Surveys. Women who had a history of trauma with PTSD (odds ratio, OR = 8.14, 95% confidence interval, CI = 3.56-18.58) or a history of trauma without PTSD (OR = 2.84, 95% CI = 1.26-6.42) were significantly more likely than women with no history of trauma to report PMDD. This graded relationship was also observed in association with premenstrual symptoms. Among trauma survivors, PTSD was independently associated with PMDD, although characteristics of participants' trauma history partially accounted for this association. Our study demonstrated that trauma and PTSD were independently associated with PMDD and premenstrual symptoms. Clinicians should be aware that women who present with premenstrual symptomatology complaints may also have a history of trauma and PTSD that needs to be addressed. This pattern of comorbidity may complicate the treatment of both conditions.

Criminal justice system involvement among people with schizophrenia.

There is growing concern that people with schizophrenia and other severe mental illnesses are increasingly at risk for unnecessary criminal justice system (CJS) involvement. There has been limited examination, however, of which individual characteristics predict future CJS involvement. This study uses data from the Clinical Antipsychotic Trials of Intervention Effectiveness on sociodemograhic characteristics, baseline clinical status, and service use among patients diagnosed with schizophrenia to prospectively identify predictors of CJS involvement during the following year. A series of bivariate chi-square and F tests were conducted to examine whether significant relationships existed between CJS involvement during the first 12 months of the trial and baseline measures of sociodemographic characteristics, psychiatric status, substance abuse, and other patient characteristics. Multivariate logistic regression analysis was then used to identify the independent strength of the relationship between 12-month CJS involvement and potential risk factors that were found to be significant in bivariate analyses. Multivariate logistic regression analyses indicated that past adolescent conduct disorder, being younger and male, symptoms of Akathisia (movement disorder, most often develops as a side effect of antipsychotic medications), and particularly drug abuse increase the risk for CJS involvement. Since CJS involvement among people with schizophrenia was most strongly associated with drug abuse, treatment of co-morbid drug abuse could reduce the risk of stigma, pain, and other adverse consequences of CJS involvement as well as save CJS expenditures.

Regional variation in total cost per radical prostatectomy in the healthcare cost and utilization project nationwide inpatient sample database.

PURPOSE: Surgical treatment for prostate cancer represents a large national health care expenditure. We determined whether state level variation in the cost of radical prostatectomy exists and whether we could explain this variation by adjusting for covariates associated with cost. MATERIALS AND METHODS: Using the 2004 Healthcare Cost and Utilization Project National Inpatient Sample of 7,978,041 patients we identified 9,917 who were 40 years old or older with a diagnosis of prostate cancer who underwent radical prostatectomy without cystectomy. We used linear regression to examine state level regional variation in radical prostatectomy costs, controlling for the local area wage index, patient demographics, case mix and hospital characteristics. RESULTS: The mean +/- SD unadjusted cost was $9,112 +/- $4,434 (range $2,001 to $49,922). The unadjusted mean cost ranged from $12,490 in California to $4,650 in Utah, each significantly different from the mean of $8,903 in the median state, Washington (p <0.0001). After adjusting for all potential confounders total cost was highest in Colorado and lowest in New Jersey, which were significantly different from the median, Washington ($10,750 and $5,899, respectively, vs $8,641, p <0.0001). The model explained 85.9% of the variance with regional variation accounting for the greatest incremental proportion of variance (35.1%) and case mix variables accounting for an incremental 32.3%. CONCLUSIONS: The total cost of radical prostatectomy varies significantly across states. Controlling for known total cost determinants did not completely explain these differences but altered ordinal cost relationships among states. Cost variation suggests inefficiencies in the health care market. Additional studies are needed to determine whether these variations in total cost translate into differences in quality or outcome and how they may be translated into useful policy measures.

Gender-related influences of parental alcoholism on the prevalence of psychiatric illnesses: analysis of the National Epidemiologic Survey on Alcohol and Related Conditions.

BACKGROUND: Offspring of individuals with alcoholism are at increased risk for psychiatric illness, but the effects of gender on this risk are not well known. In this study, we tested the hypothesis that the gender of the parent with alcoholism and the gender of offspring affect the association between parental alcoholism and offspring psychiatric illness. METHOD: We analyzed the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) data to examine the gender-specific prevalence of axis I and axis II disorders in 23,006 male and 17,368 female respondents with and without a history of paternal or maternal alcoholism. Adjusted odds ratios were calculated for the disorders based on gender and presence of maternal or paternal alcoholism. RESULTS: Maternal or paternal alcoholism was associated with a higher prevalence of every disorder examined, regardless of the gender of offspring. Gender-related differences in prevalences were present in nearly all examined disorders, and the association between parental alcoholism and offspring psychiatric disorders was significantly different in men and women. These differences included stronger associations in female offspring of men with alcoholism (alcohol abuse without dependence); in female offspring of women with alcoholism (mania, nicotine dependence, alcohol abuse, and schizoid personality disorder); in male offspring of men with alcoholism (mania); and in male offspring of women with alcoholism (panic disorder). CONCLUSIONS: Interactions between gender and parental alcoholism were specific to certain disorders but varied in their effects, and in general female children of women with alcoholism appear at greatest risk for adult psychopathology.

Differential associations between problem and pathological gambling and psychiatric disorders in individuals with and without alcohol abuse or dependence.

BACKGROUND: Alcohol abuse and/or dependence, alcohol use disorders (AUDs), and problem and/or pathological gambling (PPG) frequently co-occur with each other and other psychiatric disorders. However, prior studies have not investigated the relative influence of AUDs on the associations between PPG and other psychiatric disorders, METHODS: Nationally representative data froni the National Epidemiologic Survey on Alcohol and Related Conditions (n=43,093; United States residents > or = 18 years of age) was used to examine the influence of AUDs on the associations between gambling and other psychiatric disorders and behaviors. The main outcome measures were co-occurrence of past-year AUD and Axis I and II disorders and severity of gambling based on the 10 inclusionary diagnostic criteria for pathological gambling. RESULTS: Among non-AUD respondents, increasing gambling severity was associ- ated with increasingly elevated odds for the majority of Axis I and II disorders. Among AUD respondents, this pattern was typically not observed. Alcohol-by-gambling-group interactions for PPG were also found and the odds of these disorders was significantly increased in non-AUD respondents with PPG, but either unchanged or significantly lower in AUD respondents with PPG. CONCLUSIONS: Gambling-related associations exist with multiple psychiatric disorders, but particularly in those without AUD. These associations have important implications with respect to conceptualization, prevention, and treatment of psychiatric disorders in individuals with gambling and/or AUDs.

Gender differences in the association between body mass index and psychopathology.

INTRODUCTION: The objective of the study was to examine gender differences in the relationship between weight group (under-weight to severely obese), and Axis I and Axis II psychopathology. METHODS: Data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) were analyzed. Logistic regression models examined the past-year likelihood for meeting diagnostic criteria for psychiatric disorders. Interactions between weight group and gender were utilized to determine whether associations were significantly different in men and women after adjusting for demographic characteristics. RESULTS: First, consistent with previous NESARC analyses, the prevalence estimates of psychiatric disorders were higher among people of higher body mass index groups, regardless of gender. However, these patterns differed across genders. Both severely obese women and men, in comparison to normal weight respondents, were much more likely to meet criteria for affective and anxiety disorders, but these associations were significantly (1.5-2 times) stronger among women. For Axis II disorders, while there were very few associations between personality disorders and weight in men, among women increases in weight group were associated with increases in the likelihood of meeting criteria for a personality disorder. CONCLUSION: Weight and psychopathology appear more strongly associated in women than in men. While these data do not allow for identification of underlying mechanisms, they highlight the importance of assessing for psychopathology in overweight and obese patients, and suggest that weight management may be an important consideration in the treatment of psychiatric disorders.

Nondaily smoking and alcohol use, hazardous drinking, and alcohol diagnoses among young adults: findings from the NESARC.

BACKGROUND: Nondaily smoking and heavy alcohol use are prevalent behaviors among young adults, with nondaily smoking occurring primarily in the context of alcohol use. Although the relationship between drinking and daily smoking has been well characterized in young adults, few epidemiological investigations have investigated the association between nondaily smoking and drinking behavior. METHODS: We examined Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Grant et al., 2003b; n = 43,093). Young adults (aged 18 to 25 years; n = 5,838) were stratified on current smoking behavior (daily, nondaily, and nonsmokers in the past 12 months) and differences in weekly quantity of alcohol use, frequency of alcohol use, frequency of binge drinking behavior, rates of NIAAA-defined hazardous drinking, and rates of DSM-IV alcohol diagnoses were investigated. College student status was examined. RESULTS: Twenty-five percent were current smokers and 7% were smoking on a nondaily basis. Seventy-one percent were current drinkers, 39% reported binge drinking at least once a month, 41% met criteria for hazardous drinking, and 18% had alcohol use disorders. Across all measures of alcohol use, there was a significant effect of smoking status, with daily smokers having greater alcohol use patterns, compared with nondaily smokers, with nonsmokers consuming the least. Nondaily smokers were more likely to report any binge drinking in the past 12 months. However, daily smokers were more likely to report daily binge drinking. With regard to hazardous drinking and alcohol use disorders, nondaily smoking conferred the greatest risk, followed by daily smoking with nonsmoking as the reference group. Multinomial logistic regression demonstrated that the odds of being a hazardous drinker were 16 times greater (95% CI 9.46-26.48) in a nondaily smoker compared with a nonsmoker, whereas the odds for a daily smoker were increased by 7-fold (95% CI 5.54-9.36). A similar pattern of results was demonstrated for DSM-IV alcohol diagnoses. No differences across college student status were observed. CONCLUSIONS: The increased risk of hazardous drinking and alcohol use disorders conferred by nondaily smoking supports the findings that nondaily smoking and drinking are highly concomitant behaviors. Results such as these suggest that interventions disengaging alcohol and cigarette use patterns (e.g., smoking bans in alcohol venues) might serve to limit the occurrence of hazardous drinking among young adults at heightened risk for this behavior.