Dose-Response Relationship of Alcohol and Injury Cause: Effects of Country-Level Drinking Pattern and Alcohol Policy.

BACKGROUND: The dose-response relationship of alcohol and injury and the effects of country-level detrimental drinking pattern (DDP) and alcohol control policy on this relationship are examined for specific causes of injury. METHODS: The dose-response risk of injury is analyzed on 18,627 injured patients in 22 countries included in the International Collaborative Alcohol and Injury Study, using case-crossover analysis by cause of injury (traffic, violence, falls, other), DDP, and the International Alcohol Policy and Injury Index. RESULTS: Risk of all injury was higher at all volume levels in higher DDP countries compared to lower DDP countries and for each cause of injury. Risk of injury from traffic was significantly greater in higher DDP than lower DDP countries at 3.1 to 6 drinks (odds ratio (OR) = 2.64, confidence interval (CI) = 1.17 to 5.97) and at ≤3 drinks for falls (OR = 2.51, CI = 1.52 to 4.16) and injuries from other causes (OR = 1.72, CI = 1.10 to 2.69). Countries with higher restrictive alcohol policy were at a lower risk of injury at lower levels of consumption (≤3 drinks) for all injuries (OR = 0.72, CI = 0.56 to 0.92) and for injuries from other causes (OR = 0.46, CI = 0.29 to 0.73) and at a lower risk of traffic injuries at higher levels of consumption (≥10 drinks). At higher levels of consumption (≥10 drinks), countries with higher alcohol policy restrictiveness were at greater risk of all injuries (OR = 2.03, CI = 1.29 to 3.20) and those from violence (OR = 9.02, CI = 3.00 to 27.13) and falls (OR = 4.29, CI = 1.86 to 9.91). CONCLUSIONS: Countries with high DDP are at higher risk of injury from most causes at a given level of consumption, while countries with low restrictiveness of alcohol policy are at higher risk of injury at lower levels of consumption and at higher risk of traffic injuries at high levels of consumption. These findings underscore the importance of aggregate-level factors which need to be considered in developing effective intervention and prevention strategies for reducing alcohol-related injury.

Intensive Motivational Interviewing for Heavy Drinking among Women.

OBJECTIVES: Women suffer more severe consequences related to heavy drinking than men. Relative to men, women who are heavy drinkers experience higher severity of medical, psychiatric, and social problems, even when they have fewer years drinking. Currently there are few gender-specific, evidence-based interventions for heavy drinking among women. METHODS: A randomized clinical trial was conducted with 215 women with alcohol problems. Half were randomly assigned to receive a 9-session, "Intensive Motivational Interviewing" (IMI) intervention (N=107) and half were randomly assigned to a standard single session of MI (SMI) along with 8 sessions of nutritional education (N=108) to achieve time equivalence. Both conditions received weekly outpatient group counseling. Follow-up interviews were conducted at 2 months. Primary outcomes included percent drinking days (PDD), percent heavy drinking days (PHDD, 4+ drinks), and the Addiction Severity Index (ASI) Alcohol scale. Longitudinal changes were assessed using generalized estimating equations (GEE). RESULTS: The sample was predominantly white (83.3%), college educated (61.4%), and married (53.5%). The mean age was 50.9 (sd = 11.3). Relative to baseline, both study conditions showed significant reductions in PDD, PHDD, and ASI alcohol severity (p<.001). Among heavy drinkers, defined as women drinking 14+ days to the point of intoxication over the past 30 days at baseline (N=153), those assigned to IMI (n=67) showed larger reductions in PDD (p<.01) and PHDD (p<.05) at 2-months compared to women receiving SMI. CONCLUSIONS: Findings support the efficacy of IMI for heavy drinking among women. Additional studies are needed that assess drinking over longer time periods.

Development of the International Alcohol Policy and Injury Index.

OBJECTIVE: The current work develops the International Alcohol Policy Injury Index (IAPII) to measure the effectiveness of control policies that impact reduction of alcohol-related injury. METHODS: Using cross-sectional data on alcohol policies from five policy domains (physical availability, drinking context, pricing, advertising, and vehicular), injury death, and alcohol-attributable fractions (AAFs) for vehicular deaths were accessed from the WHO database for 156 countries. A composite indicator, the International Alcohol Policy Injury Index (IAPII), was created to assess the association between policy and death due to injury. FINDINGS: Controlling for per-capita alcohol consumption, injury deaths and AAF deaths were inversely associated with four of the five policy domains. The domains were weighted according to effectiveness and used to construct the IAPII which produced acceptable sensitivity and specificity. Regression results, controlling for consumption, demonstrated the IAPII was significantly associated with AAF vehicular injury death for males, AAF vehicular injury death for females and overall injury death at p< 0.01. CONCLUSION: Findings support the IAPII as a reliable indicator of the relationship between alcohol policies and injury deaths; the stronger the policy the less the likelihood of both overall and vehicular injury death. Future work should test the effectiveness of the IAPII in reducing alcohol-related injury morbidity, which accounts for a larger share of the global burden of disease than alcohol-related injury mortality.

Drinking context and cause of injury: Emergency department studies from 22 countries.

BACKGROUND: It is estimated that up to a third of injuries requiring emergency department admission are alcohol-related. While injuries that are alcohol-related are unsurprising to emergency department staff, less is understood about the precursors to the injury event. METHODS: Using data from representative emergency department injury patients in 22 countries, we examined associations between context of injury (private or public), cause of injury (fall or trip, being stuck/cut/ or burned and violence) and alcohol use. Alcohol-related policy data were also obtained from each study locale. RESULTS: Injuries were similarly reported in private (54%) and public settings (46%) while cause of injury was most often due to falls (39%) or being struck/cut or burned (38%). Violence-related injuries were reported by approximately 1 in 5 patients (23%). Increased odds of drinking prior to the injury event was associated with injury due to violence in private settings but not public venues. Similarly, patients from regions with fewer restrictive alcohol policies were more likely to report drinking prior to an injury event and have elevated violence-related injuries in private settings. CONCLUSION: Understanding the cause and context of injury and alcohol use are important components to evaluation and development of alcohol policies.

Interaction of Motivation and Social Support on Abstinence among Recovery Home Residents.

BACKGROUND AND AIMS: The impetus to abstain from alcohol and drugs is especially robust when individuals seek help. However, motivation to continue abstinence during ongoing recovery is less understood. The present study assessed how social support interacted with motivation to affect abstinence over an 18-monthe time period. METHODS: A sample of 289 residents entering residential recovery homes were recruited and followed at 6-, 12-, and 18-months. Motivation was measured as the perceived costs and benefits of abstinence. Five social influence measures were used to assess interactive effects with costs and benefits on abstinence. RESULTS: Perceived costs and benefits of abstinence were robust predictors of abstinence over the 18 month assessment period. Two social support factors interacted with perceived benefits to influence abstinence: 12-step involvement and number of persons in the social network. CONCLUSION: Suggestions are made for recovery services to influence perceived costs, benefits, and social network characteristics.

Interaction of motivation and psychiatric symptoms on substance abuse outcomes in sober living houses.

BACKGROUND: Studies show residents of sober living recovery houses (SLHs) make improvements in a variety of areas including alcohol and drug use, arrests, and employment. Longitudinal measures of motivation (assessed as costs and benefits of continuing sobriety) have been shown to be associated with alcohol and drug outcomes in SLHs. However, how motivation interacts with other potentially important factors, such as psychiatric severity, is unclear. OBJECTIVE: The present study aimed to assess how perceived costs and benefits of sobriety among residents of SLHs differed by psychiatric severity. The study also aimed to assess how costs and benefits interacted with psychiatric severity to influence outcome. METHODS: Two hundred forty-five residents of SLHs were assessed at baseline and 6, 12, and 18 months. RESULTS: High psychiatric severity was associated with higher severity of alcohol and drug problems and higher perceived costs of sobriety at all data collection time points. Perceived costs and benefits of sobriety were strong predictors of alcohol and drug problems for participants with low psychiatric severity. Perceived costs, but not perceived benefits, predicted outcomes for residents with high psychiatric severity. CONCLUSIONS/IMPORTANCE: High psychiatric severity is a serious impediment for some residents in SLHs. These individuals perceive sobriety as difficult and that perception is associated with worse outcome. Finding ways to decrease perceived costs and challenges to sustained sobriety among these individuals is essential as is collaboration with local mental health services. SLHs should consider whether additional onsite services or modifications of SLH operations might help this population.

Feasibility and acceptability of a novel, computerized screening and brief intervention (SBI) for alcohol and sweetened beverage use in pregnancy.

BACKGROUND: Recommended screening and brief intervention (SBI) for alcohol use during pregnancy is impeded by high patient loads and limited resources in public health settings. We evaluated the feasibility, acceptability and validity of a new self-administered, single-session, bilingual, computerized Screening and Brief Intervention (SBI) program for alcohol and sugar sweetened beverage (SSB) use in pregnancy. METHODS: We developed and tested the computerized SBI program at a public health clinic with 290 pregnant women. Feasibility, acceptability, and validity measures were included in the program which had several modules, including those on demographics, health and beverage use. Time to complete the program and user experience items were used to determine program feasibility and acceptability. Validity analyses compared proportions of prenatal alcohol use identified by the program versus in-person screening by clinic staff. RESULTS: Most program users (87%, n = 251) completed the entire program; 91% (n = 263) completed the key screening and brief intervention modules. Most users also completed the program in ten to fifteen minutes. Program users reported that the program was easy to use (97%), they learned something new (88%), and that they would share what they learned with others (83%) and with their doctors or clinic staff (76%). Program acceptability did not differ by age, education, or type of beverage intervention received. The program identified alcohol use in pregnancy among 21% of users, a higher rate than the 13% (p < .01) found via screening by clinic staff. CONCLUSIONS: Computerized Screening and Brief Intervention for alcohol and SSB use in public health clinics is feasible and acceptable to English and Spanish speaking pregnant women and can efficiently identify prenatal alcohol use.

Pressure to change drinking behavior: An exploratory analysis of US general population subgroups.

BACKGROUND: General population studies have shown that pressure from others to change drinking can come from different sources. Receipt of informal pressure (IP) and formal pressure (FP) is known to vary by quantity and consequences of drinking, but less is known about how pressure varies among subgroups of the population. METHOD: This exploratory study utilizes data from the National Alcohol Surveys from 1995-2010 (N=26,311) and examines associations between receipt of pressure and subgroups of drinkers. RESULTS: Increased relative risk of receiving IP and FP were observed for individuals reporting an arrest for driving after drinking and illicit drug use while poverty and lack of private health insurance increased risk of receipt of formal pressures. Regular marijuana use increased IP. CONCLUSION: The subgroups that were studied received increased pressures to change drinking behavior, though disentangling the societal role of pressure and how it may assist with interventions, help seeking, and natural recovery is needed.

Gender and Social Pressure to Change Drinking Behavior: Results from the National Alcohol Surveys from 1984-2010.

OBJECTIVE: Research shows social and institutional pressure influences drinking, yet determinants of who receives pressure are understudied. This paper examines age, time period, and birth cohort (APC) effects on pressure to stop or reduce drinking among U.S. men and women. METHODS: Data were drawn from six National Alcohol Surveys (NAS) conducted from 1984 to 2010 (N=32,534). Receipt of pressure during the past year to quit or change drinking from formal (police, doctor, work) and informal (spouse, family, friends) sources was assessed. RESULTS: Determinants of pressure were similar for men and women but varied in strength. They included younger age, less education, and younger cohort groups. Cohort effects were stronger for women than men. CONCLUSIONS: Cohort effects among women may be due to increased alcohol marketing to younger women and the changing social contexts of their drinking. Future studies should assess associations between drinking contexts, pressures, and outcomes.

Prevalence and predictors of risky and heavy alcohol consumption among adult siblings of childhood cancer survivors.

OBJECTIVE: To describe alcohol consumption patterns and risk factors for risky and heavy alcohol use among siblings of childhood cancer survivors compared with survivors and national controls. METHODS: Secondary analysis of prospectively collected data from two national surveys was performed including a cohort of 3034 adult siblings of childhood cancer survivors (age 18-56 years) and 10,398 adult childhood cancer survivors, both from the Childhood Cancer Survivor Study, plus 5712 adult participants from the population-based National Alcohol Survey. Cancer-related experiences, self-reported current health, and mental health were examined in relation to alcohol consumption patterns including heavy and risky drinking. RESULTS: Adult siblings of childhood cancer survivors were more likely to be heavy drinkers (OR adj = 1.3; 1.0-1.6) and risky drinkers (OR adj = 1.3; 1.1-1.6) compared with controls from a national sample. Siblings were also more likely to drink at these two levels compared with survivors. Factors associated with heavy drinking among siblings included being 18-21 years old (OR adj = 2.9; 2.0-4.4), male (OR adj = 2.3; 1.7-3.0), having a high school education or less (OR adj = 2.4; 1.7-3.5), and drinking initiation at a young age (OR adj = 5.1; 2.5-10.3). Symptoms of depression, (OR adj = 2.1; 1.3-3.2), anxiety (OR adj = 1.9; 1.1-3.3), and global psychiatric distress (OR adj = 2.5; 1.5-4.3) were significantly associated with heavy alcohol use. CONCLUSIONS: Siblings of children with cancer are more likely to be risky and heavy drinkers as adults compared with childhood cancer survivors or national controls. Early initiation of drinking and symptoms of psychological distress should be identified during early adolescence and effective sibling-specific interventions should be developed and made available for siblings of children with cancer.

Child physical and sexual abuse: a comprehensive look at alcohol consumption patterns, consequences, and dependence from the National Alcohol Survey.

BACKGROUND: Previous research has documented a relationship between child sexual abuse and alcohol dependence. This paper extends that work by providing a comprehensive description of past year and lifetime alcohol consumption patterns, consequences, and dependence among women reporting either physical and sexual abuse in a national sample. METHODS: This study used survey data from 3,680 women who participated in the 2005 U.S. National Alcohol Survey. Information on physical and sexual child abuse and its characteristics were assessed in relation to 8 past year and lifetime alcohol consumption measures. RESULTS: Child physical or sexual abuse was significantly associated with past year and lifetime alcohol consumption measures. In multivariate analyses, controlling for age, marital status, employment status, education, ethnicity, and parental alcoholism or problem drinking, women reporting child sexual abuse vs. no abuse were more likely to report past year heavy episodic drinking (OR(adj) = 1.7; 95% CI 1.0 to 2.9), alcohol dependence (OR(adj) = 7.2; 95% CI 3.2 to 16.5), and alcohol consequences (OR(adj) = 3.6; 95% CI 1.8 to 7.3). Sexual abuse (vs. no abuse) was associated with a greater number of past year drinks (124 vs. 74 drinks, respectively, p = 0.002). Sexual child abuse was also associated with lifetime alcohol-related consequences (OR(adj) = 3.5; 95% CI 2.6 to 4.8) and dependence (OR(adj) = 3.7; 95% CI 2.6 to 5.3). Physical child abuse was associated with 4 of 8 alcohol measures in multivariate models. Both physical and sexual child abuse were associated with getting into fights, health, legal, work, and family alcohol-related consequences. Alcohol-related consequences and dependence were more common for women reporting sexual abuse compared to physical abuse, 2 or more physical abuse perpetrators, nonparental and nonfamily physical abuse perpetrators, and women reporting injury related to the abuse. CONCLUSION: Both child physical and sexual abuse were associated with many alcohol outcomes in adult women, even when controlling for parental alcohol problems. The study results point to the need to screen for and treat underlying issues related to child abuse, particularly in an alcohol treatment setting.

Substance use and motivation: a longitudinal perspective.

BACKGROUND: Motivation to change substance use behavior is an important component of the recovery process that has usually been studied at entry into treatment. Less studied, but equally important, is the measurement of motivation over time and the role motivation plays in subsequent substance use. OBJECTIVES: The present study sought to examine longitudinal motivation toward sobriety among residents of sober living houses. METHODS: Sober living residents (n = 167) were followed at 6-month intervals over an 18-month period and assessed for motivation and substance use outcomes at each study interview. Motivation was measured using the costs and benefits subscales of the Alcohol and Drug Consequences Questionnaire (ADCQ) and substance use outcomes included the Addiction Severity Index (ASI) alcohol scale, ASI drug scale, and peak density of substance use (number of days of most use in a month). RESULTS: Participants reported higher benefits than costs of sobriety or cutting down substance use at every study time point. Using lagged generalized estimating equation models, the ADCQ costs predicted increased severity for alcohol, drugs, and peak density, whereas the benefits subscale predicted decreased drug and peak density. CONCLUSION: Longitudinal measurement of motivation can be a useful clinical tool to understand later substance use problems. SCIENTIFIC SIGNIFICANCE: Given the mixed findings from prior studies on the effects of baseline motivation, a shift toward examining longitudinal measures of motivation at proximal and temporal intervals is indicated.

Screening, brief intervention, and referral to treatment (SBIRT): 12-month outcomes of a randomized controlled clinical trial in a Polish emergency department.

BACKGROUND: A randomized controlled trial of screening, brief intervention, and referral to treatment (SBIRT) among at-risk (based on average number of drinks per week and drinks per drinking day) and dependent drinkers was conducted in an emergency department (ED) among 446 patients 18 and older in Sosnowiec, Poland. METHODS: Patients were recruited over a 23-week period (4:00 pm to 12:00 midnight) and randomized to 1 of 3 conditions: screened-only (n = 147), assessed (n = 152), and intervention (n = 147). Patients in the assessed and intervention conditions were blindly reassessed via a telephone interview at 3 months, and all 3 groups were assessed at 12 months (screened-only = 92, assessed = 99, and intervention = 87). RESULTS: No difference was found across the 3 conditions in at-risk drinking at 12 months, as the primary outcome variable, or in decrease in the number of drinks per drinking day, with all 3 groups showing a significant reduction in both. Significant declines between baseline and 12 months in secondary outcomes of the RAPS4, number of drinking days per week, and the maximum number of drinks on an occasion were seen only for the intervention condition, and in negative consequences for both the assessment and intervention conditions. CONCLUSIONS: Data suggest that improvements in drinking outcomes found in the assessment condition were not because of assessment reactivity, with both the screened and intervention conditions demonstrating greater (although nonsignificant) improvement than the assessed condition. Only those in the intervention condition showed significant improvement in all outcome variables from baseline to 12-month follow-up. Although group by time interaction effects were not found to be significant, these findings suggest that declines in drinking measures for those receiving a brief intervention can be maintained at long-term follow-up.

Alcohol use, mental health, and HIV-related risk behaviors among adult men in Karnataka.

This study critically examined associations among past year alcohol use, self-rated mental health and HIV risk-related behaviors for men and their partners, i.e., two or more partners and/or perpetration of partner violence. Data are reported from a population sample of 1,137 men aged 16-49 in Karnataka. Overall, 9.5% of all men reported HIV risk-related behaviors, 38.1% consumed alcohol, and about half (54.5%) of all current drinkers met criteria for hazardous alcohol use. Hazardous alcohol use and poorer mental health remained significantly associated with HIV-risk related behaviors after controlling for socio-demographics and psychosocial risk factors. More severe alcohol misuse, specifically alcohol dependence, and co-morbid hazardous alcohol use and poorer mental health, was associated with over two- and five-fold increases, respectively, in men's HIV risk-related behaviors. Implications of findings for HIV prevention and intervention programs for men and their partners and directions for future research are discussed.

Risk of Alcohol-Related Injury: Does Societal Drinking Context Make a Difference?

OBJECTIVE: The aim of this study is to examine whether country-level frequency of drinking in a public context and in a private context is associated with rates of alcohol-related injury in emergency department studies from those same countries. METHOD: Emergency department data on 5,104 injured patients in 10 countries from the International Collaborative Alcohol and Injury Study (ICAIS) and aggregate level drinking context data from the Gender, Alcohol and Culture: An International Study (GENACIS) are analyzed. The association of societal drinking context (public and private) with variation in the rate of self-reported drinking before injury is examined using multilevel modeling. RESULTS: Controlling for demographic characteristics, individual-level volume and drinking pattern, study-level volume, and country-level drinking pattern and alcohol control policy, societal public drinking context was significantly predictive of an alcohol-related injury (odds ratio [OR] = 1.08, CI [1.02, 1.13]), whereas societal private drinking context was not. Public drinking context was predictive of violence-related injury (OR = 1.09, CI [1.01, 1.17]), whereas private drinking context was predictive of injuries from falls (OR = 1.01, CI [1.01, 1.02]). Neither societal drinking context was significantly predictive of traffic-related injuries whereas both public (OR = 1.06, CI [1.01, 1.12]) and private (OR = 1.01, CI [1.01, 1.03]) contexts were predictive of injuries from other causes. CONCLUSIONS: These data suggest that societal drinking context does make a difference in the likelihood of an alcohol-related injury, which is important for a better understanding of the role of drinking context in a country in the occurrence of an alcohol-related injury and may inform future recommendations for reducing this harmful consequence.

Strengths and coping strategies in the life narratives of sexual minority women.

This study explored self-described strengths and strategies for coping with stress among sexual minority women (SMW), drawing on qualitative narratives of sexual minority and heterosexual women who were recruited from a population based sample. In-depth follow-up qualitative telephone interviews were conducted with 48 women who had participated the National Alcohol Survey, a U.S. population-based survey. Participants included 25 SMW and 16 matched exclusively heterosexual women. Narrative data were analyzed using inductive thematic analysis and constant comparison to explore the study aim, with an emphasis on themes that diverged or that were particularly salient for SMW relative to heterosexual women. Strengths and coping strategies that were especially meaningful in the narratives of sexual minority women emerged in two areas. First, participants described development of intrapersonal strengths through nurturing an authentic sense of self and embracing multifaceted identity. Second, participant described multiple strategies for cultivation of interpersonal resources: navigating distance and closeness with family of origin, cultivating supportive friends and chosen family, connecting to community, finding solace and joy with animals, and engaging in collective action. Findings underscore the importance of considering protective factors that are salient to SMW in developing or refining prevention and intervention efforts.

Multi-level analysis of alcohol-related injury, societal drinking pattern and alcohol control policy: emergency department data from 28 countries.

BACKGROUND AND AIMS: Societal-level volume and pattern of drinking and alcohol control policy have received little attention in the alcohol and injury literature. The aim of this study was to estimate the association between alcohol-related injury, individual-level drinking variables, country-level detrimental drinking pattern and alcohol policy. DESIGN: Probability samples of emergency department (ED) patients from the International Collaborative Alcohol and Injury Study (ICAIS), which includes four collaborative ED studies on alcohol and injury, all using a similar methodology, were analyzed with multi-level modeling of individual-level drinking variables and aggregate-level variables (country drinking pattern and alcohol policy) on alcohol-related injury in 33 ED studies. SETTING: Sixty-two emergency departments in 28 countries covering five regions. PARTICIPANTS: A total of 14 390 injured patients arriving to the ED within 6 hours following injury. MEASURES: Alcohol-related injuries (self-reported drinking prior to the event and causal attribution of injury to drinking) were analyzed in relation to individual-level volume and pattern of drinking, study-level alcohol volume, country detrimental drinking pattern (DDP) and an alcohol policy measure, the International Alcohol Policy and Injury Index (IAPII). The IAPII includes four regulatory domains: availability, vehicular, advertising and drinking context. FINDINGS: Controlling for demographic characteristics, individual-level drinking and study-level volume, the IAPII was associated significantly with the proportion of both self-reported drinking [confidence interval (CI) = 0.97-0.99; P < 0.001] and causal attribution (CI = 0.97-0.99; P < 0.01) and DDP had little effect on these associations. All four domains were significantly predictive of self-reported drinking [availability (CI = 0.93-0.98, P < 0.01); vehicular (CI = 0.91-0.97, P < 0.001); advertising CI = 0.82-0.94, P < 0.01); and context (CI = 0.93-0.99, P < 0.01], while only the vehicular domain was significantly predictive of causal attribution (CI = 0.92-0.99; P < 0.05). CONCLUSIONS: The more restrictive the alcohol policy in a country, the lower the rate of alcohol-related injury, with country-level drinking pattern having little effect on this relationship.

Comparing substance use and mental health outcomes among sexual minority and heterosexual women in probability and non-probability samples.

OBJECTIVE: To examine similarities and differences in demographics and key substance use and mental health outcomes in a probability sample of heterosexual women and two samples of sexual minority women (SMW), one recruited using probability and the other using non-probability methods. METHODS: Using data from four waves of the National Alcohol Survey (NAS; n = 315 SMW; 10,523 heterosexual women) and Wave 3 of the Chicago Health and Life Experiences of Women (CHLEW; n = 688 SMW) study, we examined hazardous drinking, drug use, tobacco use, depression, and help-seeking for alcohol or other drug problems. RESULTS: Compared to SMW in the probability sample, SMW in the non-probability sample were older, more likely to be college educated, and more likely to be in a partnered relationship. Compared to heterosexuals, SMW in both the probability and non-probability samples had greater odds of past-year hazardous drinking, marijuana use, and other drug use. We found similar results for lifetime help-seeking for alcohol or drug problems, past week depression, and co-occurring hazardous drinking and depression. In comparisons with heterosexual women, the magnitude of difference for drug use was greater for the SMW non-probability sample; for tobacco use, the difference was greater for the SMW probability sample. CONCLUSION: Given the difficulties recruiting probability samples of SMW, researchers will continue to use non-probability samples in the foreseeable future. Thus, understanding how findings may differ between probability and non-probability samples is critically important in advancing research on sexual-orientation-related health disparities.

Conducting qualitative interviews by telephone: Lessons learned from a study of alcohol use among sexual minority and heterosexual women.

This study explored effective interviewer strategies and lessons-learned based on collection of narrative data by telephone with a sub-sample of women from a population-based survey, which included sexual minority women. Qualitative follow-up, in-depth life history interviews were conducted over the telephone with 48 women who had participated in the 2009-2010 National Alcohol Survey. Questions explored the lives and experiences of women, including use of alcohol and drugs, social relationships, identity, and past traumatic experiences. Strategies for success in interviews emerged in three overarching areas: 1) cultivating rapport and maintaining connection, 2) demonstrating responsiveness to interviewee content, concerns, and 3) communicating regard for the interviewee and her contribution. Findings underscore both the viability and value of telephone interviews as a method for collecting rich narrative data on sensitive subjects among women, including women who may be marginalized.