Associations between social media usage and alcohol use among youths and young adults; findings from Understanding Society

Background and Aims: Given the decline in alcohol consumption and rise in technological use among young people, there is a need to investigate whether technology use might influence how young people drink. This study explores how social media use and changes in social media use over time could affect alcohol use among youths. Design: The UK Household Longitudinal Study (Understanding Society). Setting: United Kingdom. Participants: Participants aged 10–15 (n = 4093) and 16–19 (n = 2689) from the youth and main survey interviewed in 2011–13, and followed-up in 2014–16 (aged 10–15 n = 2588, aged 16–19 n = 1057). Measurements: Self-reported social media usage on an average day (no profile/non-daily/less than an hour/1–3/4+ hours use), drinking frequency (never/one to three times/weekly) and binge drinking frequency (never/one to two/three/more than three times) in the past month. Covariates included sex, age, educational status, household income, urban/rural, number of friends and life satisfaction. Findings: Among 10–15-year-olds, compared with those who used social media for less than an hour, those with no profile [odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.25–0.67] and non-daily users (OR = 0.49, 95% CI = 0.33–0.72) had a lower risk of drinking at least monthly, whereas those with 1–3 hours’ use (OR = 1.44, 95% CI = 1.14–1.81) and 4+ hours’ use (OR = 2.08, 1.47–2.95) had a greater risk. Among participants aged 16–19, a lower risk of binge drinking three or more times per month was found for those with no profile [relative risk ratios (RRR) = 0.29, 95% CI = 0.17–0.48] and a higher risk for those with 4+ hours’ use (RRR = 1.47, 95% CI = 1.03–2.09). Longitudinally, among 10–15-year-olds, those who had increased their social media usage versus no change were more likely to have increased their drinking frequency (OR = 1.89, 95% CI = 1.45–2.46). Some social media use at baseline (rather than none) was predictive of increased drink and binge drinking frequency over time among youths and young adults. Conclusions: Heavier social media use was associated with more frequent alcohol consumption among young people in the United Kingdom

Investigating the health of non-drinkers: the sick-quitter and sick non-starter hypotheses

Non-drinkers have been consistently found to have worse health outcomes than moderate drinkers in later life. Explanations for this include a protective effect of moderate alcohol consumption on health, or alternatively that some non-drinkers are ex-drinkers who may have had to stop drinking because of poor health hence suffering from a pre-existing poor health bias. Another factor, which has been unexplored in the literature, is the early life health and social circumstances of non-drinkers; this is the subject of investigation in this thesis The Health Survey for England was used to explore the early life social, health and health behaviours of non-drinkers aged 18 to 34 years. The National Child Development Study and the 1970 British Cohort Study were used to investigate the childhood health characteristics of non-drinkers in early adulthood. Binary logistic regression was carried out to assess whether poor health from an early age and persistent poor health was associated with being a persistent non-drinker across time at different ages, adjusting for sex, highest qualification, mental health and marital and parental status. Poor health from an early age and persistent poor health were associated with being a lifetime abstainer, consistently between two cohorts, which is an original contribution to knowledge. Non-drinkers from an early age had higher rates of emotional and behaviour problems than drinkers; this may contribute to greater risk of cognitive decline. Furthermore non-drinkers in early adulthood had higher rates of health conditions in adolescence, and had lower educational levels from early adulthood. This might increase the risk of mortality among non-drinkers in later life through persistent multiple disadvantage from an early age. The health and social characteristics of non-drinkers in early life need to be considered when comparing health outcomes of non-drinkers with drinkers in later life. The worse health and lower social circumstances of non-drinkers from an early age may be why non-drinkers consistently have worse health outcomes than drinkers across a broad range of conditions

Social inequalities in prevalence of diagnosed and undiagnosed diabetes and impaired glucose regulation in participants in the Health Surveys for England series

OBJECTIVES: To ascertain the extent of socioeconomic and health condition inequalities in people with diagnosed and undiagnosed diabetes and impaired glucose regulation (IGR) in random samples of the general population in England, as earlier diagnosis of diabetes and treatment of people with IGR can reduce adverse sequelae of diabetes. Various screening instruments were compared to identify IGR, in addition to undiagnosed diabetes. DESIGN: 5, annual cross-sectional health examination surveys; data adjusted for complex survey design. SETTING: Random selection of private homes across England, new sample annually 2009-2013. PARTICIPANTS: 5, nationally representative random samples of the general, free-living population: ≥1 adult interviewed in 24 254 of 36 889 eligible addresses selected. 18 399 adults had a valid glycated haemoglobin (HbA1c) measurement and answered the diabetes questions. MAIN OUTCOME MEASURES: Diagnosed diabetes, undiagnosed diabetes (HbA1c ≥48 mmol/mol), IGR (HbA1c 42-47 mmol/mol). RESULTS: Overall, 11% of the population had IGR, 2% undiagnosed and 6% diagnosed diabetes. Age-standardised prevalence was highest among Asian (19% (95% CI 16% to 23%), 3% (2% to 5%) and 12% (9% to 16%) respectively) and black participants (17% (13% to 21%), 2% (1% to 4%) and 14% (9% to 20%) respectively). These were also higher among people with lower income, less education, lower occupational class and greater deprivation. Education (OR 1.49 (95% CI 1.27 to 1.74) for no qualifications vs degree or higher) and income (1.35 (1.12 to 1.62) for lowest vs highest income quintile) remained significantly associated with IGR or undiagnosed diabetes on multivariate regression. The greatest odds of IGR or undiagnosed diabetes were with increasing age over 34 years (eg, OR 18.69 (11.53 to 30.28) aged 65-74 vs 16-24). Other significant associations were ethnic group (Asian (3.91 (3.02 to 5.05)), African-American (2.34 (1.62 to 3.38)) or 'other' (2.04 (1.07 to 3.88)) vs Caucasian); sex (OR 1.32(1.19 to 1.46) for men vs women); body mass index (3.54 (2.52 to 4.96) for morbidly obese vs not overweight); and waist circumference (2.00 (1.67 to 2.38) for very high vs low). CONCLUSIONS: Social inequalities in hyperglycaemia exist, additional to well-known demographic and anthropometric risk factors for diabetes and IGR

Does the use of prediction equations to correct self-reported height and weight improve obesity prevalence estimates? A pooled cross-sectional analysis of Health Survey for England data.

OBJECTIVE: Adults typically overestimate height and underestimate weight compared with directly measured values, and such misreporting varies by sociodemographic and health-related factors. Using self-reported and interviewer-measured height and weight, collected from the same participants, we aimed to develop a set of prediction equations to correct bias in self-reported height and weight and assess whether this adjustment improved the accuracy of obesity prevalence estimates relative to those based only on self-report. DESIGN: Population-based cross-sectional study. PARTICIPANTS: 38 940 participants aged 16+ (Health Survey for England 2011-2016) with non-missing self-reported and interviewer-measured height and weight. MAIN OUTCOME MEASURES: Comparisons between self-reported, interviewer-measured (gold standard) and corrected (based on prediction equations) body mass index (BMI: kg/m2) including (1) difference between means and obesity prevalence and (2) measures of agreement for BMI classification. RESULTS: On average, men overestimated height more than women (1.6 cm and 1.0 cm, respectively; p<0.001), while women underestimated weight more than men (2.1 kg and 1.5 kg, respectively; p<0.001). Underestimation of BMI was slightly larger for women than for men (1.1 kg/m2 and 1.0 kg/m2, respectively; p<0.001). Obesity prevalence based on BMI from self-report was 6.8 and 6.0 percentage points (pp) lower than that estimated using measured BMI for men and women, respectively. Corrected BMI (based on models containing all significant predictors of misreporting of height and weight) lowered underestimation of obesity to 0.8pp in both sexes and improved the sensitivity of obesity over self-reported BMI by 15.0pp for men and 12.2pp for women. Results based on simpler models using age alone as a predictor of misreporting were similar. CONCLUSIONS: Compared with self-reported data, applying prediction equations improved the accuracy of obesity prevalence estimates and increased sensitivity of being classified as obese. Including additional sociodemographic variables did not improve obesity classification enough to justify the added complexity of including them in prediction equations

Ethnic differences in multimorbidity after accounting for social-economic factors, findings from The Health Survey for England

BACKGROUND: Social-economic factors and health behaviours may be driving variation in ethnic health inequalities in multimorbidity including among distinct ethnic groups. METHODS: Using the cross-sectional nationally representative Health Surveys for England 2011-18 (N = 54 438, aged 16+), we performed multivariable logistic regression on the odds of having general multimorbidity (≥2 longstanding conditions) by ethnicity [British White (reference group), White Irish, Other White, Indian, Pakistani, Bangladeshi, Chinese, African, Caribbean, White mixed, Other Mixed], adjusting for age, sex, education, area deprivation, obesity, smoking status and survey year. This was repeated for cardiovascular multimorbidity (N = 37 148, aged 40+: having ≥2 of the following: self-reported diabetes, hypertension, heart attack or stroke) and multiple cardiometabolic risk biomarkers (HbA1c ≥6.5%, raised blood pressure, total cholesterol ≥5mmol/L). RESULTS: Twenty percent of adults had general multimorbidity. In fully adjusted models, compared with the White British majority, Other White [odds ratio (OR) = 0.63; 95% confidence interval (CI) 0.53-0.74], Chinese (OR = 0.58, 95% CI 0.36-0.93) and African adults (OR = 0.54, 95% CI 0.42-0.69), had lower odds of general multimorbidity. Among adults aged 40+, Pakistani (OR = 1.27, 95% CI 0.97-1.66; P = 0.080) and Bangladeshi (OR = 1.75, 95% CI 1.16-2.65) had increased odds, and African adults had decreased odds (OR = 0.63, 95% CI 0.47-0.83) of general multimorbidity. Risk of cardiovascular multimorbidity was higher among Indian (OR = 3.31, 95% CI 2.56-4.28), Pakistani (OR = 3.48, 95% CI 2.52-4.80), Bangladeshi (OR = 3.67, 95% CI 1.98-6.78), African (OR = 1.61, 95% CI 1.05-2.47), Caribbean (OR = 2.18, 95% CI 1.59-2.99) and White mixed (OR = 1.98, 95% CI 1.14-3.44) adults. Indian adults were also at risk of having multiple cardiometabolic risk biomarkers. CONCLUSION: Ethnic inequalities in multimorbidity are independent of social-economic factors. Ethnic minority groups are particularly at risk of cardiovascular multimorbidity, which may be exacerbated by poorer management of cardiometabolic risk requiring further investigation

The silent epidemic of obesity in The Gambia: evidence from a nationwide, population-based, cross-sectional health examination survey

OBJECTIVES: Non-communicable diseases account for 70% of global deaths; 80% occur in low-income and middle-income countries. The rapid increase of obesity in sub-Saharan Africa is a concern. We assessed generalised and abdominal obesity and their associated risk factors among adults in The Gambia. DESIGN: Nationwide cross-sectional health examination survey using the WHO STEPwise survey methods. SETTING: The Gambia. PARTICIPANTS: This study uses secondary analysis of a 2010 nationally representative random sample of adults aged 25-64 years (78% response rate). The target sample size was 5280, and 4111 responded. Analysis was restricted to non-pregnant participants with valid weight and height measurements (n=3533). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome variable was generalised obesity, using WHO body mass index (BMI) thresholds. Analyses used non-response weighting and adjusted for the complex survey design. We conducted multinomial logistic regression analysis to identify factors associated with BMI categories. The secondary outcome variable was abdominal obesity, defined as high waist circumference (using the International Diabetes Federation thresholds for Europeans). RESULTS: Two-fifths of adults were overweight/obese, with a higher obesity prevalence in women (17%, 95% CI 14.7 to 19.7; men 8%, 95% CI 6.0 to 11.0). 10% of men and 8% of women were underweight. Urban residence (adjusted relative risk ratio 5.8, 95% CI 2.4 to 14.5), higher education (2.3, 1.2 to 4.5), older age, ethnicity, and low fruit and vegetable intake (2.8, 1.1 to 6.8) were strongly associated with obesity among men. Urban residence (4.7, 2.7 to 8.2), higher education (2.6, 1.1 to 6.4), older age and ethnicity were associated with obesity in women. CONCLUSION: There is a high burden of overweight/obesity in The Gambia. While obesity rates in rural areas were lower than in urban areas, obesity prevalence was higher among rural residents in this study compared with previous findings. Preventive strategies should be directed at raising awareness, discouraging harmful beliefs on weight, and promoting healthy diets and physical activity

Investigating the growing trend of non-drinking among young people; analysis of repeated cross-sectional surveys in England 2005–2015

BACKGROUND: Non-drinking among young people has increased over the past decade in England, yet the underlying factor driving this change is unknown. Traditionally non-drinking has been found to be associated with lower socio-economic status and poorer health. This study explores among which sub-groups non-drinking has increased, and how this correlates with changes in drinking patterns, to identify whether behaviours are becoming more polarised, or reduction is widespread among young people. METHODS: Among participants aged 16 to 24 years (N = 9699), within the annual cross-sectional nationally-representative Health Survey for England 2005-2015 datasets, the following analyses were conducted: 1) The proportion of non-drinkers among social-demographic and health sub-groups by year, and tests for linear trends among sub-groups, adjusting for age were calculated. In pooled analyses, an interaction between year and each variable was modelled in sex- and age-adjusted logistic regression models on the odds of being a non-drinker versus drinker 2) At the population level, spearman correlation co-efficients were calculated between the proportion non-drinking and the mean alcohol units consumed and binge drinking on the heaviest drinking day, by year. Ordinary least squares regression analyses were used, modelling the proportion non-drinking as the independent variable, and the mean units/binge drinking as the dependent variable. RESULTS: Rates of non-drinking increased from 18% (95%CI 16-22%) in 2005 to 29% (25-33%) in 2015 (test for trend; p < 0.001), largely attributable to increases in lifetime abstention. Not drinking in the past week increased from 35% (32-39%) to 50% (45-55%) (p < 0.001). Significant linear increases in non-drinking were found among most sub-groups including healthier sub-groups (non-smokers, those with high physical activity and good mental health), white ethnicity, north and south regions, in full-time education, and employed. No significant increases in non-drinking were found among smokers, ethnic minorities and those with poor mental health. At the population-level, significant negative correlations were found between increases in non-drinking and declines in the mean units consumed (ρ = - 0.85, p < 0.001), and binge drinking (ρ = - 0.87, p < 0.001). CONCLUSION: Increases in non-drinking among young people has coincided with a delayed initiation into alcohol consumption, and are to be welcomed. Future research should explore attitudes towards drinking among young people

Worsening of health and a cessation or reduction in alcohol consumption to special occasion drinking across three decades of the life-course

Background: Ex-drinkers suffer from worse health than drinkers; however, whether a worsening of health is associated with a change in drinking status from early adulthood has not been previously investigated. We assesses whether a worsening of health is associated with a cessation in consumption or reduction to special occasion drinking from early adulthood to middle age. Methods: Multinomial logistic regression assessing whether a change in self-reported limiting longstanding illness (LLI) was associated with ceasing alcohol consumption, or a reduction to special occasion drinking compared with being a persistent drinker from age 23 in separate models at ages 33, 42 and 50. All models adjusted for sex, poor psychosocial health, education, marital and children in the household. Sample included participants from Great Britain followed longitudinally in the National Child Development Study (NCDS) from ages 23 to 33 (N=5,529),42 (N=4,787) and 50 (N=4,476). Results: Developing a LLI from the previous wave was associated with ceasing alcohol consumption at ages 33 (OR= 2.71, 95%CI= 1.16-4.93), 42 (OR=2.44, 95%CI=1.24-4.81) and 50 (OR=3.33, 95%CI=1.56-7.12) and a reduction to special occasion drinking at ages 42 (OR=2.04, 95%CI=1.40-2.99) and 50 (OR=2.04, 95%CI= 1.18-3.53). Having a persistent LLI across two waves increased the odds of ceasing consumption at ages 42 (OR=3.22, 95%CI=1.06-9.77) and 50 (OR=4.03, 95%CI=1.72-9.44), and reducing consumption to special occasion drinking at ages 33 (OR=3.27, 95%CI=1.34-8.01) and 42 (OR=2.25, 95%CI=1.23-4.50)). Persistent drinkers at older ages had the best overall health suffering less from previous poor health compared with those who reduced or ceased consumption at an earlier time-point. Conclusion: Developing a LLI was associated with a cessation in alcohol consumption and a reduction in consumption to special occasion drinking from early adulthood. Persistent drinkers who drank at least till 50 were the healthiest overall. Health selection is likely to influence non-drinking across the life course