Amount and consequences of alcohol drinking are modulated by ever using cigarettes and cannabis : a comparison between Sweden and US

Background. To study effects of ever used cigarettes or cannabis on amount and consequences of alcohol drinking. The ATLAS Project is a long-term longitudinal study comparing the development of substance use from high school to the young adult life period (18-23 years) in the US and Sweden. Methods. Baseline data for 3352 17-19 year-old students (65% from Sweden, 35% from US). Measurements: Questionnaire AUDIT-C, Rutgers Alcohol Problem Index, RAPI, ever use of marijuana, cigarettes and alcohol, onset of alcohol drinking, Conduct problems, SCL-8, Impulsivity. Results. The patterns of ever use differed distinctly between the two countries. In US 35% had never used alcohol, 17% had used alcohol and cannabis, 4% alcohol and cigarettes and 22% alcohol, cannabis and cigarettes. Corresponding figures in Sweden were 7%, 1%, 48% and 17%, respectively. Sweden had higher scores on AUDIT C and RAPI than US in the first three groups. In hierarchical multiple regression analyses on AUDIT C early drinking onset, conduct problems and impulsivity had about the same positive effects. Sweden, ever use of cigarettes and marijuana were all significantly related. Marijuana influenced less in Sweden than in the US. In hierarchical multiple regression analyses on RAPI conduct problems had a very strong effect. Sweden, cigarettes and marijuana were all significantly related. Cigarettes influenced less on consequences of drinking in Sweden than in the US. Conclusions. Sweden and the US differed in important aspects on modulating effects of cannabis and cigarettes on alcohol drinking. Supported by a grant from NIAAA/NIH for Larimer/Berglund

Relationship of Protective Behavioral Strategies to Alcohol Consequences Among Swedish High School Seniors : Moderating Role of Conduct Disorder Symptoms

Abstrakt 023This observational study sought to improve our understanding of factors that contribute to risky sexual behavior among women seeking treatment for alcohol and other substance use disorders. Women were recruited at the start of outpatient (n=236) or inpatient (n=166) treatment. At intake, a Timeline Follow-back interview was used to obtain retrospective reports of daily drinking, drug use, and sexual behavior for a 90-day pre-treatment baseline period. Additional interview and questionnaire measures also were obtained. Measures were re- administered at four 90-day follow-up interviews. Among women who reported sex with a primary partner during baseline (n=261), 15% reported consistent condom use for all events with this partner, whereas 80% reported no condom use with this partner. Among women who reported sex with a non-primary partner (n=159; doesn’t include commercial sex trading), 26% reported consistent condom use and 45% reported no condom use with such partners. Significant correlates of non-use of condoms included negative beliefs and attitudes and low self-efficacy regarding condom use and AIDS prevention, as well as psychological distress, sexual impulsiveness and sensation seeking, history of severe assault by a male partner, and (with primary partners) negative partner attitudes toward condom use. Some of these correlates also predicted unprotected sex with a primary partner during the first 90 days after treatment entry, after controlling for baseline. However, unsafe sex with a non-primary partner during follow-up was most notably associated with follow-up levels of substance use, i.e., more drinks per drinking day and greater frequency of alcohol, marijuana, and cocaine use. In sum, preliminary analyses of baseline and follow-up data indicate a high prevalence of unprotected sex in this population. Identification of factors related to baseline and follow-up levels of risky behavior may suggest targets for future intervention development

Self-reported disability in relation to alcohol and other drug use and mental health among emerging adults : an international comparison

The present study includes baseline data from 2867 students (77.8% from Sweden, 22.2% from US) and evaluates the relationships among self-reported disabilities, alcohol use, other substance use, and psychosocial adjustment. There were 114 (4.6%) ‘‘hard-of-hearing’’ (HH) students, 129 (5.2%) reported visual disabilities, 33 (1.3%) reported motor disabilities, 223 (9.0%) reported a reading/writing disability, and 97 (3.6%) reported they had ‘‘other’’ disabilities. Of these, 70 (14.1%) reported more than one disability. Presence of a disability was significantly higher among Sweden students (2 (1)=19.93, p< 0.001), with 19.1% of Sweden students and 11.5% of US students reporting at least one disability. Reporting any type of disability was associated with significantly greater alcohol use frequency, intensity, and related problems (all p < 0.02), significantly more mental health symptoms and conduct problems (p < 0.005), and significantly greater likelihood of illicit and prescription drug use (all p < 0.001). With respect to specific disabilities, individuals with motor disabilities reported the highest levels of alcohol use and mental health symptoms, whereas individuals who reported ‘‘other’’ disabilities had higher rates of illicit drug use and conduct problems. Further, there was a significantly positive correlation between the number of disabilities and intensity of alcohol use, mental health symptoms, conduct problems, illicit and prescription drug use, and alcohol related problems (all p < 0.001). The association between conduct problems and disability (any disability and number of disabilities) was moderated by country of origin, gender, and drinking for coping reasons on the Drinking Motives Questionnaire. Participants in Sweden, males, and those who drank for coping reasons were more likely to report a relationship between disability and conduct problems (p < 0.001). Participants who drank for coping reasons were also more likely to report a relationship between disability and alcohol related problems (p=0.001). These findings indicate students with disabilities are an important risk group for preventive interventions for alcohol, substance, and mental health problems, and may benefit from interventions which target healthy coping skills. This research was supported by NIAAA # 5R01AA018276 awarded to Drs. Larimer & Berglun

An international comparison of a web-based personalized feedback intervention in high school students USA and Sweden

A key developmental period for alcohol misuse is emerging adulthood (roughly ages 18–25). Personalized Feedback Interventions (PFI) are effective in reducing alcohol-related harmin college populations, however little research has evaluated PFIs given during high school.Moreover, cultural differences influence both alcohol misuse and response to interventions. The purpose of this study is to evaluate the efficacy of a web-based PFI given to high school seniors (ages 17-19) in the USA and Sweden. 1181 participants (42.3%male; 28.3%risky drinkers based on AUDIT-C) in the USA and 2171 in Sweden (44.1%male; 52.3% risky drinkers based on AUDIT-C) were assessed during their high school senior year. Approximately 1/3 were randomized to receive PFI. Approximately 1 week after viewing the PFI, participants were asked to complete a post-feedback satisfaction survey (3 subscales: information motivated change, shared information with friends, information was educational), and their “stage” on the readiness to change scale. Results showed 1) information motivated change subscale was associated with increases in contemplation and action stages of change and decreases in precontemplation; Swedish participants and those with higher AUDIT-C scores had lower scores; (2) USA sample was less likely to share information with friends; those with higher AUDIT-C scores were more likely to share information with friends; and (3) those with higher AUDIT-C scores were less likely to find information educational. Participants completed 6- and 12- month follow up surveys. After controlling for key baseline variables and using appropriate distributions for analyses, 6 month outcomes from 2236 participants (852 in USA; 1384 in Sweden; 731 received PFI), found those who received PFI drank significantly less alcohol per occasion (typical and peak), had lower blood alcohol concentration (typical and peak) and drank on fewer occasions than those who did not receive the PFI (effect size range: d = .12 to d = .22). There were no significant effects of PFI on alcohol-related problems or readiness to change and no significant interactions between country of residence and intervention on drinking outcomes. Results suggest web-based PFIs given during senior year of high school are efficacious in reducing alcohol use during transition to adulthood. Twelve-month outcomes and mediators will also be presented. This research was supported by NIAAA # 5R01AA018276 awarded to Drs. Larimer & Berglund

Protective behavioral strategies and future drinking behaviors: Effect of drinking intentions.

Alcohol use is common among United States and Swedish high school students and is related to negative consequences. Whereas drinking intentions are associated with future drinking behaviors, the use of protective behavioral strategies (PBS) is associated with decreased alcohol-related harm among young adults. The interactive effect of PBS and drinking intentions in predicting alcohol outcomes has not been examined. Further, because most PBS studies have been conducted among U.S. college students, PBS research among other populations is needed. The aims of this study were to evaluate longitudinally (a) the relationships between drinking intentions, PBS and alcohol outcomes, and (b) the moderating roles of drinking intentions and country in these relationships among United States and Swedish high school drinkers. Data were collected at baseline, 6- and 12-month follow-ups on 901 Swedish and 288 U.S. high school drinkers. Drinking intentions were associated with more alcohol use and consequences, and use of certain PBS was related to fewer alcohol-related consequences over time. Additionally, the negative prospective relationship between use of PBS and alcohol use, but not alcohol-related consequences, was moderated by intentions, such that the relationship was stronger among participants endorsing high drinking intentions. Country did not moderate these relationships. These results provide initial support for the generalizability of PBS college research to United States and Swedish high school students and suggest that interventions targeting the use of PBS may be most effective among high school drinkers endorsing high drinking intentions. (PsycINFO Database Recor

An International Comparison of a Web-Based Personalized Feedback Intervention for Alcohol use During the Transition out of High School in the United States and Sweden.

Young adult drinkers engage in a range of drinking patterns from abstaining to heavy drinking in both the United States and Sweden. Heavy drinking during young adulthood in both countries is associated with a variety of negative consequences. Personalized feedback interventions have been identified as effective prevention strategies to prevent or reduce heavy drinking in the United States. This study examined transitions in drinking profiles and compared the efficacy of a personalized feedback intervention for 3965 young adults in the United States (1,735) and Sweden (2230) during their transition out of high school. Using goodness-of-fit criteria, results indicated that three drinking profiles exist among young adults transitioning out of high school: very low drinkers/abstainers, moderate to heavy drinkers, and very heavy drinkers. Latent Markov models revealed a moderating effect of country on personalized feedback intervention such that intervention condition participants in the United States were more likely to belong to the light drinker/abstainer or moderate to heavy profile relative to the very heavy drinking profile at 6-month follow-up. There was no significant effect of personalized feedback intervention in Sweden. Future research could investigate the impact of when personalized feedback interventions are administered and could examine if personalized feedback interventions should be more intentionally culturally adapted in order to be more effective