BACKGROUND: Food insecurity and alcohol consumption are prevalent and have health consequences among people living with HIV infection or AIDS (PLWHA). Food insecurity could be associated with unhealthy alcohol use via hunger or other mechanisms. However, it is not well-known whether the two (food insecurity and unhealthy alcohol use) are associated. OBJECTIVE: The objective of this study was to determine an association between food insecurity and unhealthy alcohol use in people with HIV/AIDS and substance use disorder. It was hypothesized that food insecurity, compared to food security, would be associated with unhealthy alcohol use in this population. METHODS: This study is a cross sectional analysis of data collected from adults with HIV infection and current alcohol or other drug dependence or ever injection drug use, who were participants in a cohort study known as the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) study. Food insecurity, the independent variable, was assessed using the Household Food Insecurity Assessment Scale (HFIAS) questionnaire (defined as a dichotomized measure of food insecure (mild, moderate, severe) versus food secure). Unhealthy alcohol use, the dependent variable, was assessed using the Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) questionnaire (defined as a score greater than 3 in males and a score greater than 2 in females). Participants were assessed at two time points 12 months apart. In generalized estimating equations, we studied the association between food insecurity and unhealthy alcohol use at each time point. Covariates adjusted for included age, sex, race, HIV viral load, CD4 cell count, physical health, mental health, number of people the individual spent time with who were heavy or problem drinkers, homelessness, if the participant had someone to turn to in a time of need, and drug dependence. RESULTS: Of the 250 participants enrolled in the Boston ARCH cohort, 233 completed the HFIAS and the AUDIT-C questionnaires at either or both time points. There were 100 participants who completed the questionnaires at time point 1 only, 67 at time point 2 only, and 66 at both time points resulting in a total of 299 data points. The mean age of our sample was in the 6th decade and the majority were Black/African American and identified as male. The majority (80%) had an HIV viral load under 200 and over half of the sample also had a CD4 cell count greater than or equal to 500. Unhealthy alcohol use was common (40%) and 44% had food insecurity. In unadjusted analysis, food insecurity was associated (p=0.08) with unhealthy alcohol use [OR=1.58 (CI 95%: 0.95, 2.62)]; however, this association disappeared in adjusted analysis [OR: 1.06 (CI 95%: 0.59, 1.87), p=0.85]. / 2018-07-11T00:00:00Z

Estimates suggest that 6% of adults aged 65 years and older reported binge drinking in the past month and 2.2% reported heavy drinking. This dissertation investigates the associations between stress, coping, and alcohol consumption specifically in older adults. The literature on the direct relationship between stress and drinking in older adults has yielded inconsistent results (i.e., some produced positive associations, others yielded negative or nonsignificant relations). Previous findings for the relationship between various types of coping and drinking in older adults have yielded more consistent results, with avoidant coping, alcohol outcome expectancy, and/or drinking to cope generally contributing to alcohol use either independently or in combination. The strengths and limitations of currently used alcohol screening instruments with older adults (e.g., Michigan Alcoholism Screening Test-Geriatric Version, CAGE Questionnaire, and Alcohol Use Disorders Identification Test) are also reviewed. Based on the literature, it was hypothesized that (a) lowering the definition of binge drinking to make it more age-sensitive to older adults would identify more individuals drinking at at-risk levels, (b) perceived stress, coping, and alcohol consumption would correlate with each other, and (c) coping would mediate the association between perceived stress and alcohol consumption. The study's sample consisted of 60 independent-living older adults (65 years of age and older), most of whom were White, female, and well educated. The results of this study only partially supported the hypotheses. Specifically, there was no clinically meaningful difference when the definition of binge drinking was lowered to a more age-specific classification on the Alcohol Use Disorders Identification Test - Consumption measure. Perceived stress and both task- and avoidant-focused coping were correlated, but perceived stress and alcohol consumption were not significantly correlated, nor were either task- or avoidant-focused coping and alcohol consumption correlated. Finally, neither task- nor avoidant-focused coping mediated the relationship between perceived stress and alcohol consumption. Limitations of the present study are discussed.

Alcohol use during pregnancy can damage the fetus. Midwives at antenatal care (ANC) screen pregnant women for risk drinking in early pregnancy. There are however, no routines involving both parents-to-be in a dialogue about alcohol. The aim of this thesis is to investigate alcohol use among pregnant women and their partners and to evaluate a method for midwives’ dialogue about alcohol in a life cycle perspective with both parents-to-be. Study I was a quasi-experiment within ANC. An intervention group (IG) received counseling with the midwife about alcohol use. The IG (238 couples) and a comparison group (271 couples) filled out questionnaires in early and in late pregnancy about alcohol use and support for an alcohol-free pregnancy. Study II was a cross-sectional study where 444 partners of pregnant women filled out a questionnaire at ANC about alcohol use, motives for decreased drinking and their perception about the midwives’ counseling about alcohol. Alcohol consumption was low among the pregnant women. One third (30 %) had decreased alcohol use before pregnancy and 90% stopped drinking after pregnancy confirmation. Of the partners, 24 % decreased alcohol use before pregnancy and 40 % decreased during pregnancy. Around 90 % of the women received support for an alcohol-free pregnancy, compared to 37 % of the partners. Twenty per cent of partners and 25 % of pregnant women reported alcoholism in their family. Partners who had alcoholism in the family drank more than partners without this experience. A majority, 95 %, of the partners in study II used alcohol, 29 % were binge drinking on a normal drinking day and 74 % were binge drinking occasionally. Most partners appreciated the counseling about alcohol and reported various motives for decreased alcohol consumption. Many pregnant women and partners decreased alcohol consumption in transition to parenthood, which is a crucial time for changing alcohol-drinking patterns. Involving both parents-to-be in counseling about alcohol restrictions during pregnancy may be a useful health promotion strategy.

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Alkohol är en källa till glädje men är också orsaken till många människors lidande och död. Värst drabbade är de som redan är missgynnade i samhället och den världsdel där alkohol konsumeras som mest är Europa. Alkoholen är integrerad i det sociala livet människor emellan och är något som är förknippat med mat och fest. Människor påverkas av de sociala nätverk som de befinner sig i, där vanor överförs och anammas. Därför är det viktigt i studiet av alkoholvanor att inkludera indikatorer på sociala faktorer. Syftet med studien var att undersöka alkoholvanor i relation till socioekonomisk status och kön. Tidigare forskning om alkoholvanor i Europa bildar en bas för en ökad förståelse för hur alkohol konsumeras i de olika regionerna och länderna. Trots skillnader mellan länder avseende alkoholkonsumtion så finns det fortfarande landspecifika mönster som denna studie ämnar undersöka. Dessa mönster omfattar frekvens, intensivkonsumtion och riskfyllt drickande. Datamaterialet som använts är från omgång 7 av European Social Survey, ESS, år 2014. Data för studien omfattar 37 623 respondenter från 20 europeiska länder. För att mäta socioekonomisk status användes utbildningsnivå och föräldrars utbildningsnivå. Alkoholvanor mättes med frekvens, intensivkonsumtion och riskfyllt drickande genom AUDIT-C. För att analysera samband mellan socioekonomisk status och alkoholvanor användes bivariat analys samt linjära regressionsanalyser. Resultaten visar att lågutbildade dels konsumerar alkohol mest frekvent och intensivkonsumerar i större utsträckning än högutbildade och att män i högre grad än kvinnor har riskfyllda alkoholvanor. Alkoholvanorna skiljde sig mellan olika europeiska regioner, vilket stöds av resultat från tidigare forskning. Sammanfattningsvis visar studien att sociala faktorer har betydelse för alkoholvanor och är något som bör beaktas i framtida forskning. Studien visar även att det fortfarande finns regionala skillnader i Europa gällande alkoholvanor.