Those who misuse alcohol in the United States do not regularly seek treatment on their own to reduce use and avoid consequences of misuse. Because of the association between alcohol misuse, alcohol-related risk behaviors, and injury; alcohol misuse in the United States has serious societal and individual repercussions. To alleviate these problems, health care professionals; including doctors, nurses, and social workers; have an opportunity to screen injured patients for alcohol misuse and provide brief interventions. Although some brief intervention research has demonstrated reductions in alcohol misuse and other injury-related behaviors, other evidence indicates that brief alcohol interventions are not equally effective for all injured patients. Moreover, screening and brief alcohol interventions are not reimbursed in most states, leaving providers and medical centers uncompensated for providing services. A possible way to address these challenges is to target intervention services to patients who are most likely to make positive changes. Therefore, this dissertation used mixture modeling to identify subclasses of injured patients based on their past injury-related consequences and risks of alcohol misuse in order to describe which subgroups made the greatest reductions in drinking in the year following discharge from a Level-1 trauma center. This dissertation also identified which subclasses of patients made the greatest behavioral improvements for injury-related consequences and risks of alcohol misuse during the year following discharge from the trauma center. Patients with profiles that contained high probabilities of multiple consequences and risks and those with histories of alcohol-related accidents and injuries reported some of the largest improvements in drinking and injury-related consequences and risks following discharge. Those classes that made the fewest changes had profiles that consisted of fighting and taking foolish risks while drinking or that consisted of low probabilities of risks or consequences of alcohol misuse. This dissertation provides tentative evidence for targeting intervention services to injured patients. Further research should verify which subclasses of patients are most likely to reduce alcohol misuse and other alcohol-related risk behaviors in order to more effectively target brief alcohol interventions, increase cost savings, and improve the health and behavioral health outcomes for injured patients who misuse alcohol. / text

Introduction: Alcohol misuse is a major public health concern, resulting in an estimated 88,000 deaths annually in the U.S. Negative religious coping (NRC) is a known risk factor for alcohol misuse; yet, research has not examined potential protective factors that might weaken this linkage. Forgiveness and humility are commonly-studied spiritual factors linked to positive health-related outcomes, but they have not been explored in the context of NRC and alcohol misuse. In our study, we assessed the potential protective role of forgiveness and humility in the association between NRC and alcohol misuse, among religious believers and non-believers. Methods: Participants in this IRB-approved study were recruited online via Amazon’s Mechanical Turk and self-identified as religious believers (n = 146) or non-believers (n = 120). After providing informed consent, participants completed self-report surveys including the Alcohol Use Disorders Identification Test (AUDIT), Brief RCOPE, Heartland Forgiveness Scale (Forgiveness of Others), and a single item measure of humility. Results: At the bivariate level, for religious non-believers, humility was positively associated with forgiveness (r = .27, p < .01) and negatively associated with NRC (r = -.20, p < .05) and AUDIT scores (r = -.17, p < .05). Forgiveness was negatively associated with NRC (r = -.18, p < .05) and NRC was positively associated with AUDIT scores (r = .28, p < .01). For religious believers, humility was positively associated with forgiveness (r = .25, p < .01) and negatively associated with AUDIT scores (r = -.17, p < .05). Forgiveness was negatively associated with NRC (r = -.29, p < .01) and AUDIT scores (r = -.20, p < .01) and NRC was positively associated with AUDIT scores (r = -.22, p < .01). At the multivariate level, for religious believers, forgiveness moderated the relation between NRC and AUDIT scores (R2Δ = .04, p = .01), but humility did not. For religious non-believers, humility moderated the relation between NRC and AUDIT scores (R2Δ = .07, p < .01, but forgiveness did not. Conclusions: Negative religious coping is a significant risk factor for alcohol misuse among religious believers and non-believers. In the context of NRC, positive psychological constructs may provide a novel approach to reducing alcohol misuse. Forgiveness of others was protective against alcohol use problems for religious believers engaging in NRC, whereas humility was protective for religious non-believers. As a tenet of most religions, forgiveness of others may be particularly significant for religious believers in resolving NRC, of which a feature is feeling abandoned by other religious believers. For non-believers, NRC may manifest as questioning the existence of God, and humility may promote a sense of comfort in their uncertainty. Positive psychology interventions such as forgiveness therapy or the PROVE humility intervention may be effective interventions for alcohol misuse, in the context of NRC.

BACKGROUND: Soldiers face extraordinary circumstances while serving in the U.S. Armed Forces. Soldiers are required at times to live away from family and friends for extended periods of time and work in hazardous environments. Once soldiers become veterans, the experiences of military life may continue to affect them long after their duties have been carried out. These conditions put them at greater risk for alcohol misuse and depression. The purpose of this is to determine whether there is an association between alcohol misuse and depression symptomology among males who have a history of service in the U.S. Armed Forces. METHODS: Secondary data from NHANES 2005-2008 were used to analyze 1,381 men who expressed alcohol misuse and depressive symptomology. Chi-square tests were used to attain descriptive frequencies for alcohol misuse and depressive symptomology and demographic factors. Binary logistic regression was used for univariate and multivariate to test for associations between alcohol misuse, depressive symptomology, and demographic variables. RESULTS: Alcohol misuse and depressive symptomology were significantly associated with male veterans with a history of service in the Armed Forces, p= .041. Age (p< .001), race (p< .05) marital status (p<.05), and educational attainment (p< .01) are the best predictors of alcohol misuse among male veterans. Similarly, depressive symptomology had the same predictors as alcohol misuse, except race. CONCLUSIONS: The complex relationship between alcohol misuse and depressive symptomology among male veterans warrants further research. Public health professionals need to clearly establish standard measurement instruments for diagnosing these conditions. Once established, appropriate interventions can be implemented in order to combat these alcohol misuse and depressive symptomology among male veterans. INDEX WORDS: alcohol misuse, depressive symptomology, military, veterans

While there is a vast amount of research focusing on the importance of school connectedness for short-term outcomes related to alcohol use, few studies have looked at the longer-term consequences of poor school connectedness. The aim of the current study was therefore to investigate the gender-specific association between school connectedness (1966) and alcohol- related hospitalization in adulthood (1973-2007). Moreover, the role of adjustment problems in adolescence was examined. Logistic regression analysis was based on a cohort of Swedish children, born in 1953 in Stockholm, Sweden, including 6,269 males and 6,106 females. The results revealed a statistically significant relationship between having a lower level of school connectedness in childhood and an increased risk of hospitalization due to alcohol misuse in adulthood, among males. The findings for females were less conclusive. Controlling for socioeconomic background and adjustment problems in adolescence reduced the strength of the association but did not explain it. In sum, this study shows that school connectedness appear to have long-term consequences for alcohol-related diseases, but further research is needed to understand the mechanisms behind this finding.

No description available.

Magister Public Health - MPH / Background: Alcohol consumption among adolescents is increasing due to the general availability of alcohol in many community settings. Binge drinking (defined as drinking 5 or more drinks per occasion) (Parry, 2000) is considered the most common type of harmful alcohol consumption among young people. The United States Youth Risk Behaviour Surveillance report proposes that patterns of health risk behaviours are established during youth (Centre for Disease Control and Prevention,2006). The abovementioned report highlights behaviours such as alcohol misuse, drug use and risky sexual behaviour that have the potential to undermine the health and development of youth. Adolescent developmental theories recognise risk behaviours as central to normal adolescent development but there are complex predisposing risk factors that can cause these behaviours to compromise the healthy development of our youth. In order to design and implement effective intervention schemes, we need to understand the dynamics of alcohol use among local youth better, as these play out in their specific social environmental and personal contexts.Aim: The aim of this study was to gain an understanding of what influences the patterns of alcohol use among adolescents in a peri-urban historically disadvantaged community in the Western Cape. The study identified some of the factors that promote and inhibit drinking within the study community from the perspective of the adolescents themselves and a few of the adults who work with adolescents. The study also determined some of the harmful consequences to drinking as described by the adolescents.Method: This was an exploratory study using qualitative research methods. Four focus group discussions were conducted with adolescents aged between 14 and 19 years that were both attending and not attending school. Three key informant interviews with adults who were involved with the youth were conducted.Convenience sampling was used for the non-school attending participants and snowball sampling was used for the school attending youth. The adults in the study were purposively sampled. The study was conducted within the study setting during March and April 2009. Thematic and content analysis was used to interpret the data.The descriptive data was coded and categorised according to themes that emerged during analysis.Results: In general the youth of this study are drinking on weekends. They spend their time on the streets and access alcohol from the many illegal taverns in their neighbourhood. Some of the reasons why adolescents drink include just for the fun of it and because their friends drink and to cope with stress or boredom (risk factors for problem behaviour). Those who don’t drink generally have strong parental role models, have observed some of the harmful effects of alcohol use and seem able to resist peer pressure (protective factors for problem behaviour). There were no significant differences between the perceptions of male and female adolescents regarding alcohol consumption. The black adolescents in general appeared to be more affected by poverty than the coloured adolescents, a factor that influenced their choices around alcohol use. Risky sexual behaviour, rape and fighting seem to be some of the harmful consequences to drinking that are described by the youth of this study. The social environment in which the adolescents of this study live seemed to play a significant role in their attitudes toward drinking. Factors such as a lack of infrastructure for leisure, poverty and a tolerance for public drunkenness are community factors that affect these adolescents but over which they have little or no control.Conclusion: The potential for problem behaviour as perceived by the participants is determined by the balance of risk and protective factors that emanate from their social environment, the community itself and their own personality. Those fortunate enough to have cohesive families with interested adults around them are more likely to be protected from problem behaviour due to drinking.Recommendations: Recommendations from this study include engaging with the youth directly when designing intervention programmes; using peer-led programmes to effect change and to help adolescents to clarify their values; equip them with skills to plan for the future in order to develop their self-efficacy to make the right choices when it comes to alcohol consumption. It is also recommended that intervention programmes address relationships within the community itself such as strengthening parent-child communication; building positive adult role models and empowering community members to challenge issues such as illegal tavern owners serving alcohol to minors.

No description available.

Background: A wealth of quantitative literature exists exploring the impact of parental alcohol misuse on adult and child offspring. It is often proposed that children of alcoholics are at risk of experiencing a host of negative outcomes, many of which are said to persist into adulthood. Confusing and contradictory results have led researchers to identify a subset of offspring deemed to be resilient. Little remains known about the factors that influence who becomes negatively affected and who becomes resilient, or how these factors are experienced by individuals. The recent up rise of qualitative methodologies also suggest this divide is not clear, with offspring of alcoholics demonstrating a range of functioning. Aim: With this in mind, the current study aims to explore the lived experience of adult children of alcoholics to gather a richer understanding of how these individuals develop into the people they are today. Method: Semi-structured interviews were conducted with six individuals who grew up with at least one alcoholic parent. Interpretative Phenomenological Analysis was used to analyse verbatim transcripts. Results: The analysis produced four master themes. These were: ‘Dealing with the loss of connection to parents’, ‘Feeling hopeless and helpless’, Struggling to stay sane’ and ‘I know who I want to be more than I know who I am’. The master themes and corresponding subordinate themes are discussed in relation to the relevant literature. Clinical implications, methodological considerations and directions for future research are also presented. Conclusions: This study provided insight into the lived experience of being an adult child of an alcoholic. It highlighted the challenges and struggles they faced in childhood and the ways in which they battled to overcome the difficulties they experienced to forge a preferred identity in adulthood. It also emphasised the importance of perceived parental rejection as the pathway to causing distress and the desire to be better than their parents as a pathway to resiliency.

UA Open Access Publishing Fund / This study examined associations between alcohol misuse and childhood maltreatment and out-of-home placement among urban lesbian, gay, and bisexual (referred to as two-spirit) American Indian and Alaska Native adults. In a multi-site study, data were obtained from 294 individuals who consumed alcohol during the past year. The results indicated that 72.3% of men and 62.4% of women engaged in hazardous and harmful alcohol use and 50.8% of men and 48.7% of women met criteria for past-year alcohol dependence. The most common types of childhood maltreatment were physical abuse among male drinkers (62.7%) and emotional abuse (71.8%) among female drinkers. Men and women reported high percentages of out-of-home placement (39% and 47%, respectively). Logistic multiple regressions found that for male drinkers boarding school attendance and foster care placement were significant predictors of past-year alcohol dependence. For female drinkers, being adopted was significantly associated with a decreased risk of past-year drinking binge or spree. Dose-response relationships, using number of childhood exposures as a predictor, were not significant. The results highlight the need for alcohol and violence prevention and intervention strategies among urban two-spirit individuals.

The principal aims of the study were to investigate the determinants for alcohol use in adolescence and formulate a framework for intervention design, and to use this framework to design an interactive intervention to prevent alcohol misuse in adolescents. The first study was a focus group study with 27 11-14 year olds to gauge opinions related to alcohol use and the drinking environments. The results of the analysis supported a framework of the combination of the theory of planned behaviour (Ajzen, 1991), the prototype willingness model (Gibbons & Gerrard, 1995, 1997), the social norms approach (Perkins & Berkowitz, 1986). The second study was a pilot of a questionnaire based on the combined model constructs, personality characteristics associated with adolescent alcohol misuse and behavioural measures of frequency and quantity. The first pilot was with 19 adolescents aged 11-15, which indicated that three subscales needed amendment. The participants rated the scale as easy to complete. The second pilot with 31, 16-19 year olds indicated that the subscales were reliable. The third study was a quantitative longitudinal study to evaluate the threats to external validity. The cross sectional analysis (n=239) indicated that past behaviour, subjective norm, affective attitude, drinker image and typical peer frequency predicted intention to drink alcohol. The results of longitudinal study (n=60) indicated that there were no significant differences between variables at baseline. This supported the validity of the questionnaire for intervention evaluation. The most significant predictor of behaviour at follow-up was past behaviour and subjective norm at baseline. The fourth study was a focus group study with 15, 11-14 year old participants to gauge their opinions about computer games and using games for health interventions. The themes that were identified were used to formulate a conceptual framework for an interactive computer game. The fifth study was a quantitative evaluation of a preliminary interactive role-play study to examine interactive scenarios based on the environments identified in the alcohol focus group study and behaviour change techniques from the taxonomy for alcohol use (Michie, et al., 2012). The post-intervention results indicated a significant difference in perceptions of peer drinking norms. Overall, the research supported the use of a combined theory to predict and prevent alcohol use in adolescents and an interactive method for intervention.