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BACKGROUND: The FDA’s modified risk authorization for IQOS® is contingent upon approved post-market surveillance studies. The IQOS® Cross-Sectional Post-Market Adult Consumer Study (hereinafter termed IQOS® CS PACS) and the IQOS® Longitudinal Cohort Post-Market Adult Consumer Study (hereinafter termed IQOS® LC PACS) are contiguous surveys designed to fulfill this proviso. OBJECTIVES: IQOS® CS PACS seeks to assess tobacco use patterns in IQOS® users, risk perceptions of IQOS®, and tobacco transition and cessation behaviors related to IQOS®. The IQOS® LC PACS aims to follow over time, and in comparison with cigarette users, these same parameters with additional emphasis on transitions and health outcomes. METHODS AND RESULTS: The IQOS® CS PACS is a repeated cross-sectional study to be conducted annually for four years. The IQOS® LC PACS is a longitudinal study, planned to follow a cohort of new IQOS® users for two years. Potential adult IQOS® consumers aged 21 and older will be recruited from an IQOS® consumer database. Both studies will use self-administered online screening and survey assessment. At least 250 adult ever established IQOS® users (current and former) constitute the target sample size for each administration of the IQOS® CS PACS. The target sample size for the IQOS® LC PACS is 2,100 adult IQOS® users and 1,600 adult cigarette smokers as control. Data analysis includes descriptive statistics for pre-defined outcomes and inferential statistics (e.g., generalized estimating equations and propensity scoring) to compare outcomes among IQOS® and cigarette smokers. The IQOS® CS PACS is designed to commence one year after IQOS® modified risk tobacco product authorization (MRTPA) and will recur annually over the course of four years. The IQOS® LC PACS will begin two years after issuance of the IQOS® modified risk order and has been designed to follow up with participants at 3-, 6-, 12-, 18-, and 24-months from initiation. Final reports will be generated and shared with the FDA when the studies are completed. CONCLUSIONS: Postmarket studies can help inform outcomes related to risk perceptions, tobacco use patterns, and health status related to IQOS® use in a real-world setting.

Background Electronic cigarettes (e-cigarettes) have become the most common tobacco product used among adolescents in the United States (US). Prior research has shown that peer e-cigarette use was associated with increased risk of own e-cigarette use. Nonetheless, there is little empirical evidence on the directionality of these associations - if peer use predicts own use (peer influence) or if own use predicts peer use (peer selection). Methods We estimated the association between peer and own e-cigarette use among US adolescents 12–17 years of age. We used the fixed-effects model to hold constant observed and unobserved time-invariant variables and the cross-lagged model to investigate the mutual relationship between peer and own e-cigarette use over time using data from a population-based longitudinal study, Population Assessment of Tobacco and Health. Stratified analyses were conducted by sex and age subgroups. Results Having best friends who use e-cigarettes was strongly associated with the use of e-cigarettes among adolescents (OR = 17.5; 95% CI = 15.1 to 20.3 for 12–17-year-olds). This association weakened but remained statistically significant when time-invariant variables were controlled for using fixed-effect model (OR = 4.8; 95% CI = 4.0 to 5.6). Results from cross-lagged model showed a statistically significant predicting path leading from peer use at the prior time point to own use at the following time point, but not vice versa. Conclusions We found strong relationships between peer e-cigarette use and own e-cigarette use at both between- and within-individual levels. Peer influence paths were more robust than peer selection paths for e-cigarette use. Incorporating peers into prevention and intervention programs may help enhance these strategies.

Background Heavy episodic drinking is common in the United States (US) and causes substantial burden to individuals and the society. The transition from first drinking to first heavy drinking episode is a major milestone in the escalation of drinking. There is limited evidence about whether major depressive symptoms predict the progression from drinking to heavy drinking and potential variations across age, sex, and depressive symptoms. In this study, we aim to estimate the association between history of major depressive symptoms and the risk of first heavy drinking episode among new drinkers in the US. Methods Study population was US non-institutionalized civilian new drinkers 12 years of age and older who had their first drink during the past 12 months drawn from the National Survey on Drug Use and Health. History of major depressive symptoms and alcohol drinking behaviors were assessed via audio-computer-assisted self-interviews. Logistic regressions and structural equation modeling were used for analysis. Results Depressed mood and/or anhedonia predicted the transition from the first drink to a heavy drinking episode among underage female new drinkers, whereas null associations were found among males and female new drinkers who had their first drink at 21 and later. Among new drinkers with depressed mood and/or anhedonia, low mood or energy positively predicted the progression to a heavy drinking episode among late-adolescent boys, but negatively among late-adolescent girls; neurovegetative symptoms positively predicted the progression to a heavy drinking episode among young adult new drinkers. Conclusions The relationships linking major depressive symptoms and the transition from drinking to first heavy drinking episode vary across age, sex, and depressive symptoms.

Background This study aimed to describe the prevalence and lifetime criteria profiles of DSM-5 alcohol use disorder (AUD) and the transitions from alcohol use to disorder in Chifeng, China. Methods Face-to-face interviews were conducted using Composite International Diagnostic Interview-3.0 (CIDI-3.0) among 4528 respondents in Chifeng. Results The weighted lifetime and 12-month prevalence of DSM-5 AUD were 3.03 and 1.05%, respectively. Mild lifetime AUD was the most prevalent severity level (69.53%). The two most common criteria were “failure to quit/cutdown” and “drinking more or for longer than intended.” Lifetime prevalence was 65.59% for alcohol use, and 22.97% for regular drinking. Male and domestic violence were risk factors for the transition from alcohol use to regular drinking or AUD and from regular drinking to AUD. Younger age was risk factor for the transition to AUD from alcohol use or regular drinking. Poverty (OR = 2.49) was risk factor for the transition from alcohol use to regular drinking. The earlier drinkers were more likely to develop to regular drinking (OR = 2.11). Conclusion AUD prevalence in Chifeng was not as high as that in Western countries. The study revealed that multiple risk factors might contribute to the transition across different stages of alcohol use. Further research should explore the underlying mechanisms.

Dopamine (DA) signaling is central in hypothesized causal paths linking the influence of social and environmental variables with cognition, behavior and affective states, including vulnerability to drug dependence. Here, we study whether change in one’s social rank induces DA and norepinephrine (NE) changes using a novel pig model with a social-ranking-and-re-ranking protocol to investigate social context influences on catecholamine concentrations in cerebrospinal fluid (CSF) and blood. For two weeks, 16 recently weaned male piglets were socially housed in four groups, with video-recordings for social rank assessments (α, β, γ, and δ); CSF and blood were obtained from these stable social groups. Next, all four α were housed together, as were all four β, etc., again with video recording for blinded social ranking. CSF and blood samples were collected at three time points: prior to initial social housing, following social housing and following re-organization. Regression analyses disclosed a positive relationship between changes in social rank and post-rank change in CSF levels of DA; one unit increase of social rank predicted a 17.4 pg/ml increase in CSF dopamine concentrations (95% CI= 1.2, 33.7). Compared to piglets with downward shifts in ranks (i.e., high-to-low), piglets with upward shifts (i.e., low-to-high) had a statistically significant greater increase in CSF DA levels. No relationship was observed for CSF NE or blood concentrations of DA or NE at any phase of this experiment. This work, using a novel pig model, adds new evidence on alteration of the brain dopaminergic system induced by social rank change.

Background Drinking motives have been linked to alcohol consumption and drinking-related problems in western countries, but evidence about this relationship is largely lacking for Asian countries. We aim to assess the relationship between drinking motives and drinking-related outcomes in China, where alcohol use disorders are an increasingly important contributor to the overall burden of illness. Methods Validated Chinese versions of the Drinking Motives Questionnaire-Revised (DMQ-R) and the Alcohol Use Disorder Identification Test (AUDIT) were used to assess drinking motives and drinking-related outcomes among 612 current drinkers identified from a cross-sectional survey of a representative sample of 2425 adults living in Ningxia Province in 2013. Structural equation modeling was used to estimate the relationships linking specific drinking motives (‘enhancement’, ‘conformity’, ‘social’ and ‘coping’) to drinking-related outcomes (‘level of alcohol consumption’, ‘alcohol dependence’ and ‘adverse consequences’). Findings The enhancement motive is significantly associated with the level of alcohol consumption (β = 0.52, 95% CI = 0.27, 0.78). The conformity motive is associated with higher levels of alcohol dependence (β = 0.74, 95% CI = 0.50, 0.98) and adverse consequences of drinking (β = 0.43, 95% CI = 0.04, 0.81). The social motive and drinking to cope motive are not significantly associated with any of the three drinking outcomes. Interpretation The relationships between drinking motives and drinking-related outcomes in China are quite different from those reported in western countries. This study highlights the need to consider local context when adapting prevention or intervention strategies developed in western countries to address the problem of the harmful use of alcohol in China.

BackgroundStudies from high-income countries report moderate-to-strong positive associations between alcohol use disorder (AUD) and other mental disorders, but there is little evidence about the comorbidity of AUD from low-and-middle-income countries.MethodsA sample of 74 752 adults from five provinces that account for >12% of China's adult population was screened using the General Health Questionnaire, and the Structured Clinical Interview for DSM-IV was administered by psychiatrists to a subsample of 9619 males. The associations between AUD and other mental disorders at each site and the characteristics of men with AUD with and without comorbid mental disorders were estimated using logistic regression and summarized across sites using meta-analysis. Generalized estimation equations estimated the associations between the clinical features of alcohol dependence and comorbidity.ResultsRobust inverse associations were found between current AUD and any mood disorder (adjusted OR = 0.6, 95% CI = 0.4–0.8) and any anxiety disorder (OR = 0.5, 95% CI = 0.3–1.0). Compared with men without AUD, men with AUD without comorbid disorders were more likely to be middle-aged, to be currently married, and to have higher family incomes. Men with comorbid AUD and other disorders were more likely to have the clinical features of alcohol dependence than men with AUD without comorbid disorders.ConclusionsInverse associations between AUD and other mental disorders and the higher social status of men with AUD than men without AUD found in this large, representative sample of community-dwelling Chinese males highlight the importance of considering the local substance-use culture when designing clinical or preventive interventions for addictive conditions.

Background There has been mixed evidence about whether major depression predicts drinking onset. Empirical evidence about whether the heterogeneity of major depressive symptoms differentially predicts drinking onset is scarce, and potential sex- and age-variations have not been fully studied. In this study, we estimate sex- and age-specific relationships linking (a) depressed mood and/or anhedonia with drinking onset among all ‘at-risk’ individuals and (b) three latent depressive constructs, manifested by 13 clinical features, with drinking onset among individuals with depressed mood and/or anhedonia. Methods Study population was non-institutionalized civilian residents 12 years of age and older living in the United States. Major depressive symptoms and drinking onset were assessed via audio-computer-assisted self-interviews. Logistic regressions and structural equation modeling were used for analysis. Results Among all ‘at risk’ individuals, depressed mood or anhedonia strongly predicted early-adolescent drinking onset, whereas they did not predict at-age drinking onset. Among individuals with depressed mood or anhedonia, a 3-factor model provided a good fit to the data for all sex- and age-subgroups. With the exception of early-adolescent boys, neurovegetative symptoms and suicide-related symptoms tended to positively predict underage drinking onset, whereas Low mood or energy tended to inversely predict underage drinking onset; limited evidence was found for at-age and post-21 drinking onset. Limitations The observational nature precludes causal inference. Few people initiated alcohol drinking later than 21 years of age, which resulted in less precise estimates. Conclusions Strengths and directions of major depressive symptoms predicting drinking onset vary across age, sex, and depressive symptoms.

Background A comprehensive epidemiology of dependence on prescription opioid pain relievers requires evidence about age-specific female-male differences, possibly manifest during adolescent and early adult years. In this study, we identified newly incident extra-medical users of prescription pain relievers (EMPPR), all observed with onsets before the 22nd birthday. We then quantified female-male differences in clinical features or manifestations of opioid dependence (OD), devised a measurement-equivalent OD dimension, and estimated age-specific female-male differences in OD levels. Method The population under study included 12-to-21-year-old non-institutionalized civilian community residents of United States sampled for recent nation-scale surveys. Confidential computer-assisted self-interviews identified newly incident EMPPR users (n = 10,188). Analysis-weighted estimation procedures yielded cumulative incidence proportions for each OD feature, evaluated measurement non-equivalence across subgroups, and estimated female-male differences age-by-age. Results (1) Tolerance and salience (‘spending a lot of time’) are most common OD features. (2) Measurement non-equivalence (bias) was found across sex- and onset-age groups. (3) With biasing features removed, we can see elevated OD levels for female new initiates, age-by-age. Subsidiary analyses suggested possibly accelerated progression toward higher OD levels when extra-medical PPR use starts before age 18. Conclusions Dimensional approaches to OD and other drug use disorders have gained popularity but can be fragile when differential measurement biases are left uncontrolled. This study’s bias-corrected dimensional view of female-male differences shows elevated OD levels among newly incident female EMPPR users relative to new male initiates. Future studies can check for accelerated progression to higher OD levels when EM use starts before age 18 years.

Breast cancer is the leading cause of cancer-related disease in women. Cumulative evidence supports a causal role of alcohol intake and breast cancer incidence. In this study, we explore the change on expression of genes involved in the biological pathways through which alcohol has been hypothesized to impact breast cancer risk, to shed new insights on possible mechanisms affecting the survival of breast cancer patients. Here, we performed differential expression analysis at individual genes and gene set levels, respectively, across survival and breast cancer subtype data. Information about postdiagnosis breast cancer survival was obtained from 1977 Caucasian female participants in the Molecular Taxonomy of Breast Cancer International Consortium. Expression of 16 genes that have been linked in the literature to the hypothesized alcohol-breast cancer pathways, were examined. We found that the expression of 9 out of 16 genes under study were associated with cancer survival within the first 4 years of diagnosis. Results from gene set analysis confirmed a significant differential expression of these genes as a whole too. Although alcohol consumption is not analyzed, nor available for this dataset, we believe that further study on these genes could provide important information for clinical recommendations about potential impact of alcohol drinking on breast cancer survival.

We seek answers to three questions about adolescent risk of starting to drink alcoholic beverages: (1) in new United States (US) data, can we reproduce a recently discovered female excess risk? (2) has a female excess risk emerged in European countries? and (3) might the size of country-level female–male differences (FMD) be influenced by macro-level gender equality and development processes? Estimates are from US and European surveys of adolescents, 2010–2014. For US estimates, newly incident drinking refers to consuming the first full drink during the 12-month interval just prior to assessment. For all countries, lifetime cumulative incidence of drinking refers to any drinking before assessment of the sampled 15–16 years. Cumulative meta-analysis summary estimates from the US show a highly reproducible female excess in newly incident drinking among 12–17 years (final estimated female–male difference in risk, FMD = 2.1%; 95% confidence interval = 1.5%, 2.7%). Several European countries show female excess risk, estimated as lifetime cumulative incidence of drinking onsets before age 17 years. At the country level, the observed magnitude of FMD in risk is positively associated with the Gender Development Index (especially facets related to education and life expectancy of females relative to males), and with residence in a higher income European country. New FMD estimates support reproducibility of a female excess risk in the US. In Europe, evidence of a female excess is modest. Educational attainment, life expectancies, and income merit attention in future FMD research on suspected macro-level processes that influence drinking onsets.

Exposures to antioxidants (AO) are associated with levels of C-reactive protein (CRP), but the pattern of evidence is mixed, due in part to studying each potential AO, one at a time, when multiple AO exposures might affect CRP levels. By studying multiple AO via a composite indicator approach, we estimate the degree to which serum CRP level is associated with serum AO level. Standardised field survey protocols for the US National Health and Nutrition Examination Survey (NHANES) 2003–2006 yielded nationally representative cross-sectional samples of adults aged 20 years and older (n8841). NHANES latex-enhanced nephelometry quantified serum CRP levels. Liquid chromatography quantified serum concentrations of vitamins A, E and C and carotenoids. Using structural equations, we regressed CRP level on AO levels, and derived a summary estimate for a composite of these potential antioxidants (CPA), with covariates held constant. The association linking CPA with CRP was inverse, stronger for slightly elevated CRP (1·8≤CRP

Summary Background Population-representative prevalence data for mental, neurological, and substance use disorders are essential for evidence-based decision making. As a background to the China–India Mental Health Alliance Series, we aim to examine the availability of data and report prevalence for the most common mental, neurological, and substance use disorders in China and India from the Global Burden of Disease study 2013 (GBD 2013). Methods In this systematic analysis, data sources were identified from GBD 2013 for the prevalence of mental, neurological, and substance use disorders in China and India published up to Dec 31, 2013. We calculated the proportion of the population represented by the data with the adjusted population coverage (APC) method adjusting for age, sex, and population size. We developed prevalence models with DisMod-MR 2.0, a Bayesian meta-regression instrument used to pool population-representative epidemiological data as part of GBD 2013. We report estimates and 95% uncertainly intervals (95% UI) for 15 mental, neurological, and substance use disorders for China and India in 1990 and 2013, and benchmark these against those for other BRICS countries (Brazil, Russia, and South Africa) in 2013. Findings Few population-representative data were found for the disorders, with an average coverage of 15% of the population of the Chinese mainland and 1% of the population of India. For men in both China and India, major depressive disorder, anxiety disorders, and alcohol dependence were the most common mental, neurological, and substance use disorders. Prevalence of major depressive disorder was 2·2% (95% UI 1·5–2·8) in Chinese men and 3·5% (2·4–4·6) in Indian men; prevalence of anxiety disorders was 2·0% (1·1–3·2) and 1·9% (1·2–2·3), respectively. For women, anxiety disorders, major depressive disorder, and dysthymia were the most common. Prevalence of major depressive disorder was 3·3% (2·3–4·1) in Chinese women and 4·7% (95% UI 3·3–6·2) in Indian women; prevalence of anxiety disorders was 3·3% (1·6–5·3) and 4·1% (3·3–5·0), respectively. Schizophrenia was more prevalent in China (0·5%, 95% UI 0·4–0·5) than in India (0·2%; 0·2–0·2). Interpretation More data for mental, neurological, and substance use disorders are needed for India and China but the large population and geographic scale of these countries present challenges to population-representative data collection. Funding China–India Mental Health Alliance, China Medical Board.

Summary Background China and India jointly account for 38% of the world population, so understanding the burden attributed to mental, neurological, and substance use disorders within these two countries is essential. As part of the Lancet/Lancet Psychiatry China–India Mental Health Alliance Series, we aim to provide estimates of the burden of mental, neurological, and substance use disorders for China and India from the Global Burden of Disease Study 2013 (GBD 2013). Methods In this systematic analysis for community representative epidemiological studies, we conducted systematic reviews in line with PRISMA guidelines for community representative epidemiological studies. We extracted estimates of prevalence, incidence, remission and duration, and mortality along with associated uncertainty intervals from GBD 2013. Using these data as primary inputs, DisMod-MR 2.0, a Bayesian meta-regression instrument, used a log rate and incidence-prevalence-mortality mathematical model to develop internally consistent epidemiological models. Disability-adjusted life-year (DALY) changes between 1990 and 2013 were decomposed to quantify change attributable to population growth and ageing. We projected DALYs from 2013 to 2025 for mental, neurological, and substance use disorders using United Nations population data. Findings Around a third of global DALYs attributable to mental, neurological, and substance use disorders were found in China and India (66 million DALYs), a number greater than all developed countries combined (50 million DALYs). Disease burden profiles differed; India showed similarities with other developing countries (around 50% of DALYs attributable to non-communicable disease), whereas China more closely resembled developed countries (around 80% of DALYs attributable to non-communicable disease). The overall population growth in India explains a greater proportion of the increase in mental, neurological, and substance use disorder burden from 1990 to 2013 (44%) than in China (20%). The burden of mental, neurological, and substance use disorders is estimated to increase by 10% in China and 23% in India between 2013 and 2025. Interpretation The current and projected burden of mental, neurological, and substance use disorders in China and India warrants the urgent prioritisation of programmes focused on targeted prevention, early identification, and effective treatment. Funding China Medical Board, Bill & Melinda Gates Foundation.

Background Previous studies in Western countries have consistently documented positive associations of smoking and heavy drinking with depressive symptoms but a prospective analysis of these relationships among middle-aged and elderly community members in China have not previously been reported. Methods Using data from the China Health and Retirement Longitudinal Study, a two-wave nationally representative survey conducted in 15,628 adults 45 years of age and older, we estimated the prospective association between depressive symptoms and an array of smoking and drinking behaviors. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) short form. Results Inverse associations were the dominant pattern of association. For the population as a whole, individuals with baseline depressive symptoms were less likely to start drinking (OR=0.7, 95% CI=0.5, 0.9) or smoking (OR=0.6, 95% CI=0.4, 0.8). Similarly, baseline drinkers and smokers were less likely to develop depressive symptoms (OR drinkers =0.6, 95% CI=0.5, 0.7; OR smokers =0.7, 95% CJ=0.6, 0.9). No evidence was found for an increased incidence or persistence of depressive symptoms among high-frequency drinkers or heavy smokers or vice versa. Males who had never smoked prior to the onset of depressive symptoms tended to have more rapid onset of tobacco dependence compared to those without such symptoms. Males and females had different association patterns. Limitations The study is observational in nature and provides limited evidence for causality. Discussion The results are inconsistent with previous findings in Western countries, throwing into question the presumed universality of the association between alcohol drinking or tobacco use and depression among middle-aged and elderly adults.

OBJECTIVES There is an epidemic of nonmedical and extra-medical use opioid abuse, addiction, and overdose. Extended-release oxycodone (OxyContin®), a prescription opioid pain reliever, was reformulated in 2010 to deter its abuse. The aim of this study was to assess changes in the onset of abuse of OxyContin and other opioids among young people and adults after reformulation of OxyContin with abuse-deterrent properties. METHODS The study population was U.S. residents ≥ 12 years sampled in National Surveys on Drug Use and Health (NSDUH), 2004 to 2015, with subsample of 12-21-year-olds. Nonmedical and extra-medical use is the NSDUH proxy for abuse. Confidential audio-computer-assisted self-interviews were assessed. Age-specific incidence of nonmedical and extra-medical use of OxyContin and other prescription opioids were estimated year by year. Interrupted-time-series and age-period-cohort analyses were analyzed. RESULTS Interrupted-time-series analysis showed a lower incidence of OxyContin nonmedical and extra-medical use after 2010 reformulation compared to the counterfactual predicted by the trend before 2010. No such difference was seen for other prescription opioids for all ages, although a lower incidence was also observed for other prescription opioids among 12-21-year-olds. Among 12-21-year-olds, a robustly lower incidence was found in 2012 compared to 2010 for OxyContin after holding constant age and cohort effects, whereas no robust difference was observed for other prescription opioids. The results showed 137,500 fewer newly incident cases of OxyContin nonmedical and extra-medical use per year. CONCLUSIONS This study provides evidence supporting the role of OxyContin reformulation in the reduction of onset of OxyContin nonmedical and extra-medical use.

OBJECTIVE: In this study of newly incident drinkers (NID), we (1) investigate and calibrate measurement equivalence of seven clinical features of an alcohol dependence syndrome (ADS) across sex and age-of-onset subgroups, and (2) estimate female-male differences in ADS levels soon after taking the first full drink, with focus on those with first full drink before the 24(th) birthday. METHODS: The study population is 12-to-23-years-old newly incident drinkers living in the United States (US; n=33,561). Calibrated for measurement equivalence, male-female differences in levels of newly incident ADS are estimated for six age-of-onset subgroups. RESULTS: Measurement equivalence is achieved by dropping the ‘difficulty cutting down’ item. Then, among early-adolescent-onset NID, females have higher ADS levels (for 12-to-13-year-old NID: β = 0.25; 95% CI= 0.05, 0.45). In contrast, when drinking onset is delayed to adulthood, males have higher ADS levels (e.g., for 18-to-19-year-old NID: β = −0.27; 95% CI= −0.52, −0.02; for 20-to-21-year-old NID: β = −0.38; 95% CI= −0.65, −0.12). CONCLUSIONS: In the US, there is female excess in ADS levels measured soon after drinking onset in early adolescence. The traditional male excess is seen when drinking onset occurs after mid-adolescence. Evidence from other countries will be useful.

Introduction and Aims The 20-item Drinking Motives Questionnaire-Revised (DMQ-R)—which assesses social, enhancement, coping and conformity-related motives for drinking—has not previously been used in China. The aim of this paper is to evaluate the psychometric properties of the DMQ-R in China. Design and Methods DMQ-R was administered to 612 current drinkers identified from a representative sample of 2425 non-institutionalised adults living in Ningxia Province, China; 44 of these current drinkers were re-administered the questionnaire an average of 2.5 days later. Confirmatory factor analysis compared the adequacy of fit of alternative conceptual models. Due to the collectivist culture in China, we considered the possibility that item 12 (‘to fit in the group I like’) is an indicator of a ‘social’ motive (in Western studies, it is an indicator of a ‘conformity’ motive). Results Social motives for drinking were more frequently endorsed than other motives. The intraclass correlation coefficients for the test–retest reliability of the four subscales varied from 0.63 to 0.80. The originally conceptualised four-factor model showed good fit to the data [root mean square error of approximation (RMSEA) = 0.043, comparative fit index = 0.949 and Tucker-Lewis index = 0.941]. Fit indices improved (RSMEA = 0.034, comparative fit index = 0.968 and Tucker-Lewis index = 0.963) when item 12 was included in the ‘social’ dimension rather than the ‘conformity’ dimension. The 12-item short form of DMQ-R showed similar psychometric properties, but the fit indices were suboptimal. Discussion and Conclusions DMQ-R is a valid and reliable tool to assess drinking motives among current drinkers in China. Future studies in China using the DMQ-R should consider item 12 a social motive. [Cheng HG, Phillips MR, Zhang Y, Wang Z. Psychometric properties of the Drinking Motives Questionnaire-Revised among community-dwelling current drinkers in the Ningxia autonomous region of China. Drug Alcohol Rev 2015]

Background Globally, there is a male excess in the occurrence of heavy drinking once alcoholic beverages are consumed and some new evidence that this ‘gender gap’ might be null among underage drinkers. Here, we estimate age-specific male-female differences in heavy drinking episode (HDE) incidence across the first eight calendar-quarters after first full drink. Methods Study population is non-institutionalized civilians in the United States (2006–2014). Standardized audio computer-assisted self-interviews were used to assess the date of first full drink and the date of first HDE (i.e., 5+ drinks on one occasion) among ∼33,000 12-to-21-year-old newly incident drinkers (all with 1st full drink and HDE evaluated within 24 months of drinking onset). Time-to-HDE survival analyses are used to estimate age-specific male-female ratios in the hazard of HDE onset. Results We found that among early adolescent new drinkers (drinking onset at age 11–14), the newly incident drinking females progress to HDE more quickly than males (HR = 1.3, 95% CI = 1.1, 1.6). In contrast, male excess risk is observed when drinking starts at or after age 15 years. For underage drinkers, age-specific hazard ratios (HR) depend upon age at first full drink. Conclusions Based on recent survey data from the US, this study’s survival analyses support early adolescent female excess in the onset of HDE. When drinking starts at or after age 15 years, a male excess becomes apparent within two years since first full drink. Future studies may probe any sex-specific mechanisms toward the rapid onset of HDE at different age groups.

This study examined adult drinking patterns in the first year after onset and whether these patterns changed after 3 years. We also investigated whether specific demographic characteristics or DSM-IV alcohol use disorder symptoms were related to drinking transitions. Data from National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed. "Newly onset alcohol users" (NOAUs; n = 854) were adults who initiated drinking in the year prior to Wave 1 (2001-2002) and who were followed-up at Wave 2 (2004-2005). Latent class models were estimated for 10 frequency-type drinking patterns at both waves. Latent transition analysis explored changes in drinking patterns from baseline to follow-up. Three drinker classes emerged at Wave 1: (a) low risk (41%); (b) sporadic hazardous (35%); and (c) regular hazardous (24%). One in 5 (18%) NOAUs stopped drinking by Wave 2 and were assigned to an "abstainer" class. The transition probability into the "abstainer" class was highest for the Wave 1 low risk drinkers (86%). The remaining NOAUs (82%) continued to drink at Wave 2. Of these, 70% of regular hazardous drinkers at Wave 1 maintained this drinking pattern at Wave 2, with approximately 30% reducing their pattern of drinking. One third of sporadic hazardous drinkers at Wave 1 remained at this level of drinking at Wave 2; the remainder escalated the drinking. Tolerance, larger/longer, cut down/quit and withdrawal were common among regular hazardous drinkers. Adult drinkers who engage in a low frequency and quantity drinking pattern are most likely to stop drinking soon after onset. Drinking patterns adopted in the first year after onset were indicative of drinking involvement 3 years later. (PsycINFO Database Record (c) 2014 APA, all rights reserved). Language: en

Aims: This study aims to estimate, using a unique quantile regression approach, the relationship linking alcohol use disorder (AUD) and disability(physicaland mental)using datafroma prospective studyof household dwelling adults in the United States. Methods:Datafromthetwo‐waveNationalEpidemiologicSurveyon Alcohol and Related Conditions (NESARC) are used to assess AUD‐ associated disability. A total of 24,716 non‐institutionalized adults are grouped into “never AUD” and “newly incident AUD” groups. The main outcome variables of interest are the changes in physical and mental disability levels between the two waves, as measured by summary scores of the Short Form Health Survey Version 2. Alcohol use disorder and other mental disorders are assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM‐ IV version. Linear regression and quantile regression approaches are used for analysis. Results: The occurrence of AUD is associated with poorer mental disability outcomes, mainly due to the occurrence of alcohol dependence. The association for physical disability is dependent on the history of other mental disorders. Among those with antecedent mental disorders, alcohol dependence is associated with better physical health; among those without antecedent mental disorders, alcohol dependence is associated with poorer outcomes in physical health. Conclusions: Evidence tentatively supports a causal link between AUD and mental disability. (Am J Addict 2013;22:551–557)

Background This analysis estimates the association between smoking-related knowledge and smoking behaviour in a Chinese context. To identify the specific knowledge most directly related to smoking status, we used a novel latent variable analysis approach to adjust for the high correlations between different measures of knowledge about tobacco smoking. Method Data are from the Global Adult Tobacco China Survey, a nationally representative sample of 13 354 household-dwelling individuals 15 years of age or older. Multinomial logistic regressions estimated the association between smoking status (ie, never smoked, current smoker or past smoker) and four smoking-related beliefs: whether or not smoking causes lung cancer, heart attack and stroke, and whether or not low-tar cigarettes are less harmful. A latent variable approach reassessed these associations while taking into account the general level of knowledge about smoking. Results After demographic variables and general knowledge about smoking had been controlled for, the belief that low-tar cigarettes are not less harmful was more prevalent in persons who had never smoked than in current smokers (OR=1.3 (95% CI 1.0 to 1.7) in men and OR=2.8 (95% CI 1.3 to 5.9) in women); this association was even stronger when past smokers and current smokers were compared (OR=2.1 (95% CI 1.5 to 3.0) in men and OR=5.0 (95% CI 1.3 to 20.1) in women). Conclusions Compared with those who have never smoked and those who have ceased smoking, current smokers in China are more likely to believe that low-tar cigarettes are less harmful than regular cigarettes.

Background. It has been widely documented that males were more likely to drinking alcohol and have alcohol use disorders (AUD). The degrees of the male-female differences in drinking and AUD have varied across countries. The reasons behind these variations have not been fully understood. The current study compared the estimated male-female differences across US-born and foreign-born Latino and Asian Americans with respect to alcohol drinking behavior and AUD.Method. Data come from the National Latino and Asian American Study (NLAAS), a national household survey of adults with Latinos and Asian decent in the United States. Male-female differences were estimated for drinking behavior and AUD among drinkers for US-born and foreign-born individuals, respectively. Zero-inflated Poisson regressions were utilized to estimate male-female differences in the number of AUD clinical features once it occurs.Results. Larger male-female differences were found for foreign-born individuals as compared to US-born individuals, especially the occurrence of AUD among drinkers. Once AUD clinical feature occurs, there was no male-female difference for foreign-born individuals, while there was a males excess in the number of clinical features for US-born individuals.Conclusion. Results from this study supports the importance of sociocultural influence in drinking and AUD. Implications for prevention and intervention programs were discussed.

Background This study integrates data from high-quality mental health surveys in five provinces in China to examine the prevalence, demographic correlates, age of onset, and comorbidity of alcohol use disorder (AUD). Methods The five cross-sectional surveys initially screened a representative sample of 74,752 community-living adults (94% response rate) from a sampling population including over 12% of China’s adult population. Psychiatrists then administered a detailed diagnostic exam to an enriched sample of 21,015 respondents (95% response rate). The prevalence of AUD in females in China is below 0.5%, so we limited our analysis to 9619 males who completed the diagnostic interview. Results Using meta -analyses to summarize estimates across the five locations, the current (30-day) prevalence of AUD among adult Chinese males was 9.8% (95% CI = 5.7–16.9%), but there was wide cross-province variation. After adjusting for age and other demographic variables, the prevalence of AUD was significantly lower in single men than in married men (OR = 0.4, CI = 0.2–0.7), lower in men who were not currently working than in men who were currently working (OR = 0.7, CI = 0.5–0.96), and lower in men with comorbid mental disorders than in men without comorbid mental disorders (OR = 0.4, CI = 0.2–0.8). The risk of developing AUD peaked at 30 years of age. Conclusions Substantial differences in the demographic correlates and age of onset of AUD in men in China compared to those reported in other countries highlight the importance of understanding the country-specific and region-specific profile of AUD before developing intervention and prevention strategies.

Background To study male-female and age differences in estimates of rapid transition from first full drink to alcohol dependence among youthful newly incident drinkers in the United States (US). Method The study population included 12-to-25-year-old non-institutionalized US civilian residents, sampled for US National Surveys on Drug Use and Health 2002-2013, with assessments via confidential computer assisted self-interviews. Newly incident drinkers are those who had their first full drink soon before the assessment (n=32,562 12-to-25-year- olds). Alcohol dependence (AD) criteria are from DSM-IV. Results For 12-to-25-year-old females, the peak risk for making a rapid transition from first full drink to alcohol dependence is seen during adolescence, followed by declining estimates (meta-analysis summary=3% at 12-17 years of age, 95% CI=2%, 3%). Among males, corresponding estimates fluctuate around 2%, with no appreciable differences across age strata. Among 12-to-17-year-old newly incident drinkers, there is a female excess in the rapid transition to alcohol dependence; a male excess is observed among young adult newly incident drinkers. Evaluated cohort-wise, using an epidemiological mutoscope view, individual cohorts show a congruent pattern, with age at first drink held constant. Conclusions Studying multiple replication samples of young newly incident drinkers, we discovered a clear female excess in the risk of a rapid transition from first full drink to alcohol dependence among adolescents, with age patterns differing across males and females.

Background. State-level ‘age 21’ drinking laws conform generally with the United States National Minimum Drinking Age Act of 1984 (US), and are thought to protect young people from adverse drinking experiences such as heavy episodic drinking (HED, sometimes called ‘binge drinking’). We shed light on this hypothesis while estimating the age-specific risk of transitioning from 1st full drink to 1st HED among 12-to-23-year-old newly incident drinkers, with challenge to a “gender gap” hypothesis and male excess described in HED prevalence reports.Methods. The study population consisted of non-institutionalized civilians in the United States, with nine independently drawn nationally representative samples of more than 40,000 12-to-23-year-olds (2006–2014). Standardized audio computer-assisted self-interviews identified 43,000 newly incident drinkers (all with 1st HED evaluated within 12 months of drinking onset). Estimated age-specific HED risk soon after first full drink is evaluated for males and females.Results. Among 12-to-23-year-old newly incident drinkers, an estimated 20–30% of females and 35–45% of males experienced their 1st HED within 12 months after drinking onset. Before mid-adolescence, there is no male excess in such HED risk. Those who postponed drinking to age 21 are not spared (27% for ‘postponer’ females; 95% CI [24–30]; 42% for ‘postponer’ males; 95% CI [38–45]). An estimated 10–18% females and 10–28% males experienced their 1st HED in the same month of their 1st drink; peak HED risk estimates are 18% for ‘postponer’ females (95% CI [15–21]) and 28% for ‘postponer’ males (95% CI [24–31]).Conclusions. In the US, one in three young new drinkers transition into HED within 12 months after first drink. Those who postpone the 1st full drink until age 21 are not protected. Furthermore, ‘postponers’ have substantial risk for very rapid transition to HED. A male excess in this transition to HED is not observed until after age 14.

OBJECTIVE: This study sought to discover recent age-specific and cohort-specific patterns of newly incident drinking of alcoholic beverages among young people in the United States, with identification of age at peak risk, cohort by cohort, and age by age. METHOD: Data are from the U.S. National Surveys on Drug Use and Health 2002-2013, with 12 independent successive replications of nationally representative surveys (n ≈ 420,000 12- to 25-year-olds). Drinking was assessed via confidential computer-assisted self-interviews. RESULTS: Looking across age strata, we found rising age-specific drinking incidence rates across adolescence to a plateau at age 16-18 years and made a new discovery of a statistically robust and highly reproducible dip in incidence at age 19-20 years, followed by the major peak at age 21 years, with sharply reduced incidence thereafter. Evaluated using an epidemiological mutoscope view, individual cohorts showed a congruent pattern, with starting age held constant. A completely different pattern was seen in age-specific prevalence estimates that showed monotonic linear increases. CONCLUSIONS: The novelty seen here, with multiple replications, is a set of clearly nonlinear, age-specific drinking incidence patterns not documented in prior studies. Evidence of noncongruent prevalence patterns is provided. We hope these simple examples will be useful in teaching the epidemiology of alcohol drinking. Language: en

Despite many studies on cognitive function and its influential factors among old population, relatively little research has been designed to study the relationship between dietary intake and cognitive function in elderly.We conducted a population-based, prospective nested case-control study to investigate the association between dietary habits and declines in cognitive function over three years among Chinese illiterate elderly.This study was part of the Chinese Longitudinal Health Longevity Study (CLHLS). Six thousand nine hundred and eleven illiterate residents aged 65 or older were investigated. Socio-demographic and dietary habits data were collected at baseline. The cognitive function of illiterate elderly persons was assessed using Chinese revised Mini Mental State Examination (MMSE-r) in 2002 and 2005. Cognitive decline was defined as MMSE-r score dropped to less than 18 at follow-up among those with normal cognitive function (MMSE-r≥18 at baseline). Odds ratios (OR) were calculated via logistic regression models.Five thousand six hundred and ninety one elderly were included in the current analysis. In bivariate analysis, cognitive decline was associated with gender, marital status ,financial status, smoking, drinking alcohol, drinking tea, eating fruits, vegetables, legumes, fishes, meat, egg and sugar. Multivariate logistic regression analysis found that always eating vegetable (Adjusted OR: 0.66; 95% confidence intervals, CI: 0.58, 0.75), always consuming legumes (AOR:0.78; 95% CI: 0.64, 0.96) were inversely associated with cognitive decline.Lower intakes of vegetables and legumes were associated with cognitive decline among illiterate elderly Chinese. Dietary factors may be important for prevention cognitive decline.

Evidence in support of a suspected causal association linking childhood physical punishment (CPP) and later alcoholic beverage-related disturbances has been found in metropolitan China. Here, the focus shifts to the CPP association with the estimated risk of starting to drink, having the first drinking problem, and transitioning from first drink to the first drinking problem.Data are from the World Mental Health Surveys-metropolitan China study, with representative samples of adult household residents living in two metropolitan cities, Beijing and Shanghai. Recalled information was available for early life experiences (including CPP, other childhood adversities, and parental alcohol and drug problems), as well as the onset age of drinking and drinking problems. Survival analyses were used to estimate the Hazard Ratio. A structural equation modeling approach was used to control for other inter-correlated childhood adversities.Cox proportional hazards modeling discloses statistically robust associations linking CPP with drinking and drinking problems, as well as more rapid transitions from first drink to first drinking problem, even after accounting for other childhood adversities and parental drinking problems. These associations cannot be attributed to a more general noxious family environment.These results lay a foundation for future experimental studies on the possible causal relationship linking CPP with the onset of drinking problems and the transition from drinking to drinking problems.

Alcohol problems are widespread throughout the United States. While treatment can be successful, many individuals continue to drink. One method to assess treatment results over time is by investigating abstinence as a measure of success.The main aim of this study is to investigate factors that may be associated with past-year (PY) abstinence among individuals who received prior-to-past-year (PPY) treatment for alcohol problems, while also assessing abstinence by treatment subtype.This study uses data from 1742 individuals who received PPY treatment for alcohol problems in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Logistic regression models were used to assess the strength of association between alcohol abstinence and key demographic and clinical factors.The level of PY abstinence was 36.5% among those who previously sought treatment for alcohol problems. Younger age groups and those who were nicotine dependent or had a cannabis use disorder were less likely to be abstinent. There were no differences based on sex or PY major depression or generalized anxiety disorder.While causal inferences cannot be made, these results suggest that the majority of people continue to drink, even after being treated for alcohol problems. Nonetheless, variation may exist depending on the form of treatment a person receives. More research is needed regarding long-term levels of abstinence after individuals receive treatment.

Sex differences in opportunities to use alcohol or drugs, and transition to use, were investigated in 15 surveys, in 2001-2004 (Europe 6; Americas 3; Africa 2, Asia 3; Oceania 1). The paper focuses on 18-29 year olds (N = 9,873). The World Mental Health Survey Initiative oversaw the surveys; each country obtained its own funding. A complex picture emerged with different results for alcohol and for drugs and for opportunity to use and the transition to use. Sex differences in opportunity to use alcohol were small except in Lebanon and Nigeria, whereas for drugs, the largest differences were in Mexico and Colombia.

This epidemiological study of a sample of smokers from the general population of Colombia examined the population distribution and dimensionality of eight hypothesized inter-correlated clinical features (CFs) associated with tobacco dependence syndrome (TDS). Data were drawn from interviews of 4 426 smokers conducted in a national survey in Colombia as part of the World Mental Health Survey Initiative. Daily smokers completed a Spanish-language TDS module, and the 237 smokers who had begun smoking during the five years prior to the assessment were selected. Confirmatory factor analysis (CFA) for a unidimensional TDS provided discrimination and difficulty parameter estimates. Two CFs that were reported very infrequently among the study sample were dropped from the CFA. Among the six remaining CFs, discrimination (D1) estimates ranged from 1.1 to 6.0 and difficulty (D2) estimates ranged from 1.1 to 2.2, providing evidentiary support for a unidimensional tobacco dependence construct. The Spanish-language TDS module used in this study could serve as a valuable tool in future studies for evaluating public health outreach and early intervention programs directed toward community residents who have begun smoking tobacco.En el presente estudio epidemiológico de una muestra de fumadores de la población general de Colombia se examinó la distribución y la magnitud de ocho características clínicas interrelacionadas en forma hipotética, que se asocian con el síndrome de dependencia del tabaco. Los datos se extrajeron de las entrevistas realizadas a 4-426 fumadores en una encuesta nacional en Colombia, que formó parte de la Iniciativa de la Encuesta de Salud Mental Mundial. Los fumadores habituales completaron un módulo de evaluación del síndrome de dependencia del tabaco y se escogieron los 237 fumadores que habían comenzado el consumo de tabaco en los cinco años que precedieron a la evaluación. El análisis factorial confirmatorio del modelo unidimensional del síndrome de dependencia del tabaco proporcionó los índices de discriminación y de dificultad de cada variable. Dos características clínicas que se notificaron con muy poca frecuencia en la muestra del estudio se excluyeron del análisis factorial. El índice de discriminación de las seis características restantes osciló entre 1,1 y 6,0, y el índice de dificultad fluctuó entre 1,1 y 2,2, con lo cual se demostró la validez de un modelo unidimensional de la dependencia. El módulo de evaluación en español del síndrome de dependencia del tabaco usado en este estudio podría constituir un instrumento valioso en estudios futuros destinados a evaluar los programas de salud pública de divulgación y de intervención temprana dirigidos a los residentes de la comunidad que han comenzado a fumar.

The aim of the current study is to estimate a link between early physical punishment in childhood and later alcohol outcomes, taking family history of drinking problems into account, with epidemiological data from China. The yield from previous studies on this relationship is mixed evidence, largely traceable to research design variations, including model specifications that concern parental alcohol or other drug problems (AODPs) that might account for both earlier discipline practices and later drinking problems in the offspring.Data are from the World Mental Health Surveys-metropolitan China study, with cross-sectional representative sample surveys of adult household residents living in two metropolitan cities, Beijing and Shanghai. Participants in this general mental health survey were asked about early life experiences (e.g., parental AODP, childhood misbehavior), as well as their own drinking outcomes. Stratification was used to control for parental AODP.Logistic regressions found robust associations linking childhood physical punishment with drinking outcomes, even with stratification for parental AODP and childhood misbehavior.These results from a cross-sectional survey lay a foundation for future prospective and longitudinal research on possible causal relationships that link childhood physical punishment with later drinking outcomes in China.

Aims This study investigates the occurrence of clinical features of alcohol dependence and socially maladaptive drinking during the first 24 months after the onset of alcohol use. Design Data for this study are from the nationally representative 2004-07 National Surveys on Drug Use and Health (NSDUH). Setting General population of the United States, aged 12 years and older. Participants New-onset alcohol users (NOAUs) were drinkers who started to drink alcohol within 24 months of the NSDUH assessment and consumed alcohol during the last 12 months. Measurements The NSDUH assessed for clinical features of alcohol dependence and socially maladaptive drinking, consistent with the DSM-IV. Findings NOAUs frequently experienced problems relating to self-reported tolerance, spending a great deal of time recovering from the effects of alcohol and unsuccessful attempts at cutting down on drinking. The likelihood of experiencing the clinical features increased steadily in the first 9 months after use, but appeared to plateau or only gradually increase thereafter. Strong evidence emerged that the clinical features measured a single latent dimensional of 'alcohol use disorder' (AUD) in this sample. The majority of the clinical features were good indicators of the underlying AUD continuum in the 2 years after first drinking onset. Conclusions There may be a period of time during the second year of alcohol use, when level of alcohol use disorder fluctuates rather than increases. Public health and safety efforts designed to target problematic alcohol use in the earliest stages of alcohol involvement could be useful in preventing the escalation of alcohol problems in this group of drinkers. Language: en

Aims The aim of the current study is to estimate the association between childhood physical punishment (CPP) and level of alcohol use disorder (AUD), using two different approaches to take other childhood adversities into account. Design and setting Population survey using face-to-face interviews to a representative sample of non-institutionalized adult residents of Beijing and Shanghai, China. Participants A total of 5201 participants aged 18-70 years. Measurements A version of the World Mental Health Composite International Diagnostic Interview was used. Standardized assessments covered early life experiences of childhood physical punishment, other childhood adversities, parental drinking problems, childhood conduct problems and clinical features of AUD. Findings A robust association linking CPP and level of AUD was found, holding other childhood adversities constant (probit coefficient = 0.70, 95% CI = 0.40, 1.00) via covariate terms in structural equations modeling. Furthermore, there was evidence that CPP might exert an additional influence on level of AUD over and above a generally noxious family environment (probit coefficient = 0.20, 95% CI = 0.02, 0.38). Conclusions There appears to be a robust association between reports of harsh punishment in childhood and alcohol dependence in adulthood adjusting for a range of possible confounding factors. Whether the association is causal or whether both are related to a common underlying factor or recall bias needs to be investigated further. Language: en

Drug-related social role impairments and social maladaptation are referenced explicitly in the case defi nitions for drug dependence within DSM-IV-TR. Nonetheless, cases of drug dependence without this type of secondary consequence have been observed in recent epidemiological studies. When an ‘impairment/maladaptation gating’ approach has been taken during recent large-scale psychiatric surveys (for example, to reduce participant fatigue or burden), the net effect may include (a) a reduced number of identifi ed drug dependence cases and (b) biases in the estimates of association linked to the occurrence of drug dependence. In this report, we probe these issues with respect to cannabis dependence, making use of data from the cross-sectional United States National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a household survey of 43,093 adults aged 18 years and over. In this process, we shed light on actual impact of the gating approach mentioned above. Specifi cally, when we simulated a social impairment/maladaptation ‘gated’ assessment of cannabis dependence, the end result was a very modest reduction in the estimated prevalence of cannabis dependence. It suggested that for every 10 000 general population survey respondents there would be no more than 12 cases of cannabis dependence without the above-referenced impairments/maladaptations. Patterns of association linking suspected background characteristics to the prevalence of cannabis dependence were not appreciably different when the ‘gated’ and ‘ungated’ approaches were applied. In summary, there are reasons to take the ungated approach in detailed research on cannabis use and dependence. Nevertheless, in panoramic mental health surveys, the ineffi ciency of an ‘ungated’ approach must be balanced against the anticipated yield of cannabis dependence cases who lack social role impairments or socially maladaptive behaviours. Copyright © 2007 John Wiley & Sons, Ltd.

BACKGROUND: This research extends prior epidemiological estimates for the United States and re-examines a previously described male excess in alcohol drinking. Its aim was to estimate fine-grained age-specific incidence of becoming a drinker among 12- to 24-year-old U.S. males and females, and to compare incidence estimates with prevalence proportions. METHODS: The study population is 12- to 24-year-old noninstitutionalized U.S. civilian residents. Estimates are from 12 successive U.S. National Surveys on Drug Use and Health (NSDUH), with nationally representative samples drawn each year from 2002 to 2013 and assessed via computer-assisted self-interviews (n ~ 390,000). Analysis-weighted incidence and prevalence estimates are generated using the NSDUH Restricted Data Analysis System for 6 year-pairs. Meta-analysis-derived summary estimates are provided, treating each year-pair as a replication. RESULTS: In this 21st century evidence, there no longer is male excess of incidence with respect to underage drinking. Indeed, in mid-adolescence, there is a clear female excess for the risk of becoming an underage drinker. Meta-analytic summaries disclosed no other male-female differences in incidence. Nevertheless, a male excess in the prevalence of recently active drinking can be seen after the age of 19 years. CONCLUSIONS: This new evidence from the United States shows that the so-called "gender gap" in risk of becoming a drinker has narrowed to the point of there being no gap at all. Indeed, in mid-adolescence, risk of starting to drink is greater for females than for males.Copyright © 2016 by the Research Society on Alcoholism. Language: en

Aims This study examines the type of alcohol-related problems that commonly occur before the onset of depressive experiences to shed light on the mechanisms underlying the alcohol-depression comorbidity relationship. Methods Data were from the 1992 USA National Longitudinal Alcohol Epidemiologic Survey. Analytical sample comprised of drinkers with a prior to past year (PPY) history of alcohol-related problems with or without any experiences of depressed mood in the past year (PY). The prevalence of PPY alcohol-related problems was examined, as well as the ability of specific alcohol problems to predict PY experiences of depressed mood. The type of depressed mood experienced by drinkers with PPY history of alcohol-related problems was compared to those without. Results All but one alcohol-related problem PPY was more frequently endorsed among drinkers with PY experiences of depressed mood. Controlling for confounders, five alcohol-related problems experienced PPY were significantly predictive of depressed mood PY: tolerance, drinking longer than intended, inability to perform important social and occupational roles/obligations, as well as drinking in physically hazardous situations. Drinkers with alcohol-related problems PPY more frequently experienced difficulties with concentration, energy, and thoughts of death, than those without. Conclusions Alcohol-related problems are likely associated with depressive experiences through a complex network, whereby experiences of physical dependence and negative consequences increase the likelihood of negative affect. Novel study designs are necessary to fully understand the complex mechanisms underlying this comorbidity.