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Papers by Thomas Greenfield

Addiction, Oct 1, 1996

To assess the relationship of alcohol use and three types of alcohol‐related problems (ICD‐10 dep... more To assess the relationship of alcohol use and three types of alcohol‐related problems (ICD‐10 dependence syndrome, work problems and drunk driving), risk curves were developed for average number of drinks per day during last year (volume) and number of days drinking five or more drinks during one day (5 +). Using data from the I98S National Health Interview Alcohol Supplement, risk curves were derived from data on 22 102 current drinkers who consumed at least 12 drinks in the last year. The emphasis in this analysis was on the proportion of drinkers at lower levels reporting different types of problems. The results indicate that even at lower levels of drinking (volume averaging one or fewer drinks/day) there is considerable risk for drunk driving and less risk for work problems and alcohol dependence. The risk for all types of problems at lower and moderate levels of drinking was significantly higher for respondents who had five or more drinks during one day in the last year. These findings underscore the importance of examining risk (physical and social) at lower levels of drinking and for using both overall volume and heavier quantity per occasion drinking measures when assessing risk for any alcohol‐related problem.

Alcoholism: Clinical and Experimental Research, 2007

Background: This study reports lifetime estimates of the extent of unmet need for alcohol service... more Background: This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over-represented in treatment settings. Methods: Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence. Results: While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higherseverity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care. Conclusions: Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care.

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014), Nov 17, 2014

Alcoholism: Clinical and Experimental Research, Jan 28, 2021

Introduction:International drink-driving policy research generally focuses on aggregate outcomes ... more Introduction:International drink-driving policy research generally focuses on aggregate outcomes (e.g., rates of crashes, fatalities) without emphasizing secondhand alcohol-related vehicular harms. In contrast, we investigate associations between drink-driving policies and harms involving another driver’s impairment.Methods:Alcohol’s harms to others (AHTO) survey data from 12 countries (analytic N=29,616) were linked to national alcohol policy data from the World Health Organization. We examined separately associations of two 12-month driving-related AHTOs (passenger with an impaired driver; vehicular crash involving someone else’s drink driving) with three national drinking-driving policies--legal blood alcohol concentration (BAC) limits, use of random breath testing, use of sobriety checkpoints, and comprehensive penalties for drink-driving (community service, detention, fines, ignition interlocks, license suspension/revocation, mandatory alcohol treatment, vehicle impoundment, and penalty point system), plus two alcohol tax variables (having excise taxes and value-added tax [VAT] rate). Multilevel logistic regression addressed clustering of individuals within countries and subnational regions, while adjusting for individuals’ gender, age, marital status, risky drinking, and regional drinking culture (% male risky drinkers in sub-national region).Results:Controlling for national-, regional-, and individual-level covariates, comprehensive penalties were significantly and negatively associated with both outcomes; other vehicular policy variables were not significantly associated with either outcome. A society’s VAT rate was negatively associated with riding with a drunk driver. Regional male drinking culture was positively associated with riding with an impaired driver, but was not significantly associated with being in a vehicular crash due to someone else’s drinking. In both models, being male, being younger, and engaging in risky drinking oneself each were positively associated with vehicular harms due to someone else’s drinking.Conclusions:Although results are associational and not causal, comprehensive penalties may be promising policies for mitigating driving-related harms due to another drinker. Higher VAT rate might reduce riding with a drunk driver.

Hispanic Journal of Behavioral Sciences, Jul 28, 2017

Objective-Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico ... more Objective-Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico border. Few studies describe the impact of violence on drinking between countries and along the border. Methods-Survey data is from U.S. Mexican origin adults living in Texas and Mexican border and non-border cities, N=4,796. Participants were asked about alcohol consumption, interpersonal physical violence (IPV) and exposure to community violence. Monthly hazardous drinking (5+/4+ for men/women) was the primary outcome. Multivariate logistic regression model comparisons identified best predictors. Results-In the U.S. hazardous drinking was associated with past year IPV (OR adj =2.5; 1.8-3.5) and community violence (OR adj =1.4; 1.1-1.8). In Mexico, IPV (OR adj =3.9; 2.0-7.4) and border proximity (OR adj =0.5; 0.4-0.8) were associated with hazardous drinking but not community violence. Conclusion-Hazardous drinking is associated with IPV in both countries, but violence did not explain border hazardous drinking differences where they existed in Mexico.

Addiction, Oct 1, 1996

To assess the relationship of alcohol use and three types of alcohol‐related problems (ICD‐10 dep... more To assess the relationship of alcohol use and three types of alcohol‐related problems (ICD‐10 dependence syndrome, work problems and drunk driving), risk curves were developed for average number of drinks per day during last year (volume) and number of days drinking five or more drinks during one day (5 +). Using data from the I98S National Health Interview Alcohol Supplement, risk curves were derived from data on 22 102 current drinkers who consumed at least 12 drinks in the last year. The emphasis in this analysis was on the proportion of drinkers at lower levels reporting different types of problems. The results indicate that even at lower levels of drinking (volume averaging one or fewer drinks/day) there is considerable risk for drunk driving and less risk for work problems and alcohol dependence. The risk for all types of problems at lower and moderate levels of drinking was significantly higher for respondents who had five or more drinks during one day in the last year. These findings underscore the importance of examining risk (physical and social) at lower levels of drinking and for using both overall volume and heavier quantity per occasion drinking measures when assessing risk for any alcohol‐related problem.

Alcoholism: Clinical and Experimental Research, 2007

Background: This study reports lifetime estimates of the extent of unmet need for alcohol service... more Background: This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over-represented in treatment settings. Methods: Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence. Results: While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higherseverity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care. Conclusions: Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care.

Contemporary drug problems, Dec 1, 2004

This article describes policy developments in alcohol advertising and counter-advertising at the ... more This article describes policy developments in alcohol advertising and counter-advertising at the U.S. national level, including federally mandated warning labels on alcoholic beverage containers, the campaign for health warnings on broadcast advertising, the end of the voluntary ban on advertising ofdistilled spirits on television and radio, and the debate concerning a healthbenefits label on wine products. Federal legislative documents and media accounts provided the context for 64 key-informant interviews with persons working for the federal government, the alcohol industry, public health, and research and media

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014), Nov 17, 2014

Alcoholism: Clinical and Experimental Research, Jan 28, 2021

Introduction:International drink-driving policy research generally focuses on aggregate outcomes ... more Introduction:International drink-driving policy research generally focuses on aggregate outcomes (e.g., rates of crashes, fatalities) without emphasizing secondhand alcohol-related vehicular harms. In contrast, we investigate associations between drink-driving policies and harms involving another driver’s impairment.Methods:Alcohol’s harms to others (AHTO) survey data from 12 countries (analytic N=29,616) were linked to national alcohol policy data from the World Health Organization. We examined separately associations of two 12-month driving-related AHTOs (passenger with an impaired driver; vehicular crash involving someone else’s drink driving) with three national drinking-driving policies--legal blood alcohol concentration (BAC) limits, use of random breath testing, use of sobriety checkpoints, and comprehensive penalties for drink-driving (community service, detention, fines, ignition interlocks, license suspension/revocation, mandatory alcohol treatment, vehicle impoundment, and penalty point system), plus two alcohol tax variables (having excise taxes and value-added tax [VAT] rate). Multilevel logistic regression addressed clustering of individuals within countries and subnational regions, while adjusting for individuals’ gender, age, marital status, risky drinking, and regional drinking culture (% male risky drinkers in sub-national region).Results:Controlling for national-, regional-, and individual-level covariates, comprehensive penalties were significantly and negatively associated with both outcomes; other vehicular policy variables were not significantly associated with either outcome. A society’s VAT rate was negatively associated with riding with a drunk driver. Regional male drinking culture was positively associated with riding with an impaired driver, but was not significantly associated with being in a vehicular crash due to someone else’s drinking. In both models, being male, being younger, and engaging in risky drinking oneself each were positively associated with vehicular harms due to someone else’s drinking.Conclusions:Although results are associational and not causal, comprehensive penalties may be promising policies for mitigating driving-related harms due to another drinker. Higher VAT rate might reduce riding with a drunk driver.

Journal of Studies on Alcohol and Drugs, Mar 1, 2020

Media coverage of alcohol-related policy measures can influence public debate and is often more a... more Media coverage of alcohol-related policy measures can influence public debate and is often more aligned with interests of the alcohol industry than public health. The purpose of this study was to examine the framing of news coverage of alcohol warning label (AWL) initiatives that included a cancer message on alcohol containers in two different countries. Policy contexts and industry perspectives were also evaluated. Method: We identified and systematically reviewed news articles published between 2017-2019 covering an AW L academic study in Yu kon, Canada, and labeling provisions in a Public Health (Alcohol) Bill in Ireland. Both included a cancer message. News stories were coded for media type and topic slant; inclusion of alcohol industry perspectives was examined using content analysis. Results: Overall, 68.4% of media articles covering the Yu kon Study (n = 38) and 18.9% covering the Ireland Bill (n = 37) were supportive of AW Ls with a cancer message. The majority of articles in both sites presented alcohol industry perspectives (Yukon, 65.8%; Ireland, 86.5%), and industry arguments opposing AW Ls were similar across both contexts. In articles with statements from industry representatives, the label message was frequently disputed by distorting or denying the evidence that alcohol causes cancer (n = 33/43). Conclusions: News coverage of AW Ls with a cancer message was more supportive in Canada than Ireland, where alcohol industry perspectives were consistently foregrounded. Industry arguments opposing the cancer label bore similarities across contexts, often distorting or denying the evidence. Increasing awareness of industry messaging strategies may generate more critical coverage of industry lobbying activities and increase public support for alcohol policies. (J.

Hispanic Journal of Behavioral Sciences, Jul 28, 2017

Objective-Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico ... more Objective-Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico border. Few studies describe the impact of violence on drinking between countries and along the border. Methods-Survey data is from U.S. Mexican origin adults living in Texas and Mexican border and non-border cities, N=4,796. Participants were asked about alcohol consumption, interpersonal physical violence (IPV) and exposure to community violence. Monthly hazardous drinking (5+/4+ for men/women) was the primary outcome. Multivariate logistic regression model comparisons identified best predictors. Results-In the U.S. hazardous drinking was associated with past year IPV (OR adj =2.5; 1.8-3.5) and community violence (OR adj =1.4; 1.1-1.8). In Mexico, IPV (OR adj =3.9; 2.0-7.4) and border proximity (OR adj =0.5; 0.4-0.8) were associated with hazardous drinking but not community violence. Conclusion-Hazardous drinking is associated with IPV in both countries, but violence did not explain border hazardous drinking differences where they existed in Mexico.

PubMed, 2014

To assess alcohol consumption levels in large populations, researchers often rely on self-report ... more To assess alcohol consumption levels in large populations, researchers often rely on self-report measures. However, these approaches are associated with several limitations, particularly underreporting. Use of noninvasive biomonitoring approaches may help validate self-report alcohol consumption measurements and thus improve their accuracy. Two such devices currently are available, the WrisTASTM and SCRAMTM devices, both of which measure alcohol vapors emitted through the skin after alcohol consumption. Several studies assessing the utility of the WrisTASTM bracelet in determining alcohol consumption levels noted that it was associated with relatively high failure rates. The SCRAMTM is an ankle bracelet intended for court-ordered alcohol monitoring. In studies, its sensitivity exceeded that of the WrisTASTM and increased with increasing blood alcohol concentrations. Although early studies also identified some equipment concerns with the SCRAMTM, studies of its ability to detect moderate and heavy drinking recently have yielded good results. Biomonitoring devices already are valuable tools and with further improvements may become even more useful in both research and practical applications.

Contemporary drug problems, Dec 1, 2004

This article describes policy developments in alcohol advertising and counter-advertising at the ... more This article describes policy developments in alcohol advertising and counter-advertising at the U.S. national level, including federally mandated warning labels on alcoholic beverage containers, the campaign for health warnings on broadcast advertising, the end of the voluntary ban on advertising ofdistilled spirits on television and radio, and the debate concerning a healthbenefits label on wine products. Federal legislative documents and media accounts provided the context for 64 key-informant interviews with persons working for the federal government, the alcohol industry, public health, and research and media

Clinical Pharmacology & Therapeutics, Feb 27, 2008

Alcohol policy has been shown to have an impact on the incidence and prevalence of alcohol "addic... more Alcohol policy has been shown to have an impact on the incidence and prevalence of alcohol "addiction", or alcohol use disorders (AUD), as currently defined by the International Classification of Diseases Volume 10 (ICD-10) or by DSM IV. We will use mainly the term "addiction" to depict a state involving loss of control over intense urges to consume alcohol even at the expense of adverse consequences. This definition goes beyond pure "physiological dependence" (1). We will use the term AUD when referring to statistics based on the above-described definitions. In this overview we identify the pathways for the relationship between alcohol policy and addiction, present the empirical evidence and draw conclusions. Special emphasis will be put on treatment policy. Addiction as one of many health consequences of alcohol consumption Consumption of alcohol has impacts on many different disease and injury categories. Over 60 single categories in ICD-10 have been identified as being potentially caused by drinking (2), and more than 30 conditions have alcohol or alcoholic in their name, indicating that they would not exist in absence of alcohol. Certainly, the most important among the latter conditions are AUD or "alcohol addiction" itself. While addiction certainly is important, it does not comprise the majority of either alcohol-attributable mortality or burden of disease (3). But addiction also may also act indirectly by underlying chronic disease or injury. However, alcohol may kill or may cause disability in persons who do not quality for any psychiatric diagnosis, such as an occasional drinker who causes an alcohol-attributable traffic accident due to intoxication, or a female with a lifetime consumption of two glasses of red wine per day and an alcoholattributable breast cancer (for the carcinogenicity of alcohol see (4)). It should be recognized that co-occurring substance use (including tobacco use) and other mental disorders (e.g., depression) complicate the causal attribution to alcohol in many conditions. Additionally, some heavy drinkers may not meet formal criteria for AUD owing to denial, so that for these two reasons, attribution of morbidity and mortality to alcohol may both be under and over stated to an unknown degree.

Journal of Studies on Alcohol and Drugs, Mar 1, 2020

Media coverage of alcohol-related policy measures can influence public debate and is often more a... more Media coverage of alcohol-related policy measures can influence public debate and is often more aligned with interests of the alcohol industry than public health. The purpose of this study was to examine the framing of news coverage of alcohol warning label (AWL) initiatives that included a cancer message on alcohol containers in two different countries. Policy contexts and industry perspectives were also evaluated. Method: We identified and systematically reviewed news articles published between 2017-2019 covering an AW L academic study in Yu kon, Canada, and labeling provisions in a Public Health (Alcohol) Bill in Ireland. Both included a cancer message. News stories were coded for media type and topic slant; inclusion of alcohol industry perspectives was examined using content analysis. Results: Overall, 68.4% of media articles covering the Yu kon Study (n = 38) and 18.9% covering the Ireland Bill (n = 37) were supportive of AW Ls with a cancer message. The majority of articles in both sites presented alcohol industry perspectives (Yukon, 65.8%; Ireland, 86.5%), and industry arguments opposing AW Ls were similar across both contexts. In articles with statements from industry representatives, the label message was frequently disputed by distorting or denying the evidence that alcohol causes cancer (n = 33/43). Conclusions: News coverage of AW Ls with a cancer message was more supportive in Canada than Ireland, where alcohol industry perspectives were consistently foregrounded. Industry arguments opposing the cancer label bore similarities across contexts, often distorting or denying the evidence. Increasing awareness of industry messaging strategies may generate more critical coverage of industry lobbying activities and increase public support for alcohol policies. (J.

American Journal of Health Promotion, 1997

Purpose. Guided by information processing theory and the health belief model, this paper consider... more Purpose. Guided by information processing theory and the health belief model, this paper considers the relationship between health consciousness among the general population and attention to environmental health warnings about alcohol consumption, Mechanisms of exposure to three dominant types of impersonal alcohol-related health messages in the environment are explored. Design. Cross-sectional survey using telephone interviezo data. Subjects. A representative nationwide sample of adults was interviewed in 1993 (n 1026), with a response rate of 63 %. Measures. Key variables include exposure to warning labels on alcoholic beverages, to pointof-sale posters, and to advertisements in the media, as well as respondents' alcohol consumption, health problems (indicative of salience of health warnings), and level of health consciousness assessed by items tapping concern with nutrition and seeking information on health topics. Results. In the total sample, over a third had seen a warning label or poster and almost all had seen an advertisement about the risks associated with alcohol consumption in 1993. Survey respondents scored very high on five individual items that make up the health consciousness scale introduced here, with 69% endorsing all items. The scale demonstrated good internal reliability (alpha =. 70) and was significantly correlated (p <. 01) with not enjoying getting drunk and with usually reading product warning labels, suggesting construct validity. Yet the hypothesized strong relationships between health consciousness and attention to health warnings about drinking were not observed; nor was salience of messages a predictor of recall. Importantly, high proportions of underage drinkers and young adults at elevated risk for drinking problems are reached by container warning label messages. Mechanisms of exposure recall vary based on message source, with "container label recall" associated with heavier drinking, younger age, and purchasing patterns; "poster recall" associated with purchasing and health consciousness; and "advertisement recall" associated with heavy consumption and younger age. Conclusions. These results are contrary to predictions from skeptics of broad-based informational interventions, who argue that only the already-health conscious are attentive to health warnings about the risks of alcohol consu~nption. These data suggest that the label is reaching intended target audiences, especially younger people, males, and heavier alcohol consumers, Future research in predicting attention to impersonal health warnings in the environment should continue to improve the assessment of constructs such as salience and health consciousness, and should further test the applicability of available theoretical models. Subsequent research should also consider additional measures to tap mechanisms of exposure to impersonal health messages to enable a better understanding of the population that is not being reached by such public health interventions.

PubMed, 2014

To assess alcohol consumption levels in large populations, researchers often rely on self-report ... more To assess alcohol consumption levels in large populations, researchers often rely on self-report measures. However, these approaches are associated with several limitations, particularly underreporting. Use of noninvasive biomonitoring approaches may help validate self-report alcohol consumption measurements and thus improve their accuracy. Two such devices currently are available, the WrisTASTM and SCRAMTM devices, both of which measure alcohol vapors emitted through the skin after alcohol consumption. Several studies assessing the utility of the WrisTASTM bracelet in determining alcohol consumption levels noted that it was associated with relatively high failure rates. The SCRAMTM is an ankle bracelet intended for court-ordered alcohol monitoring. In studies, its sensitivity exceeded that of the WrisTASTM and increased with increasing blood alcohol concentrations. Although early studies also identified some equipment concerns with the SCRAMTM, studies of its ability to detect moderate and heavy drinking recently have yielded good results. Biomonitoring devices already are valuable tools and with further improvements may become even more useful in both research and practical applications.

Addiction, Oct 1, 1996

To assess the relationship of alcohol use and three types of alcohol‐related problems (ICD‐10 dep... more To assess the relationship of alcohol use and three types of alcohol‐related problems (ICD‐10 dependence syndrome, work problems and drunk driving), risk curves were developed for average number of drinks per day during last year (volume) and number of days drinking five or more drinks during one day (5 +). Using data from the I98S National Health Interview Alcohol Supplement, risk curves were derived from data on 22 102 current drinkers who consumed at least 12 drinks in the last year. The emphasis in this analysis was on the proportion of drinkers at lower levels reporting different types of problems. The results indicate that even at lower levels of drinking (volume averaging one or fewer drinks/day) there is considerable risk for drunk driving and less risk for work problems and alcohol dependence. The risk for all types of problems at lower and moderate levels of drinking was significantly higher for respondents who had five or more drinks during one day in the last year. These findings underscore the importance of examining risk (physical and social) at lower levels of drinking and for using both overall volume and heavier quantity per occasion drinking measures when assessing risk for any alcohol‐related problem.

Alcoholism: Clinical and Experimental Research, 2007

Background: This study reports lifetime estimates of the extent of unmet need for alcohol service... more Background: This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over-represented in treatment settings. Methods: Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence. Results: While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higherseverity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care. Conclusions: Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care.

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014), Nov 17, 2014

Alcoholism: Clinical and Experimental Research, Jan 28, 2021

Introduction:International drink-driving policy research generally focuses on aggregate outcomes ... more Introduction:International drink-driving policy research generally focuses on aggregate outcomes (e.g., rates of crashes, fatalities) without emphasizing secondhand alcohol-related vehicular harms. In contrast, we investigate associations between drink-driving policies and harms involving another driver’s impairment.Methods:Alcohol’s harms to others (AHTO) survey data from 12 countries (analytic N=29,616) were linked to national alcohol policy data from the World Health Organization. We examined separately associations of two 12-month driving-related AHTOs (passenger with an impaired driver; vehicular crash involving someone else’s drink driving) with three national drinking-driving policies--legal blood alcohol concentration (BAC) limits, use of random breath testing, use of sobriety checkpoints, and comprehensive penalties for drink-driving (community service, detention, fines, ignition interlocks, license suspension/revocation, mandatory alcohol treatment, vehicle impoundment, and penalty point system), plus two alcohol tax variables (having excise taxes and value-added tax [VAT] rate). Multilevel logistic regression addressed clustering of individuals within countries and subnational regions, while adjusting for individuals’ gender, age, marital status, risky drinking, and regional drinking culture (% male risky drinkers in sub-national region).Results:Controlling for national-, regional-, and individual-level covariates, comprehensive penalties were significantly and negatively associated with both outcomes; other vehicular policy variables were not significantly associated with either outcome. A society’s VAT rate was negatively associated with riding with a drunk driver. Regional male drinking culture was positively associated with riding with an impaired driver, but was not significantly associated with being in a vehicular crash due to someone else’s drinking. In both models, being male, being younger, and engaging in risky drinking oneself each were positively associated with vehicular harms due to someone else’s drinking.Conclusions:Although results are associational and not causal, comprehensive penalties may be promising policies for mitigating driving-related harms due to another drinker. Higher VAT rate might reduce riding with a drunk driver.

Hispanic Journal of Behavioral Sciences, Jul 28, 2017

Objective-Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico ... more Objective-Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico border. Few studies describe the impact of violence on drinking between countries and along the border. Methods-Survey data is from U.S. Mexican origin adults living in Texas and Mexican border and non-border cities, N=4,796. Participants were asked about alcohol consumption, interpersonal physical violence (IPV) and exposure to community violence. Monthly hazardous drinking (5+/4+ for men/women) was the primary outcome. Multivariate logistic regression model comparisons identified best predictors. Results-In the U.S. hazardous drinking was associated with past year IPV (OR adj =2.5; 1.8-3.5) and community violence (OR adj =1.4; 1.1-1.8). In Mexico, IPV (OR adj =3.9; 2.0-7.4) and border proximity (OR adj =0.5; 0.4-0.8) were associated with hazardous drinking but not community violence. Conclusion-Hazardous drinking is associated with IPV in both countries, but violence did not explain border hazardous drinking differences where they existed in Mexico.

Addiction, Oct 1, 1996

To assess the relationship of alcohol use and three types of alcohol‐related problems (ICD‐10 dep... more To assess the relationship of alcohol use and three types of alcohol‐related problems (ICD‐10 dependence syndrome, work problems and drunk driving), risk curves were developed for average number of drinks per day during last year (volume) and number of days drinking five or more drinks during one day (5 +). Using data from the I98S National Health Interview Alcohol Supplement, risk curves were derived from data on 22 102 current drinkers who consumed at least 12 drinks in the last year. The emphasis in this analysis was on the proportion of drinkers at lower levels reporting different types of problems. The results indicate that even at lower levels of drinking (volume averaging one or fewer drinks/day) there is considerable risk for drunk driving and less risk for work problems and alcohol dependence. The risk for all types of problems at lower and moderate levels of drinking was significantly higher for respondents who had five or more drinks during one day in the last year. These findings underscore the importance of examining risk (physical and social) at lower levels of drinking and for using both overall volume and heavier quantity per occasion drinking measures when assessing risk for any alcohol‐related problem.

Alcoholism: Clinical and Experimental Research, 2007

Background: This study reports lifetime estimates of the extent of unmet need for alcohol service... more Background: This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over-represented in treatment settings. Methods: Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence. Results: While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higherseverity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care. Conclusions: Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care.

Contemporary drug problems, Dec 1, 2004

This article describes policy developments in alcohol advertising and counter-advertising at the ... more This article describes policy developments in alcohol advertising and counter-advertising at the U.S. national level, including federally mandated warning labels on alcoholic beverage containers, the campaign for health warnings on broadcast advertising, the end of the voluntary ban on advertising ofdistilled spirits on television and radio, and the debate concerning a healthbenefits label on wine products. Federal legislative documents and media accounts provided the context for 64 key-informant interviews with persons working for the federal government, the alcohol industry, public health, and research and media

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014), Nov 17, 2014

Alcoholism: Clinical and Experimental Research, Jan 28, 2021

Introduction:International drink-driving policy research generally focuses on aggregate outcomes ... more Introduction:International drink-driving policy research generally focuses on aggregate outcomes (e.g., rates of crashes, fatalities) without emphasizing secondhand alcohol-related vehicular harms. In contrast, we investigate associations between drink-driving policies and harms involving another driver’s impairment.Methods:Alcohol’s harms to others (AHTO) survey data from 12 countries (analytic N=29,616) were linked to national alcohol policy data from the World Health Organization. We examined separately associations of two 12-month driving-related AHTOs (passenger with an impaired driver; vehicular crash involving someone else’s drink driving) with three national drinking-driving policies--legal blood alcohol concentration (BAC) limits, use of random breath testing, use of sobriety checkpoints, and comprehensive penalties for drink-driving (community service, detention, fines, ignition interlocks, license suspension/revocation, mandatory alcohol treatment, vehicle impoundment, and penalty point system), plus two alcohol tax variables (having excise taxes and value-added tax [VAT] rate). Multilevel logistic regression addressed clustering of individuals within countries and subnational regions, while adjusting for individuals’ gender, age, marital status, risky drinking, and regional drinking culture (% male risky drinkers in sub-national region).Results:Controlling for national-, regional-, and individual-level covariates, comprehensive penalties were significantly and negatively associated with both outcomes; other vehicular policy variables were not significantly associated with either outcome. A society’s VAT rate was negatively associated with riding with a drunk driver. Regional male drinking culture was positively associated with riding with an impaired driver, but was not significantly associated with being in a vehicular crash due to someone else’s drinking. In both models, being male, being younger, and engaging in risky drinking oneself each were positively associated with vehicular harms due to someone else’s drinking.Conclusions:Although results are associational and not causal, comprehensive penalties may be promising policies for mitigating driving-related harms due to another drinker. Higher VAT rate might reduce riding with a drunk driver.

Journal of Studies on Alcohol and Drugs, Mar 1, 2020

Media coverage of alcohol-related policy measures can influence public debate and is often more a... more Media coverage of alcohol-related policy measures can influence public debate and is often more aligned with interests of the alcohol industry than public health. The purpose of this study was to examine the framing of news coverage of alcohol warning label (AWL) initiatives that included a cancer message on alcohol containers in two different countries. Policy contexts and industry perspectives were also evaluated. Method: We identified and systematically reviewed news articles published between 2017-2019 covering an AW L academic study in Yu kon, Canada, and labeling provisions in a Public Health (Alcohol) Bill in Ireland. Both included a cancer message. News stories were coded for media type and topic slant; inclusion of alcohol industry perspectives was examined using content analysis. Results: Overall, 68.4% of media articles covering the Yu kon Study (n = 38) and 18.9% covering the Ireland Bill (n = 37) were supportive of AW Ls with a cancer message. The majority of articles in both sites presented alcohol industry perspectives (Yukon, 65.8%; Ireland, 86.5%), and industry arguments opposing AW Ls were similar across both contexts. In articles with statements from industry representatives, the label message was frequently disputed by distorting or denying the evidence that alcohol causes cancer (n = 33/43). Conclusions: News coverage of AW Ls with a cancer message was more supportive in Canada than Ireland, where alcohol industry perspectives were consistently foregrounded. Industry arguments opposing the cancer label bore similarities across contexts, often distorting or denying the evidence. Increasing awareness of industry messaging strategies may generate more critical coverage of industry lobbying activities and increase public support for alcohol policies. (J.

Hispanic Journal of Behavioral Sciences, Jul 28, 2017

Objective-Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico ... more Objective-Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico border. Few studies describe the impact of violence on drinking between countries and along the border. Methods-Survey data is from U.S. Mexican origin adults living in Texas and Mexican border and non-border cities, N=4,796. Participants were asked about alcohol consumption, interpersonal physical violence (IPV) and exposure to community violence. Monthly hazardous drinking (5+/4+ for men/women) was the primary outcome. Multivariate logistic regression model comparisons identified best predictors. Results-In the U.S. hazardous drinking was associated with past year IPV (OR adj =2.5; 1.8-3.5) and community violence (OR adj =1.4; 1.1-1.8). In Mexico, IPV (OR adj =3.9; 2.0-7.4) and border proximity (OR adj =0.5; 0.4-0.8) were associated with hazardous drinking but not community violence. Conclusion-Hazardous drinking is associated with IPV in both countries, but violence did not explain border hazardous drinking differences where they existed in Mexico.

PubMed, 2014

To assess alcohol consumption levels in large populations, researchers often rely on self-report ... more To assess alcohol consumption levels in large populations, researchers often rely on self-report measures. However, these approaches are associated with several limitations, particularly underreporting. Use of noninvasive biomonitoring approaches may help validate self-report alcohol consumption measurements and thus improve their accuracy. Two such devices currently are available, the WrisTASTM and SCRAMTM devices, both of which measure alcohol vapors emitted through the skin after alcohol consumption. Several studies assessing the utility of the WrisTASTM bracelet in determining alcohol consumption levels noted that it was associated with relatively high failure rates. The SCRAMTM is an ankle bracelet intended for court-ordered alcohol monitoring. In studies, its sensitivity exceeded that of the WrisTASTM and increased with increasing blood alcohol concentrations. Although early studies also identified some equipment concerns with the SCRAMTM, studies of its ability to detect moderate and heavy drinking recently have yielded good results. Biomonitoring devices already are valuable tools and with further improvements may become even more useful in both research and practical applications.

Contemporary drug problems, Dec 1, 2004

This article describes policy developments in alcohol advertising and counter-advertising at the ... more This article describes policy developments in alcohol advertising and counter-advertising at the U.S. national level, including federally mandated warning labels on alcoholic beverage containers, the campaign for health warnings on broadcast advertising, the end of the voluntary ban on advertising ofdistilled spirits on television and radio, and the debate concerning a healthbenefits label on wine products. Federal legislative documents and media accounts provided the context for 64 key-informant interviews with persons working for the federal government, the alcohol industry, public health, and research and media

Clinical Pharmacology & Therapeutics, Feb 27, 2008

Alcohol policy has been shown to have an impact on the incidence and prevalence of alcohol "addic... more Alcohol policy has been shown to have an impact on the incidence and prevalence of alcohol "addiction", or alcohol use disorders (AUD), as currently defined by the International Classification of Diseases Volume 10 (ICD-10) or by DSM IV. We will use mainly the term "addiction" to depict a state involving loss of control over intense urges to consume alcohol even at the expense of adverse consequences. This definition goes beyond pure "physiological dependence" (1). We will use the term AUD when referring to statistics based on the above-described definitions. In this overview we identify the pathways for the relationship between alcohol policy and addiction, present the empirical evidence and draw conclusions. Special emphasis will be put on treatment policy. Addiction as one of many health consequences of alcohol consumption Consumption of alcohol has impacts on many different disease and injury categories. Over 60 single categories in ICD-10 have been identified as being potentially caused by drinking (2), and more than 30 conditions have alcohol or alcoholic in their name, indicating that they would not exist in absence of alcohol. Certainly, the most important among the latter conditions are AUD or "alcohol addiction" itself. While addiction certainly is important, it does not comprise the majority of either alcohol-attributable mortality or burden of disease (3). But addiction also may also act indirectly by underlying chronic disease or injury. However, alcohol may kill or may cause disability in persons who do not quality for any psychiatric diagnosis, such as an occasional drinker who causes an alcohol-attributable traffic accident due to intoxication, or a female with a lifetime consumption of two glasses of red wine per day and an alcoholattributable breast cancer (for the carcinogenicity of alcohol see (4)). It should be recognized that co-occurring substance use (including tobacco use) and other mental disorders (e.g., depression) complicate the causal attribution to alcohol in many conditions. Additionally, some heavy drinkers may not meet formal criteria for AUD owing to denial, so that for these two reasons, attribution of morbidity and mortality to alcohol may both be under and over stated to an unknown degree.

Journal of Studies on Alcohol and Drugs, Mar 1, 2020

Media coverage of alcohol-related policy measures can influence public debate and is often more a... more Media coverage of alcohol-related policy measures can influence public debate and is often more aligned with interests of the alcohol industry than public health. The purpose of this study was to examine the framing of news coverage of alcohol warning label (AWL) initiatives that included a cancer message on alcohol containers in two different countries. Policy contexts and industry perspectives were also evaluated. Method: We identified and systematically reviewed news articles published between 2017-2019 covering an AW L academic study in Yu kon, Canada, and labeling provisions in a Public Health (Alcohol) Bill in Ireland. Both included a cancer message. News stories were coded for media type and topic slant; inclusion of alcohol industry perspectives was examined using content analysis. Results: Overall, 68.4% of media articles covering the Yu kon Study (n = 38) and 18.9% covering the Ireland Bill (n = 37) were supportive of AW Ls with a cancer message. The majority of articles in both sites presented alcohol industry perspectives (Yukon, 65.8%; Ireland, 86.5%), and industry arguments opposing AW Ls were similar across both contexts. In articles with statements from industry representatives, the label message was frequently disputed by distorting or denying the evidence that alcohol causes cancer (n = 33/43). Conclusions: News coverage of AW Ls with a cancer message was more supportive in Canada than Ireland, where alcohol industry perspectives were consistently foregrounded. Industry arguments opposing the cancer label bore similarities across contexts, often distorting or denying the evidence. Increasing awareness of industry messaging strategies may generate more critical coverage of industry lobbying activities and increase public support for alcohol policies. (J.

American Journal of Health Promotion, 1997

Purpose. Guided by information processing theory and the health belief model, this paper consider... more Purpose. Guided by information processing theory and the health belief model, this paper considers the relationship between health consciousness among the general population and attention to environmental health warnings about alcohol consumption, Mechanisms of exposure to three dominant types of impersonal alcohol-related health messages in the environment are explored. Design. Cross-sectional survey using telephone interviezo data. Subjects. A representative nationwide sample of adults was interviewed in 1993 (n 1026), with a response rate of 63 %. Measures. Key variables include exposure to warning labels on alcoholic beverages, to pointof-sale posters, and to advertisements in the media, as well as respondents' alcohol consumption, health problems (indicative of salience of health warnings), and level of health consciousness assessed by items tapping concern with nutrition and seeking information on health topics. Results. In the total sample, over a third had seen a warning label or poster and almost all had seen an advertisement about the risks associated with alcohol consumption in 1993. Survey respondents scored very high on five individual items that make up the health consciousness scale introduced here, with 69% endorsing all items. The scale demonstrated good internal reliability (alpha =. 70) and was significantly correlated (p <. 01) with not enjoying getting drunk and with usually reading product warning labels, suggesting construct validity. Yet the hypothesized strong relationships between health consciousness and attention to health warnings about drinking were not observed; nor was salience of messages a predictor of recall. Importantly, high proportions of underage drinkers and young adults at elevated risk for drinking problems are reached by container warning label messages. Mechanisms of exposure recall vary based on message source, with "container label recall" associated with heavier drinking, younger age, and purchasing patterns; "poster recall" associated with purchasing and health consciousness; and "advertisement recall" associated with heavy consumption and younger age. Conclusions. These results are contrary to predictions from skeptics of broad-based informational interventions, who argue that only the already-health conscious are attentive to health warnings about the risks of alcohol consu~nption. These data suggest that the label is reaching intended target audiences, especially younger people, males, and heavier alcohol consumers, Future research in predicting attention to impersonal health warnings in the environment should continue to improve the assessment of constructs such as salience and health consciousness, and should further test the applicability of available theoretical models. Subsequent research should also consider additional measures to tap mechanisms of exposure to impersonal health messages to enable a better understanding of the population that is not being reached by such public health interventions.

PubMed, 2014

To assess alcohol consumption levels in large populations, researchers often rely on self-report ... more To assess alcohol consumption levels in large populations, researchers often rely on self-report measures. However, these approaches are associated with several limitations, particularly underreporting. Use of noninvasive biomonitoring approaches may help validate self-report alcohol consumption measurements and thus improve their accuracy. Two such devices currently are available, the WrisTASTM and SCRAMTM devices, both of which measure alcohol vapors emitted through the skin after alcohol consumption. Several studies assessing the utility of the WrisTASTM bracelet in determining alcohol consumption levels noted that it was associated with relatively high failure rates. The SCRAMTM is an ankle bracelet intended for court-ordered alcohol monitoring. In studies, its sensitivity exceeded that of the WrisTASTM and increased with increasing blood alcohol concentrations. Although early studies also identified some equipment concerns with the SCRAMTM, studies of its ability to detect moderate and heavy drinking recently have yielded good results. Biomonitoring devices already are valuable tools and with further improvements may become even more useful in both research and practical applications.