Mood and Changes in Alcohol Consumption in Young Adults during COVID-19 Lockdown: A Model Explaining Associations with Perceived Immune Fitness and Experiencing COVID-19 Symptoms

The aim of this study was to explore the effects of the 2019 Coronavirus (COVID-19) lockdown on mood states, stress, alcohol consumption and perceived immune fitness in a Dutch sample. Analysis included a subsample from the “Corona Lockdown: how fit are you?” (CLOFIT) study, comprising N = 761 participants who reported consuming alcohol in 2020. Results show that, compared to pre-lockdown, the first COVID-19 lockdown (March 2020) was associated with experiencing poorer mood (e.g., anxiety, depression, loneliness, fatigue) and increased stress levels. Among younger participants (18 to 35 years old), a significant decrease in weekly alcohol consumption was found during COVID-19 lockdown, which was not significant in older individuals. For the younger age cohort (18 to 35 years old), increased stress significantly correlated to increased weekly alcohol consumption (r = 0.163, p = 0.003), which in turn, correlated significantly to reporting a poorer perceived immune fitness (r = −0.165, p = 0.002). Poorer perceived immune fitness correlated significantly with increases in the presence and severity of COVID-19 symptoms (r = −0.313, p < 0.001, and r = −0.325, p < 0.001, respectively). The data provides evidence for significant relationships between changes in mood, stress and alcohol consumption during COVID-19 lockdown, and supports a model that links these changes to perceived immune fitness and susceptibility to experiencing COVID-19 symptoms.

Alcohol Consumption Patterns during COVID-19 Lockdown and Their Relationship with Perceived Immune Fitness and Reported COVID-19 Symptoms

Since the outbreak of the 2019 coronavirus (COVID-19) pandemic, lockdown periods have been installed to counteract the spread of the virus. These lockdowns, characterized by social isolation, have been associated with mood changes and increased stress. Individuals have used various strategies to cope with the negative effects of being in lockdown, including increasing the frequency and quantity of alcohol consumption. The aim of this study was to investigate mood before and during lockdown of individuals who reported consuming more, less, or the same amount of alcohol during lockdown, and examine how this impacts and perceived immune fitness and the presence and severity of COVID-19 symptoms. Analysis included a sub-sample from the ‘Corona Lockdown: how fit are you?’ (CLOFIT) study, comprising N = 761 participants who reported consuming alcohol in 2020. The results of the online survey showed that half of the participants did not alter their weekly alcohol consumption during lockdown (50.4%), whereas 25.9% of drinkers reported a reduction and 23.8% reported an increase in weekly alcohol consumption. Compared to individuals that did not alter their drinking behaviour, both increased and reduced alcohol consumption during lockdown was associated with poorer mood and higher stress levels. Increased alcohol consumption was associated with significantly reduced perceived immune fitness and a high presence and severity of COVID-19 symptoms. This effect was not significant among individuals with reduced or unaltered alcohol consumption.

Web-based treatment of harmful alcohol use and alcohol dependence: A randomized controlled trial (Preprint)

BACKGROUND Problematic alcohol use is a major contributor to health loss. Many people with harmful use or alcohol dependence are not reached by treatment, due to limited availability or stigma. They might use internet interventions as an alternative way of getting support. Internet interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use, but few studies with specific focus on harmful use or alcohol dependence have been conducted. The importance of internet cognitive behavioral therapy (ICBT) programs and therapist guidance in internet interventions are still unclear. OBJECTIVE To investigate the effects of a web-based alcohol-program with or without therapist guidance. METHODS We conducted a three-armed randomized controlled trial comparing therapist-guided ICBT and self-help ICBT with an information only control condition. Help-seeking adult internet-users (n=1169) with alcohol dependence (>=3 ICD criteria) or harmful alcohol use (AUDIT>15) were included in the study during the recruitment period, from March 2015 to March 2017. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of five main and three extra modules as well as a drinking-calendar with automatic feedback. The guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol related problems measured with the total AUDIT-score, diagnostic criteria for alcohol dependence (ICD-10 criteria) and Alcohol Use Disorder (DSM-5), depression (MADRS-S), anxiety (GAD-7), health (EQ-5D-5L), readiness to change (Readiness Ruler) and access to other treatment or support. Follow-up was conducted 3 (post-treatment) and 6 months after recruitment. RESULTS Participants had a mean age of 45 (SD=13) years and 56% were women. At 3-months follow-up the therapist-guided ICBT and control group differed significantly in weekly alcohol consumption (-3.84, 95 CI=-6.53 to -1.16, t=2.81, p=.005, d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between self-help ICBT and the control group at 3 months or between any of the groups at 6 months. CONCLUSIONS In this study we did not find a therapist-guided ICBT program to be more effective than the same program as self-help ICBT in reducing alcohol consumption or other alcohol-related outcomes. In the short run therapist-guided ICBT seems be more effective than information. Only some internet help-seekers might need a multi-session program and therapist guidance in order to change their drinking when they use internet interventions. CLINICALTRIAL Trial registration: ClinicalTrials.gov, identifier: NCT02377726, https://clinicaltrials.gov/ct2/show/NCT02377726 This trial was approved by the Stockholm Regional Ethical Review Board (No. 2014/1758-31/2).

Revisiting the continuum of resistance model in the digital age: a comparison of early and delayed respondents to the Norwegian counties public health survey

Background The continuum of resistance model’s premise is that delayed respondents to a survey are more similar to non-respondents than early respondents are. For decades, survey researchers have applied this model in attempts to evaluate and adjust for non-response bias. Despite a recent resurgence in the model’s popularity, its value has only been assessed in one large online population health survey. Methods Respondents to the Norwegian Counties Public Health Survey in Hordaland, Norway, were divided into three groups: those who responded within 7 days of the initial email/SMS invitation (wave 1, n = 6950); those who responded after 8 to 14 days and 1 reminder (wave 2, n = 4950); and those who responded after 15 or more days and 2 reminders (wave 3, n = 4045). Logistic regression analyses were used to compare respondents’ age, sex and educational level between waves, as well as the prevalence of poor general health, life dissatisfaction, mental distress, chronic health problems, weekly alcohol consumption, monthly binge drinking, daily smoking, physical activity, low social support and receipt of a disability pension. Results The overall response to the survey was 41.5%. Respondents in wave 1 were more likely to be older, female and more highly educated than those in waves 2 and 3. However, there were no substantial differences between waves for any health outcomes, with a maximal prevalence difference of 2.6% for weekly alcohol consumption (wave 1: 21.3%, wave 3: 18.7%). Conclusions There appeared to be a mild continuum of resistance for demographic variables. However, this was not reflected in health and related outcomes, which were uniformly similar across waves. The continuum of resistance model is unlikely to be useful to adjust for nonresponse bias in large online surveys of population health.

Concurrent validity of an Estimator of Weekly Alcohol Consumption (EWAC) based on the Extended AUDIT

Background and Aims: The 3-question Alcohol Use Disorders Identification Test (AUDIT-C) is commonly employed in healthcare to screen for levels of alcohol consumption. AUDIT-C scores (0-12) have no direct interpretation and do not provide information on alcohol intake, an important variable for behaviour change. The study aimed to (a) develop a continuous metric from the Extended AUDIT-C, offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC); (b) evaluate the EWAC's bias and error using the Graduated-Frequency (GF) questionnaire as a reference standard of alcohol consumption. Design: Cross-sectional diagnostic study based on a nationally-representative survey. Settings: Community-dwelling households in England. Participants: 22,404 household residents aged ≥16 years reporting drinking alcohol at least occasionally. Measurements: Computer-assisted personal interviews consisting of (a) Extended AUDIT and (b) GF. The primary outcomes were: mean deviation <1 UK unit (metric of bias); root mean squared deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was an equivalent receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units compared to AUDIT-C and AUDIT. Findings: EWAC had a positive bias of 0.2 UK units [95% confidence interval: 0.04, 0.3] compared to GF. Deviations were skewed: while the mean error was +/-11 UK units/week [9.8, 12.0], in half of participants the deviation between EWAC and GF was between 0 and +/-2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.921 [0.917, 0.925]) than AUDIT-C (0.871 [0.866, 0.876]) or the full AUDIT (0.854 [0.849, 0.860]). Conclusions: The EWAC https://ewac.netlify.app is designed to estimate weekly alcohol consumption using answers to the Extended AUDIT-C questionnaire. Using the detailed GF as a reference standard, the EWAC met the targeted bias tolerance. Its accuracy was superior to that of both AUDIT-C and the full AUDIT in relation to consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions.

Revisiting the continuum of resistance model in the digital age: A comparison of early and delayed respondents to the Norwegian Counties Public Health Survey

BackgroundThe continuum of resistance model’s premise is that delayed respondents to a survey are more similar to non-respondents than early respondents are. For decades, survey researchers have applied this model in attempts to evaluate and adjust for non-response bias. Despite a recent resurgence in the model’s popularity, its value has not been assessed in a large online population health survey.MethodsRespondents to the Norwegian Counties Public Health Survey in Hordaland, Norway, were divided into three groups: those who responded within 7 days of the initial email/SMS invitation (wave 1, n = 6950); those who responded after 8 to 14 days and 1 reminder (wave 2, n =4950); and those who responded after 15 or more days and 2 reminders (wave 3, n = 4045). Logistic regression analyses were used to compare respondents’ age, sex and educational level between waves, as well as the prevalence of poor general health, life dissatisfaction, mental distress, chronic health problems, weekly alcohol consumption, monthly binge drinking, daily smoking, physical activity, low social support and receipt of a disability pension.ResultsThe overall response to the survey was 41.5%. Respondents in wave 1 were more likely to be older, female and more highly educated than those in waves 2 and 3. However, there were no substantial differences between waves for any health outcomes, with a maximal prevalence difference of 2.6% for weekly alcohol consumption (wave 1: 21.3%, wave 3: 18.7%).ConclusionsThere appeared to be a mild continuum of resistance for demographic variables. However, this was not reflected in health and related outcomes, which were uniformly similar across waves. The continuum of resistance model is unlikely to be useful to adjust for nonresponse bias in large online surveys of population health.

Does Class Proportion of Students with Non-Western Origin in High Schools Affect Drinking Habits Among Ethnic Danish Students?

Aim the objective was to test the hypothesis that a higher proportion of students with non-Western origin in high school classes is associated with lower and less frequent alcohol consumption among ethnic Danish students. Method data on country of origin was obtained from the Danish Civil Registration System, while information on drinking habits were derived from the Danish National Youth Study 2014. Multilevel zero-inflated binominal regression was used to assess the association between class proportion of students with non-Western origin and odds of non-drinking and mean weekly alcohol consumption, while multilevel logistic regression was used to assess the association with frequent binge drinking. Results a higher proportion of students with non-Western origin in class was associated with higher odds of non-drinking among ethnic Danish student in the same class. For example, ethnic Danish boys in classes with more than 15% of the students of non-Western origin had 77% higher odds of being non-drinkers, compared to ethnic Danish boys in classes where 0–5% had non-Western origin (OR: 1.77, 95% CI; 1.42–2.20). Among ethnic Danish students that did consume alcohol, class proportion of students with non-Western origin was not associated with weekly alcohol consumption, while a higher proportion of students with non-Western origin in class was associated with lower odds of frequent binge drinking. Conclusion the downward drinking trend among adolescents in Western countries may be partly explained by the higher proportion of youth with non-Western origin, influencing the prevalence of drinking and frequency of binge drinking among adolescents in the ethnic majority population.

Revisiting the continuum of resistance theory in the digital age: A comparison of early and delayed respondents to the Norwegian Counties Public Health Survey

BackgroundThe continuum of resistance model’s premise is that delayed respondents to a survey are more similar to non-respondents than early respondents are. For decades, survey researchers have applied this model in attempts to evaluate and adjust for non-response bias. Despite a recent resurgence in the model’s popularity, its value has not been assessed in a large online population health survey.MethodsRespondents to the Norwegian Counties Public Health Survey in Hordaland, Norway, were divided into three groups: those who responded within 7 days of the initial email/SMS invitation (wave 1, n = 6950); those who responded after 8 to 14 days and 1 reminder (wave 2, n =4950); and those who responded after 15 or more days and 2 reminders (wave 3, n = 4045). Logistic regression analyses were used to compare respondents’ age, sex and educational level between waves, as well as the prevalence of poor general health, life dissatisfaction, mental distress, chronic health problems, weekly alcohol consumption, monthly binge drinking, daily smoking, physical activity, low social support and receipt of a disability pension.ResultsThe overall response to the survey was 41.5%. Respondents in wave 1 were more likely to be older, female and more highly educated than those in waves 2 and 3. However, there were no substantial differences between waves for any health outcomes, with a maximal prevalence difference of 2.6% for weekly alcohol consumption (wave 1: 21.3%, wave 3: 18.7%).ConclusionsThere appeared to be a mild continuum of resistance for demographic variables. However, this was not reflected in health and related outcomes, which were uniformly similar across waves. The continuum of resistance model is unlikely to be useful to adjust for nonresponse bias in large online surveys of population health.

Predictors of outcome in 1-month survivors of large middle cerebral artery infarcts treated by decompressive hemicraniectomy

BackgroundDecompressive hemicraniectomy (DH) increases survival without severe dependency in patients with large middle cerebral artery (LMCA) infarcts. The objective was to identify predictors of 1-year outcome after DH for LMCA infarct.MethodsWe conducted this study in consecutive patients who underwent DH for LMCA infarcts, in a tertiary stroke centre. Using multivariable logistic regression analyses, we evaluated predictors of (1) 30-day mortality and (2) poor outcome after 1 year (defined as a modified Rankin Scale score of 4–6) in 30-day survivors.ResultsOf 212 patients (133 men, 63%; median age 51 years), 35 (16.5%) died within 30 days. Independent predictors of mortality were infarct volume before DH (OR 1.10 per 10 mL increase, 95% CI 1.04 to 1.16), delay between symptom onset and DH (OR 0.41, 95% CI 0.23 to 0.73 per 12 hours increase) and midline shift after DH (OR 2.59, 95% CI 1.09 to 6.14). The optimal infarct volume cut-off to predict death was 210 mL or more. Among the 177 survivors, 77 (43.5%) had a poor outcome at 1 year. Independent predictors of poor outcome were age (OR 1.08 per 1 year increase, 95% CI 1.03 to 1.12) and weekly alcohol consumption of 300 g or more (OR 5.30, 95% CI 2.20 to 12.76), but not infarct volume.ConclusionIn patients with LMCA infarcts treated by DH, stroke characteristics (infarct volume before DH, midline shift after DH and early DH) predict 30-day mortality, while patients’ characteristics (age and excessive alcohol intake) predict 1-year outcome survivors.