%0 Journal Article %J International Journal of Environmental Research and Public Health %D 2022 %T Gender Disparities of Heart Disease and the Association with Smoking and Alcohol Drinking Behavior Among the Middle-Aged and Older Population in the US and China, a Cross-Sectional Study of CHARLS and HRS Data %A Li, Yifei %A Lu, Yuanan %A Eric L Hurwitz %A Wu, Yanyan %K Alcohol Drinking %K CHARLS %K gender %K health survey %K Heart disease %X Background Heart disease remains the leading cause of death globally with substantial variabilities in mortalities by gender and region. Smoking and alcohol drinking are known modifiable health behaviors associated with heart disease. This study aims to estimate the prevalence of heart disease and to examine the association with smoking and drinking behavior for men and women in the United States (US) and China. Methods This study utilized the Harmonized data from the US Health and Retirement Study (HRS) and the China Health and Retirement Longitudinal Study (CHARLS), which are sister surveys as part of the Gateway to Global Aging Data (https://g2aging.org/). We performed cross-sectional comparisons using the 2016 wave HRS and 2015 wave CHARLS data. Age was categorized into four groups (50–59, 60–69, 70–79, and 80 years or older) and smoking and drinking behavior were combined to neither, smoking only, drinking only and both behaviors. Weighted analyses were conducted to estimate the prevalence and prevalence ratios (PRs) of heart disease accounting for complex survey design. Results The overall prevalence of heart disease was higher in men (24.5%) than in women (20.6%) in the US. In contrast, women had higher prevalence (22.9%) than men (16.1%) in China. The prevalence of heart disease increased by age with increasing gender gap in the US, while in China, the highest prevalence was observed in the 70–79 age group and gender difference were more apparent before 80 years of age. Adjusting for socio-demographic variables and health conditions, smoking only was associated with a higher prevalence of heart disease in both countries and the associations were stronger among women (US: PR = 1.39, 95%CI: 1.26 to 1.54; China: PR = 1.49, 95%CI: 1.30 to 1.72) than among men (US: PR = 1.20, 95%CI: 1.04 to 1.38; China: PR = 1.37, 95%CI: 0.94 to 1.98). Conclusions Findings from this study will improve present understanding of heart disease etiology and provide essential insights for future prevention, treatment, and control. Better management of smoking behaviors by gender might be beneficial for reducing the burden of heart disease in both countries and worldwide. %B International Journal of Environmental Research and Public Health %V 19 %P 2188 %G eng %N 4 %R 10.21203/rs.3.rs-626338/v1 %0 Journal Article %J International Journal of Environmental Research and Public Health %D 2022 %T Gender Disparities of Heart Disease and the Association with Smoking and Drinking Behavior among Middle-Aged and Older Adults, a Cross-Sectional Study of Data from the US Health and Retirement Study and the China Health and Retirement Longitudinal Study. %A Li, Yifei %A Lu, Yuanan %A Eric L Hurwitz %A Wu, Yanyan %K Alcohol Drinking %K CHARLS %K gender %K Heart disease %K Smoking %X

Heart disease remains the leading cause of death globally by gender and region. Smoking and alcohol drinking are known modifiable health behaviors of heart disease. Utilizing data from the US Health and Retirement Study and the China Health and Retirement Longitudinal Study, this study examines heart disease disparities and the association with smoking and drinking behavior among men and women in the US and China. Smoking and drinking behavior were combined to neither, smoke-only, drink-only, and both. In the US, the prevalence was higher in men (24.5%, 95% CI: 22.5-26.6%) than in women (20.6%, 95% CI: 19.3-22.1%) and a higher prevalence was found in the smoke-only group for both genders. In contrast, women in China had higher prevalence (22.9%, 95% CI: 21.7-24.1%) than men (16.1%, 95% CI: 15.1-17.2%), and the prevalence for women who smoked or engaged in both behaviors were ~1.5 times (95% CI: 1.3-1.8, < 0.001) those who did not smoke or drink, but no statistical difference were found in men. The findings might be due to differences in smoking and drinking patterns and cultures by gender in the two countries and gender inequality among older adults in China. Culturally tailored health promotion strategies will help reduce the burden of heart disease.

%B International Journal of Environmental Research and Public Health %V 19 %P 2188 %G eng %N 4 %R 10.3390/ijerph19042188 %0 Journal Article %J BMJ Open %D 2021 %T Brief interventions for older adults (BIO) delivered by non-specialist community health workers to reduce at-risk drinking in primary care: a study protocol for a randomised controlled trial. %A Paula, Tassiane Cristine Santos %A Chagas, Camila %A Noto, Ana Regina %A Formigoni, Maria Lucia Oliveira Souza %A Pereira, Tiago Veiga %A Ferri, Cleusa Pinheiro %K Aged %K Alcohol Drinking %K Alcoholism %K Brazil %K Community Health Workers %K Cost-Benefit Analysis %K Crisis Intervention %K Humans %K Primary Health Care %K Quality of Life %K Randomized Controlled Trials as Topic %X

INTRODUCTION: Evidence suggests that brief interventions are effective in reducing alcohol consumption among older adults. However, the effectiveness of these interventions when delivered by community health workers (non-specialists) in a primary healthcare setting is unknown. To our knowledge, this will be the first randomised trial to examine this.

METHODS AND ANALYSIS: Two hundred and forty-two individuals considered at-risk drinkers (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C score ≥4) will be recruited and randomly allocated to usual care (waiting-list) or usual care plus an intervention delivered by trained community health workers (non-specialists). Seven primary care units (PCUs) in Sao José dos Campos, Brazil. PCUs are part of the Brazilian public healthcare system (Sistema Único de Saúde).6 months.The primary outcome will be the proportion of participants considered at-risk drinkers (AUDIT-C score ≥4). Secondary outcomes will include alcohol consumption in a typical week in the last 30 days (in units per week) assessed by the AUDIT, service use questionnaire, cognitive performance-assessed by The Health and Retirement Study Harmonised Cognitive Assessment, physical activity-assessed by the International Physical Activity Questionnaire, depression-assessed by the Geriatric Depression Scale and quality of life-assessed by the Control, Autonomy, Self-realisation and Pleasure-16 instrument. The analysis will be based on intention-to-treat principle.

ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Universidade Federal de São Paulo, CEP/UNIFESP Project n: 0690/2018; CAAE: 91648618.0.0000.5505. All eligible participants will provide informed consent prior to randomisation. The results of this study will be published in relevant peer-reviewed journals and in conference presentations.

TRIAL REGISTRATION NUMBER: RBR-8rcxkk.

%B BMJ Open %V 11 %P e043918 %G eng %N 5 %R 10.1136/bmjopen-2020-043918 %0 Journal Article %J Nature Genetics %D 2019 %T Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use. %A Liu, Mengzhen %A Jiang, Yu %A Wedow, Robbee %A Li, Yue %A Brazel, David M %A Chen, Fang %A Datta, Gargi %A Davila-Velderrain, Jose %A McGuire, Daniel %A Tian, Chao %A Zhan, Xiaowei %A Choquet, Hélène %A Docherty, Anna R %A Jessica Faul %A Foerster, Johanna R %A Fritsche, Lars G %A Gabrielsen, Maiken Elvestad %A Gordon, Scott D %A Jeffrey Haessler %A Jouke-Jan Hottenga %A Huang, Hongyan %A Jang, Seon-Kyeong %A Philip R Jansen %A Ling, Yueh %A Mägi, Reedik %A Matoba, Nana %A McMahon, George %A Mulas, Antonella %A Orrù, Valeria %A Palviainen, Teemu %A Anita Pandit %A Reginsson, Gunnar W %A Skogholt, Anne Heidi %A Smith, Jennifer A %A Taylor, Amy E %A Turman, Constance %A Gonneke Willemsen %A Young, Hannah %A Young, Kendra A %A Zajac, Gregory J M %A Zhao, Wei %A Zhou, Wei %A Bjornsdottir, Gyda %A Boardman, Jason D %A Boehnke, Michael %A Dorret I Boomsma %A Chen, Chu %A Francesco Cucca %A Davies, Gareth E %A Charles B Eaton %A Ehringer, Marissa A %A Tõnu Esko %A Fiorillo, Edoardo %A Gillespie, Nathan A %A Gudbjartsson, Daniel F %A Haller, Toomas %A Kathleen Mullan Harris %A Andrew C Heath %A Hewitt, John K %A Hickie, Ian B %A Hokanson, John E %A Hopfer, Christian J %A Hunter, David J %A Iacono, William G %A Johnson, Eric O %A Kamatani, Yoichiro %A Sharon L R Kardia %A Matthew C Keller %A Kellis, Manolis %A Charles Kooperberg %A Kraft, Peter %A Krauter, Kenneth S %A Laakso, Markku %A Penelope A Lind %A Loukola, Anu %A Lutz, Sharon M %A Pamela A F Madden %A Nicholas G Martin %A McGue, Matt %A Matthew B McQueen %A Sarah E Medland %A Andres Metspalu %A Mohlke, Karen L %A Nielsen, Jonas B %A Okada, Yukinori %A Peters, Ulrike %A Tinca J Polderman %A Posthuma, Danielle %A Reiner, Alexander P %A Rice, John P %A Rimm, Eric %A Rose, Richard J %A Runarsdottir, Valgerdur %A Stallings, Michael C %A Stančáková, Alena %A Stefansson, Hreinn %A Thai, Khanh K %A Hilary A Tindle %A Tyrfingsson, Thorarinn %A Wall, Tamara L %A David R Weir %A Weisner, Constance %A Whitfield, John B %A Winsvold, Bendik Slagsvold %A Yin, Jie %A Zuccolo, Luisa %A Laura Bierut %A Hveem, Kristian %A Lee, James J %A Munafò, Marcus R %A Saccone, Nancy L %A Willer, Cristen J %A Marilyn C Cornelis %A David, Sean P %A Hinds, David A %A Jorgenson, Eric %A Kaprio, Jaakko %A Stitzel, Jerry A %A Stefansson, Kari %A Thorgeirsson, Thorgeir E %A Gonçalo R Abecasis %A Liu, Dajiang J %A Scott Vrieze %K Alcohol Drinking %K Female %K Genetic Variation %K Genome-Wide Association Study %K Humans %K Male %K Middle Aged %K Phenotype %K Risk %K Smoking %K Tobacco %K Tobacco Use Disorder %X

Tobacco and alcohol use are leading causes of mortality that influence risk for many complex diseases and disorders. They are heritable and etiologically related behaviors that have been resistant to gene discovery efforts. In sample sizes up to 1.2 million individuals, we discovered 566 genetic variants in 406 loci associated with multiple stages of tobacco use (initiation, cessation, and heaviness) as well as alcohol use, with 150 loci evidencing pleiotropic association. Smoking phenotypes were positively genetically correlated with many health conditions, whereas alcohol use was negatively correlated with these conditions, such that increased genetic risk for alcohol use is associated with lower disease risk. We report evidence for the involvement of many systems in tobacco and alcohol use, including genes involved in nicotinic, dopaminergic, and glutamatergic neurotransmission. The results provide a solid starting point to evaluate the effects of these loci in model organisms and more precise substance use measures.

%B Nature Genetics %V 51 %P 237-244 %G eng %N 2 %R 10.1038/s41588-018-0307-5 %0 Journal Article %J Biological Psychiatry %D 2019 %T Exome Chip Meta-analysis Fine Maps Causal Variants and Elucidates the Genetic Architecture of Rare Coding Variants in Smoking and Alcohol Use. %A Brazel, David M %A Jiang, Yu %A Hughey, Jordan M %A Turcot, Valérie %A Zhan, Xiaowei %A Gong, Jian %A Batini, Chiara %A Weissenkampen, J Dylan %A Liu, Mengzhen %A Barnes, Daniel R %A Bertelsen, Sarah %A Chou, Yi-Ling %A Erzurumluoglu, A Mesut %A Jessica Faul %A Jeffrey Haessler %A Anke R Hammerschlag %A Hsu, Chris %A Kapoor, Manav %A Lai, Dongbing %A Le, Nhung %A Christiaan de Leeuw %A Loukola, Anu %A Mangino, Massimo %A Melbourne, Carl A %A Pistis, Giorgio %A Qaiser, Beenish %A Rohde, Rebecca %A Shao, Yaming %A Heather M Stringham %A Wetherill, Leah %A Zhao, Wei %A Agrawal, Arpana %A Laura Bierut %A Chen, Chu %A Charles B Eaton %A Goate, Alison %A Christopher A Haiman %A Andrew C Heath %A Iacono, William G %A Nicholas G Martin %A Tinca J Polderman %A Reiner, Alex %A Rice, John %A Schlessinger, David %A H Steven Scholte %A Smith, Jennifer A %A Tardif, Jean-Claude %A Hilary A Tindle %A Van Der Leij, Andries R %A Boehnke, Michael %A Chang-Claude, Jenny %A Francesco Cucca %A David, Sean P %A Tatiana Foroud %A Howson, Joanna M M %A Sharon L R Kardia %A Charles Kooperberg %A Laakso, Markku %A Lettre, Guillaume %A Pamela A F Madden %A McGue, Matt %A Kari E North %A Posthuma, Danielle %A Timothy Spector %A Stram, Daniel %A Tobin, Martin D %A David R Weir %A Kaprio, Jaakko %A Gonçalo R Abecasis %A Liu, Dajiang J %A Scott Vrieze %K Alcohol Drinking %K Databases, Genetic %K Exome %K Genetic Predisposition to Disease %K Genetic Variation %K Genome-Wide Association Study %K Genotype %K Humans %K Oligonucleotide Array Sequence Analysis %K Phenotype %K Polymorphism, Single Nucleotide %K Smoking %X

BACKGROUND: Smoking and alcohol use have been associated with common genetic variants in multiple loci. Rare variants within these loci hold promise in the identification of biological mechanisms in substance use. Exome arrays and genotype imputation can now efficiently genotype rare nonsynonymous and loss of function variants. Such variants are expected to have deleterious functional consequences and to contribute to disease risk.

METHODS: We analyzed ∼250,000 rare variants from 16 independent studies genotyped with exome arrays and augmented this dataset with imputed data from the UK Biobank. Associations were tested for five phenotypes: cigarettes per day, pack-years, smoking initiation, age of smoking initiation, and alcoholic drinks per week. We conducted stratified heritability analyses, single-variant tests, and gene-based burden tests of nonsynonymous/loss-of-function coding variants. We performed a novel fine-mapping analysis to winnow the number of putative causal variants within associated loci.

RESULTS: Meta-analytic sample sizes ranged from 152,348 to 433,216, depending on the phenotype. Rare coding variation explained 1.1% to 2.2% of phenotypic variance, reflecting 11% to 18% of the total single nucleotide polymorphism heritability of these phenotypes. We identified 171 genome-wide associated loci across all phenotypes. Fine mapping identified putative causal variants with double base-pair resolution at 24 of these loci, and between three and 10 variants for 65 loci. Twenty loci contained rare coding variants in the 95% credible intervals.

CONCLUSIONS: Rare coding variation significantly contributes to the heritability of smoking and alcohol use. Fine-mapping genome-wide association study loci identifies specific variants contributing to the biological etiology of substance use behavior.

%B Biological Psychiatry %V 85 %P 946-955 %G eng %N 11 %R 10.1016/j.biopsych.2018.11.024 %0 Journal Article %J Nature Human Behaviour %D 2019 %T New alcohol-related genes suggest shared genetic mechanisms with neuropsychiatric disorders. %A Evangelou, Evangelos %A Gao, He %A Chu, Congying %A Ntritsos, Georgios %A Blakeley, Paul %A Butts, Andrew R %A Pazoki, Raha %A Suzuki, Hideaki %A Koskeridis, Fotios %A Yiorkas, Andrianos M %A Karaman, Ibrahim %A Elliott, Joshua %A Luo, Qiang %A Aeschbacher, Stefanie %A Traci M Bartz %A Baumeister, Sebastian E %A Braund, Peter S %A Brown, Michael R %A Brody, Jennifer A %A Clarke, Toni-Kim %A Dimou, Niki %A Jessica Faul %A Homuth, Georg %A Jackson, Anne U %A Kentistou, Katherine A %A Joshi, Peter K %A Lemaitre, Rozenn N %A Penelope A Lind %A Lyytikäinen, Leo-Pekka %A Mangino, Massimo %A Milaneschi, Yuri %A Nelson, Christopher P %A Ilja M Nolte %A Perälä, Mia-Maria %A Polasek, Ozren %A David J Porteous %A Scott M Ratliff %A Smith, Jennifer A %A Stančáková, Alena %A Teumer, Alexander %A Tuominen, Samuli %A Thériault, Sébastien %A Vangipurapu, Jagadish %A Whitfield, John B %A Wood, Alexis %A Yao, Jie %A Yu, Bing %A Zhao, Wei %A Dan E Arking %A Auvinen, Juha %A Liu, Chunyu %A Männikkö, Minna %A Risch, Lorenz %A Rotter, Jerome I %A Snieder, Harold %A Veijola, Juha %A Alexandra I Blakemore %A Boehnke, Michael %A Campbell, Harry %A Conen, David %A Johan G Eriksson %A Hans-Jörgen Grabe %A Guo, Xiuqing %A van der Harst, Pim %A Catharina A Hartman %A Caroline Hayward %A Andrew C Heath %A Järvelin, Marjo-Riitta %A Kähönen, Mika %A Sharon L R Kardia %A Kühne, Michael %A Kuusisto, Johanna %A Laakso, Markku %A Lahti, Jari %A Lehtimäki, Terho %A McIntosh, Andrew M %A Mohlke, Karen L %A Alanna C Morrison %A Nicholas G Martin %A Oldehinkel, Albertine J %A Brenda W J H Penninx %A Psaty, Bruce M %A Olli T Raitakari %A Rudan, Igor %A Nilesh J Samani %A Scott, Laura J %A Timothy Spector %A Verweij, Niek %A David R Weir %A James F Wilson %A Levy, Daniel %A Tzoulaki, Ioanna %A Bell, Jimmy D %A Matthews, Paul M %A Rothenfluh, Adrian %A Desrivières, Sylvane %A Schumann, Gunter %A Elliott, Paul %K Adult %K Aged %K Alcohol Drinking %K Alcoholism %K Brain %K Female %K genes %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Humans %K Magnetic Resonance Imaging %K Male %K Mental Disorders %K Middle Aged %K Neuroimaging %K Polymorphism, Single Nucleotide %K Quantitative Trait Loci %K Schizophrenia %K Whites %X

Excessive alcohol consumption is one of the main causes of death and disability worldwide. Alcohol consumption is a heritable complex trait. Here we conducted a meta-analysis of genome-wide association studies of alcohol consumption (g d) from the UK Biobank, the Alcohol Genome-Wide Consortium and the Cohorts for Heart and Aging Research in Genomic Epidemiology Plus consortia, collecting data from 480,842 people of European descent to decipher the genetic architecture of alcohol intake. We identified 46 new common loci and investigated their potential functional importance using magnetic resonance imaging data and gene expression studies. We identify genetic pathways associated with alcohol consumption and suggest genetic mechanisms that are shared with neuropsychiatric disorders such as schizophrenia.

%B Nature Human Behaviour %V 3 %P 950-961 %G eng %N 9 %R 10.1038/s41562-019-0653-z %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Drinking Patterns Among Older Couples: Longitudinal Associations With Negative Marital Quality. %A Kira S. Birditt %A James A. Cranford %A Jasmine A Manalel %A Toni C Antonucci %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Family Conflict %K Female %K Humans %K Longitudinal Studies %K Male %K Marriage %K Middle Aged %K Sex Factors %K Spouses %X

Objectives: Research with younger couples indicates that alcohol use has powerful effects on marital quality, but less work has examined the effects of drinking among older couples. This study examined whether dyadic patterns of drinking status among older couples are associated with negative marital quality over time.

Method: Married participants (N = 4864) from the Health and Retirement Study reported on alcohol consumption (whether they drink alcohol and average amount consumed per week) and negative marital quality (e.g., criticism and demands) across two waves (Wave 1 2006/2008 and Wave 2 2010/2012).

Results: Concordant drinking couples reported decreased negative marital quality over time, and these links were significantly greater among wives. Wives who reported drinking alcohol reported decreased negative marital quality over time when husbands also reported drinking and increased negative marital quality over time when husbands reported not drinking.

Discussion: The present findings stress the importance of considering the drinking status rather than the amount of alcohol consumed of both members of the couple when attempting to understand drinking and marital quality among older couples. These findings are particularly salient given the increased drinking among baby boomers and the importance of marital quality for health among older couples.

%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 655-665 %8 2018 04 16 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27353031 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27353031?dopt=Abstract %R 10.1093/geronb/gbw073 %0 Journal Article %J J Aging Health %D 2016 %T Association of Alcohol Use and Loneliness Frequency Among Middle-Aged and Older Adult Drinkers. %A Sarah L. Canham %A Pia M Mauro %A Christopher N Kaufmann %A Sixsmith, Andrew %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Binge drinking %K Cross-Sectional Studies %K Female %K Humans %K Loneliness %K Male %K Middle Aged %K Risk-Taking %X

OBJECTIVES: We examined the association between alcohol use, at-risk drinking, and binge drinking, and loneliness in a sample of middle-aged and older adults.

METHOD: We studied participants aged 50+ years from the 2008 wave of the Health and Retirement Study who reported alcohol use. We ran separate multinomial logistic regressions to assess the association of three alcohol use outcomes (i.e., weekly alcohol consumption, at-risk drinking, and binge drinking) and loneliness.

RESULTS: After adjusting for covariates, being lonely was associated with reduced odds of weekly alcohol consumption 4 to 7 days per week, but not 1 to 3 days per week, compared with average alcohol consumption 0 days per week in the last 3 months. No association was found between at-risk drinking or binge drinking and loneliness.

DISCUSSION: Results suggest that among a sample of community-based adults aged 50+, loneliness was associated with reduced alcohol use frequency, but not with at-risk or binge drinking.

%B J Aging Health %I 28 %V 28 %P 267-84 %8 2016 Mar %G eng %U http://jah.sagepub.com/content/early/2015/06/09/0898264315589579.abstract %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/26082130?dopt=Abstract %2 PMC4681688 %R 10.1177/0898264315589579 %0 Journal Article %J Age Ageing %D 2016 %T C-reactive protein level partially mediates the relationship between moderate alcohol use and frailty: the Health and Retirement Study. %A Mona Shah %A Daniel Paulson %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Alcohol Drinking %K Biomarkers %K C-reactive protein %K Cross-Sectional Studies %K Female %K Frail Elderly %K Frailty %K Geriatric Assessment %K Humans %K Inflammation Mediators %K Male %K Protective factors %K Risk Factors %K United States %X

BACKGROUND: frailty is an indicator of late-life decline marked by higher rates of disability and healthcare utilisation. Research has linked health benefits with moderate alcohol use, including frailty risk reduction. Past work suggests inflammation, measured by C-reactive protein (CRP), as one candidate mechanism for this effect.

OBJECTIVE: this study aims to elucidate a possible mechanism - CRP modulation - by which moderate alcohol consumption may protect against frailty.

METHODS: a cross-sectional study using data from the 2008 wave of the Health and Retirement Study (HRS) conducted by the University of Michigan. The HRS is a cohort study on health, retirement and aging on adults aged 50 and older living in the USA. A final sample of 3,229 stroke-free participants, over the age of 65 years and with complete data, was identified from the 2008 wave. Alcohol use was measured via self-report. Frailty was measured using the Paulson-Lichtenberg Frailty Index. CRP was collected through the HRS protocol.

RESULTS: results from structural equation modelling support the hypothesised model that moderate alcohol use is associated with less frailty and lower CRP levels. Furthermore, the indirect relationship from moderate alcohol use to frailty through CRP was statistically significant.

CONCLUSIONS: overall findings suggest that inflammation measured by CRP is one mechanism by which moderate alcohol use may confer protective effects for frailty. These findings inform future research relating alcohol use and frailty, and suggest inflammation as a possible mechanism in the relationship between moderate alcohol use and other beneficial health outcomes.

%B Age Ageing %V 45 %P 874-878 %8 2016 11 %G eng %U http://ageing.oxfordjournals.org/content/early/2016/06/30/ageing.afw103.long %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/27496931?dopt=Abstract %R 10.1093/ageing/afw103 %0 Journal Article %J J Health Soc Behav %D 2016 %T Marital Histories and Heavy Alcohol Use among Older Adults. %A Reczek, Corinne %A Tetyana Pudrovska %A Deborah Carr %A Thomeer, Mieke Beth %A Debra Umberson %K Adult %K Age Factors %K Aged %K Alcohol Drinking %K Divorce %K Female %K Humans %K Male %K Marital Status %K Marriage %K Middle Aged %K Models, Psychological %K Socioeconomic factors %X

We develop a gendered marital biography approach-which emphasizes the accumulating gendered experiences of singlehood, marriage, marital dissolution, and remarriage-to examine the relationship between marital statuses and transitions and heavy alcohol use. We test this approach using individual-level (n = 10,457) and couple-level (n = 2,170) longitudinal data from the Health and Retirement Study, and individual-level (n = 46) and couple-level (n = 42) in-depth interview data. Quantitative results show that marriage, including remarriage, reduces men's but increases women's drinking relative to being never married and previously married, whereas divorce increases men's but decrease women's drinking, with some variation by age. Our qualitative findings reveal that social control and convergence processes underlie quantitative results. We call attention to how men's and women's heavy drinking trajectories stop, start, and change direction as individuals move through their distinctive marital biography.

%B J Health Soc Behav %I 57 %V 57 %P 77-96 %8 2016 Mar %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26957135?dopt=Abstract %2 PMC4785832 %4 marital status/alcohol use/drinking trajectories/drinking %$ 999999 %R 10.1177/0022146515628028 %0 Journal Article %J Health Serv Res %D 2015 %T Explaining Disability Trends in the U.S. Elderly and Near-Elderly Population. %A Chen, Yiqun %A Frank A Sloan %K Activities of Daily Living %K Age Distribution %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Chronic disease %K Disabled Persons %K Female %K Health Behavior %K Health Surveys %K Humans %K Male %K Middle Aged %K Mobility Limitation %K Obesity %K Prevalence %K Sex Distribution %K Smoking %K Socioeconomic factors %K United States %X

OBJECTIVE: To examine disability trends among U.S. near-elderly and elderly persons and explain observed trends.

DATA SOURCE: 1996-2010 waves of the Health and Retirement Study.

STUDY DESIGN: We first examined trends in Activities of Daily Living and Instrumental Activities of Daily Living limitations, and large muscle, mobility, gross motor, and fine motor indexes. Then we used decomposition analysis to estimate contributions of changes in sociodemographic composition, self-reported chronic disease prevalence and health behaviors, and changes in disabling effects of these factors to disability changes between 1996 and 2010.

PRINCIPAL FINDINGS: Disability generally increased or was unchanged. Increased trends were more apparent for near-elderly than elderly persons. Sociodemographic shifts tended to reduce disability, but their favorable effects were largely offset by increased self-reported chronic disease prevalence. Changes in smoking and heavy drinking prevalence had relatively minor effects on disability trends. Increased obesity rates generated sizable effects on lower-body functioning changes. Disabling effects of self-reported chronic diseases often declined, and educational attainment became a stronger influence in preventing disability.

CONCLUSIONS: Such unfavorable trends as increased chronic disease prevalence and higher obesity rates offset or outweighed the favorable effects with the result that disability remained unchanged or increased.

%B Health Serv Res %I 50 %V 50 %P 1528-49 %8 2015 Oct %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/25655273?dopt=Abstract %2 PMC4600360 %4 ADL/IADL/Disabilities/sociodemographic factors/sociodemographic factors/Chronic Disease/Smoking/Alcohol/obesity %$ 999999 %R 10.1111/1475-6773.12284 %0 Journal Article %J Prev Chronic Dis %D 2015 %T Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions. %A Siran M Koroukian %A David F Warner %A Owusu, Cynthia %A Charles W Given %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Body Mass Index %K Chronic disease %K Cognition Disorders %K Comorbidity %K Cross-Sectional Studies %K Data Interpretation, Statistical %K ethnicity %K Female %K Health Status Indicators %K Humans %K Interviews as Topic %K Male %K Middle Aged %K Mobility Limitation %K Outcome Assessment, Health Care %K Prospective Studies %K Recurrence %K Retirement %K Self Report %K Smoking %K Social Class %K Syndrome %K United States %K Vulnerable Populations %X

INTRODUCTION: Multimorbidity is common among middle-aged and older adults; however the prospective effects of multimorbidity on health outcomes (health status, major health decline, and mortality) have not been fully explored. This study addresses this gap in the literature.

METHODS: We used self-reported data from the 2008 and 2010 Health and Retirement Study. Our study population included 13,232 adults aged 50 or older. Our measure of baseline multimorbidity in 2008 was based on the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes, as follows: MM0, no chronic conditions, functional limitations, or geriatric syndromes; MM1, occurrence (but no co-occurrence) of chronic conditions, functional limitations, or geriatric syndromes; MM2, co-occurrence of any 2 of chronic conditions, functional limitations, or geriatric syndromes; and MM3, co-occurrence of all 3 of chronic conditions, functional limitations, and geriatric syndromes. Outcomes in 2010 included fair or poor health status, major health decline, and mortality.

RESULTS: All 3 outcomes were significantly associated with multimorbidity. Compared with MM0 (respectively for fair or poor health and major health decline), the adjusted odds ratios (AORs) and 95% confidence intervals were as follows: 2.61 (1.79-3.78) and 2.20 (1.42-3.41) for MM1; 7.49 (5.20-10.77) and 3.70 (2.40-5.71) for MM2; and 22.66 (15.64-32.83) and 4.72 (3.03-7.37) for MM3. Multimorbidity was also associated with mortality: an adult classified as MM3 was nearly 12 times (AOR, 11.87 [5.72-24.62]) as likely as an adult classified as MM0 to die within 2 years.

CONCLUSION: Given the strong and significant association between multimorbidity and prospective health status, major health decline, and mortality, multimorbidity may be used - both in clinical practice and in research - to identify older adults with heightened vulnerability for adverse outcomes.

%B Prev Chronic Dis %I 12 %V 12 %P E55 %8 2015 Apr 23 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/25906436?dopt=Abstract %2 PMC4415428 %4 MORBIDITY/health status/health decline/mortality/baseline multimorbidity/health status %$ 999999 %R 10.5888/pcd12.140478 %0 Journal Article %J Addict Behav %D 2015 %T Substance-use coping and self-rated health among US middle-aged and older adults. %A Pia M Mauro %A Sarah L. Canham %A Silvia S Martins %A Adam P Spira %K Adaptation, Psychological %K Aged %K Aged, 80 and over %K Alcohol Drinking %K depression %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Smoking %K Substance-Related Disorders %K United States %X

The prevalence of alcohol, drug, and tobacco use among US middle-aged and older adults is increasing. A subset of this population uses substances to cope with stress, but the characteristics of these individuals, and the association between substance-use coping and health outcomes remain unclear. We identified correlates of substance-use coping and measured its association with self-rated health in a community-based sample of adults aged 54-99 in the Health and Retirement Study (HRS). In the 2008 HRS, 1351 participants reported their frequency of prescription/other drug-, alcohol-, and cigarette-use coping with stress and reported self-rated health (excellent/very good, good, or fair/poor); 1201 of these participants also reported self-rated health in 2010. One in six participants frequently used substances to cope. The oldest participants were least likely to engage in frequent alcohol-use coping. Those with elevated depressive symptoms were more likely to frequently engage in cigarette- and prescription/other drug-use coping. In multivariable-adjusted analyses, participants who frequently used cigarettes (compared to participants who infrequently used cigarettes) to cope had 2.7 times (95% CI=1.1-6.7) the odds of poor (vs. excellent) self-rated health. Relative to participants who infrequently used prescription/other drugs to cope, participants who frequently used prescription/other drugs to cope had 2.4 times (95% CI=1.1-5.1) the odds of reporting poor self-rated health. The association between prescription/other drug-use coping in 2008 and self-rated health in 2010 was statistically significant (relative OR=3.5, 95% CI=1.7-7.2). Participants engaging in substance-use coping likely have particular demographic and clinical characteristics. Interventions to reduce substance-use coping may prevent adverse health outcomes.

%B Addict Behav %I 42 %V 42 %P 96-100 %8 2015 Mar %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/25437264?dopt=Abstract %2 PMC4596550 %4 Coping/Older adults/Self-rated health/Substance use/Alcohol use/Drug Use/Smoking/stress/health outcomes %$ 999999 %R 10.1016/j.addbeh.2014.10.031 %0 Journal Article %J Health Econ %D 2013 %T Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals. %A Padmaja Ayyagari %A Deb, Partha %A Jason M. Fletcher %A William T Gallo %A Jody L Sindelar %K Adult %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Alcoholic Beverages %K Behavior %K Body Height %K Costs and Cost Analysis %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Models, Econometric %K Socioeconomic factors %K Taxes %K United States %X

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive. The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities. These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.

%B Health Econ %I 22 %V 22 %P 89-105 %8 2013 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/22162113?dopt=Abstract %2 PMC3641566 %4 Alcohol/Price elasticity/alcohol taxation/Public Policy/Elasticity of demand/heterogeneous policy responses/Fiscal policy/Fiscal policy/latent groups %$ 69734 %R 10.1002/hec.1817 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2012 %T The effect of stability and change in health behaviors on trajectories of body mass index in older Americans: a 14-year longitudinal study. %A Anda Botoseneanu %A Jersey Liang %K Aged %K Aging %K Alcohol Drinking %K Body Mass Index %K Cohort Studies %K Female %K Health Behavior %K Health Status %K Humans %K Linear Models %K Longitudinal Studies %K Male %K Middle Aged %K Motor Activity %K Smoking %K Socioeconomic factors %K United States %X

BACKGROUND: Obesity is increasingly prevalent among older adults, yet little is known about the impact of health behaviors on the trajectories of body weight in this age group.

METHODS: We examined the effect of time-varying smoking, physical activity (PA), alcohol use, and changes thereof, on the 14-year (1992-2006) trajectory of body- mass index (BMI) in a cohort of 10,314 older adults from the Health and Retirements Study, aged 51-61 years at baseline. Hierarchical linear modeling (HLM) quantifies the effect of smoking, PA, and alcohol use (user status, initiation and cessation) on intercept and rate-of-change in BMI trajectory, and tests for variations in the strength of association between each behavior and BMI.

RESULTS: Over 14 years (82,512 observations), BMI increased approximated by a quadratic function. Smoking and PA (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and PA resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased, while the strength of association between BMI trajectories and PA or alcohol use were constant over time. Socio-economic and health status differences explained the effects of alcohol use on BMI trajectory.

CONCLUSIONS: In older adults, smoking and PA, and changes thereof, vary in their long-term effect on trajectories of BMI. Barring increases in PA levels, older smokers who quit today are expected to gain significantly more weight than two decades ago. This knowledge is essential for the design of smoking cessation, physical activityPA, and weight-control interventions in older adults.

%B J Gerontol A Biol Sci Med Sci %V 67 %P 1075-84 %8 2012 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/22459621?dopt=Abstract %2 PMC3437967 %4 Obesity/body Mass Index/smoking/alcohol use %$ 69596 %R 10.1093/gerona/gls073 %0 Journal Article %J J Aging Health %D 2012 %T Gender differences in the link between excessive drinking and domain-specific cognitive functioning among older adults. %A Jiyoung Lyu %A SeungAh H. Lee %K Aged %K Alcohol Drinking %K Alcohol-Related Disorders %K Cognition %K Cognition Disorders %K Cross-Sectional Studies %K Female %K Humans %K Intelligence %K Male %K Multivariate Analysis %K Regression Analysis %K Sex Factors %X

OBJECTIVE: This study investigated gender differences in the relationship between excessive drinking and two cognitive domains among older adults.

METHOD: Using data from the Health and Retirement Study, 3,888 females and 2,350 males were analyzed separately. Multivariate regression was used to analyze the association between excessive drinking and fluid intelligence score. Logistic regression was conducted to examine the relationship between excessive drinking and crystallized intelligence.

RESULTS: Multivariate analysis showed that compared to non-excessive drinking, excessive drinking did not have a significant impact on fluid intelligence for either women or men, but it had a significantly negative association with a high crystallized intelligence score for women.

DISCUSSION: Findings suggest that the relationship between excessive drinking and cognition varies with gender when crystallized intelligence is measured. Clinicians and service providers should consider gender differences when developing strategies for the prevention and treatment of alcohol-related cognitive decline among older adults.

%B J Aging Health %V 24 %P 1380-98 %8 2012 Dec %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/22992713?dopt=Abstract %3 22992713 %4 alcohol Abuse/intelligence/Cognition/WOMEN/Cognitive ability/gender Differences %$ 69646 %R 10.1177/0898264312459346 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2012 %T Health behavior change following chronic illness in middle and later life. %A Jason T Newsom %A Nathalie Huguet %A Michael J. McCarthy %A Pamela Ramage-Morin %A Mark S Kaplan %A Julie Bernier %A Bentson McFarland %A Jillian Oderkirk %K Age Factors %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Chi-Square Distribution %K Chronic disease %K Diabetes Mellitus %K Exercise %K Female %K Health Behavior %K Heart Diseases %K Humans %K Longitudinal Studies %K Lung Diseases %K Male %K Middle Aged %K Neoplasms %K Smoking %K Stroke %K Time Factors %X

OBJECTIVES: Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life.

METHODS: Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease.

RESULTS: Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors.

DISCUSSION: Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.

%B J Gerontol B Psychol Sci Soc Sci %I 67B %V 67 %P 279-88 %8 2012 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/21983040?dopt=Abstract %2 PMC3325087 %4 Lifestyles/Lifestyles/Health behavior/Intervention/Quality of life/Medical diagnosis/Chronic illnesses/smoking Cessation %$ 62854 %R 10.1093/geronb/gbr103 %0 Journal Article %J J Health Econ %D 2012 %T Health investment decisions in response to diabetes information in older Americans. %A Alexander N Slade %K Adult %K Age Factors %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Body Weight %K Decision making %K Diabetes Mellitus %K Empirical Research %K Exercise %K Female %K Health Behavior %K Health Surveys %K Humans %K Male %K Middle Aged %K Models, Psychological %K Smoking %K United States %X

Diabetes is a very common and serious chronic disease, and one of the fastest growing disease burdens in the United States. Further, health behaviors, such as exercise, smoking, drinking, as well as weight status, are instrumental to diabetes management and the reduction of its medical consequences. Nine waves of the Health and Retirement Study are used to model the role of a recent diabetes diagnosis and medication on present and subsequent weight status, exercise, drinking and smoking activity. Several non-linear dynamic population average probit models are estimated. Results suggest that compared to non-diagnosed individuals at risk for high blood sugar, diagnosed diabetics respond initially in terms of increasing exercise, losing weight, and curbing smoking and drinking behavior, but the effect diminishes after diagnosis. Evidence of recidivism is also found in these outcomes, especially weight status and physical activity, suggesting that some behavioral responses to diabetes may be short-lived.

%B J Health Econ %I 31 %V 31 %P 502-20 %8 2012 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22591712?dopt=Abstract %3 22591712 %4 Studies/Diabetes/Health behavior/Physical fitness/Disease management/Public health/WEIGHT %$ 69484 %R 10.1016/j.jhealeco.2012.04.001 %0 Journal Article %J Health Econ %D 2011 %T Anticipatory ex ante moral hazard and the effect of Medicare on prevention. %A de Preux, Laure B %K Age Factors %K Aged %K Alcohol Drinking %K Female %K Health Behavior %K Health Services %K Humans %K Insurance Coverage %K Male %K Medically Uninsured %K Medicare %K Middle Aged %K Morals %K Motor Activity %K Proportional Hazards Models %K Regression Analysis %K Smoking %K United States %X

This paper extends the ex ante moral hazard model to allow healthy lifestyles to reduce the probability of illness in future periods, so that current preventive behaviour may be affected by anticipated changes in future insurance coverage. In the United States, Medicare is offered to almost all the population at the age of 65. We use nine waves of the US Health and Retirement Study to compare lifestyles before and after 65 of those insured and not insured pre 65. The double-robust approach, which combines propensity score and regression, is used to compare trends in lifestyle (physical activity, smoking, drinking) of the two groups before and after receiving Medicare, using both difference-in-differences and difference-in-differences-in-differences. There is no clear effect of the receipt of Medicare or its anticipation on alcohol consumption nor smoking behaviour, but the previously uninsured do reduce physical activity just before receiving Medicare.

%B Health Econ %I 20 %V 20 %P 1056-72 %8 2011 Sep %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/21830252?dopt=Abstract %3 21830252 %4 Age Factors/Alcohol Drinking/epidemiology/Alcohol Drinking/epidemiology/Female/Health Behavior/Health Services/economics/ethics/ utilization/Health Services/economics/ethics/ utilization/Humans/Insurance Coverage/economics/ethics/ statistics/Insurance Coverage/economics/ethics/ statistics/numerical data/Medically Uninsured/ statistics/Medically Uninsured/ statistics/numerical data/Medicare/economics/ statistics/Medicare/economics/ statistics/numerical data/Middle Aged/moral hazard/Motor Activity/Motor Activity/Proportional Hazards Models/Regression Analysis/Smoking/epidemiology/Smoking/epidemiology/United States/epidemiology/United States/epidemiology %$ 62724 %R 10.1002/hec.1778 %0 Journal Article %J J Aging Health %D 2011 %T Drinking patterns and the development of functional limitations in older adults: longitudinal analyses of the health and retirement survey. %A James C. Lin %A Guerrieri, Joy Gioia %A Alison A . Moore %K Activities of Daily Living %K Age Factors %K Aged %K Alcohol Drinking %K Female %K Humans %K Logistic Models %K Male %K Middle Aged %K Retirement %X

OBJECTIVE: To examine whether consistent low-risk drinking is associated with lower risk of developing functional limitations among older adults.

METHOD: Data were obtained from five waves of the Health and Retirement Study. Function was assessed by questions measuring four physical abilities and five instrumental activities of daily living. Five different drinking patterns were determined using data over two consecutive survey periods.

RESULTS: Over the follow-up periods, 38.6% of older adults developed functional limitations. Consistent low-risk drinkers had lower odds of developing functional limitations compared with consistent abstainers, and the effect of consistent low-risk drinking was greater among those aged 50 to 64 years compared with those aged ≥65 years. Other drinking patterns were not associated with lower odds of incident functional limitation.

DISCUSSION: Consistent low-risk drinking was associated with lower odds of developing functional limitations, and this association was greater among older middle-aged adults aged 50 to 64 years.

%B J Aging Health %I 23 %V 23 %P 806-21 %8 2011 Aug %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21311049?dopt=Abstract %2 PMC3233258 %4 Risk assessment/Older people/Alcohol use/Aging/Comparative analysis %$ 62592 %R 10.1177/0898264310397541 %0 Journal Article %J J Health Econ %D 2011 %T The effect of job loss on overweight and drinking. %A Deb, Partha %A William T Gallo %A Padmaja Ayyagari %A Jason M. Fletcher %A Jody L Sindelar %K Alcohol Drinking %K Body Mass Index %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Overweight %K Unemployment %K United States %X

This paper examines the impact of job loss due to business closings on body mass index (BMI) and alcohol consumption. We suggest that the ambiguous findings in the extant literature may be due in part to unobserved heterogeneity in response and in part due to an overly broad measure of job loss that is partially endogenous (e.g., layoffs). We improve upon this literature using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data from the Health and Retirement Study. For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. These results suggest the health effects of job loss could be concentrated among "at risk" individuals and could lead to negative outcomes for the individuals, their families, and society at large.

%B J Health Econ %I 30 %V 30 %P 317-27 %8 2011 Mar %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21288586?dopt=Abstract %2 PMC3086369 %4 Job loss/Drinking/Business closings/Finite mixture models %$ 25370 %R 10.1016/j.jhealeco.2010.12.009 %0 Journal Article %J Int J Environ Res Public Health %D 2011 %T Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval. %A Janet Kay Bobo %A April A Greek %K Aged %K Alcohol Drinking %K Alcoholic Intoxication %K Alcoholism %K Cohort Studies %K depression %K Ethanol %K Female %K Follow-Up Studies %K Humans %K Longitudinal Studies %K Middle Aged %K Retirement %K Risk Factors %K Smoking %K Surveys and Questionnaires %K United States %X

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed ≥ 3 biannual alcohol assessments during 1998-2008. The best-fitting model based on the drinks per day data had four trajectories labeled as "Increasing Drinkers" (5.3% of sample), "Decreasing Drinkers" (5.9%), "Stable Drinkers" (24.2%), and "Non/Infrequent Drinkers" (64.6%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.

%B Int J Environ Res Public Health %I 8 %V 8 %P 3263-76 %8 2011 Aug %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/21909305?dopt=Abstract %2 PMC3166741 %4 alcohol use/WOMEN/depression/Smoking %$ 62702 %R 10.3390/ijerph8083263 %0 Journal Article %J J Am Geriatr Soc %D 2010 %T Alcohol use trajectories in two cohorts of U.S. women aged 50 to 65 at baseline. %A Janet Kay Bobo %A April A Greek %A Daniel H. Klepinger %A Jerald R Herting %K Aged %K Aging %K Alcohol Drinking %K Alcoholism %K Cohort Studies %K Female %K Follow-Up Studies %K Humans %K Life Change Events %K Middle Aged %K Retirement %K Risk Factors %K Surveys and Questionnaires %K United States %X

OBJECTIVES: To examine drinking trajectories followed by two cohorts of older women over 8 to 10 years of follow-up.

DESIGN: Longitudinal analyses of two nationally representative cohorts using semiparametric group-based models weighted and adjusted for baseline age.

SETTING: Study data were obtained from detailed interviews conducted in the home or by telephone.

PARTICIPANTS: One cohort included 5,231 women in the Health and Retirement Study (HRS) aged 50 to 65 in 1996; the other included 1,658 women in the National Longitudinal Survey (NLS) aged 50 to 65 in 1995.

MEASUREMENTS: Both cohorts reported any recent drinking and average number of drinks per drinking day using similar but not identical questions. HRS women completed six interviews (one every other year) from 1996 to 2006. NLS women completed five interviews from 1995 to 2003.

RESULTS: All trajectory models yielded similar results. For HRS women, four trajectory groups were observed in the model based on drinks per day: increasing drinkers (4.9% of cohort), infrequent and nondrinkers (61.8%), consistent drinkers (25.9%), and decreasing drinkers (7.4%). Corresponding NLS values from the drinks per day model were 8.8%, 61.4%, 21.2%, and 8.6%, respectively. In 2006, the average number of drinks per day for HRS women in the increasing drinker and consistent drinker trajectories was 1.31 and 1.59, respectively. In 2003, these values for NLS women were 0.99 and 1.38, respectively.

CONCLUSION: Most women do not markedly change their drinking behavior after age 50, but some increase their alcohol use substantially, whereas others continue to exceed current recommendations. These findings underscore the importance of periodically asking older women about their drinking to assess, advise, and assist those who may be at risk for developing alcohol-related problems.

%B J Am Geriatr Soc %I 58 %V 58 %P 2375-80 %8 2010 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/21087226?dopt=Abstract %2 PMC3064493 %4 WOMEN/Alcohol Abuse/Drinking Behavior %$ 24510 %R 10.1111/j.1532-5415.2010.03180.x %0 Journal Article %J J Stud Alcohol Drugs %D 2010 %T Alcohol-consumption trajectories and associated characteristics among adults older than age 50. %A Alyssa C Platt %A Frank A Sloan %A Philip Costanzo %K Age Factors %K Alcohol Drinking %K Alcohol-Related Disorders %K Educational Status %K Female %K Follow-Up Studies %K Health Status %K Health Surveys %K Humans %K Life Change Events %K Linear Models %K Male %K Middle Aged %K Sex Factors %K Socioeconomic factors %K Time Factors %X

OBJECTIVE: This study examined changes in drinking behavior after age 50 and baseline personal characteristics and subsequent life events associated with different alcohol-consumption trajectories during a 14-year follow-up period.

METHOD: Data were taken from the Health and Retirement Study. The study sample included individuals ages 51-61 in 1992 who survived the sample period (1992-2006) and had at least five interviews with alcohol consumption information, yielding an analysis sample of 6,787 (3,760 women). We employed linear regression to determine drinking trajectories over 1992-2006. Based on these findings, each sample person was classified into one of five drinking categories. We used multinomial logit analysis to assess the relationship between personal demographic, income, health, and attitudinal characteristics as well as life events and drinking-trajectory category.

RESULTS: Overall, alcohol consumption declined. However, rates of decline differed appreciably among sample persons, and for a minority, alcohol consumption increased. Persons with increasing consumption over time were more likely to be affluent (relative-risk ratio [RRR] = 1.09, 95% CI [1.05, 1.12]), highly educated (RRR = 1.20, 95% CI [1.09, 1.31]), male, White (RRR = 3.54, 95% CI [1.01, 12.39]), unmarried, less religious, and in excellent to good health. A history of problem drinking before baseline was associated with increases in alcohol use, whereas the reverse was true for persons with histories of few or no drinking problems.

CONCLUSIONS: There are substantial differences in drinking trajectories at the individual level in midlife and late life. A problem-drinking history is predictive of alcohol consumption patterns in later life.

%B J Stud Alcohol Drugs %I 71 %V 71 %P 169-79 %8 2010 Mar %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20230713?dopt=Abstract %2 PMC2841726 %4 Older people/Alcohol use/Regression analysis/Demographics %$ 22580 %R 10.15288/jsad.2010.71.169 %0 Journal Article %J J Am Geriatr Soc %D 2009 %T Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers. %A Sei J. Lee %A Rebecca L. Sudore %A Brie A Williams %A Lindquist, Karla %A Helen L. Chen %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Alcohol Drinking %K Comorbidity %K Education %K Female %K Humans %K Income %K Male %K Obesity %K Risk Factors %K Sex Factors %K Smoking %K Socioeconomic factors %X

OBJECTIVES: To determine whether the survival benefit associated with moderate alcohol use remains after accounting for nontraditional risk factors such as socioeconomic status (SES) and functional limitations.

DESIGN: Prospective cohort.

SETTING: The Health and Retirement Study (HRS), a nationally representative study of U.S. adults aged 55 and older.

PARTICIPANTS: Twelve thousand five hundred nineteen participants were enrolled in the 2002 wave of the HRS.

MEASUREMENTS: Participants were asked about their alcohol use, functional limitations (activities of daily living, instrumental activities of daily living, and mobility), SES (education, income, and wealth), psychosocial factors (depressive symptoms, social support, and the importance of religion), age, sex, race and ethnicity, smoking, obesity, and comorbidities. Death by December 31, 2006, was the outcome measure.

RESULTS: Moderate drinkers (1 drink/d) had a markedly more-favorable risk factor profile, with higher SES and fewer functional limitations. After adjusting for demographic factors, moderate drinking (vs no drinking) was strongly associated with less mortality (odds ratio (OR)=0.50, 95% confidence interval (CI)=0.40-0.62). When traditional risk factors (smoking, obesity, and comorbidities) were also adjusted for, the protective effect was slightly attenuated (OR=0.57, 95% CI=0.46-0.72). When all risk factors including functional status and SES were adjusted for, the protective effect was markedly attenuated but still statistically significant (OR=0.72, 95% CI=0.57-0.91).

CONCLUSION: Moderate drinkers have better risk factor profiles than nondrinkers, including higher SES and fewer functional limitations. Although these factors explain much of the survival advantage associated with moderate alcohol use, moderate drinkers maintain their survival advantage even after adjustment for these factors.

%B J Am Geriatr Soc %I 57 %V 57 %P 955-62 %8 2009 Jun %G eng %N 6 %L newpubs20090908_Lee_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19473456?dopt=Abstract %2 PMC2847409 %4 Alcohol Drinking/socioeconomic status/ADL and IADL Impairments/Mobility/Survival Analysis %$ 20510 %R 10.1111/j.1532-5415.2009.02184.x %0 Journal Article %J J Prev Med Public Health %D 2006 %T A longitudinal study of the relationship between health behavior risk factors and dependence in activities of daily living. %A Sang-Hyuk Jung %A Truls Ostbye %A Kyoung-Ok Park %K Activities of Daily Living %K Alcohol Drinking %K Body Mass Index %K ethnicity %K Exercise %K Female %K Health Behavior %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Risk Factors %K Smoking %K United States %X

OBJECTIVES: The purpose of this study was to shed further light on the effect of modifiable health behavior risk factors on dependence in activities of daily living, defined in a multidimensional fashion.

METHODS: The study participants were 10,278 middle aged Americans in a longitudinal health study, the Health and Retirement Survey (HRS). A multi-stage probability sampling design incorporating the effect of population sizes (Metropolitan and non-metropolitan), ethnicity (the non-Hispanic White, the Hispanic, and the Black), and age (age 51-61) was utilized. Basic Activities of Daily Living (ADL) were measured using five activities necessary for survival (impairment in dressing, eating, bathing, sleeping, and moving across indoor spaces). Explanatory variables were four health behavior risk factors included smoking, exercise, Body Mass Index (BMI), and alcohol consumption.

RESULTS: Most participants at baseline were ADL independent (1992). 97.8% of participants were independent in all ADL's at baseline and 78.2% were married. Approximately 27.5% were current smokers at baseline, and the subjects reported moderate or heavy exercise were 74.8%. All demographic characteristics and behavioral risk factors were significantly associated with the ADL status at Wave 4 except alcohol consumption. Risk behaviors such as current smoking, sedentary life style and high BMI at Wave 1 were associated with ADL status deterioration; however, moderate alcohol consumption tended to be more related to better ADL status than abstaining at Wave 4. ADL status at Wave 1 was the strongest factor and the next was exercise and smoking affecting ADL status at Wave 4. People who were in ADL dependent at Wave 1 were 15.17 times more likely to be ADL dependent at Wave 4 than people who were in ADL independent at Wave 1. Concerning smoking cigarettes, people who kept only light exercise or sedentary life style at Wave 1 were 1.70 times more likely to be died at Wave 4 than the people who did not smoke at Wave 1.

CONCLUSIONS: All demographics and health behaviors at wave 1 had consistently similar OR trends for ADL status to each other except alcohol consumption. Smoking and exercise in health behaviors, and age and gender in demographics at Wave 1 were significant factors associated with ADL group separation at Wave 4.

%B J Prev Med Public Health %I 39 %V 39 %P 221-8 %8 2006 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/16764496?dopt=Abstract %4 Health Behavior/risk factors/Activities of Daily Living %$ 16820 %0 Journal Article %J Soc Sci Med %D 2005 %T Heavy alcohol use and marital dissolution in the USA. %A Ostermann, Jan %A Frank A Sloan %A Donald H. Taylor Jr. %K Alcohol Drinking %K Alcohol-Related Disorders %K Divorce %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Social Class %K United States %X

Using the first five waves of the US Health and Retirement Study, a nationally representative survey of middle-aged persons in the USA conducted between 1992 and 2000, we assessed the association between alcohol consumption and separation and divorce (combined as divorced in the analysis) for 4589 married couples during up to four repeated 2-yr follow-up periods. We found that drinking status was positively correlated between spouses. The correlations did not increase over the follow-up period. Discrepancies in alcohol consumption between spouses were more closely related to the probability of subsequent divorce than consumption levels per se. Couples with two abstainers and couples with two heavy drinkers had the lowest rates of divorce. Couples with one heavy drinker were most likely to divorce. Controlling for current consumption levels, a history of problem drinking by either spouse was not significantly associated with an increased probability of divorce. Our findings on alcohol use and marital dissolution were highly robust in alternative specifications.

%B Soc Sci Med %I 61 %V 61 %P 2304-16 %8 2005 Dec %G eng %N 11 %L pubs_2005_Ostermann.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16139939?dopt=Abstract %4 Alcohol Abuse/Marital Dissolution/Marriage/Divorce/Drinking Behavior %$ 15660 %R 10.1016/j.socscimed.2005.07.021 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2005 %T Social status and risky health behaviors: results from the health and retirement study. %A Linda A. Wray %A Duane F. Alwin %A Ryan J McCammon %K Aged %K Aging %K Alcohol Drinking %K Body Weight %K Exercise %K Female %K Health Behavior %K Humans %K Life Style %K Likelihood Functions %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Smoking %K Social Class %K United States %X

OBJECTIVES: We focus on a hypothesized mechanism that may underlie the well-documented link between social status and health-behavioral health risks.

METHODS: We use longitudinal data from representative samples of 6,106 middle-aged and 3,636 older adults from the Health and Retirement Study to examine the relationships between social status-including early life social status (e.g., parental schooling), ascribed social status (e.g., sex, race-ethnicity), and achieved social status (e.g., schooling, economic resources)-and behavioral health risks (e.g., weight, smoking, drinking, physical activity) to (1) assess how early life and ascribed social statuses are linked to behavioral health risks, (2) investigate the role of achieved factors in behavioral health risks, (3) test whether achieved status explains the contributions of early life and ascribed status, and (4) examine whether the social status and health risk relationships differ at midlife and older age.

RESULTS: We find that early life, achieved, and ascribed social statuses strongly predict behavioral health risks, although the effects are stronger in midlife than they are in older age.

DISCUSSION: Ascribed social statuses (and interactions of sex and race-ethnicity), which are important predictors of behavioral health risks even net of early life and achieved social status, should be explored in future research.

%B J Gerontol B Psychol Sci Soc Sci %I 60B %V 60 Spec No 2 %P 85-92 %8 2005 Oct %G eng %L pubs_2005_WrayAlwin.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16251597?dopt=Abstract %4 Social Stratification/Health Behaviors %$ 15420 %R 10.1093/geronb/60.special_issue_2.s85 %0 Journal Article %J Health Econ %D 2004 %T The effect of the tobacco settlement and smoking bans on alcohol consumption. %A Gabriel A. Picone %A Frank A Sloan %A Justin G Trogdon %K Aged %K Alcohol Drinking %K Behavior, Addictive %K Data collection %K Female %K Humans %K Male %K Middle Aged %K Models, Econometric %K Smoking %K United States %X

In the last few years, the price of cigarettes has increased considerably in the USA. In addition, a number of states have also imposed smoking bans. These increases in the cost and barriers to smoking have created a natural experiment to study relationships between smoking and drinking behaviors. In this study, we employ data from the first six waves of the Health and Retirement Survey (HRS) to analyze the effects of smoking bans and cigarette prices on alcohol consumption. We also test if past cigarette and alcohol consumption affect current alcohol consumption as predicted by co-addiction models. We estimate dynamic panel models using GMM estimators. Our approach allows us to obtain consistent estimates irrespective of the number of time periods. The three main findings of this study are: (1) there is positive reinforcement effect of past cigarette consumption on current alcohol consumption, (2) smoking bans reduce alcohol consumption and (3) there is a positive effect of cigarette prices on alcohol consumption.

%B Health Econ %I 13 %V 13 %P 1063-80 %8 2004 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/15386690?dopt=Abstract %4 Smoking/Alcohol Drinking %$ 13702 %R 10.1002/hec.930 %0 Journal Article %J Prev Med %D 2002 %T A longitudinal study of the effects of tobacco smoking and other modifiable risk factors on ill health in middle-aged and old Americans: results from the Health and Retirement Study and Asset and Health Dynamics among the Oldest Old survey. %A Truls Ostbye %A Donald H. Taylor Jr. %A Sang-Hyuk Jung %K Age Distribution %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Attitude to Health %K Chi-Square Distribution %K Exercise %K Female %K Health Behavior %K Health Status %K Health Surveys %K Humans %K Life Style %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Risk Assessment %K Risk Factors %K Sex Distribution %K Smoking %K Socioeconomic factors %K Survival Rate %K United States %X

BACKGROUND: While the effects of smoking and other modifiable risk factors on mortality and specific diseases are well established, their effects on ill health more generally are less known. Using two national, longitudinal surveys, the objective of this study was to analyze the effect of smoking and other modifiable risk factors on ill health, defined in a multidimensional fashion (i.e., disability, impaired mobility, health care utilization, and self-reported health).

METHODS: The analyses were based on the Health and Retirement Study (HRS) (12,652 persons 50-60 years old surveyed in 1992, 1994, 1996, and 1998) and the Asset and Health Dynamics among the Oldest Old survey (8,124 persons 60-70 years old surveyed in 1993, 1996, and 1998).

RESULTS: Smoking was strongly related to mortality and to ill health, with similar relative effects in the middle-aged and the elderly. There were consistent adverse dose-response relationships between smoking and ill health in the HRS. Persons who had quit smoking at least 15 years prior to the survey were no more likely than never smokers to experience ill health. A dose-response relationship was found between exercise and ill health. For body mass index and alcohol, there were U-shaped relationships with ill health.

CONCLUSIONS: Public health efforts designed to encourage smoking cessation should emphasize improvements in ill health in addition to decreased mortality.

%B Prev Med %I 34 %V 34 %P 334-45 %8 2002 Mar %G eng %N 3 %L pubs_2002_Ostbye_TPrevMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11902850?dopt=Abstract %4 Smoking/Health Status/Health Behavior/Longitudinal Studies %$ 8602 %R 10.1006/pmed.2001.0991 %0 Journal Article %J J Am Geriatr Soc %D 2002 %T The role of smoking and other modifiable lifestyle risk factors in maintaining and restoring lower body mobility in middle-aged and older Americans: results from the HRS and AHEAD. Health and Retirement Study. Asset and Health Dynamics Among the Oldest Ol %A Truls Ostbye %A Donald H. Taylor Jr. %A Katrina M. Krause %A Scoyoc, L.V. %K Age Distribution %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Body Mass Index %K Exercise %K Female %K Humans %K Leg %K Logistic Models %K Longitudinal Studies %K Male %K Marital Status %K Middle Aged %K Risk Factors %K Sex Distribution %K Smoking %K Smoking cessation %K United States %K Walking %X

OBJECTIVES: To analyze the effect of smoking, smoking cessation, and other modifiable risk factors on mobility in middle-aged and older Americans.

DESIGN: Panel study; secondary data analysis.

SETTING: United States (national sample).

PARTICIPANTS: The Health and Retirement Study (HRS) includes data on 12,652 Americans aged 50 to 61 in four waves (1992-1998). The Asset and Health Dynamics Among the Oldest Old (AHEAD) survey followed 8,124 community-dwelling people aged 70 years and older in three waves (1993-1998).

MEASUREMENTS: The relationships between the primary outcome measure, lower body mobility (ability to walk several blocks and walk up one flight of stairs without difficulty), and smoking, exercise (HRS only), body mass index (BMI), and alcohol use were estimated in bivariate and multivariate analyses.

RESULTS: Not smoking was strongly positively related to mobility, and the relative effects were similar in both panels. Among those with impaired mobility at baseline, not smoking was also strongly related to recovery. In the middle aged, there were consistent dose-response relationships between amount smoked and impaired mobility. Fifteen years after quitting, the risk of impaired mobility returned to that of never smokers. There was also a strong dose-response relationship between level of exercise and mobility. Inverted U-shaped relationships with mobility were observed for BMI and alcohol consumption.

CONCLUSIONS: The relationships between not smoking and lower body mobility in middle-aged and older Americans are strong and consistent. Interventions aimed at reducing smoking have the potential to preserve mobility and thereby prolong health and independence in later life.

%B J Am Geriatr Soc %I 50 %V 50 %P 691-9 %8 2002 Apr %G eng %N 4 %L pubs_2002_ostbye_jags.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11982670?dopt=Abstract %4 Middle Aged Adults/Smoking/Mobility Difficulty/Exercise %$ 8610 %R 10.1046/j.1532-5415.2002.50164.x %0 Journal Article %J J Stud Alcohol %D 2001 %T Life events and alcohol consumption among mature adults: a longitudinal analysis. %A Perreira, Krista M. %A Frank A Sloan %K Adaptation, Psychological %K Aged %K Alcohol Drinking %K Employment %K Family %K Health Status %K Humans %K Life Change Events %K Longitudinal Studies %K Middle Aged %K Social Support %K Stress, Psychological %X

OBJECTIVE: Four waves of the Health and Retirement Study were used to examine changes in alcohol consumption co-occurring and following stress associated with major health, family and employment events.

METHOD: The final sample consisted of 7,731 (3,907 male) individuals between the ages of 51 and 61 at baseline. We used multinomial logit analysis to study associations between important life events and changes in alcohol consumption over a 6-year study period. Interactions between stressful life events, gender and problem drinking were also evaluated.

RESULTS: Most persons (68%) did not change their use of alcohol over the entire 6 years. Hospitalization and onset of a chronic condition were associated with decreased drinking levels. Retirement was associated with increased drinking. Widowhood was associated with increased drinking but only for a short time. Getting married or divorced was associated with both increases and decreases in drinking, with a complex lag structure. A history of problem drinking influenced the association between certain life events (e.g., divorce and retirement) and changes in drinking. Gender modified the association between losing a spouse and changes in drinking.

CONCLUSIONS: Even after controlling for problem drinking history, social support and coping skills, changes in drinking behavior were related to several life events occurring over a 6-year period for a national cohort of individuals in late middle-age. The magnitude of these relationships, however, varied by gender and problem drinking history.

%B J Stud Alcohol %I 62 %V 62 %P 501-8 %8 2001 Jul %G eng %N 4 %L pubs_2001_Perriera_KJAlcStud.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11513228?dopt=Abstract %4 Stress/Drinking Behavior/Family Relations/Adults/Life Events/Alcohol Abuse %$ 1240 %R 10.15288/jsa.2001.62.501