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Baseline Protective Behavioral Strategy Use Predicts More Moderate Transdermal Alcohol Concentration Dynamics and Fewer Negative Consequences of Drinking in Young Adults’ Natural Settings

Authors:
Michael A. Russell
Michael A. Russell
Michael A. Russell
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Joshua M. Smyth
Joshua M. Smyth
Joshua M. Smyth
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Rob Turrisi
Rob Turrisi
Rob Turrisi
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Gabriel Cruz-Rodriguez at Pennsylvania State University
Gabriel Cruz-Rodriguez
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Abstract

Objective: Test whether frequent protective behavioral strategies (PBS) users report (a) fewer alcohol-related consequences and (b) less risky alcohol intoxication dynamics (measured via transdermal alcohol concentration [TAC] sensor “features”) in daily life. Method: Two hundred twenty-two frequently heavy-drinking young adults (Mage = 22.3 years) wore TAC sensors for 6 consecutive days. TAC features peak (maximum TAC), rise rate (speed of TAC increase), and area under the curve (AUC) were derived for each day. Negative alcohol-related consequences were measured in the morning after each self-reported drinking day. Past-year PBS use was measured at baseline. Results: Young adults reporting more frequent baseline PBS use showed (a) fewer alcohol-related consequences and (b) lower intoxication dynamics on average (less AUC, lower peaks, and slower rise rates). Limiting/stopping and manner of drinking PBS showed the same pattern of findings as the total score. Serious harm reduction PBS predicted fewer negative alcohol-related consequences, but not TAC features. Multilevel path models showed that TAC features peak and rise rate partially explained associations between PBS (total, limiting/stopping, and manner of drinking) and consequences. Independent contributions of PBS subscales were small and nonsignificant, suggesting that total PBS use was a more important predictor of risk/protection than the specific types of PBS used. Conclusions: Young adults using more total PBS may experience fewer alcohol-related consequences during real-world drinking episodes in part through less risky intoxication dynamics (TAC features). Future research measuring PBS at the daily level is needed to formally test TAC features as day-level mechanisms of protection from acute alcohol-related consequences.
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Baseline Protective Behavioral Strategy Use Predicts More Moderate
Transdermal Alcohol Concentration Dynamics and Fewer Negative
Consequences of Drinking in Young Adults’Natural Settings
Michael A. Russell
1
, Joshua M. Smyth
1, 2
, Rob Turrisi
1, 3
, and Gabriel C. Rodriguez
1
1
Department of Biobehavioral Health, The Pennsylvania State University
2
Department of Medicine, The Pennsylvania State University
3
The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University
Objective: Test whether frequent protective behavioral strategies (PBS) users report (a) fewer
alcohol-related consequences and (b) less risky alcohol intoxication dynamics (measured via transdermal
alcohol concentration [TAC] sensor “features”)indailylife.Method: Two hundred twenty-two
frequently heavy-drinking young adults (M
age
=22.3 years) wore TAC sensors for 6 consecutive days.
TAC features peak (maximum TAC), rise rate (speed of TAC increase), and area under the curve (AUC)
were derived for each day. Negative alcohol-related consequences were measured in the morning after
each self-reported drinking day. Past-year PBS use was measured at baseline. Results: Young adults
reporting more frequent baseline PBS use showed (a) fewer alcohol-related consequences and (b) lower
intoxication dynamics on average (less AUC, lower peaks, and slower rise rates). Limiting/stopping and
manner of drinking PBS showed the same pattern of findings as the total score. Serious harm reduction
PBS predicted fewer negative alcohol-related consequences, but not TAC features. Multilevel path
models showed that TAC features peak and rise rate partially explained associations between PBS
(total, limiting/stopping, and manner of drinking) and consequences. Independent contributions of PBS
subscales were small and nonsignificant, suggesting that total PBS use was a more important predictor of
risk/protection than the specific types of PBS used. Conclusions: Young adults using more total PBS may
experience fewer alcohol-related consequences during real-world drinking episodes in part through less
risky intoxication dynamics (TAC features). Future research measuring PBS at the daily level is needed
to formally test TAC features as day-level mechanisms of protection from acute alcohol-related
consequences.
Public Health Significance Statement
This study shows that among young adults who report frequent heavy drinking, those who report more
versus less frequently using protective behavioral strategies (PBS) show lower intoxication peaks and
slower intoxication increases during drinking events, as well as fewer negative alcohol-related
consequences following drinking events. Differences in alcohol intoxication dynamics as PBS
frequency increased explained 10%–21% of the PBS association with alcohol-related consequences.
These results support further investigation of PBS at the daily level that tests whether intoxication
dynamics provide a mechanism through which PBS reduce consequences in natural settings.
Keywords: protective behavioral strategies, transdermal alcohol concentration (TAC) features, alcohol-
related consequences
Supplemental materials: https://doi.org/10.1037/adb0000941.supp
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This article was published Online First June 29, 2023.
Michael A. Russell https://orcid.org/0000-0002-3956-604X
This research was funded in part by pilot mentoring and professional
development awards through P50DA039838 (National Institute on Drug
Abuse) and the Social Science Research Institute at Pennsylvania State
University, in addition to departmental funds awarded to Michael A. Russell.
The content is solely the responsibility of the authors and does not necessarily
represent the official views of the National Institutes of Health.
This study was not preregistered. Data and analytic code are not publicly
available but will be made available (as allowable according to institutional
review board standards) upon request from Michael A. Russell.
Michael A. Russell played a lead role in conceptualization, data curation, formal
analysis, funding acquisition, investigation, methodology, project administration,
resources, software, supervision, validation, visualization, writing–original draft,
and writing–review and editing. Joshua M. Smyth played a supporting role in
conceptualization and writing–review and editing. Rob Turrisi played a supporting
role in conceptualization and writing–review and editing. Gabriel C. Rodriguez
played a supporting role in writing–review and editing.
Correspondence concerning this article should be addressed to Michael
A. Russell, Department of Biobehavioral Health, The Pennsylvania State
University, 219 Biobehavioral Health Building, University Park, PA
16802, United States. Email: mar60@psu.edu
Psychology of Addictive Behaviors
© 2023 American Psychological Association 2024, Vol. 38, No. 3, 347–359
ISSN: 0893-164X https://doi.org/10.1037/adb0000941
347
... There are four main "elementary" features that have been derived from TAC sensors to characterize the dynamics of a drinking episode. These features include the speed of alcohol absorption (rise rate) and elimination ( fall rate), the time spent biologically exposed to alcohol (duration), and the maximum objective intoxication level (peak; Didier et al., 2024;Fridberg et al., 2022;Leffingwell et al., 2013;Russell et al., 2022Russell et al., , 2024. Russell et al. (2022) found that each of these features is a predictor of the number of negative alcohol-related consequences experienced. ...
... The clusters identified consisted of: (a) slow rise and fall rates, (b) high-peak and AUC, and (c) fast fall rates. Days in Cluster 1 consisted of fewer self-reported drinks than days in Cluster 2. Examining the data set used in the present study, Russell et al. (2024) used multilevel latent profile analysis (MLPA) in a sample of 222 young adults who engaged in weekly HED. They identified four TAC intoxication profiles: high-fast days, moderate-fast days, low-slow days, and little-to-no-drinking days. ...
... It remains unknown to what extent these latent classifications of TAC features may be predictive of these outcomes. The present study adds to the literature by testing the associations between the four latent TAC profiles identified by Russell et al. (2024;high-fast, moderate-fast, lowslow, and little-to-no-drinking) and negative and positive alcoholrelated consequences. These findings could have important implications for prevention efforts by identifying profiles of alcohol exposure associated with harm, allowing for a harm reduction approach for young adult drinking interventions. ...
Profiles of Transdermal Alcohol Concentration and Their Prediction of Negative and Positive Alcohol-Related Consequences in Young Adults’ Natural Settings
Article
Full-text available
  • Jan 2025
Objective: Transdermal alcohol concentration (TAC) sensors provide a multidimensional characterization of drinking events that self-reports cannot. These profiles may differ in their associated day-level alcohol-related consequences, but no research has tested this. We address this using multilevel latent profile analysis. Method: Two hundred twenty-two young adults who regularly engage in heavy drinking (Mage = 22.3, 64% female, 79% non-Hispanic White) responded to surveys and wore TAC sensors for 6 consecutive days. We tested whether four previously identified TAC profiles: (1) high-fast (8.5% of days), (2) moderate-fast (12.8%), (3) low-slow (20.4%), and (4) little-to-no-drinking days (58.2%) differed in numbers of negative and positive consequences and in the odds that both consequence types occurred on the same day. Results: High-fast (incident rate ratio [IRRlow-slow] = 6.18; IRRlittle-to-no-drinking = 9.47) and moderate-fast (IRRlow-slow = 3.71; IRRlittle-to-no-drinking = 5.68) days contained more negative consequences compared to low-slow and little-to-no-drinking days. High-fast (IRR = 2.05), moderate-fast (IRR = 1.88), and low-slow (IRR = 1.43) days contained more positive consequences than little-to-no-drinking days. The odds of having only positive consequences were highest on low-slow, χ²(3) = 9.10, p < .05, days but the odds of experiencing both consequence types increased on moderate-fast and high-fast days, χ²(3) = 39.63, p < .001. Conclusions: Compared to little-to-no-drinking days, TAC profiles indicative of drinking (high-fast, moderate-fast, and low-slow) contained more negative and positive consequences. However, the odds of experiencing only positive consequences were highest among low-slow days and decreased on moderate-fast and high-fast days as the odds of negative consequences rose. These findings provide novel evidence reinforcing harm reduction approaches that seek to maximize positives and minimize negatives of alcohol consumption through emphasis on slow-paced, low-volume drinking.
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... Features of these curves characterize the alcohol intoxication dynamics of the day, providing aspects of alcohol consumption events beyond the number of drinks consumed. These features include the speed of alcohol absorption (rise rate) and elimination (fall rate), the time spent biologically exposed to alcohol (duration), the maximum intoxication level (peak), and the cumulative burden of alcohol exposure (area under the curve [AUC]; Didier et al., 2024;Fridberg et al., 2022;Leffingwell et al., 2013;Russell et al., 2022Russell et al., , 2024. TAC features correspond with self-reported drink counts (r = .6-.7; Russell et al., 2022;van Egmond et al., 2020), and the unique variability of TAC features is meaningful for alcoholrelated risk. ...
... High-peak, fast-rate, short-duration events suggest rapid and heavy alcohol consumption, whereas moderate-peak, slow-rate, long-duration events suggest slower and more evenly paced drinking. Research has used AUC as predictor of behavioral risk (e.g., Gunn et al., 2021;Russell et al., 2022Russell et al., , 2024Simons et al., 2015). Although AUC is useful for prediction of outcomes (Russell et al., 2022Simons et al., 2015), it is not easily interpretable. ...
... This is because AUC is a composite summary of TAC episode length by intoxication "height", and therefore, the same AUC could result from a day with long, slow-changing, lowpeaked TAC and from a day with short, fast-changing, high-peaked TAC. The public health implications from these types of events might differ even if both reported consuming the same number of drinks (Fridberg et al., 2022;Leffingwell et al., 2013;Russell et al., 2022Russell et al., , 2024. We would not necessarily see the difference in the corresponding AUCs for each drinking day, but we would see the differences in peaks, rise rates, fall rates, and durations. ...
Profiles of Alcohol Intoxication and Their Associated Risks in Young Adults’ Natural Settings: A Multilevel Latent Profile Analysis Applied to Daily Transdermal Alcohol Concentration Data
Article
Full-text available
  • Aug 2024
Objective: Transdermal alcohol concentration (TAC) sensors capture aspects of drinking events that self-reports cannot. The multidimensional nature of TAC data allows novel classification of drinking days and identification of associated behavioral and contextual risks. We used multilevel latent profile analysis (MLPA) to create day-level profiles of TAC features and test their associations with (a) daily behaviors and contexts and (b) risk for alcohol use disorders at baseline. Method: Two hundred twenty-two regularly heavy-drinking young adults (Mage = 22.3) completed the Alcohol Use Disorders Identification Test (AUDIT) at baseline and then responded to mobile phone surveys and wore TAC sensors for six consecutive days. MLPA identified day-level profiles using four TAC features (peak, rise rate, fall rate, and duration). TAC profiles were tested as correlates of daily drinking behaviors, contexts, and baseline AUDIT. Results: Four profiles emerged: (a) high-fast (8.5% of days), (b) moderate-fast (12.8%), (c) low-slow (20.4%), and (d) little-to-no drinking days (58.2%). Profiles differed in the odds of risky drinking behaviors and contexts. The highest risk occurred on high-fast days, followed by moderate-fast, low-slow, and little-to-no drinking days. Higher baseline AUDIT predicted higher odds of high-fast and moderate-fast days. Conclusions: Days with high and fast intoxication are reflective of high-risk drinking behaviors and were most frequent among those at risk for alcohol use disorders. TAC research using MLPA may offer novel and important insights to intervention efforts.
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... The Protective Behavioral Strategy is the primary measure for alcohol-related PBS, and assesses three subtypes of PBS strategies used to drink less and/or mitigate negative consequences from drinking alcohol: manner of drinking (MD; e.g., "Avoiding mixing different types of alcohol"), stopping/limiting drinking (SLD; e.g., "Leaving the bar/party at a predetermined time"), and serious harm reduction (SHR; e.g., "Only going out with people you know and trust" ;Martens et al., 2005;Treloar et al., 2015). In cross-sectional studies, use of PBS is associated with lower intoxication levels from alcohol, as well as fewer alcohol-related consequences (Peterson, Dvorak, et al., 2021;Russell et al., 2023). ...
... Our analysis reveals a nuanced picture wherein the total PBS used on a given day moderates the effects of acute alcohol consumption on perceived control in sexual situations. Significant moderation complements findings by Russell et al. (2023), who demonstrated that baseline use of PBS predicted fewer outcomes related to alcohol consumption and its consequent negative repercussions. Our study extends this work in two key ways. ...
Feeling in control in sexual situations: Day‐level associations with alcohol use and alcohol protective behavioral strategies
Article
Full-text available
  • Sep 2024
Background Feeling in control in a sexual situation may vary as a function of contextual factors, such as whether alcohol is used prior to a sexual experience. Alcohol protective behavioral strategies (PBS) reduce adverse alcohol‐related outcomes and may promote greater sense of control in sexual situations. It was hypothesized that, at the day level, (1) greater alcohol use would be associated with lower likelihood of feeling in control in sexual situations, (2) more PBS would be associated with a greater likelihood of feeling in control, and (3) more PBS would weaken the negative association between alcohol use and sexual control. Methods For 28 days, daily data on feeling in control during sex, number of drinks, and PBS were collected from young adults who engage in high‐intensity drinking (8+/10+ drinks in a sitting for women/men). A sample of 112 young adults (age 18–29, 61% female; 78.6% White; 9.8% Hispanic/Latino) reported sex after alcohol use at least once (n = 322 days total). Alcohol use, PBS (total as well as subtype: stopping/limiting drinking [SLD], manner of drinking [MD], and serious harm reduction [SHR]), and alcohol use by PBS interactions were tested as day‐level correlates of sexual control via hierarchical generalized linear modeling. Results A significant interaction between alcohol and total PBS on control was observed. At low levels of PBS, more drinks were related to lower likelihood of feeling in control during sex. At high levels of PBS, number of drinks was unrelated to control. A similar pattern of results was observed when examining the PBS subscale of SLD. No main effects of daily PBS or alcohol use on control were observed. Conclusions Findings provide insight into feeling in control when drinking alcohol and engaging in sex, at varying levels of PBS. Interventions focused on harm reduction strategies have the potential to reduce risk of alcohol‐related adverse sexual experiences.
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Drinking Intention–Behavior Links Vary by Affect Among Heavy-Drinking Young Adults: An Ecological Momentary Assessment and Transdermal Sensor Study
Article
Full-text available
  • Jan 2025
Objective: Drinking intention is a predictor of heavy-drinking episodes and could serve as a real-time target for preventive interventions. However, the association is inconsistent and relatively weak. Considering the affective context when intentions are formed might improve results by revealing conditions in which intention–behavior links are strongest and the predictive power of intentions is greatest. Method: We investigated the links between drinking intentions reported in the morning and same-day drinking behavior, moderated by positive and negative affect (PA, NA) in a sample of heavy-drinking young adults. Participants wore the SCRAM continuous alcohol monitor transdermal alcohol sensor anklet for 6 consecutive days in their natural environments and responded to daily ecological momentary assessments that included morning intentions to drink and PA/NA items. Drinking events and patterns were measured using morning-report counts and features from the sensor. Bayesian gamma-hurdle and Poisson multilevel models with noninformative priors tested day-level associations. We hypothesized that drinking intention–behavior associations would be strongest on days with high levels of PA, but we did not hypothesize directionality for the NA effect given the conflicting results in previous literature. Results: Day-level drinking intention–behavior associations were stronger on days with higher versus lower PA according to sensors features. Associations were also stronger on days with lower versus higher NA. Conclusions: The strength of intention–behavior links may partly depend on the affective contexts in which intentions are formed. Results could fine-tune intervention approaches by elucidating the affective contexts in which intentions may more clearly link to drinking behavior to reduce the intensity of an episode—better anticipating problematic drinking among young adults.
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Sensitivity, specificity, and tolerability of the BACTrack Skyn compared to other alcohol monitoring approaches among young adults in a field‐based setting
Article
Full-text available
  • May 2022
  • ALCOHOL CLIN EXP RES
Background There is a need for novel alcohol biosensors that are accurate, able to detect alcohol concentration close in time to consumption, and feasible and acceptable for many clinical and research applications. We evaluated the field accuracy and tolerability of novel (BACTrack Skyn) and established (Alcohol Monitoring Systems SCRAM CAM) alcohol biosensors. Methods The sensor and diary data were collected in a larger study of a biofeedback intervention and compared observationally in the present sub‐study. Participants (high‐risk drinkers, 40% female; median age 21) wore both Skyn and SCRAM CAM sensors for 1–6 days and were instructed to drink as usual. Data from the first cohort of participants (N = 27; 101 person‐days) were used to find threshold values of transdermal alcohol that classified each day as meeting or not meeting defined levels of drinking (heavy, above‐moderate, any). These values were used to develop scoring metrics that were subsequently tested using the second cohort (N = 20; 57 person‐days). Data from both biosensors were compared to mobile diary self‐report to evaluate sensitivity and specificity in relation to a priori standards established in the literature. Results Skyn classification rules for Cohort #1 within 3 months of device shipment showed excellent sensitivity for heavy drinking (94%) and exceeded expectations for above‐moderate and any drinking (78% and 69%, respectively), while specificity met expectations (91%). However, classification worsened when Cohort #1 devices ≥3 months from shipment were tested (area under curve for receiver operator characteristic 0.87 vs. 0.79) and the derived classification threshold when applied to Cohort #2 was inadequately specific (70%). Skyn tolerability metrics were excellent and exceeded the SCRAM CAM (p ≤ 0.001). Conclusions Skyn tolerability was favorable and accuracy rules were internally derivable but did not yield useful scoring metrics going forward across device lots and months of usage.
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Transdermal sensor features correlate with ecological momentary assessment drinking reports and predict alcohol‐related consequences in young adults’ natural settings
Article
Full-text available
  • Jan 2022
  • ALCOHOL CLIN EXP RES
Background Wearable transdermal alcohol concentration (TAC) sensors allow passive monitoring of alcohol concentration in natural settings and measurement of multiple features from drinking episodes, including peak intoxication level, speed of intoxication (absorption rate) and elimination, and duration. These passively collected features extend commonly used self‐reported drink counts and may facilitate the prediction of alcohol‐related consequences in natural settings, aiding risk stratification and prevention efforts. Method A total of 222 young adults aged 21–29 (M age = 22.3, 64% female, 79% non‐Hispanic white, 84% undergraduates) who regularly drink heavily participated in a 5‐day study that included the ecological momentary assessment (EMA) of alcohol consumption (daily morning reports and participant‐initiated episodic EMA sequences) and the wearing of TAC sensors (SCRAM‐CAM anklets). The analytic sample contained 218 participants and 1274 days (including 554 self‐reported drinking days). Five features—area under the curve (AUC), peak TAC, rise rate (rate of absorption), fall rate (rate of elimination), and duration—were extracted from TAC‐positive trajectories for each drinking day. Day‐ and person‐level associations of TAC features with drink counts (morning and episodic EMA) and alcohol‐related consequences were tested using multilevel modeling. Results TAC features were strongly associated with morning drink reports (r = 0.6–0.7) but only moderately associated with episodic EMA drink counts (r = 0.3–0.5) at both day and person levels. Higher peaks, larger AUCs, faster rise rates, and faster fall rates were significantly predictive of day‐level alcohol‐related consequences after adjusting for both morning and episodic EMA drink counts in separate models. Person means of TAC features added little above daily scores to the prediction of alcohol‐related consequences. Conclusions These results support the utility of TAC sensors in studies of alcohol misuse among young adults in natural settings and outline the specific TAC features that contribute to the day‐level prediction of alcohol‐related consequences. TAC sensors provide a passive option for obtaining valid and unique information predictive of drinking risk in natural settings.
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A Comprehensive Review of Measures of Protective Behavioral Strategies Across Various Risk Factors and Associated PBS-Related Interventions
Article
Full-text available
  • Jun 2021
Harm reduction is a framework that places substance use on a spectrum from total abstinence to continued controlled use. Protective behavioral strategies (PBS) are a set of individually implemented harm reduction strategies that have shown to reduce the rate of use and severity of consequences from risky behaviors. Previous research has shown that PBS use effectively reduces negative consequences. The present study provides an overview of the literature on PBS measures for various risk behaviors, and common interventions used in conjunction with PBS. Of the articles reviewed, 15 validated PBS measures were found and eight distinct categories of PBS interventions. The 15 measures reviewed included risk factors such as alcohol use/consequences (n = 8), dating and sexual behaviors (n = 4), gambling (n = 1), cannabis (n = 1), and condom use (n = 1). A survey of the literature produced eight distinct categories of interventions with varying degrees of effectiveness: (a) Brief Motivational Interventions, (b) Personalized Normative Feedback, (c) PBS Skills Training, (d) PBS Instruction, (e) Deviance Regulation Theory Interventions, (f) Behavioral Economic Based Interventions, (g) Counterfactual Thinking and (h) Episodic Future Thinking. Findings from the present study corroborate the notion that PBS effectively reduce negative consequences associated with behaviors, such as negative alcohol-related consequences, harmful cannabis use, and adverse sexual outcomes. Research on interventions targeting PBS is lacking in areas outside of alcohol use. Within alcohol use, the utility of interventions varies widely. Understanding the reason for this discrepancy is an important area for future research.
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Wearable Transdermal Alcohol Monitors: A Systematic Review of Detection Validity, and Relationship Between Transdermal and Breath Alcohol Concentration and Influencing Factors
Article
Full-text available
  • Oct 2020
  • ALCOHOL CLIN EXP RES
Background Research on alcohol consumption mostly relies on self‐reported data, which are subject to recall bias. Wearable transdermal alcohol concentration (TAC) monitors address this limitation by continuously measuring the ethanol excreted via the skin. This systematic review aims to provide an overview of TAC monitors’ reliability to detect alcohol consumption and methods to estimate breath alcohol concentration (BrAC) and number of standard drinks consumed in a given time frame. Methods The databases MEDLINE, PsycINFO, SCOPUS, Engineering Village, and CINAHL were systematically searched to identify 1,048 empirical research papers published from 2013 onwards, of which 13 were included after full‐text screening. The selected studies included 3 TAC monitors: SCRAM™, WristTAS™, and Skyn™. Results TAC measures of SCRAM, WrisTAS, and Skyn are found to be positively correlated with BrAC (r = 0.56 to 0.79) and/or self‐reports (r = 0.62). Using the AMS criteria for detection results in low sensitivity, adjusted criteria can increase the sensitivity of the SCRAM from 39.9 to 68.5%. The WrisTAS and an early prototype of the Skyn showed high failure rates (17 to 38%). Recent advances toward transforming the TAC data into more clinically relevant measures have led to the development of mathematical models and the BrAC Estimator Software. Using TAC data, both approaches produce estimates explaining 70 to 82% of actual BrAC and self‐reported drinking or to highly correlate with the actual BrAC measures (β = 0.90 to 0.91). Conclusions Transdermal alcohol monitors offer an opportunity to measure alcohol consumption in a valid and continuous way with mathematical models and software estimating BrAC values improving interpretation of TAC data. However, the SCRAM seems unable to detect low‐to‐moderate drinking levels using the thresholds and criteria set by the manufacturer. Moreover, the WrisTAS and the Skyn prototype show a high failure rate, raising questions about reliability. Future studies will assess the validity of new‐generation wristbands, including the next Skyn generations.
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Alcohol Use Disorder Symptoms Reported during Midlife: Results from the Monitoring the Future Study among US Adults at Modal Ages 50, 55, and 60
Article
Background: The extent to which adolescent substance use is associated with alcohol use disorder (AUD) symptoms in midlife is not yet fully explored. Methods: Longitudinal data from the national Monitoring the Future study was used. The sample included 11,830 12th graders (1976-1987) who were surveyed again at modal ages 50 (37.8%), 55 (46.3%), or 60 (15.8%) in 2008-2019. Approximately 48.7% were male; 81.5% identified as non-Hispanic White. Weighted logistic and multinomial logistic regressions were used to examine associations between past 30-day use of cigarettes, marijuana, and alcohol at age 18, sociodemographics, and a midlife AUD symptom outcome (coded as non-drinking, drinking without AUD [endorsed ≤1 criterion], or AUD symptoms [endorsed 2+ criteria]). Results: Prevalence of midlife AUD symptoms was 27.1%. Higher relative risk of reporting AUD symptoms (vs. drinking without AUD) was associated with age 18 substance use (any cigarette use [vs. no use], any marijuana use [vs. no use], binge drinking [vs. both no use and drinking at less than binge levels]), being male (vs. female), being non-Hispanic White (vs. non-Hispanic Black), and having a 4-year college degree. Higher relative risk of reporting non-drinking (vs. drinking without AUD) was associated with no 30-day alcohol use at age 18, being non-Hispanic Black or non-Hispanic other (vs. non-Hispanic White), and not having a 4-year college degree. Conclusions: Findings suggest substance use at age 18 has meaningful associations with midlife AUD symptoms. Dissemination of prevention and intervention efforts in adolescence and early adulthood may be important for reducing hazardous midlife drinking.
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A New Generation of Transdermal Alcohol Biosensing Technology: Practical Applications, Machine Learning Analytics, and Questions for Future Research
Article
  • Apr 2021
  • ADDICTION
The use of transdermal alcohol monitors has burgeoned in recent years, now encompassing hundreds of thousands of individuals globally. A new generation of sensors promises to expand the range of applications for transdermal technology exponentially, and advances in machine learning modeling approaches offer new methods for translating the data produced by transdermal devices. This article provides 1) a review of transdermal sensor research conducted to date, including an analysis of methodological features of past studies potentially key in driving reported sensor performance; 2) updates on methodological developments likely to be transformative for the field of transdermal sensing, including the development of new-generation sensors featuring smartphone integration and rapid sampling capabilities as well as developments in machine learning analytics suited to data produced by these novel sensors and; 3) an analysis of the expanded range of applications for this new generation of sensor, together with corresponding requirements for sensor accuracy and temporal specificity. We also note questions as yet unanswered and key directions for future research.
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Wrist-worn alcohol biosensors: Applications and usability in behavioral research
Article
  • Feb 2021
  • ALCOHOL
Wrist-worn alcohol biosensor technology has developed rapidly in recent years. These devices are light, easy to wear, relatively inexpensive, and resemble commercial fitness trackers. As a result, they may be more suitable for a wide range of clinical and research applications. In this paper, we describe three pilot projects examining the associations between reported drinking behavior and transdermal alcohol concentration (TAC) derived from a new, wrist-worn alcohol biosensor (BACtrack Skyn) in diverse participant groups and settings. Study 1 (N = 3) compared Skyn-derived TAC with that from an ankle-worn alcohol sensor (SCRAM CAM) and breath alcohol concentration (BrAC) in a laboratory setting. Study 2 (N = 10) compared Skyn TAC with BrAC during a naturalistic drinking episode in the field. Study 3 (N = 12) used the Skyn to monitor alcohol use in the field for two weeks. Study 2 and 3 also collected usability and acceptability data from participants. The results of Study 1 showed that the Skyn produced a TAC curve that closely resembled that of the validated SCRAM CAM anklet. In Study 2, Skyn detected drinking for all 10 participants (peak BrAC range: 0.02-0.21) with an average delay of 35.6±10.2 minutes after the start of self-reported drinking. In Study 3, Skyn reliably recorded continuous TAC data showing multiple drinking episodes over the monitoring period. Participants in Studies 2 and 3 both reported Skyn as highly acceptable. Collectively, the results of these pilot studies show that the Skyn was able to reliably detect drinking events in the laboratory and natural environments. We offer suggestions for further refinements of alcohol biosensors and accompanying analytic software that may facilitate adoption of these devices as cost-effective, user-friendly, and reliable tools to passively and accurately assess alcohol use in the field.
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Combining transdermal and breath alcohol assessments, real-time drink logs and retrospective self-reports to measure alcohol consumption and intoxication across a multi-day music festival
Article
  • Nov 2020
  • DRUG ALCOHOL REV
Introduction and Aims Comprehensively investigating alcohol‐related behaviours in the context of a dynamic multi‐day alcohol‐licensed event is important for understanding and minimising patron risk. We aimed to assess the measurement utility of implementing a multi‐dimensional alcohol assessment battery using biometric data collection, real‐time drink logs and retrospective self‐report measures over the course of a 4‐day music festival. Methods Fourteen adults participated (n = 7 male, mean age 21.9 years). Breath and transdermal alcohol concentration (BrAC and TAC, respectively) were measured using breathalysers and transdermal alcohol bracelets. A real‐time drink log was completed via smartphones on initiating each drink, and a retrospective questionnaire was administered up to twice daily throughout the event (6 timepoints total). Results While almost all participants (92.9%) logged significantly fewer drinks in real‐time than they retrospectively reported via the twice‐daily questionnaires, logs provided important contextual information including the types of drinks consumed and drinking intensity. Compared to BrAC, TAC provided a better understanding of the time course of intoxication, indicating highest alcohol consumption outside of static BrAC assessment windows. However, BrAC provided a better assessment of present state: all participants were 0.00% BrAC at departure despite over two‐fifths (42.9%) of the sample's last TAC reading exceeding 0.00%. Conclusions As standalone assessments, each method possessed limitations. As a combined battery, they were successfully administered simultaneously, resulting in a more comprehensive overview of alcohol consumption/intoxication over the prolonged drinking session. However, the marked burden of simultaneous administration should be considered, and measures should be chosen judiciously based on research needs.
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