Publications by authors named "Solja Niemelä"

67 Publications

Substance use confounds associations between peer victimization and aggression in adolescence with mental disorders in adulthood: A prospective birth cohort study.

J Adolesc 2022 Jul 26. Epub 2022 Jul 26.

Department of Psychiatry, University of Turku, Turku, Finland.

Introduction: Peer victimization and aggression in adolescence are associated with later mental health morbidity. However, studies examining this association have not controlled for adolescent substance use. We aimed to study the associations between peer victimization, peer aggression, and mental disorders in adulthood, adjusting for substance use in adolescence.

Methods: Participants were from the prospective Northern Finland Birth Cohort 1986. Data were available for 6682 individuals (70.8% of the original sample). Peer victimization and peer aggression were assessed with items from the Achenbach Youth Self Report at ages 15-16 years. Outcomes were nonorganic psychosis, anxiety disorder, mood disorder, substance use disorder, and any mental disorder (a none-vs-any indicator) at age 33 years collected from nationwide health care, insurance, and pension registers. Family structure, alcohol intoxication frequency, daily smoking, illicit drug use, and baseline psychopathology using Youth Self-Report total score, and parental mental disorders were considered as confounding factors.

Results: In multivariable analyses, the association between peer victimization and psychosis (Hazard ratio [HR]: 2.9, 95% confidence interval [CI]: 1.2-6.9, p = .020) and mood disorder (HR: 1.7, 95% CI: 1.2-2.4, p = .012) in females remained significant after adjusting for confounders. Other associations between female and male peer victimization or aggression and the studied outcomes attenuated after adjustments.

Conclusions: Some associations between peer victimization and aggression and later mental health morbidity are explained by adolescent substance use. For females, substance use does not account for the increased risk of psychosis and mood disorder in those who experience peer victimization.
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http://dx.doi.org/10.1002/jad.12080DOI Listing
July 2022

Use of benzodiazepine and related drugs in migrants and Finnish-born persons: a nationwide register-based study.

Scand J Public Health 2022 Jul 25:14034948221112470. Epub 2022 Jul 25.

Finnish Institute for Health and Welfare, Equality Unit, Finland.

Aims: Benzodiazepines and related drugs (BZDR) are often used longer than generally recommended. The aim is to study patterns of use among migrant and Finnish-born users of BZDR, and to identify factors that are associated with long-term use and BZDR polytherapy.

Methods: This register-based study includes a nationwide sample of migrants (=8729) and their Finnish-born controls (=11 388) who had purchased BZDR in 2011-2014, but not in 2009-2010. Information on drug purchases was obtained from the National Prescription Register and the duration of drug use was estimated using PRE2DUP method. The main outcomes were long-term use of BZDR, polytherapy and time until discontinuation of BZDR use. Sociodemographic variables and information on preceding psychiatric diagnoses were included as covariates. Logistic and Cox regression analyses were the statistical methods used.

Results: Only migrants from Sub-Saharan Africa were more likely to discontinue the medication once initiated than Finnish-born users. Migrants were significantly less likely to be long-term users (adjusted odds ratio 0.79, 95% CI 0.70-0.89) or polytherapy users (aOR 0.90, 95% CI 0.84-0.97) of BZDR compared with Finnish-born participants.

Conclusions: Migrants had less long-term and concomitant use of several BZDR than Finnish-born participants. The pattern of use is more optimal among migrants, but it may also reflect poorer access to mental health treatment.
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http://dx.doi.org/10.1177/14034948221112470DOI Listing
July 2022

Trajectories of adolescent psychotic-like experiences and early cannabis exposure: Results from a Finnish Birth Cohort Study.

Schizophr Res 2022 Aug 23;246:95-102. Epub 2022 Jun 23.

University of Turku, Faculty of Medicine, Department of Psychiatry, Turku, Finland; Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland.

Background: Longitudinal studies examining the effect of cannabis exposure (CE) on the prognosis of adolescents with psychotic-like experiences (PLEs) are scarce. We examined trajectories of mental health in adolescents with PLEs and cannabis exposure.

Methods: The Northern Finland Birth Cohort 1986 (n = 6552) with linkage to nationwide register data was used. Information on lifetime cannabis exposure was collected when participants were aged 15/16. Register-based outcome data on diagnoses made in clinical practice were obtained until age 33. Logistic regression was used to study the association of PLE/CE patterns and subsequent psychiatric disorders. The group with neither PLEs nor CE was utilized as the reference group. Parental psychiatric disorders, family structure, sex, frequent alcohol intoxications, daily smoking and illicit substance use other than cannabis were adjusted for.

Results: In all, 6552 subjects (49.2 % males) were included in analysis. PLEs with cannabis exposure were associated with any psychiatric disorder (OR = 2.59; 95 % CI 1.82-3.68), psychotic disorders (OR = 3.86; 95 % CI 1.83-8.11), mood disorders (OR 4.07; 95 % CI 2.74-6.04), depressive disorders (OR = 4.35; 95 % CI 2.93-6.48), anxiety disorders (OR = 2.06; 95 % CI 1.34-3.17) and substance use disorders (OR = 2.26; 95 % CI 1.13-4.50) compared to reference group. Effect sizes were greater for group with both PLEs and cannabis use than for group with PLEs only.

Conclusions: Early-onset cannabis use is an adverse prognostic marker for adolescents with PLEs after extensive confounder control including other substance use.
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http://dx.doi.org/10.1016/j.schres.2022.06.014DOI Listing
August 2022

Exposure to alcohol and overall survival in head and neck cancer: A regional cohort study.

Head Neck 2022 Jun 17. Epub 2022 Jun 17.

Department for Otorhinolaryngology - Head and Neck Surgery, University of Turku, Turku, Finland.

Background: There is a paucity of knowledge regarding the association of alcohol use with overall survival (OS) of patients with head and neck squamous cell carcinoma (HNSCC).

Methods: All 1033 patients treated for new HNSCC in Southwest Finland regional referral center of Turku University Hospital in 2005-2015. Cox regression analysis was used. Tumor TNM classification, age at baseline and tobacco smoking status were assessed as potential confounders.

Results: A history of severe harmful alcohol use with major somatic complications (HR: 1.41; 95%CI: 1.06-1.87; p = 0.017) as well as current use of at least 10 units per week (HR: 1.44, 95%CI: 1.16-1.78; p = 0.001) were associated with OS.

Conclusions: Alcohol consumption of 10-20 units/week, often regarded as moderate use, was found to increase risk of mortality independent of other prognostic variables. Systematic screening of risk level alcohol use and prognostic evaluation of alcohol brief intervention strategies is highly recommended.
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http://dx.doi.org/10.1002/hed.27125DOI Listing
June 2022

Association of ADHD symptoms in adolescence and mortality in Northern Finland Birth Cohort 1986.

Nord J Psychiatry 2022 May 12:1-7. Epub 2022 May 12.

Department of Psychiatry, University of Turku, Turku, Finland.

Background: Diagnosis of attention deficit hyperactive disorder (ADHD) has been associated with increased risk of mortality in large register samples. However, there is less known about the association between symptoms of ADHD in adolescents and risk of mortality in general population samples.

Methods: The Northern Finland Birth Cohort 1986 ( = 9432 at recruitment in early pregnancy) linked to nationwide register data for deaths was utilized to study the association between parent-rated ADHD symptoms assessed using Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire and mortality until age 33 years. Cox-regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) was used to study the association between SWAN inattentive, hyperactive, and combined symptom scores and risk of death.

Results: Sixty-three (0.9%) of the 6685 participants died during the follow-up. Higher SWAN inattentive (crude HR = 2.30, 95% CI 1.46-3.63), SWAN hyperactive (crude HR = 2.43, 95% CI 1.29-4.56), and SWAN combined (crude HR = 2.69, 95% CI 1.57-4.61) scores were associated with increased risk of death. After adjustments for sex, family structure, and lifetime parental psychiatric disorder, these associations persisted. Further adjustment for frequent alcohol intoxication, cannabis, and other substance use in adolescence attenuated these to below statistical significance.

Conclusions: These results extend previous findings on the risk of mortality in adolescents who have symptoms of ADHD. Further research with larger samples are needed to determine whether the association between ADHD symptoms and mortality is independent of adolescent substance use.
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http://dx.doi.org/10.1080/08039488.2022.2073389DOI Listing
May 2022

SYMPOSIUM 9: cannabis: a friend or a foe?

Nord J Psychiatry 2021 12 13;75(sup1):S5. Epub 2022 Apr 13.

Copenhagen Research Center for Mental Health (CORE) and University of Copenhagen, Copenhagen, Denmark.

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http://dx.doi.org/10.1080/08039488.2021.2019907DOI Listing
December 2021

Is early exposure to cannabis associated with bipolar disorder? Results from a Finnish birth cohort study.

Addiction 2022 Aug 8;117(8):2264-2272. Epub 2022 Apr 8.

Faculty of Medicine, Department of Psychiatry, University of Turku, Turku, Finland.

Background And Aims: There are few longitudinal studies assessing the association of cannabis use and subsequent onset of bipolar disorder. We aimed to measure the association between early cannabis exposure and subsequent bipolar disorder.

Design, Setting And Participants: Observational study linking a sample from the northern Finland birth cohort 1986 (n = 6325) to nation-wide register data to examine the association of life-time cannabis exposure at age 15/16 years and subsequent bipolar disorder until age 33 (until the end of 2018); 6325 individuals (48.8% males) were included in the analysis.

Measurements: Cannabis exposure was measured via self-report. Bipolar disorder was measured via bipolar disorder-related diagnostic codes (ICD-10: F30.xx, F31.xx) collected from the Care Register for Health Care 2001-18, the Register of Primary Health Care Visits 2011-18, the medication reimbursement register of the Social Insurance Institution of Finland 2001-05 and the disability pensions of the Finnish Center for Pensions 2001-16. Potential confounders included demographic characteristics, parental psychiatric disorders, emotional and behavioral problems and other substance use.

Findings: Three hundred and fifty-two adolescents (5.6%) reported any cannabis use until the age of 15-16 years. Of the whole sample, 66 (1.0%) were diagnosed with bipolar disorder. Adolescent cannabis use was associated with bipolar disorder [hazard ratio (HR) = 3.46; 95% confidence interval (CI) = 1.81-6.61]. This association remained statistically significant after adjusting for sex, family structure and parental psychiatric disorders (HR = 3.00; 95% CI = 1.47-6.13) and after further adjusting for adolescent emotional and behavioral problems (HR = 2.34; 95% CI = 1.11-4.94). Further adjustments for frequent alcohol intoxications, daily smoking and lifetime illicit drug use attenuated the associations to statistically non-significant.

Conclusions: In Finland, the positive association between early cannabis exposure and subsequent development of bipolar disorder appears to be confounded by other substance use.
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http://dx.doi.org/10.1111/add.15881DOI Listing
August 2022

Parental smoking and young adult offspring psychosis, depression and anxiety disorders and substance use disorder.

Eur J Public Health 2022 04;32(2):254-260

Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland.

Background: To study the associations between maternal smoking during pregnancy and paternal smoking before pregnancy and adult offspring psychiatric disorders.

Methods: Prospective general population cohort study in Northern Finland, with people from the Northern Finland Birth Cohort 1986: 7259 subjects (77% of the original sample). Data on parental smoking were collected from parents during pregnancy using questionnaires. Outcomes were offspring's register-based diagnoses: any psychiatric disorder, any non-organic psychosis, mood disorder, anxiety disorder and substance use disorder (SUD) until the age of 29-30 years. Maternal smoking during pregnancy and paternal smoking before pregnancy were pooled to three-class variables: (i) none; (ii) 1-9 and (iii) ≥10 cigarettes/day. Information regarding both parents' alcohol use during pregnancy and at offspring age 15-16 years, maternal education level, family structure, parental psychiatric diagnoses and offspring gender, smoking, intoxication frequency and illicit substance use at the age of 15-16 years were investigated as covariates.

Results: In the multivariable analyses, maternal smoking during pregnancy did not associate with the studied outcomes after adjusting for offspring smoking and other substance use at offspring age 15-16 years and parental psychiatric disorders. However, paternal smoking ≥10 cigarettes/day before pregnancy [hazard ratio (HR) = 5.5, 95% confidence interval (CI) 2.7-11.2, P < 0.001] and paternal psychiatric disorders (HR = 1.7, 95% CI 1.1-2.8, P = 0.028) associated with offspring SUD after adjustments.

Conclusions: Information across the offspring life course is essential in exploring the association between parental smoking and offspring psychiatric disorders. Paternal smoking before pregnancy and paternal psychiatric disorders may act as modifiers in elevating the risk of substance-use-related problems among offspring.
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http://dx.doi.org/10.1093/eurpub/ckac004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9090280PMC
April 2022

Reaction Time and Visual Memory in Connection to Hazardous Drinking Polygenic Scores in Schizophrenia, Schizoaffective Disorder and Bipolar Disorder.

Brain Sci 2021 Oct 27;11(11). Epub 2021 Oct 27.

Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, 90014 Oulu, Finland.

The purpose of this study was to explore the association of cognition with hazardous drinking Polygenic Scores (PGS) in 2649 schizophrenia, 558 schizoaffective disorder, and 1125 bipolar disorder patients in Finland. Hazardous drinking PGS was computed using the LDPred program. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on a tablet computer: the 5-choice serial reaction time task, or Reaction Time (RT) test, and the Paired Associative Learning (PAL) test. The association between hazardous drinking PGS and cognition was measured using four cognition variables. Log-linear regression was used in Reaction Time (RT) assessment, and logistic regression was used in PAL assessment. All analyses were conducted separately for males and females. After adjustment of age, age of onset, education, household pattern, and depressive symptoms, hazardous drinking PGS was not associated with reaction time or visual memory in male or female patients with schizophrenia, schizoaffective, and bipolar disorder.
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http://dx.doi.org/10.3390/brainsci11111422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8615595PMC
October 2021

Reaction Time and Visual Memory in Connection to Hazardous Drinking Polygenic Scores in Schizophrenia, Schizoaffective Disorder and Bipolar Disorder.

Brain Sci 2021 Oct 27;11(11). Epub 2021 Oct 27.

Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, 90014 Oulu, Finland.

The purpose of this study was to explore the association of cognition with hazardous drinking Polygenic Scores (PGS) in 2649 schizophrenia, 558 schizoaffective disorder, and 1125 bipolar disorder patients in Finland. Hazardous drinking PGS was computed using the LDPred program. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on a tablet computer: the 5-choice serial reaction time task, or Reaction Time (RT) test, and the Paired Associative Learning (PAL) test. The association between hazardous drinking PGS and cognition was measured using four cognition variables. Log-linear regression was used in Reaction Time (RT) assessment, and logistic regression was used in PAL assessment. All analyses were conducted separately for males and females. After adjustment of age, age of onset, education, household pattern, and depressive symptoms, hazardous drinking PGS was not associated with reaction time or visual memory in male or female patients with schizophrenia, schizoaffective, and bipolar disorder.
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http://dx.doi.org/10.3390/brainsci11111422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8615595PMC
October 2021

Reaction Time and Visual Memory in Connection to Alcohol Use in Persons with Bipolar Disorder.

Brain Sci 2021 Aug 30;11(9). Epub 2021 Aug 30.

Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, 90014 Oulu, Finland.

The purpose of this study was to explore the association of cognition with hazardous drinking and alcohol-related disorder in persons with bipolar disorder (BD). The study population included 1268 persons from Finland with bipolar disorder. Alcohol use was assessed through hazardous drinking and alcohol-related disorder including alcohol use disorder (AUD). Hazardous drinking was screened with the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) screening tool. Alcohol-related disorder diagnoses were obtained from the national registrar data. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on A tablet computer: the 5-choice serial reaction time task, or reaction time (RT) test and the Paired Associative Learning (PAL) test. Depressive symptoms were assessed with the Mental Health Inventory with five items (MHI-5). However, no assessment of current manic symptoms was available. Association between RT-test and alcohol use was analyzed with log-linear regression, and eβ with 95% confidence intervals (CI) are reported. PAL first trial memory score was analyzed with linear regression, and β with 95% CI are reported. PAL total errors adjusted was analyzed with logistic regression and odds ratios (OR) with 95% CI are reported. After adjustment of age, education, housing status and depression, hazardous drinking was associated with lower median and less variable RT in females while AUD was associated with a poorer PAL test performance in terms of the total errors adjusted scores in females. Our findings of positive associations between alcohol use and cognition in persons with bipolar disorder are difficult to explain because of the methodological flaw of not being able to separately assess only participants in euthymic phase.
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http://dx.doi.org/10.3390/brainsci11091154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8467646PMC
August 2021

Reaction Time and Visual Memory in Connection with Alcohol Use in Schizophrenia and Schizoaffective Disorder.

Brain Sci 2021 May 23;11(6). Epub 2021 May 23.

Department of Psychiatry, University of Oulu, 90014 Oulu, Finland.

The purpose of this study was to explore the association between cognition and hazardous drinking and alcohol use disorder in schizophrenia and schizoaffective disorder. Cognition is more or less compromised in schizophrenia, and schizoaffective disorder and alcohol use might aggravate this phenomenon. The study population included 3362 individuals from Finland with diagnoses of schizophrenia or schizoaffective disorder. Hazardous drinking was screened with the AUDIT-C (Alcohol Use Disorders Identification Test for Consumption) screening tool. Alcohol use disorder (AUD) diagnoses were obtained from national registrar data. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on a tablet computer: The Five-Choice Serial Reaction Time Task (5-CSRTT) or the reaction time (RT) test and the Paired Associative Learning (PAL) test. The association between alcohol use and the RT and PAL tests was analyzed with log-linear regression and logistic regression, respectively. After adjustment for age, education, housing status, and the age at which the respondents had their first psychotic episodes, hazardous drinking was associated with a lower median RT in females and less variable RT in males, while AUD was associated with a poorer PAL test performance in terms of the total errors adjusted scores (TEASs) in females. Our findings of positive associations between alcohol and cognition in schizophrenia and schizoaffective disorder are unique.
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http://dx.doi.org/10.3390/brainsci11060688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224767PMC
May 2021

Age of first alcohol intoxication and psychiatric disorders in young adulthood - A prospective birth cohort study.

Addict Behav 2021 07 11;118:106910. Epub 2021 Mar 11.

Department of Psychiatry, University of Turku, Turku, Finland; Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland.

Objective: Early onset of alcohol use is associated with an increased risk of substance use disorders (SUD), but few studies have examined associations with other psychiatric disorders. Our aim was to study the association between the age of first alcohol intoxication (AFI) and the risk of psychiatric disorders in a Finnish general population sample.

Methods: We utilized a prospective, general population-based study, the Northern Finland Birth Cohort 1986. In all, 6,290 15-16-year old adolescents answered questions on AFI and were followed up until the age of 33 years for psychiatric disorders (any psychiatric disorder, psychosis, SUD, mood disorders and anxiety disorders) by using nationwide register linkage data. Cox-regression analysis with Hazard Ratios (HR, with 95% confidence intervals (CI)) was used to assess the risk of psychiatric disorders associated with AFI.

Results: Statistically significant associations were observed between AFI and any psychiatric disorder, psychosis, SUDs, and mood disorders. After adjustments for other substance use, family structure, sex and parental psychiatric disorders, AFIs of 13-14 years and ≤12 years were associated with SUD (HR = 5.30; 95%CI 2.38-11.82 and HR = 6.49; 95%CI 2.51-16.80, respectively), while AFI ≤ 12 years was associated with any psychiatric disorder (HR = 1.59; 95%CI 1.26-2.02) and mood disorders (HR = 1.81; 95%CI 1.22-2.68). After further adjustments for Youth Self Report total scores, AFI ≤ 14 was associated with an increased risk of SUD and AFI ≤ 12 with an increased risk of any psychiatric disorder.

Conclusions: We found significant associations between the early age of first alcohol intoxication, later SUD and any psychiatric disorder in a general population sample. This further supports the need for preventive efforts to postpone the first instances of adolescent alcohol intoxication.
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http://dx.doi.org/10.1016/j.addbeh.2021.106910DOI Listing
July 2021

The predictive capacity of AUDIT and AUDIT-C among adolescents in a one-year follow-up study.

Drug Alcohol Depend 2021 01 22;218:108424. Epub 2020 Nov 22.

Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Aim: The Alcohol Use Disorders Identification Test (AUDIT) has been validated for use with adolescents to screen their harmful alcohol consumption. How well AUDIT or its derivative consumption version AUDIT-C predicts the development of problematic alcohol use among adolescents remains unknown. The aim of our study was to examine the predictive capacity of AUDIT and AUDIT-C among adolescents in a one-year follow-up.

Methods: Finnish adolescents (N = 337) were examined at baseline with AUDIT and one year later with the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version (K-SADS-PL) interview to assess alcohol problem use. Test characteristics and regression models were analyzed in predicting alcohol problem use.

Results: The sensitivity of AUDIT (cut-off ≥5) was 0.809 and specificity 0.621 in predicting alcohol problem use among adolescents one year later. The positive test posterior probability was 0.51. For those who screened negative at baseline, the positive test posterior probability was 0.13. With AUDIT-C (cut-off ≥3), the posterior probabilities were 0.47 and 0.12, respectively (sensitivity 0.855, specificity 0.529). The odds ratio was 6.95 for those screening positive with AUDIT and 6.59 with AUDIT-C at baseline to have alcohol problem use one year later.

Conclusions: AUDIT has utility in screening youth at risk for developing alcohol problem use. It has significant predictive capacity in detecting risk especially among adolescents with depression.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108424DOI Listing
January 2021

Frequent Alcohol Intoxication and High Alcohol Tolerance During Adolescence as Predictors of Mortality: A Birth Cohort Study.

J Adolesc Health 2020 11 29;67(5):692-699. Epub 2020 Aug 29.

Department of Psychiatry, University of Turku, Turku, Finland; Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland.

Purpose: Long-term prospective studies evaluating the health burden that is consequent to adolescent drinking are needed. The aim of this study was to examine the predictive associations between self-reported alcohol tolerance and frequent intoxication at age 15-16 years and the risk of death by age 33 years.

Methods: A sample (n = 6,615; 49.3% males) of the Northern Finland Birth Cohort Study 1986 was studied. Self-reported alcohol tolerance (drinks needed to feel intoxicated) and frequency of alcohol intoxication at age 15-16 years were analyzed along with background variables and data regarding subsequent psychiatric diagnoses. Categories were formed for both predictive variables from self-reported tolerance and frequency of intoxication in mid-adolescence. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence interval (95% CI) for death by age 30 years.

Results: By the age of 33 years, of all 6,615 participants, 53 (.8%) were deceased. The HR for death by age 33 years was 3.08 (95% CI 1.17-8.07) among adolescents with high alcohol tolerance compared with adolescents without alcohol use or intoxication. The frequency of alcohol intoxication was also associated with mortality; HR 2.05 (95% CI 1.01-4.16) for those who had been intoxicated one to two times and HR 3.02 (95% CI 1.21-7.54) for those who had been intoxicated three or more times in the past 30 days compared with adolescents without intoxication.

Conclusions: High self-reported alcohol tolerance and frequent alcohol intoxication during mid-adolescence significantly predicted death by age 33 years. These behaviors carry long-term repercussions with respect to premature loss of life. Substantial efforts should be made to diminish this mortality risk.
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http://dx.doi.org/10.1016/j.jadohealth.2020.07.034DOI Listing
November 2020

Association of age at first drink and first alcohol intoxication as predictors of mortality: a birth cohort study.

Eur J Public Health 2020 12;30(6):1189-1193

Department of Psychiatry, University of Turku, Turku, Finland.

Background: More information on the health-related repercussions of age at onset of adolescent drinking is needed. The aim of this study was to examine the associations between self-reported age at first drink and age at first alcohol intoxication with the risk of death by age 30.

Methods: The sample (n = 6564; 49.1% males) included all participants of the Northern Finland Birth Cohort Study 1986 (NFBC1986) for whom the two measures of adolescent drinking were available. Self-reported age at onset of first drink and first alcohol intoxication were analyzed along with background variables and data regarding subsequent psychiatric diagnoses. Adolescents were dichotomized into those reporting age at first drink and age at first intoxication before or after age 14. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence interval (95% CI) for death by age 30.

Results: By the age of 30, 0.7% (n = 47) of all 6564 participants were deceased. In the multivariable models, male gender and a history of illicit substance use in adolescence were associated with both all-cause mortality and mortality due to accidents or suicide. After controlling for confounding variables, age at first alcohol intoxication was associated with all-cause mortality (HR 2.33; 95% CI 1.04-5.20) as well as death due to accidents or suicide (HR 2.99; 95% CI 1.11-8.05).

Conclusions: Earlier age at first intoxication carries long-term repercussions with respect to premature loss of life. Efforts should be made targeting the prolongation of initiating binge drinking in adolescence to diminish this mortality risk.
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http://dx.doi.org/10.1093/eurpub/ckaa134DOI Listing
December 2020

Author's reply.

Br J Psychiatry 2020 08;217(2):458

Center for Life Course Health Research, University of Oulu; and Medical Research Center Oulu, Oulu University HospitalFinland.

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http://dx.doi.org/10.1192/bjp.2020.28DOI Listing
August 2020

Author's reply.

Br J Psychiatry 2020 08;217(2):458

Center for Life Course Health Research, University of Oulu; and Medical Research Center Oulu, Oulu University HospitalFinland.

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http://dx.doi.org/10.1192/bjp.2020.28DOI Listing
August 2020

Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study.

Addiction 2020 06 8;115(6):1160-1171. Epub 2020 Jan 8.

Department of Psychiatry, University of Turku, Turku, Finland.

Background And Aims: The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds.

Design: Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language.

Setting: Population-based data were collected from six cities in Finland during 2010-12.

Participants: The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%).

Measurements: The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for.

Findings: Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18).

Conclusions: In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.
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http://dx.doi.org/10.1111/add.14904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317749PMC
June 2020

Frequent intoxication and alcohol tolerance in adolescence: associations with psychiatric disorders in young adulthood.

Addiction 2020 05 17;115(5):888-900. Epub 2020 Jan 17.

Department of Psychiatry, University of Turku, Turku, Finland.

Aims: To assess the associations of intoxication frequency and number of drinks needed to become intoxicated in mid-adolescence with onset of psychiatric disorders in early adulthood.

Design, Setting And Participants: Prospective cohort study in Northern Finland, with people from the Northern Finland Birth Cohort 1986 who self-reported adolescent alcohol use: 6548 subjects (69.4% of the original sample). Data on alcohol use were collected using questionnaires at ages 15-16 years.

Measurements: Outcomes were any non-organic psychosis, mood disorder, anxiety disorder, any substance use disorder (SUD) and all the studied psychiatric disorders in early adulthood gathered from nation-wide health care, pension and insurance registers. Number of drinks needed to become intoxicated was categorized into three classes: (1) no alcohol use or intoxication, and (2) low and (3) high alcohol tolerance (more than seven/nine drinks for females/males) groups. Similarly, intoxication frequency was divided into three classes: (1) never, (2) one to two times and (3) three or more times during the past 30 days. Information regarding gender, family type, other drug use, psychopathology using Youth Self-Report (YSR) total score and parental psychiatric disorders were used as covariates.

Findings: In the multivariable analyses, both low [odds ratio (OR) = 3.0, 95% confidence interval (CI) = 1.3-6.7, P-value = 0.009] and high (OR = 4.4, 95% CI = 1.8-11.1, P-value = 0.001) alcohol tolerance were associated with increased risk of SUD. More frequent intoxication was associated with increased frequency of SUD (OR = 3.9, 95% CI = 2.0-7.3, P-value < 0.001) and mood disorder (OR = 1.6, 95% CI = 1.1-2.3, P-value = 0.008). The latter was attenuated after adjusting with concurrent psychopathology (YSR) and other drug use.

Conclusions: Both higher alcohol tolerance and frequent intoxication in adolescence appear to be associated with increased risk of future substance use disorder.
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http://dx.doi.org/10.1111/add.14889DOI Listing
May 2020

Mental health problems among clients with substance use problems: a nationwide time-trend study.

Soc Psychiatry Psychiatr Epidemiol 2020 Apr 4;55(4):507-516. Epub 2019 Sep 4.

Department of Psychiatry, Institute of Clinical Medicine, University of Turku, 20014, Turku, Finland.

Purpose: Mental health and substance use disorders are notable contributors to the global total burden of disease. On a population level, co-occurring mental health and substance use problems are estimated to account for 2-4%. In clinical samples, estimate is even higher. The aim of this study was to examine changes in recognized mental health problems (MHPs) and in the substance use profiles among clients with substance use problems in Finland.

Methods: Data concerning individuals with substance use entering Finnish social and health care services during 1 day were collected nationwide at three time-points in 2007, 2011, and 2015. Cross-tabulations and logistic regression were used for statistical analysis.

Results: Co-occurring MHPs and substance use problems were common: 56-60% of the clients with substance use problems were reported to have had MHPs between the years 2007 and 2015. The proportion of MHPs remained rather stable among them. Substance use profiles have changed: the proportion of illicit drug use among those who had MHPs has increased in health care services, social services, and substance use problem services.

Conclusion: Co-occurring substance use and MHPs among clients with substance use problems are common, and substance use profile is shifting from using alcohol only towards illicit drug use. This may even bring along more challenges for the treatment system and should be considered in future service planning.
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http://dx.doi.org/10.1007/s00127-019-01753-3DOI Listing
April 2020

Evidence of a Causal Relationship Between Smoking Tobacco and Schizophrenia Spectrum Disorders.

Front Psychiatry 2018 20;9:607. Epub 2018 Nov 20.

Center for Life Course Health Research, University of Oulu, Oulu, Finland.

There has been emerging evidence of an association between tobacco smoking and schizophrenia spectrum disorders (SSD). Two meta-analyses have reported that people who smoke tobacco have an ~2-fold increased risk of incident schizophrenia or psychosis, even after adjusting for confounding factors. This study aimed to critically appraise the research which has examined the association between tobacco smoking and SSD against the Bradford Hill criteria for causality, to determine the strength of the evidence for a causal relationship. Eight longitudinal studies (seven cohort studies and one case control study) were identified which examined tobacco smoking as an exposure and psychosis as an outcome. All seven cohort studies were assessed as being of high quality using the Newcastle-Ottawa Scale. Six of the eight studies found a statistically significant positive association between tobacco smoking and onset of SSD. These studies reported a consistent association with a moderate to large effect size and a dose response relationship. The studies adjusted for multiple potential confounders including age, sex, socioeconomic status, shared genetic risk, prodromal symptoms, and comorbid cannabis and other substance use. The studies did not adjust for exposure to childhood trauma or prenatal tobacco. There was substantial though inconclusive evidence supporting a causal relationship between tobacco smoking and increased risk of SSD. If a causal relationship does exist, nicotine is most likely responsible for this association. This raises serious public health concerns about the increasing use of e-cigarettes and other products, particularly by adolescents whose nicotine use may increase their risk of SSD. Research is urgently needed to examine the association between e-cigarette use and incident psychosis, particularly in adolescents and young adults.
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http://dx.doi.org/10.3389/fpsyt.2018.00607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255982PMC
November 2018

Cloninger's Temperament Dimensions and Longitudinal Alcohol Use in Early Midlife: A Northern Finland Birth Cohort 1966 Study.

Alcohol Clin Exp Res 2018 10 27;42(10):1924-1932. Epub 2018 Aug 27.

Center for Life Course Health Research, University of Oulu, Oulu, Finland.

Background: Temperament is theorized to be an important factor contributing to the development of alcohol use disorder, but longitudinal studies on how temperament is related to alcohol use among general population in midlife are scarce. Our aims were to investigate potentially reciprocal associations between temperament and changes in alcohol use from age 31 to 46 using prospective birth cohort data.

Method: Within the Northern Finland Birth Cohort 1966, alcohol use and temperament were studied at ages 31 and 46. Participants (N = 5,274) were classified into moderate users, abstainers and heavy users based on their mean alcohol use (g/d). Additionally, participants were categorized as steady users, reducers, or increasers. Multinomial regression analyses were conducted with Cloninger's Temperament and Character Inventory (TCI) scores as factors influencing alcohol use using moderate and stable users as reference groups. Reciprocity of relations was assessed with cross-lagged structural equation modeling.

Results: Temperament and alcohol use are rather stable in midlife. Novelty seeking (NS) predicted heavy use (OR = 1.4; CI: 1.3 to 1.6 for men, OR = 1.3; CI: 1.1 to 1.5 for women) and increasing use (OR = 1.2; CI: 1.1 to 1.4 for men, OR = 1.1; CI: 1.0 to 1.3 for women), whereas low NS predicted abstaining among women (OR = 0.7; CI: 0.6 to 0.8). High harm avoidance (HA) predicted abstaining (OR = 1.3; CI: 1.1 to 1.5) for men. Low persistence (P) among men predicted both abstaining (OR = 0.9; CI: 0.7 to 0.98) and heavy use (OR = 0.9; CI: 0.8 to 0.98). Among women, low reward dependence (RD) predicted heavy use (OR = 0.8; CI: 0.7 to 0.9). Among TCI scores, only NS predicted increasing use in the cross-lagged models.

Conclusions: Temperament has an impact on alcohol use in midlife. Of the TCI dimensions, only NS seems to predispose to increased alcohol use and problem use throughout life. Additionally, RD among women and P among men are significant factors from a life-course perspective. Our results did not support Cloninger's theory on type I alcoholism, as HA showed no relation to problematic alcohol use in midlife.
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http://dx.doi.org/10.1111/acer.13857DOI Listing
October 2018

Adolescent inhalant use and psychosis risk - a prospective longitudinal study.

Schizophr Res 2018 11 27;201:360-366. Epub 2018 Jun 27.

Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia; Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.

Background: Cross-sectional studies have suggested inhalant use is associated with psychosis. This association was examined in a longitudinal study accounting for other substance use and potential confounders.

Methods: We used a prospective sample (N = 6542) from the Northern Finland Birth Cohort 1986. Self-report questionnaires on substance use and psychotic experiences were completed when the cohort members were 15-16 years old. Inhalant use was categorized into four groups (never, once, 2-4 times, 5 times or more). Subsequent psychosis diagnoses (ICD-10) until age 30 years were obtained from national registers. Cox regression analysis was used to examine the association between adolescent inhalant use and risk of psychosis.

Results: During the observation period 124 individuals were diagnosed with incident psychosis. Overall, there were 225 (3.4%) subjects with any inhalant use, 18 (8.0%) of whom were diagnosed with psychosis during the follow up. Of non-inhalant users (n = 6317) 106 (1.7%) were diagnosed with psychosis. Compared to non-users, those using inhalants had increased risk of incident psychosis with most frequent inhalant use associated with the greatest risk (unadjusted HR = 9.46; 3.86-23.20). After adjusting for baseline psychotic experiences, other substance use, comorbid mental disorder and parental substance abuse, the increased risk of psychosis persisted (HR = 3.06; 1.05-8.95). Furthermore, a dose-response effect between inhalant use and risk of psychosis was identified (OR = 2.34; 1.83-2.99).

Conclusions: Inhalant use in adolescence was independently associated with incident psychosis. The adverse health outcomes associated with adolescent inhalant use provide compelling reasons for implementation of policies to reduce the use of volatile substances in adolescents.
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http://dx.doi.org/10.1016/j.schres.2018.05.013DOI Listing
November 2018

AUDIT and AUDIT-C as screening instruments for alcohol problem use in adolescents.

Drug Alcohol Depend 2018 07 19;188:266-273. Epub 2018 May 19.

Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, 00260, Helsinki, Finland.

Background: The Alcohol Use Disorders Identification Test (AUDIT) is commonly used in adults to screen for harmful alcohol consumption but few studies exist on its use among adolescents. Our aim was to validate the AUDIT and its derivative consumption questionnaire (AUDIT-C) as screening instruments for the detection of problem use of alcohol in adolescents.

Methods: 621 adolescents (age-range, 12-19 years) were drawn from clinical and population samples who completed the AUDIT questionnaire. Psychiatric diagnoses were assessed using K-SADS-PL. A rating based on the K-SADS-PL was used to assess alcohol use habits, alcohol use disorders, screening and symptom criteria questions. Screening performance of the AUDIT and AUDIT-C sum scores and Receiver Operating Characteristic (ROC) curves were calculated. The diagnostic odds ratios (dOR) were calculated to express the overall discrimination between cut-offs.

Results: Comparisons of ROC between the AUDIT and AUDIT-C pairs indicated a slightly better test performance by AUDIT for the whole sample and in a proportion of the subsamples. Optimal cut-off value for the AUDIT was ≥5 (sensitivity 0.931, specificity 0.772, dOR 45.22; 95% CI: 24.72-83.57) for detecting alcohol problem use. The corresponding optimal cut-off value for the AUDIT-C was ≥3 in detecting alcohol problem use (sensitivity 0.952, specificity 0.663, dOR 39.31; 95% CI: 19.46-78.97). Agreement between the AUDIT and AUDIT-C using these cut-off scores was high at 91.9%.

Conclusions: Our results for the cut-off scores for the early detection of alcohol problem use in adolescents are ≥5 for AUDIT, and ≥3 for AUDIT-C.
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http://dx.doi.org/10.1016/j.drugalcdep.2018.04.015DOI Listing
July 2018

The prevalence of substance use among Russian, Somali and Kurdish migrants in Finland: a population-based study.

BMC Public Health 2018 05 22;18(1):651. Epub 2018 May 22.

National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271, Helsinki, Finland.

Background: Substance use is a well-known public health problem, but population-based research on migrants' substance use in Europe is limited. Factors related to the cultural background and current life situation might influence substance use among migrants. Here, the prevalence of substance use in Russian, Somali and Kurdish migrants in Finland is reported in comparison with the general population, and the associations between substance use and socio-economic and migration-related background factors among migrants are analysed.

Methods: Cross-sectional data from the Finnish Migrant Health and Wellbeing Study (Maamu) and comparison group data of the general Finnish population (n = 1165) from the Health 2011 Survey were used. The survey participants were of Russian (n = 702), Somali (n = 512), and Kurdish (n = 632) origin. Substance use included self-reported alcohol use within previous 12 months (AUDIT-C questionnaire), current and lifetime daily smoking and lifetime use of cannabis and intravenous drugs.

Results: Binge drinking was less prevalent among all migrant groups than in the general Finnish population (Russian men 65%, p < 0.01; Russian women 30%, p < 0.01, Somali men 2%, p < 0.01, Kurdish men 27%, p < 0.01, Kurdish women 6%, p < 0.01, general population men 87% and women 72%). Current daily smoking was more prevalent among Russian (28%, p = 0.04) and Kurdish (29%, p < 0.01) migrant men compared with the reference group (20%). Younger age and employment were associated with binge drinking among migrants. Socio-economic disadvantage increased the odds for daily smoking in Russian, Somali and Kurdish migrant men. Several migration-related factors, such as age at migration and language proficiency, were associated with substance use.

Conclusions: Binge drinking is less common among migrants than in the Finnish general population. However, current daily smoking was more prevalent among Russian and Kurdish migrant men compared with the general population. Younger age, level of education, employment, duration of residence in Finland and language proficiency were associated with binge drinking and daily smoking with varying patterns of association depending on the migrant group and gender. These findings draw attention to the variation in substance use habits among migrant populations.
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http://dx.doi.org/10.1186/s12889-018-5564-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964663PMC
May 2018

Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis.

Br J Psychiatry 2018 04;212(4):227-233

Center for Life Course Health Research,University of Oulu, Oulu, Finland and Medical Research Center Oulu, Oulu University Hospital and University of Oulu,Oulu,Finland.

Background: The association between cannabis use and the risk of psychosis has been studied extensively but the temporal order still remains controversial. Aims To examine the association between cannabis use in adolescence and the risk of psychosis after adjustment for prodromal symptoms and other potential confounders.

Method: The sample (n = 6534) was composed of the prospective general population-based Northern Finland Birth Cohort of 1986. Information on prodromal symptoms of psychosis and cannabis use was collected using questionnaires at age 15-16 years. Participants were followed up for ICD-10 psychotic disorders until age 30 years using nationwide registers.

Results: The risk of psychosis was elevated in individuals who had tried cannabis five times or more (hazard ratio, (HR) = 6.5, 95% CI 3.0-13.9). The association remained statistically significant even when adjusted for prodromal symptoms, other substance use and parental psychosis (HR = 3.0, 95% CI 1.1-8.0).

Conclusions: Adolescent cannabis use is associated with increased risk of psychosis even after adjustment for baseline prodromal symptoms, parental psychosis and other substance use. Declaration of interest None.
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http://dx.doi.org/10.1192/bjp.2017.52DOI Listing
April 2018

Treatment Profile and 1-Year Mortality Among Nontraumatic Intensive Care Unit Patients With Alcohol-Related Health Problems.

J Intensive Care Med 2020 Mar 5;35(3):244-250. Epub 2017 Nov 5.

Division of Intensive Care Medicine, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland.

Background: Long-term excessive use of alcohol leads to severe complications, which often require treatment in an intensive care unit (ICU). The aim of this study was to report on the associations between alcohol-related health problems and treatment profile, as well as 1-year mortality among patients with nontrauma-related ICU admissions.

Methods: Information on the history of alcohol-related health problems or excessive alcohol use and ICU treatment was collected retrospectively from electronic medical records and ICU patient data management systems at Oulu University Hospital, Finland. Information on 1-year mortality was obtained from the Finnish Population Register Center.

Results: According to the medical records, in a total of 899 admissions, 32.9% (n = 296) of patients had a history of alcohol-related problems. In the alcohol group, intoxications were more frequent and respiratory and cardiovascular causes were less frequent, compared to those without alcohol-related problems. Patients without alcohol-related problems had a higher rate of previous comorbidities compared with the alcohol group. There were no differences concerning age, severity of illness scores, length of stay, or intensive care outcome. Mortality during the 1-year follow-up was 32.8% in total: 35.1% among those without alcohol-related history and 28.0% in the alcohol group ( = .041). The difference in mortality appeared during the first month following admission and remained throughout the follow-up period. The highest 1-year mortality (59.3%) was observed among patients with alcohol-related liver disease.

Conclusion: Every third patient admitted to ICU used alcohol excessively or had alcohol-related diseases, and those patients with alcohol-related liver disease had the poorest 1-year survival rate. We found higher long-term mortality in nonalcohol-related admissions, which can be explained by the case mix, including a lower rate of chronic diseases, such as malignancies and coronary artery disease, and a higher rate of low-risk admission diagnoses in the alcohol group.
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http://dx.doi.org/10.1177/0885066617740071DOI Listing
March 2020

Alcohol Consumption and Binge Drinking in Young Men as Predictors of Body Composition Changes During Military Service.

Alcohol Alcohol 2017 May;52(3):365-371

Center for Life Course Health Research, University of Oulu, Aapistie 5/PO Box 5000, Oulu FIN-90014, Finland.

Aims: To evaluate the influences of alcohol consumption frequency and binge drinking on changes in the body composition, lifestyle habits and physical fitness of healthy young men during military service.

Methods: A population-based study of men performing their military service in the Sodankylä Jaeger Brigade, Finland in 2005. Body composition, fitness and lifestyle habits were evaluated at baseline and 6-12 months follow-up. Alcohol consumption frequency and binge drinking were categorized as: 'not at all', 'at least once a month' and 'at least once a week'.

Results: Data were available for 983 participants. Mean (SD) age was 19.2 (1.0) years. At baseline, participants who reported binge drinking at least once a week (29.8%) had the most unfavourable body composition, lifestyle habits and physical fitness compared with the group with no binge drinking. Significant (P < 0.05) mean reductions in % body fat (-2.3%) and weight (-1.8 kg), as well as improvements in lifestyle habits and physical fitness were observed in the weekly binge drinking group during the military service. The reductions in relative weight (%) and % body fat were associated with binge drinking at least once a week (regression coefficient for relative weight -1.39, 95% CI [-2.32; -0.45], P = 0.004, and for % body fat -0.68, 95% CI [-1.35; -0.01], P = 0.049).

Conclusion: Frequent binge drinking is associated with poorer body composition, lifestyle habits and fitness among young men. Frequent binge drinkers may obtain the greatest benefit of military-service-based exercise intervention, as reflected in the improvements in body composition, lifestyle habits and physical fitness.

Short Summary: Frequent binge drinking is associated with poorer body composition, lifestyle habits and fitness among young men. The greatest benefit of military service comprehending exercise intervention was observed among those with binge drinking once a week at the baseline, with favourable changes in lifestyle factors, body composition and fitness.
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http://dx.doi.org/10.1093/alcalc/agx002DOI Listing
May 2017
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