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Examining the Relationship between Heavy Alcohol Use and Assaults: With Adjustment for the Effects of Unmeasured Confounders.

Liang W, Chikritzhs T - Biomed Res Int (2015)

Bottom Line: After adjusting for the effects of unknown/unmeasured confounders, the risk of assault remained 43% and 63% higher (P < 0.05) among participants who consumed 5+ drinks/day for 5-8 days/month and 9-30 days/month, respectively.Even after adjustment for unknown/unmeasured confounders the association between heavy alcohol use and risk of violence remained significant.These findings support the hypothesis that heavy alcohol use can cause violence.

View Article: PubMed Central - PubMed

Affiliation: National Drug Research Institute, Curtin University, P.O. Box U1987, Perth, WA 6845, Australia.

ABSTRACT

Background: Experimental studies suggest that alcohol can lead to aggression in laboratory settings; however, it is impossible to test the causal relationship between alcohol use and real-life violence among humans in randomized clinical trials. Objectives. (i) To examine the relationship between heavy alcohol use and assaults in a population based study; (ii) to demonstrate the proxy outcome method, as a means of controlling the effects of unknown/unmeasured confounders in observational studies.

Methods: This study used data collected from three waves of the National Survey on Drug Use and Health (NSDUH). The effects of heavy alcohol use on assault were measured using multivariable logistic regressions in conjunction with the proxy outcome method.

Results: Application of the proxy outcome method indicated that effect sizes of heavy alcohol use on the risk of assault were overestimated in the standard models. After adjusting for the effects of unknown/unmeasured confounders, the risk of assault remained 43% and 63% higher (P < 0.05) among participants who consumed 5+ drinks/day for 5-8 days/month and 9-30 days/month, respectively.

Conclusions: Even after adjustment for unknown/unmeasured confounders the association between heavy alcohol use and risk of violence remained significant. These findings support the hypothesis that heavy alcohol use can cause violence.

No MeSH data available.


Related in: MedlinePlus

Illustration of an alternative approach to dealing with confounding effects.
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Related In: Results  -  Collection


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fig1: Illustration of an alternative approach to dealing with confounding effects.

Mentions: In the current study, the proxy outcome method was adopted to control the effects of unknown confounders. The criteria for a proxy outcome are (i) the exposure of interest is not a cause for the proxy outcome and (ii) causes of the proxy outcome and the main outcome are subsets of a pool of correlated variables [17]. In order to avoid overadjustment, a positive outcome was used. The criteria for a positive outcome are (i) the exposure of interest is a cause for the positive outcome and (ii) causes of the positive outcome, the proxy outcome, and the main outcome are subsets of a pool of correlated variables. In relation to this study, driving without a seatbelt at all times met the criteria of a proxy outcome, and driving while under the influence of alcohol met the criteria of a positive outcome since (i) the three outcomes (violent behavior, driving without a seatbelt at all times, and driving while under the influence of alcohol) are all risk-taking illegal behaviors which share a set of similar social, environmental, and genetic risk factors [15, 33–35], as well as a similar direction and magnitude of response bias due to social desirability [36], and (ii) heavy alcohol use has minimum effect on driving without a seatbelt at all times while heavy alcohol use is an important cause of drink-driving (but not an essential cause, as some cases may be due to “moderate” level drinking) (also see Figure 1).


Examining the Relationship between Heavy Alcohol Use and Assaults: With Adjustment for the Effects of Unmeasured Confounders.

Liang W, Chikritzhs T - Biomed Res Int (2015)

Illustration of an alternative approach to dealing with confounding effects.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4561945&req=5

fig1: Illustration of an alternative approach to dealing with confounding effects.
Mentions: In the current study, the proxy outcome method was adopted to control the effects of unknown confounders. The criteria for a proxy outcome are (i) the exposure of interest is not a cause for the proxy outcome and (ii) causes of the proxy outcome and the main outcome are subsets of a pool of correlated variables [17]. In order to avoid overadjustment, a positive outcome was used. The criteria for a positive outcome are (i) the exposure of interest is a cause for the positive outcome and (ii) causes of the positive outcome, the proxy outcome, and the main outcome are subsets of a pool of correlated variables. In relation to this study, driving without a seatbelt at all times met the criteria of a proxy outcome, and driving while under the influence of alcohol met the criteria of a positive outcome since (i) the three outcomes (violent behavior, driving without a seatbelt at all times, and driving while under the influence of alcohol) are all risk-taking illegal behaviors which share a set of similar social, environmental, and genetic risk factors [15, 33–35], as well as a similar direction and magnitude of response bias due to social desirability [36], and (ii) heavy alcohol use has minimum effect on driving without a seatbelt at all times while heavy alcohol use is an important cause of drink-driving (but not an essential cause, as some cases may be due to “moderate” level drinking) (also see Figure 1).

Bottom Line: After adjusting for the effects of unknown/unmeasured confounders, the risk of assault remained 43% and 63% higher (P < 0.05) among participants who consumed 5+ drinks/day for 5-8 days/month and 9-30 days/month, respectively.Even after adjustment for unknown/unmeasured confounders the association between heavy alcohol use and risk of violence remained significant.These findings support the hypothesis that heavy alcohol use can cause violence.

View Article: PubMed Central - PubMed

Affiliation: National Drug Research Institute, Curtin University, P.O. Box U1987, Perth, WA 6845, Australia.

ABSTRACT

Background: Experimental studies suggest that alcohol can lead to aggression in laboratory settings; however, it is impossible to test the causal relationship between alcohol use and real-life violence among humans in randomized clinical trials. Objectives. (i) To examine the relationship between heavy alcohol use and assaults in a population based study; (ii) to demonstrate the proxy outcome method, as a means of controlling the effects of unknown/unmeasured confounders in observational studies.

Methods: This study used data collected from three waves of the National Survey on Drug Use and Health (NSDUH). The effects of heavy alcohol use on assault were measured using multivariable logistic regressions in conjunction with the proxy outcome method.

Results: Application of the proxy outcome method indicated that effect sizes of heavy alcohol use on the risk of assault were overestimated in the standard models. After adjusting for the effects of unknown/unmeasured confounders, the risk of assault remained 43% and 63% higher (P < 0.05) among participants who consumed 5+ drinks/day for 5-8 days/month and 9-30 days/month, respectively.

Conclusions: Even after adjustment for unknown/unmeasured confounders the association between heavy alcohol use and risk of violence remained significant. These findings support the hypothesis that heavy alcohol use can cause violence.

No MeSH data available.


Related in: MedlinePlus