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Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions
Open accessAbstract
Importance: Lack of current and comprehensive trend data derived from a uniform, reliable, and valid source on alcohol use, high-risk drinking, and DSM-IV alcohol use disorder (AUD) represents a major gap in public health information. Objective: To present nationally representative data on changes in the prevalences of 12-month alcohol use, 12-month high-risk drinking, 12-month DSM-IV AUD, 12-month DSM-IV AUD among 12-month alcohol users, and 12-month DSM-IV AUD among 12-month high-risk drinkers between 2001-2002 and 2012-2013. Design, Setting, and Participants: The study data were derived from face-to-face interviews conducted in 2 nationally representative surveys of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions, with data collected from April 2001 to June 2002, and the National Epidemiologic Survey on Alcohol and Related Conditions III, with data collected from April 2012 to June 2013. Data were analyzed in November and December 2016. Main Outcomes and Measures: Twelve-month alcohol use, high-risk drinking, and DSM-IV AUD. Results: The study sample included 43 093 participants in the National Epidemiologic Survey on Alcohol and Related Conditions and 36 309 participants in the National Epidemiologic Survey on Alcohol and Related Conditions III. Between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, and DSM-IV AUD increased by 11.2%, 29.9%, and 49.4%, respectively, with alcohol use increasing from 65.4% (95% CI, 64.3%-66.6%) to 72.7% (95% CI, 71.4%-73.9%), high-risk drinking increasing from 9.7% (95% CI, 9.3%-10.2%) to 12.6% (95% CI, 12.0%-13.2%), and DSM-IV AUD increasing from 8.5% (95% CI, 8.0%-8.9%) to 12.7% (95% CI, 12.1%-13.3%). With few exceptions, increases in alcohol use, high-risk drinking, and DSM-IV AUD between 2001-2002 and 2012-2013 were also statistically significant across sociodemographic subgroups. Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income. Increases were also seen for the total sample and most sociodemographic subgroups for the prevalences of 12-month DSM-IV AUD among 12-month alcohol users from 12.9% (95% CI, 12.3%-17.5%) to 17.5% (95% CI, 16.7%-18.3%) and 12-month DSM-IV AUD among 12-month high-risk drinkers from 46.5% (95% CI, 44.3%-48.7%) to 54.5% (95% CI, 52.7%-56.4%). Conclusions and Relevance: Increases in alcohol use, high-risk drinking, and DSM-IV AUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis. Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role.
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Written from the paper’s full text.
TL;DR
Between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder (AUD) increased significantly in the US adult population. Increases were greatest among women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged.
Key findings
- 12-month alcohol use rose from 65.4% to 72.7% (relative increase, 11.2%); high-risk drinking rose from 9.7% to 12.6% (29.9%); DSM-IV AUD rose from 8.5% to 12.7% (49.4%).
- Among 12-month alcohol users, DSM-IV AUD increased from 12.9% to 17.5% (35.7%); among 12-month high-risk drinkers, DSM-IV AUD increased from 46.5% to 54.5% (17.2%).
- Increases were significant across most sociodemographic subgroups, with notable rises among women (AUD +83.7%), adults aged ≥65 years (AUD +106.7%), black individuals (AUD +92.8%), and those with lower education or family income.
Methods
- Repeated cross-sectional analysis of two nationally representative face-to-face US adult surveys: NESARC 2001-2002 (n = 43,093) and NESARC-III 2012-2013 (n = 36,309).
- Outcomes were 12-month alcohol use, high-risk drinking (exceeding daily drinking limits at least weekly), and DSM-IV AUD, assessed with AUDADIS-IV/AUDADIS-5.
- Weighted cross-tabulations estimated prevalences; SUDAAN was used for complex survey design, and 2-sided t tests compared survey estimates (P < .05).
Limitations
- Stated: NESARC and NESARC-III lacked biological testing for substance use; homeless and incarcerated populations were not covered, potentially underestimating outcomes; AUDADIS interviewers were not clinicians, though a validation substudy showed similar prevalence and good concordance; NESARC-III response rate was acceptable (60.1%) but lower than NESARC (81.0%), with weighting to compensate for nonresponse.
- Stated: three AUD items were slightly reworded and three additional abuse questions appeared in NESARC-III, but the paper reports near-perfect concordance with and without the additional questions (κ = 0.97 for NESARC and κ = 0.98 for NESARC-III).
- Evident from the design: repeated cross-sectional surveys cannot establish causality, and alcohol measures rely on self-report.
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20 Own result · 15 Own method · 8 Own interpretation · 5 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Significant increases, seen across all sociodemographic subgroups, were particularly notable among women (15.8%), racial/ethnic minorities (from 17.2% among Hispanic to 29.1% among Asian or Pacific Islander individuals), adults 65 years and older (22.4%), and respondents with lower educational level and family income (range, 11.7%-22.3%).”
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The prevalence of 12-month DSM-IV AUD increased significantly from 8.5% to 12.7% (change, 49.4%) in the total population (Table 3).”
- Also stated in: § Results · plain
“DSM-IV AUD increasing from 8.5% (95% CI, 8.0%-8.9%) to 12.7% (95% CI, 12.1%-13.3%)”
plaindirect- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the prevalence of AUD among 12-month users (12.9% in 2001-2002 and 17.5% in 2012-2013)”
- Also stated in: § Results · plain
“Total 12.9 (12.3-17.5) 17.5 (16.7-18.3) a 35.7”
plaindirectn = 43- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Significant increases in high-risk drinking were also seen for all sociodemographic subgroups except Native Americans and respondents residing in rural areas.”
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“12-month DSM-IV AUD among 12-month high-risk drinkers from 46.5% (95% CI, 44.3%-48.7%) to 54.5% (95% CI, 52.7%-56.4%)”
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Twelve-month DSM-IV AUD among 12-month alcohol users significantly increased from 12.9% to 17.5% (change, 35.7%) in the total population (Table 4).”
- Also stated in: § Results · plain
“prevalences of 12-month DSM-IV AUD among 12-month alcohol users from 12.9% (95% CI, 12.3%-17.5%) to 17.5% (95% CI, 16.7%-18.3%)”
plaindirect- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Between 2001-2002 and 2012-2013, the 12-month prevalence of alcohol use increased 11.2% in the United States from 65.4% to 72.7%.”
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Twelve-month alcohol use significantly increased from 65.4% in 2001-2002 to 72.7% in 2012-2013, a relative percentage increase of 11.2% (Table 1).”
- Also stated in: § Results · plain
“alcohol use increasing from 65.4% (95% CI, 64.3%-66.6%) to 72.7% (95% CI, 71.4%-73.9%)”
plaindirectn = 309- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the prevalence of AUD among high-risk drinkers (46.5% in 2001-2002 and 54.5% in 2012-2013) was much greater than the prevalence of AUD among 12-month users (12.9% in 2001-2002 and 17.5% in 2012-2013)”
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Increases were significant for all sociodemographic subgroups except Native American, Asian or Pacific Islander, previously married respondents, those with less than a high school education, and those residing in rural areas, the Northeast, and the Midwest.”
plaindirect- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 21
- Probably not a substantial claim. 13
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The prevalence of 12-month high-risk drinking increased significantly between 2001-2002 and 2012-2013 from 9.7% to 12.6% (change, 29.9%) in the total population (Table 2).”
- Also stated in: § Results · plain
“high-risk drinking increasing from 9.7% (95% CI, 9.3%-10.2%) to 12.6% (95% CI, 12.0%-13.2%)”
plaindirect- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Results · plain
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Between 2001-2002 and 2012-2013, increases in alcohol use, high-risk drinking, and AUD were generally much greater among minorities than among white individuals, results that are consistent with substantial increases among individuals with the lowest educational levels and family incomes seen in this study.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Increases in high-risk drinking and AUD among women (57.9% and 83.7%, respectively) relative to men (15.5% and 34.7%, respectively) were alarming”
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“High-risk drinking increased almost 30% from 9.7% to 12.6%, representing approximately 20.2 million and 29.6 million Americans, respectively.”
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“increases in alcohol use (22.4%), high-risk drinking (65.2%), and AUD (106.7%) among older adults”
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was a 49.4% increase in 12-month DSM-IV AUD during this time from 8.5% to 12.7% (representing approximately 17.6 million and 29.9 million Americans, respectively)”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Notable increases were seen for women (34.7%), those who were black (25.7%) or Hispanic (16.8%), respondents aged 45 to 64 years (34.8%) and 65 years and older (58.1%), and those residing in urban areas (21.1%).”
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“These limitations are balanced by the numerous strengths of the Wave 1 NESARC and NESARC-III, including their large sample sizes and detailed measures of alcohol use, high-risk drinking, and DSM-IV AUD that have been extensively tested and validated, in addition to their rigorous epidemiologic study methods.”
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In the paper
“The sampling frame response rate was 98.5%, the household response rate was 88.5%, and the person response rate was 93.0%, yielding an overall survey response rate of 81.0%.”
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“much greater than the corresponding 14.8% increase in DSM-IV AUD observed between 1991-1992 (7.4%) and 2001-2002 (8.5%).”
plain- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Like other national surveys, some population segments were not covered in either survey (eg, the homeless and those who are incarcerated), potentially leading to underestimation of alcohol use, high-risk drinking, and DSM-IV AUD.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Between 2001-2002 and 2012-2013, an increase in alcohol use, high-risk drinking, and AUD occurred in the total US population and across almost all sociodemographic subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged.”
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Weighting that compensated for nonresponse facilitated comparisons between the surveys.”
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The National Health Interview Survey showed a 6.0% increase in 12-month alcohol use, while the National Survey on Drug Use and Health showed a 9.1% increase in 12-month alcohol use.”
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“consistent with earlier studies demonstrating a narrowing of the gender gap in these drinking patterns and AUD between 1991-1992 and 2001-2002.”
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Parallel increases were also seen in per capita alcohol consumption based on alcohol sales data, which rose 6.4%.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“These increases constitute a public health crisis that may have been overshadowed by increases in much less prevalent substance use (marijuana, opiates, and heroin) during the same period.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“NESARC and NESARC-III lacked biological testing for substance use.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“The smaller increase in 12-month high-risk drinking (21.3%) and the larger increase in 12-month alcohol use (48.6%) seen between the early 1900s and the early 2000s were associated with a much lower increase in AUD (14.9%), again underscoring the more important influence of increases in high-risk drinking relative to alcohol use on increases in AUD.”
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In the paper
“AUDADIS interviewers were not clinicians, but a NESARC-III validation substudy comparing AUDADIS and clinician diagnoses of 12-month AUD showed similar prevalence and good concordance.”
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Increases in alcohol use, high-risk drinking, and DSM-IV AUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis.”
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Data were adjusted for oversampling and nonresponse and were weighted to represent the civilian US population based on the 2000 Decennial Census.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“These 2 surveys are also unique in providing a uniform source of alcohol information and AUD to examine trends over time.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“were substantial and unprecedented relative to earlier surveys.”
plaindirect- Asserted: passes — The authors put it forward as true.
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- Rests on an assumption: Older adults have had consistently lower rates than others of alcohol use, high-risk drinking, and alcohol use disorder over the past 40 years.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The household response rate was 72.0%, the person-level response rate was 84.0%, and the overall response rate was 60.0%, which were comparable with other current US national surveys.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“The NESARC-III response rate was acceptable (60.1%) but was lower than that of NESARC (81.0%).”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Data were adjusted for oversampling and nonresponse and were weighted to represent the US civilian population based on the 2012 American Community Survey.”
plain- Asserted: passes — The authors put it forward as true.
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The paper relies on this without support.
There is a lack of current and comprehensive trend data derived from a uniform source on alcohol use, high-risk drinking, and DSM-IV alcohol use disorder since the early 2000s, representing a major gap in public health information.
“Lack of current and comprehensive trend data derived from a uniform source on alcohol use, high-risk drinking, and DSM-IV AUD since the early 2000s represents a major gap in public health information.”
The paper relies on this without support.
Between the early 1990s and the early 2000s, 12-month alcohol consumption increased from 44.0% to 65.4%, 12-month high-risk drinking increased from approximately 8.0% to 9.7%, and DSM-IV alcohol use disorder increased from 7.4% to 8.5%.
“Between the early 1990s and the early 2000s, 12-month alcohol consumption increased from 44.0% to 65.4%, 12-month high-risk drinking increased from approximately 8.0% to 9.7%, and DSM-IV AUD increased from 7.4% to 8.5%.”
The paper relies on this without support.
High-risk drinking and alcohol use disorder are important risk factors for morbidity and mortality from various chronic diseases and injuries.
“High-risk drinking and AUD are important risk factors for morbidity and mortality from fetal alcohol spectrum disorders, hypertension, cardiovascular diseases, stroke, liver cirrhosis, several types of cancer and infections, pancreatitis, type 2 diabetes, and various injuries.”
The paper relies on this without support.
Older adults have had consistently lower rates than others of alcohol use, high-risk drinking, and alcohol use disorder over the past 40 years.
“Older adults have had consistently lower rates than others of alcohol use, high-risk drinking, and AUD over the past 40 years.”
The paper relies on this without support.
Treatment rates for alcohol use disorder remain low (less than 10%) despite the significant rise in high-risk drinking and alcohol use disorder and the existence of a broad spectrum of evidence-based and effective behavioral and pharmacological approaches.
“Treatment rates for AUD remain low (<10%) despite the significant rise in high-risk drinking and AUD and the existence of a broad spectrum of evidence-based and effective behavioral and pharmacological approaches.”
The paper relies on this without support.
The older adult population will increase from 40 million in 2010 to 80 million in 2030.
“the projected increase in the size of this segment of the population (from 40 million in 2010 to 80 million in 2030)”
The paper relies on this without support.
Wealth inequality between minorities and whites has widened during and after the 2008 recession.
“Wealth inequality between minorities and whites has widened during and after the 2008 recession”
The paper relies on this without support.
Adversities that disproportionately affect racial/ethnic minorities include family income and educational disparities, unemployment, residential segregation, discrimination, decreased access to health care, and increased stigma associated with drinking.
“Adversities that disproportionately affect racial/ethnic minorities include family income and educational disparities, unemployment, residential segregation, discrimination, decreased access to health care, and increased stigma associated with drinking.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Although SUDs remain more prevalent in men than in women, the gender gap has been narrowing 150,328- 330 , possibly in part due to changes in gender roles 331 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [328]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“Total 12.9 (12.3-17.5) 17.5 (16.7-18.3) a 35.7”
Reported 12.9 · recomputed 14.9
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Discussion
“The smaller increase in 12-month high-risk drinking (21.3%) and the larger increase in 12-month alcohol use (48.6%) seen between the early 1900s and the early 2000s”
§ Introduction
“Between the early 1990s and the early 2000s, 12-month alcohol consumption increased from 44.0% to 65.4%, 12-month high-risk drinking increased from approximately 8.0% to 9.7%, and DSM-IV AUD increased from 7.4% to 8.5%.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Methods
“the overall response rate was 60.0%”
§ Discussion
“The NESARC-III response rate was acceptable (60.1%)”
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Metadata
- Authors
- Grant, B. F., Chou, S. P., Saha, T. D., Pickering, R. P., Kerridge, B. T., Ruan, W. J., Huang, B., Jung, J., Zhang, H., Fan, A., & Hasin, D. S.
- Affiliations
- National Institute on Alcohol Abuse and Alcoholism (US)
- New York State Psychiatric Institute (US)
- Corresponding author
- Grant, Bridget F.
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2017-09-01
- Volume
- 74
- Issue
- 9
- Pages
- 911
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC5710229
- OpenAlex
- W2744192774
- Semantic Scholar
- 192ff84504ad4a8617e96051ed59a8e9ec69c9d8
- Cited by
- 1,362
- References
- 136
- Citations by year
- 2026: 87 · 2025: 128 · 2024: 156 · 2023: 146 · 2022: 193 · 2021: 192 · 2020: 182 · 2019: 166 · 2018: 101 · 2017: 11
- FWCI
- 98.55
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- JAMA Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (K05AA014223)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- alcohol use prevalence, hazardous drinking, alcoholism, temporal trends, NESARC, binge drinking, alcohol-related problems, United States adults, 12-month prevalence
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Alcohol Drinking, Educational Status, Ethnicity, Female, Health Surveys, Humans, Income, Male, Middle Aged, Risk-Taking, Sex Factors, United States, Prevalence, Alcohol-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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