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Introduction: The Massachusetts Academic Health Department Consortium (AHD) established the Academic Public Health Volunteer Corps (APHVC) to support Local Health Departments (LHDs, n = 351) to meet rapidly emerging needs during the COVID-19 pandemic through engaging student volunteers. A program evaluation captured lessons learned and informed recommendations for sustainability and future replication. Methods: The mixed-methods evaluation leveraged the Consolidated Framework for Implementation Research (CFIR). Data were stratified by LHD engagement with APHVC. Quantitative surveys informed probes for qualitative focus groups and interviews; findings were categorized into CFIR constructs using a deductive approach. Results: One-fifth of LHDs (n = 76, 27 used APHVC services, 45 did not) completed the survey. Eleven employees participated in follow-up focus groups or interviews. APHVC filled resource gaps, built capacity, and provided high-quality deliverables. LHDs experienced issues with reliability and communication of volunteers and lacked time to train volunteers. Conclusions: CFIR aided in evaluating APHVC in real time, producing actionable recommendations for best practices, dissemination, and future iterations of the program. Results are being used to enhance program effectiveness and sustainability, community health, and health equity across Massachusetts, and may help inform academic practice-based programs across the United States.

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BACKGROUND: With US Centers for Disease Control and Prevention funding, from 2018 to 2022, 4 large healthcare systems (n = 53 health centers across 7 states) serving people of reproductive age trained staff and provided implementation support for alcohol screening and brief intervention (SBI). This cross-site evaluation explores each healthcare system's implementation approach to implement SBI, reduce excessive alcohol use, and prevent prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders. METHODS: The SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix framed the multilevel strategies to implement alcohol SBI programs from 2018 to 2022. Qualitative and quantitative data sources examined outcomes, guided by one logic model, through systems-level process data and provider-level performance metrics. Data analyses utilized frequencies and means for quantitative data and themes for qualitative data according to an established framework. RESULTS: Successful approaches within systems included using electronic health records, flexible implementation and workflow protocols, customized training and technical assistance programs, quality assurance feedback loops, and stakeholder buy-in. Centralized management structures were efficient in standardizing implementation across health centers. Decentralized management structures used tailored approaches, enhancing provider/staff SBI acceptance. Across systems, 1259 staff (eg, clinicians, medical assistants) were trained to provide alcohol SBI services and reported pre-post training increases in self-efficacy in performing brief intervention; skills in PAE counseling; and confidence in screening. Fifty-three (48 providing data) health centers implemented alcohol SBI, screening 106 826 patients over the study period with most of the 10 087 patients who screened positive for excessive alcohol use receiving a BI. CONCLUSIONS: Maximizing the use of technology, employing flexibility in program delivery, and institutionalizing processes and protocols improved workflow, efficiency, and program reach. Ongoing partnership and stakeholder communication identify areas for ongoing improvement, engagement, and best practices for sustainability around substance use screening, which are essential with increases in substance use since the pandemic.

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Healthcare-based food assistance programs have the potential to improve patients' food security, but are underutilized. We conducted a qualitative study of user and staff perceptions of an on-site mobile market at a federally-qualified health center (FQHC). Five themes were identified: 1) financial need drives the decision to use the market, 2) people attend specifically to receive healthy food, 3) users feel a connection to the FQHC, which increases participation, 4) social networks increase usage of the program, and 5) long lines, inclement weather, inaccessibility, and inconsistent marketing and communication are attendance barriers. Findings should inform implementation of future healthcare-based food assistance programs.

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BACKGROUND: Health care-based food assistance programs show promise but are underutilized. Strict eligibility requirements and program scheduling may dampen reach and outcomes. OBJECTIVE: To explore factors associated with uptake of a health center-based mobile produce market with no eligibility requirements and few barriers to entry. DESIGN: A cross-sectional analysis of medical record, sociodemographic, environmental, and market attendance data was used. PARTICIPANTS/SETTING: The study sample consisted of 3071 adults (18+ years) who were patients of an urban health center in eastern Massachusetts and registered for the mobile market during the study period of August 2016 to February 2020. MAIN OUTCOME MEASURES: The main outcome measure was monthly market attendance over the study period. STATISTICAL ANALYSES: T-tests and χ2 tests were used to compare market users and never-users. Multiple logistic regression was used to analyze variables associated with market attendance each month. RESULTS: In multiple variable analyses, Supplemental Nutrition Assistance Program enrollment was associated with slightly less frequent monthly market use (odds ratio [OR], 0.989; 95% CI, 0.984-0.994). Day-of, on-site market registration was associated with more frequent monthly use than self-registration on nonmarket days (OR, 1.08; 95% CI, 1.07-1.08). Having a psychiatric or substance use disorder diagnosis was associated with slightly less frequent market attendance (OR, 0.99; 95% CI, 0.98-0.99; and OR, 0.96; 95% CI, 0.95-0.97, respectively) compared with registrants without these diagnoses. CONCLUSIONS: Individual, community-level, and organizational factors are associated with uptake of a free mobile produce market and should be considered when designing programs.

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This scoping review aimed to identify the breadth of healthcare-based food assistance programmes in the United States and organize them into a typology of programmes to provide implementation guidance to aspiring food assistance programmers in healthcare settings. We searched PubMed, Cochrane, and CINAHL databases for peer-reviewed articles published between 1 January 2010 and 31 December 2021, and mined reference lists. We used content analysis to extract programmatic details from each intervention and to qualitatively analyse intervention components to develop a typology for healthcare institutions in the United States. Eligible articles included descriptions of patient populations served and programmatic details. Articles were not required to include formal evaluations for inclusion in this scoping review. Our search resulted in 8706 abstracts, which yielded forty-three articles from thirty-five interventions. We identified three distinct programme types: direct food provision, referral, and voucher programmes. Programme type was influenced by programme goals, logistical considerations, such as staffing, food storage or refrigeration space, and existence of willing partner CBOs. Food provision programmes (n 13) were frequently permanent and leveraged partnerships with community-based organisations (CBOs) that provide food. Referral programmes (n 8) connected patients to CBOs for federal or local food assistance enrollment. Voucher programmes (n 14) prioritised provision of fruits and vegetables (n 10) and relied on a variety of clinic staff to refer patients to months-long programmes. Healthcare-based implementers can use this typology to design and maintain programmes that align with the needs of their sites and patient populations.

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This study assessed relationship between adverse economic events (AEE) and hunger level (i.e., little to no, moderate, severe). A cross-sectional survey was conducted from June to August 2018 in 10 food pantries with 616 food pantry users. Hunger level was assessed by the Household Hunger Scale. AEE were evaluated over the past 3 months. Participants (60.55%) experienced unexpected or increased medical expenses (17.69%), job loss (13.64%), pay reduction (11.85%), and death of a family member (9.09%). Pay reduction (OR = 1.87, 95% CI: 1.12, 3.14) and increased debt (OR = 2.71, 95% CI: 1.92, 3.84) were associated with moderate hunger; death of a family member (OR = 2.43, 95% CI: 1.21, 4.90), pay reduction (OR = 2.95, 95% CI: 1.24, 7.04), and increased debt (OR = 3.46, 95% CI: 1.98, 6.04) were associated with severe hunger. Awareness of AEE can inform public health programs and policies for people in need of additional resources, which is essential in times of increased economic instability.

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To assess the determinants of hunger among food pantry users, the present study used a cross-sectional survey that included a modified Household Hunger Scale to quantify hunger. Mixed-effects logistic regression models were used to assess the relationship between hunger categories and various household socio-demographic and economic characteristics, such as age, race, household size, marital status and experience of any economic hardship. The survey was administered to food pantry users from June 2018 to August 2018 at various food pantries across Eastern Massachusetts with 611 food pantry users completing the questionnaire at any of the 10 food pantry sites. One-fifth (20⋅13 %) of food pantry users experienced moderate hunger and 19⋅14 % experienced severe hunger. Food pantry users who were single, divorced or separated; had less than a high school education; working part-time, unemployed or retired; or, who earned incomes less than $1000 per month were most likely to experience severe or moderate hunger. Pantry users who experienced any economic hardship had 4⋅78 the adjusted odds of severe hunger (95 % CI 2⋅49, 9⋅19), which was much larger than the odds of moderate hunger (AOR 1⋅95; 95 % CI 1⋅10, 3⋅48). Younger age and participation in WIC (AOR 0⋅20; 95 % CI 0⋅05-0⋅78) and SNAP (AOR 0⋅53; 95 % CI 0⋅32-0⋅88) were protective against severe hunger. The present study illustrates factors affecting hunger in food pantry users, which can help inform public health programmes and policies for people in need of additional resources. This is essential particularly in times of increasing economic hardships recently exacerbated by the COVID-19 pandemic.

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In 2021, over 50% of U.S. adults drank alcohol in the past month with over 25% reporting binge drinking, an increase over previous years. Alcohol use is associated with increased risk of accidents, poor birth outcomes, cancer, chronic diseases, and mortality. During the COVID-19 pandemic alcohol consumption and alcohol-related deaths increased. National organizations recommend screening for unhealthy alcohol use in general health care settings as a prevention strategy. This observational study examined alcohol screening rates in primary care practices in Boston, MA in the context of the COVID-19 pandemic, from July 2019 through May 2022. Screening rates were mapped, by month, to the number of COVID-19 cases. Alcohol screening dropped substantially during the first COVID-19 surge but steadily increased to baseline between the second and third surges. This decline was likely due to competing pandemic-related priorities (e.g., testing, urgent care) and the transition to telemedicine. While some health screening cannot be completed virtually, screening for alcohol is possible. Innovative workflow strategies (e.g., pre-visit screening via patient portals, support staff screening using virtual rooming processes) should be considered to avoid future interruptions of screening for unhealthy alcohol use in primary care.

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The pandemic necessitated teaching competencies that allow public health (PH) students to be immediately workforce ready. The shift to virtual learning provided an ideal time to consider pedagogies focused on applied learning opportunities, such as practice-based teaching (PBT). This multi-year, post-test evaluation of one PBT course explored differences in students' competency achievement immediately post-course with different modalities of delivery: fall 2019 in-person (n = 16), summer 2020 virtual (n = 8), and fall 2020 hybrid (n = 15). Using a variety of methods to assess across semesters, the study found virtual and hybrid learning environments resulted in equally high levels of competency achievement as in-person delivery. Regardless of course delivery, students reported, with no difference across semesters, PBT directly contributed to their workforce readiness, helped with acquisition of essential workforce skills such as problem-solving, leadership, and teamwork, and led to skill and knowledge acquisition they would not have achieved in a non-PBT course. The increased emphasis on virtual learning changed the higher education landscape and the need for students to be workforce-ready with the technical and professional skills demanded by the field and offered opportunity to redesign courses with an emphasis on applied opportunities. Virtually delivered PBT is an effective, adaptable, and sustainable pedagogy worth the investment.

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BACKGROUND: Opioid addiction and overdose is a public health problem in the United States and is expected to remain with substance use increasing due to the COVID-19 pandemic. Communities that approach this issue through multi-sector partnerships experience more positive health outcomes. Understanding motivation for stakeholder engagement in these efforts is essential to successful adoption, implementation, and sustainability particularly in the shifting landscape of needs and resources. METHODS: A formative evaluation was conducted on the C.L.E.A.R. Program in Massachusetts, a state heavily impacted by the opioid epidemic. A stakeholder power analysis identified appropriate stakeholders for the study (n = 9). The Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Surveys (n = 8) examined perception and attitudes on the program; motivations and communication for engagement; and, benefits and barriers to collaboration. Stakeholder interviews (n = 6) explored the quantitative findings in more detail. Surveys were analyzed using descriptive statistics and a content analysis with deductive approach was conducted for stakeholder interviews. The Diffusion of Innovation (DOI) Theory guided recommendations for communications to engage stakeholders. RESULTS: Agencies represented a range of sectors and the majority (n = 5) were familiar with the C.L.E.A.R. PROGRAM: Despite the many strengths of the program and existing collaboration, based on the coding densities of each CFIR construct stakeholders identified crucial gaps in the services the program provided and noted that the overall infrastructure of the program could be enhanced. Opportunities for strategic communication to address the stages of DOI align with the gaps identified in the CFIR domains to result in increased agency collaboration and expansion of services into the surrounding communities to ensure sustainability of the C.L.E.A.R. CONCLUSIONS: This study explored factors necessary for ongoing multi-sector collaboration and sustainability of an existing community-based program especially given the changing context from COVID-19. Findings informed both program revisions and communication strategies to promote the program to new and existing collaborating agencies and the community served, and identify effective communication approaches across sectors. This is essential for successful implementation and sustainability of the program, especially as it is adapted and expanded to address post-pandemic times. TRIAL REGISTRATION: This study does not report results of a health care intervention on human participants, however it was reviewed and determined an exempt study with the Boston University Institutional Review Board (IRB #H-42107).

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OBJECTIVES: Schools of public health (SPHs) must train students through real-world situations. Practice-based teaching (PBT) uses immediate application for skill development through multiple modes of delivery including virtual collaborations. PBT provides short-term benefits but is less understood long term. We sought to understand the longer-term impacts of PBT on students, public health agencies, faculty, and SPH administration and determine if the reported benefits of PBT outweigh the challenges. METHODS: We used a mixed-methods pre-post-test evaluation to assess short-term outcomes in spring 2015 and long-term outcomes 3 years later using quantitative and qualitative assessments. The evaluation included 4 PBT courses spanning disciplines in 1 SPH. Participants included students (n = 56), collaborating agencies (n = 9), teaching faculty (n = 7), and SPH administrators (n = 8). RESULTS: Students reported acquisition of competencies, application at follow-up, and being workforce ready (91.0%) with greater appreciation 3 years post-semester (78.6%). Collaborating agencies reported successful implementation of deliverables (77.8%) and enhanced networks (88.7%) with cost savings and better outcomes for the communities served. Faculty recognized beneficial outcomes to students including workforce preparation (71.4%), and administration recognized the benefits and worth of PBT to the school for teaching (100%) and research opportunities (87.5%). CONCLUSIONS: Given the shifting higher education landscape as a result of the pandemic, public health courses are being redesigned to provide opportunities for skill development, regardless of delivery mode, and enhanced connections to the field are essential. PBT is a flexible pedagogy that results in lasting and innovative resources to agencies and prepares public health students with technical skills and professional competencies to be workforce ready.

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Background: There is growing demand for developmental and behavioral pediatric services including autism evaluation and care management. Clinician trainings have been found to result in an increase of knowledge and attitudes. This study utilizes Normalization Process theory (NPT) to evaluate a clinician training program and its effects on practice. Methods: The year-long virtual training program about autism screening and care management included didactic portions and case presentations. Focus groups and interviews were conducted with primary care clinicians (n = 10) from community health centers (n = 6) across an urban area five months post-training. Transcripts were deductively coded using NPT to uncover barriers to implementation of autism screening and care, benefits of the training program, and areas for future training. Results: Participants were motivated by the benefits of expanding and improving support for autistic patients but noted this effort requires effective collaboration within a complex network of care providers including clinicians, insurance agencies, and therapy providers. Although there were support that participants could provide to families there were still barriers including availability of behavior therapy and insufficient staffing. Overall, participants positively viewed the training and reported implementing new strategies into practice. Conclusion: Despite the small sample size, application of NPT allowed for assessment of both training delivery and implementation of strategies, and identification of recommendations for future training and practice sustainability. Follow-up focus groups explored participants' practice five months post-program. Variations in participants' baseline experience and context at follow-up to enable application of skills should be considered when using NPT to evaluate clinician trainings.

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BACKGROUND: Strategies selected to implement the WHO's Surgical Safety Checklist (SSC) are key factors in its ability to improve patient safety. Underutilization of implementation frameworks for informing implementation processes hinders our understanding of the checklists' varying effectiveness in different contexts. This study explored the extent to which SSC implementation practices could be assessed through the i-PARIHS framework and examined how it could support development of targeted recommendations to improve SSC implementation in high-income settings. METHODS: This qualitative study utilized interviews with surgical team members and health administrators from five high-income countries to understand the key elements necessary for successful implementation of the SSC. Using thematic analysis, we identified within and across-case themes that were mapped to the i-PARIHS framework constructs. Gaps in current implementation strategies were identified, and the utility of i-PARIHS to guide future efforts was assessed. RESULTS: Fifty-one multi-disciplinary clinicians and health administrators completed interviews. We identified themes that impacted SSC implementation in each of the four i-PARIHS constructs and several that spanned multiple constructs. Within innovation, a disconnect between the clinical outcomes-focused evidence in the literature and interviewees' patient-safety focus on observable results reduced the SSC's perceived relevance. Within recipients, existing surgical team hierarchies impacted checklist engagement, but this could be addressed through a shared leadership model. Within context, organizational priorities resulting in time pressures on surgical teams were at odds with SSC patient safety goals and reduced fidelity. At a health system level, employing surgical team members through the state or health region resulted in significant challenges in enforcing checklist use in private vs public hospitals. Within its facilitation construct, i-PARIHS includes limited definitions of facilitation processes. We identified using multiple interdisciplinary champions; establishing checklist performance feedback mechanisms; and modifying checklist processes, such as implementing a full-team huddle, as facilitators of successful SSC implementation. CONCLUSION: The i-PARIHS framework enabled a comprehensive assessment of current implementation strategies, identifying key gaps and allowed for recommending targeted improvements. i-PARIHS could serve as a guide for planning future SSC implementation efforts, however, further clarification of facilitation processes would improve the framework's utility. TRIAL REGISTRATION: No health care intervention was performed.

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Health is influenced by a broad range of factors beyond the typical remit of public health. It is therefore increasingly recognized that multiple sectors need to be engaged to improve population health. Health in All Policies (HiAP) is an approach to systematically consider health across policies and programs. This study assessed best practices and gaps in HiAP operationalization to inform practitioners aiming to incorporate HiAP in their work. We used Delaware as a model state to examine operationalization factors in a jurisdiction planning to implement HiAP. Methods included document review, key informant interviews, focus groups, and a questionnaire conducted in Delaware and virtually. Thematic analysis was used to analyze qualitative data to provide information on best practices and gaps in existing HiAP programs and context in Delaware. Descriptive statistics were used to examine collaboration in Delaware and to support or refute qualitative findings. We identified two gaps that can hinder HiAP implementation: 1) HiAP practitioners do not adequately use strategic communications to increase buy-in across sectors; 2) practitioners do not fully recognize the importance of being adaptable throughout HiAP implementation, which hinders sustainability. Qualitative findings from Delaware offer insight to these gaps and opportunities to address them. Refining the essential elements of HiAP to add: 1) strategic communications across sectors and 2) flexibility throughout HiAP implementation may point the way to more successful adoption of HiAP approaches across jurisdictions. This research demonstrated the importance of examining local perspectives on HiAP before implementation based on a jurisdiction's context.

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This paper examines risk factors influencing food insecurity during the first year of the COVID-19 pandemic in a state in the U.S. heavily impacted by it and offers recommendations for multi-sector intervention. The U.S. Census Bureau Household Pulse Survey was analyzed to evaluate the impacts of COVID-19 on food security in Massachusetts from April 2020 through March 2021 using a study sample of 57,678 participants. Food security was defined as a categorical variable (food security, marginal food security, low food security, very low food security) and binary variable (food security and food insecurity). Known or suspected factors that contribute to it, such as childcare, education, employment, housing, and transportation were examined in multivariate logistic regression models. Data imputation methods accounted for missing data. Sociodemographic characteristics, including lower education level and living in a household with children, were determinants of food insecurity. Another factor that influenced food insecurity was economic hardships, such as unemployment, being laid off due to COVID-19, not working due to concerns about contracting or spreading COVID-19, or not having enough money to buy food. A third factor influencing food insecurity was food environment, such as lack of geographic access to healthy foods. Some of these factors have been exacerbated by the pandemic and will continue to impact food security. These should be addressed through a comprehensive approach with public health efforts considering all levels of the social ecological model and the context created by the pandemic.

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CONTEXT: To prepare master of public health graduates for successful application of public health competencies in their careers, accredited schools of public health must identify the knowledge, technical and professional skills needed for practice, and provide opportunities for application of these skills in public health settings. PROGRAM: Practice-based teaching (PBT) is a pedagogical approach where students learn through course instruction while working on a real problem and producing implementable deliverables for a public health agency. Currently, no framework exists for designing, implementing, and evaluating the pedagogy. This article defines PBT for public health and presents a novel 5-step framework, PBT STEPS, to guide faculty in development of a practice-based curriculum for public health education, including (1) securing partnerships, (2) training and technology, (3) engagement and implementation, (4) presenting deliverables, and (5) sizing up the results. IMPLEMENTATION: PBT has been implemented using PBT STEPS in both domestic and global courses, teaching a variety of technical competencies. Collaborating agencies for PBT courses have ranged from small community-based organizations to large departments of public health, to international nongovernmental organizations and to private hospitals. Each step is described and illustrated through a practical example from a past PBT course. EVALUATION: The practical example was evaluated through a mixed-methods approach to assess outcomes for students and collaborating agencies. All students (n = 12) reported significant increases in ability with the technical and professional competencies addressed in the course, and all agencies (n = 3 representing 5 distinct projects) reported utility of the final deliverables to the agency and populations served. DISCUSSION: Evidence-informed, feasible, and innovative solutions created through PBT collaboration provide significant benefits to the agency and the communities they serve while successfully training students for the public health workforce. Utilizing the PBT STEPS framework allows for successful and productive academic and community collaborations.

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Modifying the school food environment is on the national agenda as one strategy to improve the nutritional quality of children's diets. Because few environmental-level interventions have been rigorously evaluated, the evidence base to inform programs and policies is limited. Of concern is the impact that changes to cafeteria offerings will have on participation in school meal programs. This study evaluates school lunch participation in the setting of a year-long middle school cafeteria intervention by examining the association between body mass index (BMI), sociodemographics, and the purchases of school lunch meals. IMOVE meals were healthier choices that met stringent nutritional criteria and were offered alongside standard lunch meals. Students who were overweight had a significantly higher purchase rate for both types of meals compared to those with a healthy BMI. Non-white race, younger age, being male, and low-income status were also significantly associated with participation in school lunch. Results indicate that nutritionally vulnerable students participate in school lunch and are equally likely to buy healthy alternatives or standard meals. This behavioral observation has important implications for school foodservice programs and policies. These results are timely given recent federal legislation to improve the school food environment to influence students' food choice behaviors.

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OBJECTIVES: We conducted a pilot study of the Integrated Vaccine Surveillance System (IVSS), a novel active surveillance system for monitoring influenza vaccine adverse events that could be used in mass vaccination settings. METHODS: We recruited 605 adult vaccinees from a convenience sample of 12 influenza vaccine clinics conducted by public health departments of two U.S. metropolitan regions. Vaccinees provided daily reports on adverse reactions following immunization (AEFI) using an interactive voice response system (IVR) or the internet for 14 consecutive days following immunization. Followup with nonrespondents was conducted through computer-assisted telephone interviewing (CATI). Data on vaccinee reports were available real-time through a dedicated secure website. RESULTS: 90% (545) of vaccinees made at least one daily report and 49% (299) reported consecutively for the full 14-day period. 58% (315) used internet, 20% (110) IVR, 6% (31) CATI, and 16% (89) used a combination for daily reports. Of the 545 reporters, 339 (62%) reported one or more AEFI, for a total of 594 AEFIs reported. The majority (505 or 85%) of these AEFIs were mild symptoms. CONCLUSIONS: It is feasible to develop a system to obtain real-time data on vaccine adverse events. Vaccinees are willing to provide daily reports for a considerable time post vaccination. Offering multiple modes of reporting encourages high response rates. Study findings on AEFIs showed that the IVSS was able to exhibit the emerging safety profile of the 2008 seasonal influenza vaccine.

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AIM: To assess the effects of binge drinking on students' next-day academic test-taking performance. DESIGN: A placebo-controlled cross-over design with randomly assigned order of conditions. Participants were randomized to either alcoholic beverage [mean = 0.12 g% breath alcohol concentration (BrAC)] or placebo on the first night and then received the other beverage a week later. The next day, participants were assessed on test-taking, neurocognitive performance and mood state. PARTICIPANTS: A total of 196 college students (>or=21 years) recruited from greater Boston. SETTING: The trial was conducted at the General Clinical Research Center at the Boston Medical Center. MEASUREMENTS: The Graduate Record Examinations(c) (GREs) and a quiz on a lecture presented the previous day measured test-taking performance; the Neurobehavioral Evaluation System (NES3) and the Psychomotor Vigilance Test (PVT) measured neurocognitive performance; and the Profile of Mood States (POMS) measured mood. FINDINGS: Test-taking performance was not affected on the morning after alcohol administration, but mood state and attention/reaction-time were affected. CONCLUSION: Drinking to a level of 0.12 g% BrAC does not affect next-day test-taking performance, but does affect some neurocognitive measures and mood state.

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BACKGROUND: This study assessed the effects of heavy drinking with high or low congener beverages on next-day neurocognitive performance, and the extent to which these effects were mediated by alcohol-related sleep disturbance or alcoholic beverage congeners, and correlated with the intensity of hangover. METHODS: Healthy heavy drinkers age 21 to 33 (n = 95) participated in 2 drinking nights after an acclimatization night. They drank to a mean of 0.11 g% breath alcohol concentration on vodka or bourbon one night with matched placebo the other night, randomized for type and order. Polysomnography recordings were made overnight; self-report and neurocognitive measures were assessed the next morning. RESULTS: After alcohol, people had more hangover and more decrements in tests requiring both sustained attention and speed. Hangover correlated with poorer performance on these measures. Alcohol decreased sleep efficiency and rapid eye movement sleep, and increased wake time and next-day sleepiness. Alcohol effects on sleep correlated with hangover but did not mediate the effects on performance. No effect of beverage congeners was found except on hangover severity, with people feeling worse after bourbon. Virtually no sex differences appeared. CONCLUSIONS: As drinking to this level affects complex cognitive abilities, safety could be affected, with implications for driving and for safety-sensitive occupations. Congener content affects only how people feel the next day so does not increase risk. The sleep disrupting effects of alcohol did not account for the impaired performance so other mechanisms of effect need to be sought. As hangover symptoms correlate with impaired performance, these might be contributing to the impairment.

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