Objective: The aim of this study was to understand how and why young people drink less or not at all when with their peers. Understanding the subjective experiences of moderate or non-drinkers may help identify protective processes facilitating resilience to cultural norm and influences that encourage excessive alcohol consumption among young people.Design: Semi-structured interviews were conducted with 25 moderate- or non-drinkers aged 17–25 years (13 young women) living in South East England. Interviews explored recent experiences of social situations and encounters that did or did not involve alcohol. Transcripts were analysed using Interpretative Phenomenological Analysis.Results: Analysis identified six conceptually coherent themes clustering within a superordinate theme of a healthy experience of moderate alcohol use or abstention: ‘the sweet spot’. These themes were: feeling good in the body, feeling like you can be who you are, feeling like you belong, making a free choice, enjoying the moment, and feeling safe and secure.Conclusions: This resilience-based analysis showed how non-drinking and moderate-drinking may be experienced as a positive and proactive choice. Understanding the subjective experiences of young people may aid development of specific, realistic interventions to promote moderate drinking and abstention among young people in drinking cultures. Encouraging young people to drink less can have compelling benefits for their health and psychological well-being, and for public health. Alcohol consumption is one of the world’s leading risk factors for disease and injury, with the highest proportion of the disease burden carried by people aged 15–29 years  and the level of social and cultural context  aged 17–25 years participated: 9 younger moderate drinkers, 8 older moderate drinkers, 7 older non-drinkers, and 1 younger non-drinker. Nineteen participants were of ‘white British’ or ‘other white’ background; four were South Asian; one was of mixed White and South Asian descent; and one was Chinese. Most, but not all, participants were students. Fifteen were in full-time education. Seven worked alongside full-time study. One was solely in part-time employment, one was employed full-time, and one was not employed or in education.Ethical approval was granted by the host university. Semi-structured interviews lasting between 40 and 110 min were conducted by the first author, a 28-year old White woman: 23 in a private room at the host university, one at a college and one at a community organisation. Interviews focused on participants’ experiences of social situations in which they had the option of consuming alcohol to provide a rich account of the lifeworld suitable for interpretative phenomenological analysis  which suggests that abstention could feel undesirable in certain circumstances.[I prefer] having full control of everything and [being] on a high I guess, rather than having that one drink too much and then just kind of sort of coming down … and wanting to go home ‘cos you’re ill.Gaby  identified other key features of the ‘sweet spot’:Feeling good, for Gaby, also involved feelings of security and making free choices, but also touched upon a desire to feel physically well and to enjoy the moment. The language of being on a ‘high’ and ‘coming down’ evokes a sense of threshold. The assurance of knowing she can stay on a ‘high’ is worth refraining from the ‘one drink too much’. Rather than experiencing moderation negatively as a restriction – a mechanism of withholding – moderation is experienced positively as a means of staying in a good place – a mechanism of facilitation.I like letting loose and I like being comfortable, but I don’t mind the being a bit tipsy, that’s kind of fine, but I can’t, I wouldn’t feel comfortable about being drunk.Angela  identified the remaining key features of the ‘sweet spot’:In this extract, Angela conveyed a strong sense of knowing herself, differentiating between being able to be herself (‘letting loose’), and feeling discomfort. She appears less relaxed in this liminal space than John and Gaby  but again identifies moderation as a way to maintain feeling comfortable: in this case, through being herself.In summary, these young people generally experienced ‘feeling good’ as staying in a ‘sweet spot’ along one or more thematic dimensions: feeling good in the body, feeling like you belong, making a free choice, feeling like you can be who you are, enjoying the moment, and feeling safe and secure. We now describe each in turn.anything past [tipsy] I sort of get really tired and a bit grumpy, and I just don’t really feel like partying very much … [so I want to stay in] that stage between tipsy and drunk where, where you sort of get really happy, and you’re up for dancing and stuff.Participants expressed a desire to ‘feel good in the body’ before, during and after drinking. Many participants wished to maintain physical well-being by avoiding the anticipated physical consequences of excessive drinking. Heather  said:Heather, like many other participants, experienced mild alcohol use pleasurably, but was unwilling to pass through a tipping point, beyond which additional alcohol would lead to unpleasant sensations such as illness, loss of control, vulnerability, dehydration or regretted physical or sexual activities. Enjoyment acted as an incentive to avoid excess. For many participants including Heather, moderate, but not excessive, alcohol use was generally associated with pleasurable sensations such as relaxation, heightened sensation, giddiness, expression and disinhibition. Participants reported that they sometimes had to learn that pleasurable sensations such as relaxation or disinhibition could be achieved without alcohol.Gareth, 18+, moderate drinker.The drinks are usually … horrible but if you’re on a tight budget, you’ll buy one anyway, because you know it’s best to have a little bit of a drink to just kind of calm down a bit, ‘cos there’s always the euphoria of being in a club for the first time you feel like oh I can’t dance … If I’m out with a friend maybe just at a pub, I like to have a beer that actually tastes nice’ – Enjoying the taste of drinks was also an important component of feeling good in the body:In this extract, Gareth shifted from experiencing drinks as instruments to facilitate well-being, rather than objects of enjoyment in themselves. Prioritizing sensory pleasures led him to moderate his intake, choosing quality over quantity. His discomfort and anticipation in the club appear key to this utilitarian view of alcohol, contrasting with the pub setting which emphasized pleasure and social connection. Some moderate drinkers such as Angela and Gareth found their discomfort in social situations was eased by shifting to consuming smaller amounts of more enjoyable alcoholic drinks or non-alcoholic drinks: ‘I had like one [cocktail] and that was … enough for me to just be like oh, I’m fine, I don’t need anything else’ . Other moderate and former drinkers felt that learning to enjoy the taste of certain drinks, or to drink despite not enjoying the taste, was associated with feelings of youth and inexperience. Learning to drink entailed training themselves to enjoy or tolerate drinks that did not taste pleasurable, compromising feeling good in the body.In summary, many participants experienced ‘feeling good in the body’ as enjoying feelings of pleasure and exhilaration which they sought to preserve. They also enjoyed the taste of their drinks, whether they contained alcohol or not.‘Feeling like you belong’ meant feeling authentically connected and accepted within one’s interpersonal relationships, especially while drinking.In the grand scheme of things it’s not that serious … it’s not like our friendship was based on alcohol.The ability to maintain a friendship through changes in drinking behaviours could signify relationship integrity. In this extract, Mark  reflected on his enduring relationship with a childhood friend who was briefly unhappy when Mark quit drinking:could have been based on alcohol, as suggested by Iris : ‘The only reason some people want me in their lives is [to] have a companion to get wasted … that’s not really what friendship should be about’. For Iris, alcohol masked incompatibility. Loss of control during drinking was perceived by many moderate drinkers to reveal a shared vulnerability, making the exhilaration of being ‘wasted’ seem like true friendship. Iris asserts it certainly is not. Mark’s account draws particular attention to participants’ common concern that cutting down drinking may threaten a friendship by introducing the question of what the basis of the friendship actually is. For Mark, maintaining his friendship was associated with emotional authenticity and stronger bonds.Referencing the time-frame of their friendship, Mark took a wide view of the ‘scheme of things’, instead of narrowing in on what might otherwise have been a pivotal juncture in the friendship. He situated their friendship on the broader, long-lasting ‘grand scheme’ of intimacy, compatibility and endurance. An implicit option is that the friendship With this threat in mind, refusing drinks tactfully was important to many participants. Returning to Mark: ‘I think my friends … respected when I said no because they knew I [would] get in a bit of a state … [by saying no] you’re kind of a dampener to fun … instead of just saying no and potentially seeming rude it’s sometimes best to … offer a reason’. Without negative judgement Mark suggested that drink refusal might be confused with ‘fun’ refusal. Providing a reason for refusal maintains mutual respect: his friends value his well-being and he values their perspectives. Avoiding being in a ‘state’ may facilitate belonging, since sobriety will prevent him being too incapacitated to socialise.feeling like one belonged. Kathryn  relates:a lot of my friends [at uni] had known people who hadn’t drunk, whereas [growing up] I was like a complete anomaly … I could’ve been an alien.Being ‘seen’ as belonging was important for actually Kathryn, a lifelong non-drinker, described her feelings of alienation during her adolescence quite vividly, placing her as coming from a different planet. She was an ‘anomaly’, but this is something more than simply being outnumbered. Being an ‘alien’ may involve not only having different social practices and values which erect barriers to connection, but, strikingly, implies a ‘seen’ physical difference. This seeing may work both ways, with her viewing her peers from a distance. Elsewhere, Kathryn related finding an accepting friendship group who ranged from moderate drinkers to abstainers. Knowing other non-drinkers and having peers who know other non-drinkers made her teetotal status less salient. Drawing attention to differences with peers was an uncomfortable way of being ‘seen’. It could be the catalyst for feelings of isolation, as shown by Vinay : ‘That’s when I felt left out, seeing how many people going to enjoy themselves and me not being able to’. Feelings of connectedness were maintained by Vinay through engaging in activities where alcohol would not be present, and by others as frequenting clubs and pubs while sticking to soft drinks.In summary, belonging involved feeling that friendships were founded on authenticity. Alcohol was adaptively experienced as demonstrating relationship strength once the social glue of drinking was stripped away. It also facilitated artificial closeness. Being seen as different could involve separation and isolation, particularly for non-drinkers. Participants often valued an accepting peer group with diverse consumption levels.My friends say they wouldn’t want to meet the drunk version of themselves. I don’t like the idea of there being a part of me that I wouldn’t want to know fully.‘Feeling like you can be who you are’ meant feeling like yourself before, during and after drinking. Corinne’s account verbalized common concerns over feeling authentic during instances of social drinking:know who you are, and feeling that sense of self resonate through social drinking situations even when exploring new relationships, identities and activities. Alcohol was seen to introduce a fragmentation which ruptures the true nature of the self as whole. In other participants’ accounts this experience was realized through a felt separation between ‘real’ choices when sober or tipsy and choices made ‘only because I was drunk’. Beyond the ‘sweet spot’, participants felt inauthentic or lost.Here, Corinne  differentiated between a view of the self as comprising alternative ‘versions’, and a coherent view of the self as a core containing many ‘parts’. She believed that her friends perceive a ‘drunk version’ of themselves as a mask, an inauthentic and fragmented representation of who they really are, creating a distance between this ‘drunk version’ and the implied ‘real self’. By contrast, a ‘drunk’ Corinne would be ‘a part of me’. Self-knowledge is a revelatory process of developing relationships: parts of the self are like friends she can get to know, but they still belong to a whole, retaining a sense of closeness. Being who you are involved feeling like you Everyone has their own … values, like own ideas and own perception of themselves, like, what to do and what not to do … I do what makes me feel comfortable … instead of like, doing the opposite which makes me feel uncomfortableRecognizing ‘who you are’ required understanding one’s personal values, as Ting  explained:For Ting, a strong understanding of her values and a reflective self-awareness reliably guided moderation in drinking. ‘Everyone’ has these resources, but must choose whether to explore and engage with them. In other accounts, self-beliefs incorporated the opinions of friends, community leaders, and family, with pride in accompanying social roles .when you’re … a bit tipsy, and you feel it’s a bit easier to speak to people … that kind of inhibition was like lowered a bit … it’s just like if this is gonna work I will do itAn important part of ‘feeling like you can be who you are’ is feeling that you do not need alcohol to be yourself. Alcohol could nonetheless be experienced as strategically valuable, as shown in this extract from Lucy’s account :This extract illustrates a common view in these moderate drinkers’ accounts: that alcohol might enable the courage and sociability needed to feel like yourself. In Lucy’s case, this meant feeling more able to express herself in front of colleagues while socialising. Alcohol could therefore be experienced positively, if not un-problematically, as facilitating self-expression. However, beyond the ‘sweet spot’ could lie a jarring disjunction between self-beliefs and the social presentation of the self – feeling like the ‘drunk version of themselves’ (Corinne) did not match their ‘perception of themselves’ (Ting). This negative feeling of disjunction sometimes prompted self-insight: ‘if I’m not enjoying it … that should tell me something’ . Iris realized that her drinking behaviours were not facilitating her well-being. As in Corinne’s extract, parts of the self were experienced in empathic conversation, ‘telling’ her what she really felt.In summary, ‘feeling like you can be who you are’ involved feeling a sense of authenticity about the self which carries through relationships, activities and interests. Limited use of alcohol could align with authenticity, but self-knowledge helped participants recognize boundaries beyond which behaviour jarred with who they believed themselves to be.‘Making a free choice’ meant feeling like the decisions made about drinking, and while drinking, were truly one’s own. Making a free choice was also experienced as feeling proud about making drinking choices which reflect one’s personality, values and priorities.more was not really free, as demonstrated by Gaby :Me and my friends literally have no idea what happened ‘cause all of us obviously went out with the same intentions … to stay sober (laughs) and the opposite happening.Drinking more than intended could mean feeling like the choice to drink As suggested by Gaby’s laughter, a limited loss of control was part of the thrill of drinking. It also entailed risks of getting carried away in the moment. For Gaby and others, intentions set when sober might be overpowered by the physical effects of alcohol, the seduction of feeling even better by drinking more, or social encouragement. For some, drinking involved a voluntary, limited loss of control, with feelings of exhilaration, escape, and unpredictability. However, choosing to lose control could entail regret or victim-shaming when negative consequences were perceived. Many identified this as incentive to limit their drinking.When people talk about peer pressure to drink I’m just like ‘doesn’t exist’. I’ve never felt any pressure to, I do it because I’ve chosen to, not because someone’s forced me to … [‘peer pressure’] sounds like people are just like ‘Drink drink drink’ … I’ve never had someone be like that to me, or … it was only jokingly.Participants distinguished between engaging with norms about drinking and experiencing autonomy in social situations. Returning to Gaby’s account:Gaby suggested that her actions were not directly affected by social pressures in specific interactions. She, like nearly all participants, was generally resolute that her choices were ultimately her own. Instead, she experienced expectations for cultural practices, such as being ‘jokingly’ egged on. Participants reported experiencing expectations to drink through socialising at pubs and parties, purchasing rounds or playing drinking games, fixed ideas of a ‘good night out’ and wanting to experience excess in order to develop personal boundaries.not to drink was experienced as freethinking individuality. Social acceptance and admiration were not required, but were welcomed.Many accounts also referenced cultural norms of drinking as an important part of emerging young adult socializing, associated with freedom from parents or authority figures. However, this could contribute to a ‘teenage drama-y atmosphere’ in which peers were overly interested in one’s personal choices about alcohol: ‘at first some people got pissed off, but then … everyone was like well she can do what she likes’ . Choosing to drink can, in such situations, signify autonomy. For Lucy, and particularly amongst abstainers, choosing Participants experienced ‘making a free choice’ as feeling that their choices were truly their own. Choices were contextualized within positively-experienced desires to cede control in thrilling situations, and more limiting norms.‘Enjoying the moment’ was perhaps the most constant dimension of well-being across participant accounts, experienced as joy or contentment in activities and relationships, regardless of the amount of drinking.fun. Gaby bluntly illustrated the contrasting case: ‘there’s no need to get yourself into that state, it’s not enjoyable, you’re gonna get taken home, miss what you paid £200 for’ . If drinking should be fun, then moderating intake in order to enable enjoyment was perceived as desirable, if sometimes hard to achieve. Like Gaby, participants across ages and consumption levels perceived excess as a waste of time and resources, and many reflected on whether or not pubs and clubs were enjoyable places.At its most basic, enjoying the moment involved, simply, I’ve enjoyed being with my friends and I’ve enjoyed like dancing and spending time with them … when they drink they become more fun in some ways … and I’m happy for those people. But I don’t feel like I need [it].More deeply, ‘enjoying the moment’ involved feeling that the experience of fun was not dependent on alcohol, as indicated by Corrine’s extract:For Corinne , ‘feeling good’ meant feeling connected, enjoying the situation, and enjoying her friends’ company even when they had consumed alcohol. The underlying work involved in building a good moment, in the immediate sensory and social experience, appeared in her sense of security in interpersonal bonds and authenticity in self-expression. As a non-drinker who proudly socialized primarily with drinkers, Corinne’s extract draws attention to the centrality of participants’ experiences of shared enjoyment with friends to the ‘sweet spot’. Her tone demonstrates a loving and non-judgemental attitude towards her friends, while directly acknowledging her own reservations about drinking.I know in my heart of hearts actually I’ve got it going good because I do my art work, I have my friendship groups … I can enjoy being with them, with or without alcohol.Corrine’s extract also hints at the work of building a good moment, exemplified in this extract from Angela :For Angela, ‘going good’ was experienced as having other meaningful interests, preferences and priorities, that facilitated personal expression, creativity and social connectedness. Having friends with interests beside alcohol was important for Angela, as it was for a number of participants. Being able to identify ‘going good’ involved an awareness of what she found fulfilling (in her ‘heart of hearts’). Self-knowledge might direct a person towards other ways of ‘enjoying the moment’, so that alcohol becomes incidental. Conversely, refusing alcohol may also bring self-knowledge: particularly within accounts of young men non-drinkers, this choice was experienced as opening up new social worlds through activities such as fitness and music. Saying ‘no’ to excessive drinking could mean saying ‘yes’ to other experiences.abstaining from an experience of social drunkenness, and more as facilitating enjoyment.Enjoying the moment, therefore, involved an immediate sense of fun and having time and resources to pursue valued interests unrelated to drinking. Social life and self were not primarily defined by drinking practices. In this way, refusing alcohol was experienced less as My friends are there so that if anything does happen … I just feel very comfortable, I feel able to try things really … [Sometimes] if I get drunk [other] people are going to give me a hard time, and probably make me do something silly and embarrass me, and those people are probably going to look after me … I don’t want to be in either of those places so I’m not going to drink.‘Feeling safe and secure’ meant feeling a fundamental sense of control about oneself and one’s environment. This might involve exploring, discovering and challenging boundaries within a safe environment, as demonstrated in this extract from Joseph’s account:social and emotional experiences . ‘Feeling safe and secure’ therefore extended to emotional and social security. As shown here, security involved feeling connected to reliable caretakers such as friends, parents, siblings, and medical personnel. Avoiding risk entirely was not desirable to Joseph: he valued feeling able to ‘try things’. Attraction to managed risk ran through the accounts of many moderate drinkers: ‘feeling safe and secure’ could involve a temporary, exploratory and experimental loss of control, with no lasting emotional, instrumental or physical effects upon the self, others or valued priorities. Advance planning could facilitate this sense of security, such as through discussions with friends about how to party safely, arranging lifts home, or testing out a club with a more experienced friend.Joseph  felt able to ‘try things’ within the realm of normative risks, bolstered by reassurance that his friends were there to help. He expressed pride in refusing alcohol when drinking might exploit his friends’ good will or introduce uncomfortable levels of social risk. Joseph’s extract illustrates how feeling safe and secure is not restricted to concerns about sexual predation, criminal or antisocial activity, and physical safety, although these concerns underlie many participants’ experiences. Participants also expressed concerns about negative provide support, as Joseph suggested later: ‘my friends very much respect me for thinking that [supportive] way’. It was important, however, that this contribution be valued and reciprocal: ‘my role on a night out was always to be like the primary carer, and people’s friends, parents would be happy with that ... because they knew their kids would be ok, and I was like, this isn’t really fair’ . Kathryn resented this exploitation of her caretaking role. Whereas Joseph experienced inclusion within the friendship group through his support provision, Kathryn experienced division from her peers, reducing her presence from friend to a ‘carer’ ‘role’ in substitute for parental supervision. As with other themes, feelings of authenticity and connection can be identified here as guideposts through which safety behaviours may be experienced as enabling well-being, instead of placing restrictions.Feeling safe and secure could also mean feeling available to ‘Feeling safe and secure’ involved negotiating between challenge and thrill-seeking on one hand, and comfort and stability on the other. Safely losing control could feel exhilarating. Feeling able to receive and provide support through valued relationships was important to sustaining a feeling of enjoyable, and safe, social interaction.Feeling good in the body entailed feeling good physically before, during and after drinking. Feeling like you belong involved feeling authentically connected to and accepted by one’s significant others. Making a free choice meant feeling like the decisions made about drinking, and while drinking, are truly one’s own. Feeling like you can be who you are entailed feeling that the self expressed when drinking is really ‘you’. Enjoying the moment was experienced as having a good time regardless of the amount consumed. Finally, feeling safe and secure meant feeling a sense of control about the self and the environment. These dimensions varied in significance and expression across individuals but were generally present to some degree in all accounts.A resilience-based analysis identified a ‘sweet spot’ of multidimensional subjective well-being characterized by feelings of enjoyment, control, release, and a lack of regret with respect to low-risk drinking and abstention. The sense of balancing enjoyment with restraint to continue to experience well-being was captured in the thematic cluster of the ‘sweet spot’ and its six composite dimensions. maintaining ‘the sweet spot’ capture a sense of proactivity and agency. Ultimately, alcohol resilience is more than alcohol refusal, although it is that, too: it is actively choosing to stay in one’s ‘sweet spot’.Within the frame of meaning-making offered by our analytical method, we suggest that the ‘sweet spot’ is a coherent conceptual rendering of subjective alcohol resilience among young people in a drinking culture. Whether this corresponds to observable behaviour and measures of psychological and physical health is a matter for future research. However, among participants who were below the threshold for high-risk alcohol consumption, the ‘sweet spot’ captured lived experience of subjective well-being in social situations where drinking was an option. It incorporates meaning-making and perceived growth in the face of challenging encounters, relationships and spaces, situated against a cultural context of alcohol-based risk. Yet ‘feeling good’ is not a passive state: participants’ experiences of The findings suggest the utility of developing experienced-based definitions of optimal drinking experiences, capturing resilience in the face of culturally-situated alcohol risk. The ‘sweet spot’ may be a useful guiding concept, providing a positive experience to aim for and reassurances of feasibility that support behaviour change (Abraham et al., The analysis revealed that, contrary to much prior research, peer influences may be experienced as adaptive in the realm of alcohol use. The risks of peer influence are well-documented: alcohol consumption is associated with a peer-oriented lifestyle and peers’ consumption (de Visser et al., Many frameworks of youth resilience (e.g. Hart et al., start drinking, then stop. This dance between engagement in and disengagement from a behaviour is more broadly reflected in participants’ experiences of balancing a threshold of well-being. We suggest that one novel component of alcohol resilience is adeptness with balancing competing desires and coming to a resolution which lies within the ‘sweet spot’. Participants negotiated desires to feel safe and take risks; to feel present and alter the senses; to feel exhilarated and avoid sickness; to conserve and push boundaries. This sense of threshold was particularly evident in ‘feeling good in the body’ and ‘feeling safe and secure’. It also involved feeling present to experience well-being, even amid experimentation. Important facilitators of this experience were practical planning in relation to safety, using social support and self-knowledge to practice a boundaried loss of control and using embodied experience to monitor well-being. The thresholds of well-being may be rendered visually as the boundaries of the hexagons in Figure Analysis highlighted a unique challenge for moderate drinkers: they must first The resilience-based approach used here invites conversation about strengths-based positive approaches to preventing problems of alcohol use that incorporate young people’s subjective perspectives Cheon, . A frameadaptive social influences, psychosocial interventions may aim to build psychosocial skills, strengthen accuracy of social drinking norms and shift perceptions among friendship groups regarding drinking quantities, frequency and social facilitation (Foxcroft & Tsertsvadze, Our findings suggest that interventions focusing on developing social integration, social support, sense of core self, self-efficacy, self-monitoring and planning may be particularly effective in developing resilience in the face of cultural alcohol risk. In the domain of developing self-based strengths while acknowledging the social nature of alcohol use to calibrate feasibility and explore anticipated barriers to change. The importance of ‘making a free choice’ supports previous indications of the utility of enhancing moderate drinking self-efficacy (Atwell, Abraham, & Duka, Interventions might focus on balancing a threshold of well-being. This construct resonates with previous research that has identified adaptive functions of moderate social drinking experiences such as social facilitation, altering mood, stress relief, or providing temporary escape from difficulties (Bernstein et al., Finally, we suggest exploring interventions focused on We acknowledge limitations to this research, which in turn suggest directions for future research exploring the concept of the ‘sweet spot’ and clarifying its relationship to drinking patterns and other health behaviours. First, this study aimed to explore subjective experiences. We therefore did not assess individuals’ alcohol consumption beyond using prior reports of alcohol intake to inform our sampling by categorizing participants as non-drinkers or moderate drinkers. Using objective consumption criteria to direct investigation of a subjective experience is a valuable use of a pragmatic mixed-methods approach (de Visser et al., Second, our findings may be argued to promote alcohol use by positioning moderate alcohol use within the realm of healthy behaviour patterns. We caution against this interpretation. In the absence of changes to legislation, cultural alcohol risk may never disappear entirely. Positive adaptation is a continual process of experiencing psychological change as one encounters and responds to challenges. It may be therefore be useful to complement abstention approaches with a harm-minimisation approach aimed at the wider population of general alcohol drinkers (Danielsson et al., Finally, it is unclear whether the experience of the ‘sweet spot’ is specific to alcohol use. Research using other age groups, cultural contexts or methodologies might yield different findings. It is important to continue to explore the potential adaptive benefits of friendships and peer groups. Researchers might explore whether young people who are skilled at staying within their ‘sweet spot’ better manage other health risks in which peers and cultural norms influence individual behaviour, such as smoking, substance use and sexual risk-taking (Avry, Duncan, Duncan, & Hops, We suggest that the construct of the ‘sweet spot’ is a coherent conceptual rendering of subjective alcohol resilience among young people in a drinking culture. Our findings highlight the importance of adaptive social relationships, self-based strengths and balancing a threshold of well-being across six identified dimensions of optimal drinking experience. Researchers and practitioners are encouraged to continue engaging with young people’s lived experience in order to develop effective behavioural interventions and community-based policies to improve individuals’ psychological well-being and minimise alcohol-related harm.


Salmonella belongs to the latter class. This regulatory RNA exists in two isoforms. The first forms, when a portion of transcripts originating from isrK promoter reads-through the IsrK transcription-terminator producing a translationally inactive mRNA target. Acting in trans, the second isoform, short IsrK RNA, binds the inactive transcript rendering it translationally active. By switching on translation of the first isoform, short IsrK indirectly activates the production of AntQ, an antiterminator protein located upstream of isrK. Expression of antQ globally interferes with transcription termination resulting in bacterial growth arrest and ultimately cell death. Escherichia coli and Salmonella cells expressing AntQ display condensed chromatin morphology and localization of UvrD to the nucleoid. The toxic phenotype of AntQ can be rescued by co-expression of the transcription termination factor, Rho, or RNase H, which protects genomic DNA from breaks by resolving R-loops. We propose that AntQ causes conflicts between transcription and replication machineries and thus promotes DNA damage. The isrK locus represents a unique example of an island-encoded sRNA that exerts a highly complex regulatory mechanism to tune the expression of a toxic protein.While an increasing number of conserved small regulatory RNAs (sRNAs) are known to function in general bacterial physiology, the roles and modes of action of sRNAs from horizontally acquired genomic regions remain little understood. The IsrK sRNA of Gifsy-1 prophage of  Salmonella. Here, we report a complex mechanism in which the IsrK RNA functions as both sRNA and mRNA to control the production of the toxic AntQ protein. The isrK promoter directs the synthesis of two distinct RNA species: a full-length translationally inactive target mRNA and the correctly terminated, shorter IsrK sRNA. IsrK sRNA binds the full-length inactive mRNA producing an antiterminator protein, AntQ, which interferes with transcription termination. Expression of antQ results in bacterial growth arrest and ultimately cell death. Fluorescence microscopy of E. coli and Salmonella expressing antQ revealed condensed chromatin morphology as observed upon exposure to DNA-damaging agents. We propose that expression of the phage antiterminator protein results in conflicts between transcription and replication machineries and thus facilitates DNA damage. In summary, the RNA regulator IsrK presents a new regulatory principle in which a horizontally acquired sRNA controls genome integrity.As the function of conserved core-genome-encoded small RNAs (sRNA) reflects the basic lifestyle of bacteria, the function of non-conserved island-encoded sRNAs remains enigmatic. The island-encoded sRNA IsrK belongs to Gifsy-1 prophage of  Thereafter, in vitro synthesized IsrK or IsrKG31A RNAs were added as indicated in the Fig and incubated for 15 minutes at 37°C. The RNA samples were analyzed on 5% non-denaturing polyacrylamide gels (19:1) run at 50 volts in 20 mM Tris-HCl (pH 7.5), 60 mM KCl and 10 mM MgCl2 for 5–6 hours at 4°C as described before [orf45 specific primer (1948). To detect RNA conformations the template RNAs wild type and mutants  were incubated in Native Buffer (as above) for 15 minutes at 37°C and then analyzed as describe above. The RNAs were also analyzed on denatured gels (see orf45 specific primer that detects isrK-orf45 templates (1948).To detect binding of IsrK to its templates d before . After igels see  using enin vitro (0.7–1 pmol) was incubated in 50 mM Na-cacodylate (pH 7.4), 10 mM magnesium acetate, 100 mM NH4Cl and 2.5 mM β-mercaptoethanol for 3 minutes at 70°C and chilled on ice for 10 min. Thereafter, in vitro synthesized wild type IsrK or IsrKG31A (7–10 pmol) was added and the mixture was incubated for 15 minutes at 37°C. Pre-activated (30 minutes at 37°C) 30S ribosomal subunits (1.2–2.4 pmol) were added for 5 minutes prior to the addition of uncharged fMet-tRNA (12 pmol). The binding reactions were incubated for 15 min before DMS  was added. The modification reaction was allowed to proceed for 5 minutes. Reactions were stopped with phenol/chloroform and precipitated with ethanol in the presence of 0.3 M sodium acetate, 1 μl of Quick-Precip (Edge BioSystems) and 20 μg yeast RNA. The modification sites were detected by primer extension using MMLV reverse transcriptase (Promega) and end-labeled primer (1948).Template RNA synthesized Fluorescence microscopy was carried out as described previously . In brieS1 FigSalmonella wild type and cells deleted of SL2575 and SL2576 genes encoding proteins of phage lysis and phage lysozyme superfamily, respectively, were transformed with Ptac plasmid and Ptac-isrK, expressing IsrK constitutively.(PNG)Click here for additional data file.S2 FigSalmonella, wild type, ΔantQ::frt and ΔanrP::frt were transformed with Ptac plasmid and Ptac-isrK expressing IsrK constitutively (A). (B) Salmonella deleted of the entire locus between antQ and the Gifsy-1 lysis genes SL2575-SL2576 (including) was transformed with plasmids expressing anrP or antQ from Ptac promoter under the control of LacI repressor (pKK177-3-lacI). The transformations were plated on LB plates supplemented with IPTG (0.05 mM) and antibiotics. Plasmids are denoted in red.(PNG)Click here for additional data file.S3 FigisrK promoter in the chromosome (ΔPisrK) as well as cells carrying a control plasmid (PBAD) or an isrK expressing plasmid (PBAD-isrK) as indicated. Cultures carrying plasmids were induced with arabinose at dilution. (A) 1% agarose formaldehyde gel detecting the full-length transcript isrK-orf45-anrP-isrJ. The membrane was probed with 5’-end labeled IsrK and IsrJ specific primers. (B) 6% urea-PAGE detecting short IsrK (77nt) both chromosomally (lanes 1–3) and plasmid encoded (lanes 4–9). It is interesting to note that the northern also detects a stable transcript (isrK-orf45’) that was generated by processing of the long polycistronic transcript, (lanes 1–3 and 6). The membrane was probed with end-labeled isrK specific primer. The left panel (lanes 1–3) was exposed longer (3x) than the right panel. (C) 6% urea-PAGE carrying RNA extracted from cultures of wild type and ΔPisrK grown for 3 (OD600 of 1.0), 8 and 11 hours as indicated. The membrane was probed with fully labeled antisense of orf45’. The riboprobe detects two RNA species that are generated by processing of the read-through transcript; a ~180 nt long RNA  and a small species of ~ 80 nt that is generated by further processing of isrk-orf45’. The truncated RNA species (orf45’) was also detected in Salmonella’s transcriptome (see isrK. Both short isrK and isrK-orf45’ that is generated by processing of the long polycistronic transcript are detected in response to exposure to hydrogen peroxide (see isrK specific primer. 5S RNA serves as a loading control.Northern blot of RNA extracted from wild type and cells deleted of the (PNG)Click here for additional data file.S4 FigisrK) (A) or AnrP (Ptac-anrP-lacI) (B). SL2581 is the second gene in antQ operon [antQ). Salmonella carrying control, IsrK, and AnrP expressing plasmids were exposed to arabinose and IPTG to activate PBAD and Ptac promoters, respectively Click here for additional data file.S5 FigisrK locus. Cultures of S. typhimurium wild type and isrK promoter deletion mutant (ΔPisrK::frt) carrying PBAD and PBAD-isrK were grown with arabinose to induce isrK expression for two hours. Thereafter, their phages were released by chloroform and plated on LT2 (lambda sensitive) as described in isrK locus. Wild type, (ΔPisrK::frt), and Gifsy-1 lysis proteins deletion mutant (ΔSL2575-SL2576::frt) carrying Ptac-anrP-lacI were grown with IPTG to induce expression of anrP and their phages were collected and plated on LT2 (lambda sensitive) as described in (A) Gifsy-1 phage induction by IsrK requires an intact (PNG)Click here for additional data file.S6 FigantQ and SL2581 mRNAs expressed upon phage induction by hydrogen peroxide as indicated in the Fig. Samples were taken and assayed as described in antQ operon [antQ). Two samples per treatment and two reactions per sample were analyzed.Real-Time PCR of (PNG)Click here for additional data file.S7 Figorf45 and anrP are marked in red. Complementary nucleotides between isrK and orf45 are marked in green. The black arrows under the green sequences denote the position and the orientation of basepairing.Representative genera from the original analysis (blast) are shown. Initiation and stop codons of (PDF)Click here for additional data file.S8 Figdysenteriae orf45 seem to be fused to anrP (287 amino acids).The signs represents full identity (*) conservation (.) and semi conservation (:). Red asterisks represent stop codons. In S. (PDF)Click here for additional data file.S9 FigisrK-orf45 and mutant isrKG31A-orf45 were incubated for 15 minutes at 37°C in the presence of increasing amounts of IsrK, as indicated. The samples were separated on non-denaturing polyacrylamide gels. Arrows indicate the two conformations observed. The target-RNAs were detected using an orf45 specific labeled primer (1948). Analysis of the RNA samples on denaturing gels exhibits one form (see RNAs (0.2 pmol), wild type form see .(PNG)Click here for additional data file.S10 FigisrK expressing plasmids; wild type, isrKG28A and isrKG31. (B) Northern blot comparing RNA levels of wild type and isrK mutants. RNA was extracted from cells deleted of the isrK locus (ΔisrK to isrJ) carrying plasmids as in A. Cells were induced with arabinose (0.2%) at the time of dilution and RNA was extracted at OD600 1.0(A) Growth curves of wild type cells carrying control (PBAD) or (PNG)Click here for additional data file.S11 FigIn vitro synthesized RNA templates were incubated with and without 30S ribosomes, IsrK RNA or IsrKG31A prior to the addition of DMS. Thereafter, the samples were treated with phenol as described in (PNG)Click here for additional data file.S12 FigE. coli strains, wild type (MG1655) and a strain deleted of all genetic islands phages and insertion elements (MDS42). The strains were transformed with control and antQ expressing plasmids. IPTG (0.2 mM) to induce expression of antQ was added at dilution. OD600 values were measured at indicated times. (B) Survival assay. The cultures as above were treated with IPTG (0.2 mM) 60 minutes after dilution. Samples were taken prior to the addition of IPTG and 20 and 40 minutes after its addition. Survival rates were calculated using the CFU of the first time point as the 100% reference.Growth curves (A) showing the toxic effect of AntQ in (PNG)Click here for additional data file.S13 Figtac) or antQ expressing plasmids. The cultures were grown and induced with IPTG, as described in SDS-PAGE analysis of total protein extracted from wild type cells carrying control plasmid (P(PNG)Click here for additional data file.S14 FigSalmonella cells carrying plasmids expressing orf45 and/or isrK as indicated. In the absence of tetR, orf45 is expressed constitutively. isrK expression was induced by arabinose as described in the orf45 RNA levels from the PLtetO promoter in the absence of tetR. The membrane was probed with fully labeled antisense of orf45’. The riboprobe detects the long RNA species extending from at the transcription start site of PLtetO to the plasmid encoded T1 terminator. Also visible is the short RNA species (STnc1160) that is generated by processing of the long transcript. STn1160 [orf45 and thus denoted orf45’. The first two lanes also appear in (A) Growth curves of  STn1160  is a tru(PNG)Click here for additional data file.S15 FigisrK, wild type and (ΔPisrK::frt) mutant strains were grown in LB medium to OD600 ~ 0.3, 0.6, 1.0 and for 8 hours or in low MgCl2 N-minimal medium to OD600 ~ 0.3 [isrK from PBAD promoter after induction in (ΔPisrK::frt) mutant strain. (C) Gifsy-1 prophage induction requires expression of the chromosomally encoded isrK. Wild type and (ΔPisrK::frt) mutant strains were grown in minimal medium to stationary phase. Thereafter, phage particles were collected and 15μ of the supernatant were plated on LT2 (lambda sensitive) as described in isrK under these conditions, RNA samples were subjected to RT-PCR as described before.Two samples per treatment and two reactions per sample were analyzed. (A) IsrK RNA levels increase at stationary phase and under low magnesium conditions. To monitor expression of chromosomally encoded-(PNG)Click here for additional data file.S1 Table(DOCX)Click here for additional data file.S2 Table(DOCX)Click here for additional data file.S3 Table(DOCX)Click here for additional data file.S4 Table(DOCX)Click here for additional data file.S1 Text(DOCX)Click here for additional data file.


Parental alcohol-related practices are important risk factors of adolescent drinking, but little is known about the factors associated with these parental pro-drinking practices (PPDPs). We investigated the correlates of 9 PPDPs in drinking parents of adolescents in Hong Kong.A total of 2200 students  participated in a school-based cross-sectional survey in 2012. Analysis was restricted to 1087 (61.8%) students with at least 1 drinking parent as PPDPs were much more common in these families. Logistic regression was used to identify correlates of each PPDP.Among 1087 students, the prevalence of PPDPs ranged from 8.2% for training drinking capacity to 65.7% for seeing parents drink. Only 14.8% of students had not experienced any of these practices. More frequent maternal drinking predicted parental training of drinking capacity. Older age predicted helping parents buy alcohol and parental encouragement of drinking. Adolescent girls were more likely to have received parental training of drinking capacity than boys. Higher perceived family affluence was associated with hearing parents saying benefits of drinking, and helping parents open bottle and pour alcohol.PPDPs were associated with parental drinking frequency and various socio-demographic factors. These results have implications on alcohol control programmes involving parents to tailor messages for reducing PPDPs based on the characteristics of adolescents and parents. Parental drinking is a well-known risk factor of adolescent drinking –4. HowevWe have recently identified 9 parental practices that may potentially promote alcohol drinking in Hong Kong Chinese adolescents . These pStudying adolescent and parental factors associated with these practices may help identify adolescents at risk of such exposures and understand reasons behind these practices. However, such studies are scarce and all based on Western populations. In an American study, mothers who drank heavily were more likely to be younger, born outside the United States, and had higher education . An EuroDespite alcohol use is glamorized with its purported health  and psycIn the present study, we investigated the correlates of PPDPs in Hong Kong Chinese adolescents. We hypothesized that these practices are generally associated with parental drinking frequency and age of adolescents. Moderate alcohol drinking has been associated with higher socioeconomic status, suggesting that this group is more health conscious and may drink for the perceived benefits of alcohol . SimilarA total of 2200 Secondary 1 (Grade 7 in the United States) to 6 students  from 4 randomly selected schools, including 2 co-education and 2 boy schools in different districts of Hong Kong were recruited for a school-based cross-sectional study in 2012. In order to recruit 4 schools, invitations to 8 schools were made with a response rate of 50%. Time and administrative issues were the main reasons for school refusals. Response rate at the student level was 92% and non-participation was due to absence from school. Parents and students were informed of the survey through an invitation letter. No reply was required for participation and declining parents were to ask their children to return a blank questionnaire during the survey. Student participation was voluntary even with parental consent. Students completed an anonymous questionnaire independently in classrooms. Teachers were present to maintain classroom order and provide guidance based on survey instructions. Completed questionnaires were immediately collected and sealed in an opaque envelope in front of students. Ethical approval was granted by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 12–421), including consent procedure with written consent waived.The students with missing data  were excluded. To account for the differences between our sample and the underlying population in Hong Kong (Cohen effect size 0.06 for age and 0.23 for sex), the remaining 1757 students were weighted to reflect the age and sex distributions of the corresponding general population based on census data for the calculation of prevalence estimates in the present study . WeightiAs a comprehensive list of such practices was not available in the literature, these 9 PPDPs were based on observations, discussions with adolescents and parents, and anecdotal reports. Students were asked “Have you experienced the following situations?” with response options categorized into 4 groups: 1. Saw parents a) drink and b) being drunk; 2. Heard parents mention a) benefits of drinking and b) alcohol tasted good; 3. Helped parents a) buy alcohol, b) open bottle and c) pour alcohol; and 4. Parental actions a) encouraged me to drink and b) trained my drinking capacity. Students chose each option that was applicable. These pro-drinking practices in each student were analysed as individual practices and the total number of practices .Paternal and maternal drinking were assessed by the items “How often did your father/mother drink alcohol in the past 30 days?” in two separate items each with 5 options: “never”, “seldom”, “sometimes”, “always”, “unknown”.Age, sex, family structure, place of birth, highest parental education and perceived family affluence were included as socio-demographic factors. Age was dichotomised as junior (11 or below to 14) and senior (15 or above); family structure as intact (parents together) and non-intact ; and place of birth as Hong Kong and outside Hong Kong . Highest parental education was classified as primary or below, secondary, and tertiary. Perceived family affluence was categorized into low , average, and high .Adjusted odds ratios (AORs) and 95% confidence interval (95% CI) were computed using STATA 10.1. Logistic regression yielded AORs and 95% CI for each PPDP by the above-mentioned socio-demographic factors adjusting for each other and school clustering. School clustering was adjusted using the command “robust clust (school variable)” in STATA 10.1. Linear regression was used to derive the regression coefficients for the number of PPDPs with similar adjustments.We found that PPDPs were correlated with various socio-demographic factors. Older age predicted helping parents buy alcohol and parental encouragement of drinking. It is well known that adolescent drinking increases with age . Our finAdolescent girls were more likely to have received parental training in drinking capacity. Female drunkenness is often linked to sexual harassment and unprotected sex , 25. ParSupporting the hypothesis that pro-drinking practices are associated with higher socioeconomic status, higher perceived family affluence predicted hearing parents saying benefits of drinking, and helping parents open bottle and pour alcohol. Moreover, tertiary parental education also predicted parents saying alcohol tasted good. Higher socioeconomic status has been linked to health consciousness . SimilarStudents born outside Hong Kong, mainly from Mainland China, were more likely to report helping parents buy alcohol. The type of alcohol bought was not recorded but beer or Chinese wines seemed more likely as they would be easier for adolescents to identify and buy than the vast variety of Western wines and spirits. This speculation is consistent with the beer drinking preference of people with lower socioeconomic status that is more common among new immigrants from the Mainland . These pThe results of the present study would be useful for family-based and school-based alcohol control programmes involving parents to tailor contents targeting various PPDPs according to the socio-demographic characteristics of students  and parents . Our results also provide support for persuading parents to drink less, not to drink in front of children and not to involve them in buying alcohol, opening bottles and pouring alcohol. The present study would be particularly relevant also to Mainland Chinese parents who share similar cultural backgrounds.Our study has several limitations. All data were reported by students including PPDPs and parental drinking, although adolescent reports were found to correlate with parental drinking practices . MoreovePPDPs were associated with parental drinking frequency and various socio-demographic factors. These results have implications on alcohol control programmes involving parents to tailor messages for reducing PPDPs based on the characteristics of adolescents and parents.


Under-reporting of alcohol consumption is widespread; surveys typically capture 40-60% of alcohol sales. However the population distribution of under-reporting is not well understood.Mixed-methods study to identify factors associated with under-reporting, using the nationally-representative Health Survey for England (HSE) 2011 . Comparison of retrospective computer-assisted personal interview and seven-day drinking diary  to identify factors associated with diary responses exceeding those of the interview using multivariable linear regression for three outcomes: drinking days in the week recorded, volume consumed on heaviest drinking day in the week recorded, and weekly alcohol consumption. Qualitative semi-structured interviews (n = 10) explored reasons for under-reporting in further detail.Number of drinking days was slightly greater in the diary than the interview (P < 0.001). Reported consumption was higher in the diary than in the interview for heaviest drinking day in the week recorded , and weekly alcohol consumption in women only . Participants who drank more frequently, more heavily, and had a more varied drinking pattern with respect to the types of drink consumed or choice of drinking venues had a larger difference between their diary week and their interview week.The qualitative interviews identified having a non-routine drinking pattern, self-perception as a non-frequent drinker, and usually tracking drinking using experiential approaches as linked to more drinking being reported in the diary than the retrospective interview.Heavy drinking and non-routine drinking patterns may be associated with greater under-reporting of alcohol consumption. Estimates of drinking above recommended levels are likely to be disproportionately under-estimated.The online version of this article (doi:10.1186/1471-2458-14-1297) contains supplementary material, which is available to authorized users. Rather than, um, finessing certain bits or missing certain bits out.Effects of survey mode were apparent; participants made a clear distinction between the diary and the CAPI questions about drinking which reflect a social desirability bias in speaking to an interviewer about alcohol. Six participants said that the anonymity of the self-completion diary led to increased honesty. These participants believed they were likely to make generalisations in the CAPI, compared with the diary: Male, age 35-44, most deprived area quintile, second highest income quintile, employed.You do it, sort of, much quicker after the event. Much more proximity to the event. I mean even if you’d sat down and at the end of the week tried to remember you’d have struggled.Another issue of the survey mode was recall. As the diary was completed in closer proximity to the drinking occasion, recall was easier: Female, age 45-54, second most deprived area quintile, highest income quintile, employed.Although there was a consensus across the interviews that the diary was a more objective - a ‘better’ measure of drinking - the reasons behind this varied, suggesting that the reasons for under-reporting are complex.I knew exactly, pretty well, what I was drinking and I was aware for some time that I was probably exceeding, certainly exceeding 21 units…no I’m quite open about it.Half of participants described their drinking pattern as routine. These participants generally felt they had a good idea of how much they drank before they did the diary: Male, 75+, least deprived area quintile, second highest income quintile, retired.It was actually the fact that sort of done [sic] two or three days in the week where I also drank. Whereas normally I think ‘I don’t drink for four days a week so it’s fine’.Routine drinkers were often older, and did most of their drinking at home. Participants with a varied drinking pattern more commonly recalled experiencing some element of surprise at their alcohol consumption when they completed the diary. Although this surprise concerned the quantity of alcohol consumed to an extent, frequency of drinking was of particular mention, and this often conflicted with participants’ perceptions: I tend to think of myself as somebody who just drinks, you know, maybe Friday and Saturday, and sometimes I thought ‘ooh, I’ve actually had four nights when I’ve had some alcohol this week’.Male, 25-34, middle deprivation area quintile, highest income quintile, employed. Female, age 45-54, second most deprived area quintile, highest income quintile, employed.Having a non-routine drinking pattern and inaccurate perceptions of that pattern were both linked to drinking more in the diary than expected, and could contribute to under-reporting.If the bottle’s empty I know I drank a bottle, don’t I?!Usual methods by which participants tracked their drinking were also associated with whether they experienced any surprise at their alcohol consumption when they completed their diary. Only one participant said units were a helpful way of tracking drinking. Most commonly drinking was tracked as numbers of drinks or fractions of bottles. Put simply: Male, 65-74, least deprived area quintile, income withheld, employed.Friday and Saturday probably not [able to estimate drinks]. You know I wouldn’t be able to put a number on it…it’s how you feel on it. You know, it’s, you get that nice little buzz.Counting drinks was frequently combined with other methods. Of the participants who exclusively used units or counted drinks (n = 5) to track their drinking, few said that they recorded higher alcohol consumption than they would have expected in their drinking diary. Participants who used more experiential approaches to track their consumption tended to recall drinking either larger quantities of alcohol or more frequently than they expected when they completed their drinking diary. Experiential approaches included embodied aspects (perceived level of intoxication) or individualised approaches. Participants who used these approaches to track drinking had varying drinking patterns. Embodied approaches are exemplified by participants who sought certain pleasurable levels of intoxication, with the amount of alcohol consumed to reach that point of little relevance: Male, aged 45-54, second least deprived area quintile, highest income quintile, employed.Individualised approaches were used by two men interviewed. For them, these were a tool used in their daily lives. One participant divided drinking occasions into lighter and heavier using a three-pint rule. For him, drinking was tracked by counting drinks if he had three pints of beer or less, but when drinking more than three pints consumption was no longer relevant (it was just ‘a big night’). The other participant’s approach used was a continuum, whereby consumption was estimated based on the time elapsed since the start of the drinking occasion. The two participants using individualised approaches to track their drinking were quite aware that these had limitations, and the origin of these approaches was unclear. These findings regarding experiential approaches to tracking drinking suggest people who track their drinking in these ways may be more prone to under-report their alcohol consumption.The differences between the prospective and retrospective measures of drinking in the HSE 2011 were modest. Even so, some alcohol-related factors were associated with the diary estimates exceeding those of the CAPI; these included consumption level as well as drink type and drinking venue. In the qualitative interviews, participants with non-routine drinking patterns or using experiential approaches to track drinking found the diary particularly revealing. Together, these findings suggest that alcohol-related factors require further investigation if the population distribution of under-reporting is to be better understood. The findings of this study are not at all consistent with those of recent Canadian study by Stockwell and colleagues. AlthougPrevious studies which have identified factors associated with a difference between two measures of drinking were small , 26, 27,why alcohol consumption is under-reported in social surveys.The qualitative component is a new approach to a quantitative and methodological problem; the findings suggest that a mixed methods approach is potentially useful in this area, and that qualitative research has a place in understanding under-reporting. The fact that participants could volunteer their experiences and ideas about doing the diary has led to a richer and more nuanced understanding of Response to the diary was 69%, and although CAPI measures of alcohol consumption were similar in the diary subsample and the full HSE sample, it is possible that non-responders to the diary were systematically different to responders. A drinking diary weight was computed to adjust for non-response, however, it has been suggested that it may be preferential to use the continuum of resistance model which takes into account the amount of time and effort required to elicit a response (after Lin and Schaeffer) to adjuIt was obviously not possible to identify risk factors for under-reporting the alcohol consumption that was not captured by the diary. A large difference between consumption reported in the diary and alcohol sales remains; if the diary estimates were used alcohol sales coverage would not improve much. The risk factors identified do not explain why alcohol sales coverage is low but they do provide clues for the direction of future research.The quantitative analyses make intra-individual comparisons between two measures of drinking. However, this not comparing drinking in the same week: the diary week and the CAPI week were two different weeks. Therefore our intra-individual comparison is of little value on an individual level. Collectively, however, it is possible to observe whether there is a tendency for diary measures of drinking to exceed those of the CAPI. We restricted our analyses to those who drank in both the diary and the CAPI therefore our findings may be biased by the exclusion of infrequent drinkers.A small number of qualitative interviews was conducted due to resource constraints in terms of the cost of selecting HSE participants through NatCen as well as travel and time. A random sample of 10 individuals would have been cheaper and quicker, but we wanted to explore HSE participants’ unique experience of having completed the drinking diary and CAPI. Saturation was not reached, and it is possible that more - or conflicting - factors would emerge in further interviews. Participants were mainly men (70%) and relatively affluent (which may be somewhat driven by selection on drinking on four or more days). However it is not the aim of qualitative research to produce findings that are generalisable – the intention was to identify factors that it was not possible to investigate in the quantitative data. The ten interviews conducted were a rich source of data and both supplement and complement the quantitative study.The qualitative interviews were carried out in late 2012, 11-20 months after the original HSE 2011 CAPI and drinking diary took place, so responses may be affected by poor recall. Participants were however recruited as soon as it was possible to select participants from the HSE 2011 dataset. Future studies might recruit participants from the general population to complete a diary and then conduct interviews with these participants in closer proximity to consumption taking place.Alcohol-related factors linked to greater quantities of alcohol consumption and a more varied drinking pattern were associated (to varying extents) with under-reporting of alcohol consumption as interpreted as a difference between the CAPI and diary measures of drinking. It is concerning that the burden of under-reporting may fall on heavier drinkers. Estimates of the prevalence of drinking above the recommended levels, hazardous levels, or harmful levels based on self-reported consumption may be disproportionately under-estimated.There is evidence that participants who are late responders to surveys have more risky health behaviours  than those who respond earlier, 36. AltaOne UK unit = 10 ml or 8 g pure alcohol (EtOH)Additional file 1: Table S1: Difference between diary and CAPI by sociodemographic factors for three outcomes in 3,774 adults aged 18 and over in the HSE 2011. (DOCX 23 KB)


Purpose. To compare near, intermediate, and distance vision and quality of vision, when refractive rotational multifocal intraocular lenses with 3.0 diopters or diffractive multifocal intraocular lenses with 2.5 diopters near addition are implanted. Methods. 41 eyes of 41 patients in whom rotational +3.0 diopters near addition IOLs were implanted and 30 eyes of 30 patients in whom diffractive +2.5 diopters near addition IOLs were implanted after cataract surgery were reviewed. Uncorrected and corrected distance visual acuity, intermediate visual acuity, near visual acuity, and patient satisfaction were evaluated 6 months later. Results. The corrected and uncorrected distance visual acuity were the same between both groups . The uncorrected intermediate and corrected intermediate and near vision acuities were better in the +2.5 near vision added intraocular lens implanted group  and the uncorrected near vision acuity was better in the +3.0 near vision added intraocular lens implanted group (p = 0.001). The patient satisfactions of both groups were similar. Conclusion. The +2.5 diopters near addition could be a better choice in younger patients with more distance and intermediate visual requirements , whereas the + 3.0 diopters should be considered for patients with more near vision correction (reading). Multifocal intraocular lenses (IOLs) were designed to correct distance and near vision, and their effectiveness in achieving this has been demonstrated before . Most muMultifocal IOLs are based on the optical principle of creating two focal planes, one for distance vision and the other for near vision , 7. AcryA new IOL, the multifocal Lentis Mplus LS-313 (Oculentis GmbH), has a rotationally asymmetric design with a sectorial-embedded near zone. The IOL also splits the image into two focal planes . TheoretThe aim of this study was to evaluate and compare the visual results achieved in patients, in whom rotational multifocal (Lentis Mplus MF30) and diffractive multifocal (AcrySof ReSTOR) intraocular lenses were implanted after cataract surgery. To avoid confusion, the AcrySof SV25TO group will be named as ReSTOR group and the Lentis-313 MF30 group will be named as Oculentis group.This retrospective study was adhered to the Declaration of Helsinki. Informed consent has been obtained from all patients enrolled between January 2010 and January 2012. The study cohort comprised presbyopic ametropic patients who had cataracts or were not suitable candidates for laser vision correction. 41 eyes of 41 patients in whom rotational +3.0 D near addition IOLs are implanted and 30 eyes of 30 patients who underwent phacoemulsification cataract surgery in whom diffractive +2.5 D near addition IOLs are implanted were enrolled into the study. The choice of the IOL depended on the age and psychosocial and physical status of the patients. This means that in patients who were active workers and had more outdoor hobbies the +2.5 D addition was preferred.Exclusion criteria were a history of glaucoma or retinal detachment, corneal disease, corneal surgery, ocular inflammation, neuroophthalmic disease, macular degeneration or retinopathy, and keratometric cylinder greater than 1.00 diopter (D). The inclusion of amblyopic patients was restricted to those with a corrected distance visual acuity (CDVA) of 6/9 or better in the amblyopic eye and of 6/6 or better in the fellow eye.All patients had a preoperative examination that included autorefraction and tonometry , corneal topography , uncorrected distance visual acuity (UDVA), CDVA, uncorrected near visual acuity (UNVA), endothelial cell count , biometry , subjective and cycloplegic refractions, slit-lamp evaluation, and dilated fundoscopy. Visual acuity was measured at distance and near vision with a Snellen visual acuity chart and converted to logMAR scores. Data , anterior chamber depth, and keratometry) from the IOLMaster were used for IOL calculation. All eyes were targeted for emmetropia. Uncorrected distance visual acuity and corrected distance visual acuity (UDVA and CDVA), uncorrected intermediate visual acuity and distance-corrected intermediate visual acuity (UIVA and CIVA), uncorrected near visual acuity and distance-corrected near visual acuity (UNVA and CNVA), and patient satisfaction were evaluated 6 months later. The type of IOL was randomized, but the visual necessities of the patients were taken into consideration. The patient satisfaction was evaluated with a questionnaire. The near vision addition was +1.0 in the ReSTOR patients, who needed aid for reading. There was no near vision addition necessary in the Oculentis group.Two different IOLs, multifocal Lentis Mplus LS-313MF30 (Oculentis GmbH) with +3.0 D near vision correction and AcrySof IQ ReSTOR SV25T0  with +2.5 D near vision correction, are used.The surgeries have been performed by two surgeons . The pupil was dilated with cyclopentolate. Oxybuprocaine 1.0% and tetracaine 1.0% local anesthesia drops were applied.Lens extraction was performed using a standard phacoemulsification technique through a 2.2 mm incision. All incisions were made on the steepest corneal meridian to neutralize corneal astigmatism. After phacoemulsification, a foldable Mplus IOL was inserted in the capsular bag through a 2.75 mm corneal incision using the Viscoject 2.2 injector  or a Monarch IOL injector was used to implant the AcrySof IQ ReSTOR IOLs. Surgery in the second eye was usually performed 1 week later. Postoperatively, patients were instructed to instill 1 drop of moxifloxacin 0.5% (Vigamox) 4 times daily for 2 weeks, 1 drop of dexamethasone 0.1% (Maxidex) 4 times daily for 2 weeks, and 1 drop of ketorolac trometamol 0.5% (Acular) 4 times daily for 1 month.p > 0.05), so an independent t-test was used to compare the continuous variables between the groups. A value of p < 0.05 was considered statistically significant.Statistical analyses were performed using the RStudio software version 0.98.501 via R language. The variables were investigated using visual  and analytical methods (Kolmogorov-Smirnov/Shapiro-Wilk test) to determine whether or not they are normally distributed. Descriptive analyses were presented using means and standard deviations for normally distributed variables . The variables showed a normal distribution (The Oculentis implanted group consisted of 41 eyes of 41 patients. The cohort comprised 20 men (48.78%) and 21 women (51.22%). The mean age of the patients at the time of surgery was 59.4 ± 7.9 (20 to 84 years). The mean power of implanted IOLs was 22.5 ± 5.0 D (range from 6.0 to 34.5 D).The ReSTOR implanted group consisted of 30 eyes of 30 patients. The cohort comprised 16 men (53.44%) and 14 women (46.66%). The mean age of the patients at the time of surgery was 56.4 ± 8.3 (21 to 77 years). The mean power of implanted IOLs was 22.0 ± 4.5 D (range from 7.0 to 33.5 D).p = 0.251 and p = 0.322, resp.). The CDVA and UDVA scores were not different between both groups either .The preoperative refractive and UCVA values were not different between both groups , whereas the UNVA scores were better in the Oculentis implanted group (p = 0.001).The postoperative UIVA, CIVA, and CNVA scores were better in the ReSTOR implanted patients . The glare and halo complaints were 9.9% in the Oculentis group and 10.4% in the ReSTOR group.The results are summarized in The visual requirements of cataract patients are different. These requirements depend on age, business, sociocultural status, and hobbies. Finding the convenient IOL can be a challenge in patients with high expectations . The preRegarding near vision, Oculentis in the current study provided a mean CNVA of 0.098 (logMAR), which was within the range of the reported values of Schmickler et al. and García-Domene et al. , 13. AliThe ReSTOR diffractive IOL with +2.5 near vision addition is merely designed for people who are more active in working life and especially driving to the ability to read the dashboard. These people depend more on distance and intermediate visual acuity . On the A thorough meta-analysis of multifocal IOLs was performed by Cochener et al. comparing literature on different types of multifocal IOLs published since 2000. The study found the mean UDVA of all multifocal IOLs to be 0.093 logMAR. When analyzing different types of multifocal IOLs, the mean UDVA was 0.105 logMAR for diffractive IOLs, 0.085 logMAR for refractive IOLs, and 0.067 logMAR when the ReSTOR IOL  was analyzed separately .Previous studies compared the performance of the Lentis Mplus IOL with that of some commonly used multifocal IOLs. Alió et al. compared the Lentis Mplus LS-312 MF30 with the Acri.Lisa 366D (Zeiss) diffractive IOL. Intermediate vision and contrast sensitivity were better with the Lentis Mplus. However, the Acri.Lisa provided better distance and near visual outcomes . Van derThe main advantage of the asymmetric design of the Lentis Mplus IOL over traditional rotationally symmetrical multifocal IOLs is the presence of only 1 transition zone between the aspheric distance vision zone and the inferior sector-shaped near vision zone. This technology should in theory reduce the source of scattering and aberrations, minimize halos and glare, and improve contrast sensitivity .To our knowledge, this is the first study in the literature in which +2.50 and +3.0 added multifocal IOLs are compared. The patients' satisfactions in our groups were high and similar. The glare and halo complaints were tolerable. The ReSTOR patients who needed +1.0 addition for near sight were not unhappy, because they reported that they use these glasses only for special situations such as reading medicine prospects or sewing. The ReSTOR IOL was enough for more routine near activities like newspaper reading or working with computers. Our opinion is that the correct patient choice was here the key factor for the happiness of both patient groups.In conclusion, we believe that the correct patient selection and IOL decision are the key factors in successful cataract surgery. The Alcon ReSTOR +2.5 near addition could be a better choice in younger patients with more distance and intermediate visual requirements. However, Oculentis could be considered for patients who are more interested in reading with a more nonactive lifestyle. Further investigations for the ideal intraocular lens are still present and it seems that it will take some time to invent the ideal one.


Countries where adult male circumcision has reached high coverage should consider national early infant male circumcision (EIMC) programs where EIMC is feasible and culturally acceptable. Ministries of health that intend to set up a routine offer of EIMC should put systems in place to ensure that its introduction (1) does not compromise adult male circumcision programs, (2) does not weaken routine service delivery platforms, (3) is done safely, and (4) adheres to the rights of the child. Countries where adult male circumcision has reached high coverage should consider national early infant male circumcision (EIMC) programs where EIMC is feasible and culturally acceptable. Ministries of health that intend to set up a routine offer of EIMC should put systems in place to ensure that its introduction (1) does not compromise adult male circumcision programs, (2) does not weaken routine service delivery platforms, (3) is done safely, and (4) adheres to the rights of the child. Njeuhmeli and colleagues estimated that scaling up VMMC in the 14 priority countries to reach 80% coverage among males ages 15 to 49 years could avert 3.4 million new HIV infections within 15 years. To achieve this goal, countries should first focus on the population in which VMMC is likely to have the most immediate and greatest impact: males ages 10 to 49 years old.Scaling up VMMC in the 14 priority countries to reach 80% coverage has the potential to avert 3.4 million new HIV infections within 15 years.-EIMC is medical male circumcision performed on healthy neonates from 12 to 24 hours after birth, and on young infants up to 60 days of age.Although the sustainability phase of circumcision includes providing the services to neonates as well as young adolescents, we only look at issues related to EIMC in this article. We discuss several issues with regard to providing routine EIMC services within the public sector, as a means to sustain the gains made by adult VMMC programs. The issues derive from global meetings, United Nations expert consultations, country assessments, and policy and strategic guidance notes.,It is essential that the introduction of the routine offer of EIMC (1) does not compromise adult VMMC programs, (2) does not weaken routine service delivery platforms, (3) is done safely, and (4) adheres to the rights of the child.The introduction of EIMC should not necessitate a priority shift away from adult VMMC and should not compete with other health services for children. EIMC can lead to both sustainable prevention programming as well as cost-beneficial impact over the long term.With any public health program, the key for sustainability is the commitment and investment of national authorities. Donor-funded programs and services face challenges at the end of the funding period and are often hard to sustain nationwide. The uptake of VMMC in sub-Saharan Africa emanates from commitment by ministries of health along with key stakeholders and growing acceptance in communities.One of the key considerations for introducing EIMC is integration within routine health services. Most ongoing adult VMMC programs are donor-funded and vertical, providing only male circumcision. Within the broader context of public health and with the interest of sustaining the impact of VMMC on HIV prevention, this should not be the case for EIMC programming. The population benefiting from EIMC is male infants, so a logical platform for EIMC services would be routine services for mothers and their children, such as maternal, newborn, and child health (MNCH) services. The advantages of linking EIMC with other maternal and infant services are multiple: it would enable access to the infant at various times, such as after delivery and before discharge where appropriate, at growth monitoring, during immunization, and during child health days. However, careful consideration must be paid to avoid creating the risk of competition for resources and clients between EIMC and MNCH programs. In addition, stakeholders implementing EIMC programs should coordinate with and bolster established adult VMMC programs, ensuring that EIMC is a complementary intervention and not a diversion of resources. Successful integration of EIMC into routine health services will require strengthened relationships between maternal and child health platforms as well as with HIV programs at all levels of service delivery, and at national and international levels.Linking EIMC with other maternal and infant services would enable access to the infant at various times, such as after delivery and before discharge, at growth monitoring, during immunization, and during child health days.,,Important considerations for program investments that strengthen service delivery platforms include infrastructure support, including for surgical procedures; training, supervision, and mentoring of providers; supply chain management; and human resource investments that facilitate service delivery, such as task shifting.As with adult VMMC, the introduction and expansion of EIMC requires measures for the procedure to be carried out safely, with informed consent, and without discrimination. WHO, in collaboration with Jhpiego, has produced a manual on providing EIMC under local anesthesia to help providers and program managers deliver high-quality and safe infant male circumcision services for HIV prevention and other health benefits.Neonatal and infant mortality rates are high in many of the male circumcision focus countries; for example, the infant mortality rate ranges from 33 infant deaths per 1,000 live births in South Africa to 73 deaths per 1,000 live births in Lesotho.According to the United Nations Convention on the Rights of the Child, social welfare institutions must make the best interests of the child the primary consideration in all actions concerning children.When considering the routine offer and delivery of EIMC services, national governments should weigh the issues of parental consent, the rights of the child, the health of the child, and the benefits for the wider population.Policies covering the issues of consent and authorization for EIMC services must be discussed and decisions made within a nation’s legal and regulatory framework.It is critical that national authorities acknowledge and address the issue of informed consent and incorporate procedures that ensure informed consent into EIMC programming.Education and information on the benefits and risks of EIMC services for both providers and clients must be offered, with an emphasis on parental rights and choice. Governments and stakeholders must ensure that parents/guardians are fully informed before they provide consent. The decision for a parent to have his or her son circumcised is a personal one, and parents/guardians should make the decision after carefully weighing the health status of the neonate and the risks and benefits, as well as religious, cultural, and personal preferences.Information and educational materials provided during routine antenatal or child health visits should be tailored to the concerns of the caregivers and the community.VMMC is an effective method to prevent heterosexual transmission of HIV, and can be provided to adults, young adolescents, and young infants. Scale-up of adult VMMC in the 14 priority countries remains the focus; introduction of EIMC as a sustainability phase is recommended once adult programs have reached high coverage. EIMC programs are not replications of adult and adolescent services, but require thoughtful consideration of many infant-specific issues. EIMC service provision should be context-specific, and led by national authorities with support from implementing agencies.EIMC services should be offered as part of routine MNCH services and used as an opportunity to strengthen newborn and child health services overall. The quality and safety of the services remain paramount: the rights of the child should be protected at all times by providing complete information to parents and guardians to inform their decisions, giving them adequate time to consider their options, offering the option of written consent, and ensuring appropriate follow-up.Although the impact of EIMC on HIV incidence and overall prevalence will not be realized immediately, the routine offering of EIMC services will provide longer-term impact, benefiting the health of the child as well as protecting against heterosexual transmission of HIV at both the individual and population level. Performing medical male circumcision in infancy will provide lifelong benefits for the child and contribute to sustaining the gains made from adult VMMC programs.


Previous neuroscientific studies have shown that the dopaminergic system plays an important role in creative potential measured by divergent thinking (CPMDT), emotional control, and motivational state. However, although associations between two of these four components have been previously established , the interactions between these four remain unknown. The purpose of this study was to reveal these interactions using path analyses. The Taq1A polymorphism of the dopamine D2 receptor (DRD2) gene was used for this purpose. For measuring emotional intelligence (EI), we used the Japanese version of the Emotional Intelligence Scale. CPMDT was measured using the S-A creativity test. Motivational state was measured using the Vigor subscale of the Japanese version of the Profile of Mood Scale (POMS). Data from 766 healthy, right-handed individuals  were used in this study. There were significant and robust positive relationships among measures of CPMDT, EI, and motivational state across sex. In addition, the polymorphism of the DRD2 gene was significantly associated with EI, specifically in females. Path analysis in females indicates that the model in which (a) the DRD2 polymorphism primarily facilitates EI, (b) EI in turn facilitates CPMDT and leads to a better motivational state, and (c) a better motivational state also directly facilitates CPMDT explains the data in the most accurate manner. This study suggested a comprehensive picture of the cascade of the associations among dopamine, EI, motivational state, and CPMDT at least in females. The broadly accepted standard definition of creativity is the ability to produce work that is both novel and useful within a certain social context Stein, . Creativthe subset of social intelligence that involves the ability to monitor one's own and others' feelings and emotions, to discriminate among them and to use this information to guide one's thinking and actions”  is associated with individual differences in perspectives of emotion, mood, and motivation. Creativity has been traditionally and essentially linked to motivation; specifically, it is predicted that brain motivational systems are critically relevant to creativity  of the DRD2 gene is a substitution located in a noncoding region of the DRD2 locus. The A1 allele  of this polymorphism was shown to be robustly associated with alcohol dependence through a meta-analysis  the associations of the DRD2 Taq1 polymorphism with EI, CPMDT, and motivational state, (b) these associations' possible sex differences, and (c) the mechanism by which the DRD2 Taq1 polymorphism, EI, CPMDT, and motivational state affect one another in the causal pathway. The purpose of this study was to reveal these mechanisms.Data from 766 healthy, right-handed individuals  were used in this study as a part of an ongoing project, consisting of various types of MRI scanning and psychological test batteries besides the ones analyzed in this manuscript, to investigate associations among brain imaging, cognitive functions, aging, genetics, and daily habits   self-awareness, (2) the ability to sustain one's behavior, and (3) the ability to act appropriately. The interpersonal factor evaluates the ability to maintain appropriate personal relationships based on the understanding and empathy toward another person's emotions. The situation management factor evaluates (1) the ability of an individual to endure and adapt to a change, (2) provide leadership, and (3) exhibit flexibility in the control and use of their abilities in dynamic situations.The following are examples of items on the Emotional Intelligence Scale.“I know when my emotions change” .“I do not want to say something that offends someone else” .“I can respond to situational changes effectively” .Other than this three-component model of EI, there are a four-component model of EI   of EIS, as in the case of the previous study , according to the manufacturer's protocol. DRD2/ANKK1 Taq1A polymorphism (rs1800497) was genotyped utilizing the Taqman Allelic Discrimination Assay System (assay ID: C_7486676_10) obtained from Applied Biosystems . Each genomic DNA (20 ng) was mixed with 0.25 ml of primer/TaqMan Probe mixture and 5 ml of TaqMan Universal PCR Master Mix (Applied Biosystems) within 10 ml of the total volume. Thermal cycling conditions were 95°C for 10 min, followed by 50 cycles of 92°C for 15 s and 59°C for 1 min in the CFX96 Real-Time System . Alleles were determined on the basis of allelic discrimination features of the CFX Manager software (BioRad). qRT-PCR-based genotyping data was validated on the basis of sequencing of PCR products (635 bp) of representative subjects, utilizing the following primers: forward: ccctgcatctagcagcctac, reverse: gagacagggttttgccatgt, spanning the polymorphic site.n = 57, 7.4%; women, n = 37, 4.8%), DRD2 Taq1A A1/A2 , and DRD2 Taq1A A2/A2 . Allele frequencies of A1 and A2 alleles were 35.1% and 64.9%, respectively, which were concordant with previous findings .DRD2 was coded A1/A1, A1/A2, and A2/A2. Among the 778 participants whose psychological and genetic data were obtained in this study, data for the polymorphism were successfully obtained from 766 subjects ; genotyping data of 12 subjects were not available because of failures either in proper extraction of a DNA sample from the saliva or in amplification in the PCR procedure or failure to provide a (proper) saliva sample. The genotypic distributions of the 766 subjects were as follows: DRD2 Taq1A A1/A1 . First, the associations between the DRD2 Taq1A polymorphism  and the scores for the cognitive measures that were common to both sexes were analyzed using multiple regression analyses. Additional covariates for each analysis were age and sex. Second, the interaction effects between sex and the DRD2 Taq1A polymorphism on cognitive measures were analyzed using analyses of covariance (ANCOVAs). Sex was a fixed factor, and additional covariates were the DRD2 Taq1A polymorphism and age. These three variances and the interaction between sex and the DRD2 Taq1A polymorphism were included in the model. Finally, associations between the DRD2 Taq1A polymorphism  and the scores for the cognitive measures in each sex were analyzed using multiple regression analyses with age as a covariate.p < 0.05, corrected for false discovery rate (FDR) using the two-stage sharpened method  but not on the score of the Vigor subscale of POMS  and the score of the S-A creativity test . For the descriptive data, see Table ANCOVA with age as a covariate revealed the significant effect of the interaction between sex and the polymorphism of the DRD2 gene on the total score of EIS . In this final model, all the paths reached significance. In this final model, (a) the DRD2 polymorphism primarily facilitated EI , (b) EI in turn facilitated CPMDT (the score of the S-A creativity test) and led to a better motivational state , and (c) the better motivational state also directly facilitated CPMDT.For females, from each initial model , the paths with the highest P-values were deleted recursively one by one, and analyses were rerun after each path was removed, until the model fit stopped improving. The three paths from the DRD2 polymorphism were removed. However, the directions of the paths among the three psychological variables could not be determined and there were eight final models that showed the same statistics for the fit of the models .For males, from each initial model , the paths with the highest In this study, we demonstrated that there were significant positive relationships among CPMDT, EI, and motivational state across sex. In addition, the polymorphism of the DRD2 gene was significantly associated with EI, specifically in females. Path analysis in females indicated that the model in which (a) the DRD2 polymorphism primarily facilitates EI, (b) EI in turn facilitates CPMDT and leads to a better motivational state, and (c) the better motivational state also directly facilitates CPMDT explained the data in the most accurate manner. Thus, our hypothesis was at least partially confirmed in females. However, it should be noted that the results of path analysis do not prove that the finalized model is statistically significantly better than the other models and that it does not account for the variables that are not in the models. For males, the associations among EI, CPMDT, and a better motivational state were confirmed and the polymorphisms of DRD2 did not show an association with any of these factors.This study depicted a comprehensive picture of the association among dopamine, EI, motivational state, and CPMDT at least in females. As described in the Introduction, the associations between two of these factors have been previously reported. These include the association between emotional regulation and the polymorphism of the DRD2 gene (Blasi et al., One interesting speculation arising from this study is that in females, because the physiology of dopamine receptor D2 is associated with EI, by modulating this physiology through agonist and antagonist, we may be able to modulate EI. On the other hand, it has been shown that EI can be trained and consequently improve well-being (Slaski and Cartwright, The studies of polymorphism suffer from low effect sizes of the polymorphism (Murphy et al., The possible mechanism of how the A1 allele of the DRD2 Taq1 polymorphism is associated with behaviors that are apparently related to less EI is summarized in a previous study (Bowirrat and Oscar-Berman, One possible speculation about why there was a female-specific effect of the DRD2 Taq1 polymorphism in the present sample is related to environmental and cultural backgrounds. As hypothesized in the Introduction, a previous meta-analytic study showed sex differences in the effects of the DRD2 Taq1 polymorphism on substance dependence (Munafò et al., It should be noted that perhaps, the present finding of the positive associations among EI, CPMDT, and better motivational state does not apply to the group in the field of art. While a previous study has identified the positive relationship between EI and verbal divergent thinking using a large sample (Guastello et al., Limited sampling of the full range of intellectual abilities is a common hazard when sampling from college cohorts. However, given the correlation between intelligence and creativity among subjects with normal and inferior intelligence (but not subjects with higher intelligence,” Another limitation is common to our previous studies using the S-A creativity test. To measure creativity, we only used the S-A creativity test, which is a measure of verbal CPMDT, and we did not use tests for figural divergent thinking. However, as summarized by Jung et al. (several cognitive processes are important for creativity or creative measures, such as flow (Csikszentmihalyi,  Divergent thinking tests are by far the most used measure in the field to measure creative potential (Dietrich, This study had at least a few limitations. One was common to our previous studies and other studies that used college cohorts (Song et al., g et al. , and as g et al. , p. 1823The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.