Gender differences in drinking behaviour in the Netherlands: convergence or stability?

Gender differences in drinking behavior are analysed with emphasis on their relationship with changes in roles and positions of men and women in society. The 'convergence hypothesis' is used as a starting point. From its implications, a number of specific hypotheses are derived and tested using data from six surveys of the general population of the Netherlands, held between 1958 and 1993. No convergence of gender differences is found for abstinence and heavy frequent drinking. Convergence of male-female differences in average weekly consumption appeared in the 1980s, but it is no longer significant at 5% level after controlling for age, education and family situation. Further elaboration of the gender by year interaction shows that convergence is related to a decrease in consumption among higher educated men. Contrary to expectation, an increase in consumption has occurred among women over 40 years of age. No relationship appears with female employment and religion. Having a family is related to lower consumption among women, while it has no significant effect on men's consumption. Although some evidence for convergence was found, results are not in agreement with expectations formulated from the perspective of the convergence hypothesis.

[What, how much and when the university student drinks]

The aim of this work was to define the epidemiological profile of alcohol ingestion and its associated risks, in university students. A social survey about drinking habits was performed to a random sample of 528 students, aged 17 to 26 years old, 54% male, from Austral University. Eighty two percent of males and 79% of females drink alcoholic beverages. They mainly consume beer and strong spirits. Their main consumption is occasional, during parties or celebrations. Thirty percent of males and 15% of females had three or more inebriations during the last year. Nine percent of males and 3% of females can be considered as problem drinkers. Student that drink alcohol have lower grades that teetotalers. It is concluded that alcohol consumption is frequent among students.

Reliability of alcohol intake as recalled from 10 years in the past

The authors assessed the reliability of alcohol intake as recalled from 10 years in the past in a cohort of 2,907 US adults. Participants reported their drinking habits in the First National Health and Nutrition Examination Survey interview during 1971-1975. During a follow-up interview in 1982-1984, they were asked to recall their drinking habits 10 years earlier and to report their current habits. In general, the correlation for recalled alcohol intake versus reported intake at baseline was good (r = 0.7). For all subgroups stratified by race, sex, education, smoking status, and disease status, the age-adjusted correlations for recalled alcohol intake versus baseline intake were equal to or higher than those for current alcohol intake versus baseline intake. The reliability of recall of alcohol intake in the past differs among subgroups with different age and education levels. Recalled alcohol intake was also highly correlated with current alcohol intake; in particular, current heavier drinkers tended to underestimate their previous amount of drinking, an effect that was independent of other factors. These data suggest that although recalled alcohol intake is a better predictor of past intake than are reports of current intake, current drinking habits may be an important influencing factor in the estimation of alcohol intake as recalled from the distant past.

Using panel data to determine the effect of advertising on brand-level distilled spirits sales

OBJECTIVE

The purpose of the present study is to determine the effect that brand-level advertising has on brand-level spirits demand.

METHODS

Using a panel data set consisting of 16 brands and 14 years of data, a fixed effects model of brand-level spirits demand was estimated.

RESULTS

It was found that own-brand advertising, income, rival-brand price, a time trend and brand loyalty all have a significant effect on brand-level spirits demand.

CONCLUSIONS

These results indicate that brand-level spirits advertising results only in brand switching and does not increase the overall size of the market.

Beverage effects on patterns of alcohol consumption

In this paper an analysis is made of beverage preferences and their effect on alcohol consumption patterns. For this purpose we have used the 1993 Spanish National Household Health Survey conducted on members of the population aged 16 or over. Beer and spirits are consumed more frequently by young people and wine by older people. The most consumed daily drink is wine and beer on a weekly basis. Men always drank more frequently and consumed a greater number of drinks per occasion than women for the three types of drink analyzed. The study shows that beverage preference is an important factor in the characterization of alcohol use patterns.

The relationship of alcohol sales to cirrhosis mortality

OBJECTIVE

The goal of the current study was to evaluate the extent to which beverage specific alcohol sales (beer, wine and distilled spirits) are associated with cirrhosis mortality rates.

METHOD

Cirrhosis mortality rates were related to measures of beverage specific alcohol sales data from 50 states in the United States taken over 12 years. Cirrhosis mortality rates were regressed over beverage specific alcohol sales in a time series cross-sectional analysis that included age compositions of state populations, measures of the availability of health care, population density, proscriptions on alcohol use, income, tourism and nighttime traffic fatality crash rates as covariates.

RESULTS

Controlling for empirically observed first order autocorrelated errors in estimation, and the effects of other related covariates, the analyses showed that there was a beverage specific effect of distilled spirits sales on cirrhosis mortality rates. One percent increases in spirits sales were reflected in .282% increases in cirrhosis mortality rates. There were no significant effects for either beer or wine sales.

CONCLUSIONS

The relationship of spirits sales to cirrhosis mortality rates may be explained most reasonably by the association of chronic heavy drinking with the consumption of spirits.

Style, consumption, and problem drinking: a measurement model

Yu and Williford (J. Drug Issues 22:75-90, 1992) report from a structural study that drinking style is the best predictor of problem drinking. This study further examines a measurement model on drinking style, alcohol consumption, and problem drinking. Four measures are specified for drinking style, three for alcohol consumption, and two for problem drinking. The maximum-likelihood procedure through the LISREL program is used to reproduce the observed correlations by allowing correlations among systematic measurement errors. Strong associations are noted among drinking style, alcohol consumption, and problem drinking. The analysis suggests that the style of drinking should be included in research on problem drinking. Implications of the findings and future research issues are discussed.

Do not change the numbers--clarify the message. The government review of the Sensible Drinking message: a Medical Council on Alcoholism view

This is an edited version of the evidence from The Medical Council on Alcoholism (MCA) on 'Sensible Drinking', which is based on the collective views of the Education and Public Health Committee and of The MCA Regional Advisers in medical schools throughout the UK. The contributors are not only university teachers, but also clinicians and health service providers in touch with patients and the public. On one aspect there is total unanimity. On no account should the 21/14 units per week figures for men and women, respectively, be changed: the evidence indicates that this could only lead to increased harm. There seems to be some scope for restatement of the significance of the benchmark such as that 'below 21/14 units per week is a sensible level, and that, at twice this level, there is an appreciable increase in risk of harm which continues to increase as consumption rises'. Drink-free days are recommended, but the need to suggest an additional curb on intake on any given occasion is also emphasized, since heavy consumption of this sort is that which is particularly associated with behavioural and psychosocial problems, notably in the young. Driving is an obvious example where any drinking could be dangerous. A simple statement such as 'avoid intoxication and do not exceed 6/4 units in a day, while maintaining the weekly guidelines as at present and bearing in mind the circumstances' is proposed.

Suicide rates and alcohol consumption in the United States, 1970-89

This study investigates the aggregate relationships between suicide rates and beverage specific measures of alcohol consumption for states in the United States over periods of from 14 to 20 years. Time series cross-sectional analyses of these aggregate state level data are presented which control for exogenous differences between states, time trends and covariations over time in nine measures; age composition, male population, non-white population, per capita land area, metropolitanism, income, unemployment, measures of religious preferences and divorce. After correcting for substantial autocorrelations in measurement error, the analyses revealed that suicide rates were specifically associated with spirits sales, age composition of state populations, per capita land area, unemployment and religious preferences over time. While suicide rates increased significantly as a function of increased spirits sales, beer and wine sales were not associated with suicide rates. These findings suggest that it is not the consumption of ethanol per se but rather the consumption of ethanol in the form of spirits that is related to suicides. Rather, it would appear that a population-based preference for the consumption of spirits is associated with suicide events.

Is wine the drink of moderation?

OBJECTIVE

To examine, in the light of a current national inquiry into taxation for wine, claims that wine drinkers rarely misuse alcohol and that cask wine is more likely to be misused than bottled wine.

METHODS

1272 persons aged 16 years and over and resident in metropolitan Perth were interviewed in their homes regarding their use of alcohol.

RESULTS

The alcohol consumption of 524 (373 women, 151 men) who had drunk at least one glass of wine on one or more of their last four drinking days was examined in relation to National Health and Medical Research Council guidelines. While only 2.9% of women and 2.6% of men had an average daily intake of wine above low risk levels, 6.9% of women and 13.2% of men had exceeded these levels when considering all alcoholic beverages. When wine intake was examined for the day of highest consumption of the last four drinking days recalled by each respondent, 41.1% of women and 17.0% [corrected] of men had exceeded low risk levels. There was no significant difference in the amounts of cask and bottled wine consumed in 180 wine drinkers for whom the distinction between cask and bottled varieties could be made and who drank wine on their last drinking occasion.

CONCLUSIONS

Past estimates of the contribution of wine consumption to excessive alcohol intake are underestimates. Raising the tax on wine should be considered as a public health measure and taxes should be levied in direct relation to alcohol content to encourage the consumption of lower alcohol varieties.

New beverages, new drinking contexts? Signs of modernization in Finnish drinking habits from 1984 to 1992, compared with trends in the European Community

The dynamics of change in drinking patterns is discussed using the data from the drinking habits surveys conducted in Finland in 1984 and 1992. The results are compared with a respective analysis on the EU countries from 1988 by Hupkens, Knibbe & Drop (1993). The analysis is based on changes in beverage preferences. In the Finnish case, both wine and mild beer appear as new beverages, gaining popularity in the late 1980s. For beer, both the elites and the population at large were involved in that process. For wine, the interest in the new beverage was stronger among the elites. There were notable gender differences in adopting the new beverage. Some of the differences were related to the older cultural patterns of wine as a woman's drink and beer as a male beverage. The results also point to difficulties in analysing the dynamics of change on the basis of cross-sectional data, as was done in the earlier analysis on the EC countries. The Finnish data shows that even the inter-group dynamics of drinking patterns may change over a relatively short period of time.

Development and applications of a city-level alcohol availability and alcohol problems database

Data on alcohol availability and problems in all cities in Los Angeles County were collected from several different sources and linked together to form a Local Alcohol Availability Database (LAAD). The two major purposes of the project are to provide a city-level alcohol availability and alcohol-related problems database needed by local community alcohol policy planners and to collect the data necessary for research on the relationship between these measures. The prevalence of drunk driving arrests is displayed on a map. We describe how the LAAD has been used to guide alcohol policy decisions. A fixed year and city effects regression model suggests that outlet density is positively related to several alcohol-related problems.

High-risk behaviors in teenage male athletes

This project studied high-risk activities in adolescent male athletes (ages 13-19) compared with a control group of adolescent male and female nonathletes. All athletes surveyed participated in one or more interscholastic sports. The prevalence of drug use by athletes compared to nonathletes was determined. Of the 19 drugs observed in this study, all were shown to have a lower prevalence of use among athletes in their senior year of high school, compared to the comparison group. Among the more commonly abused substances by the athlete population, beer, wine and whiskey, cigarettes, and marijuana were shown to have a lower use rate, by 25.5, 39.9, 57.5, and 57.7%, respectively. The prevalence of drug use by adolescent male athletes compared to adolescent nonathletes was also studied. Of the 19 individual drugs surveyed, all demonstrated a lower prevalence of use among athletes in their senior year of high school compared to the national data. The second high-risk activity measured was sexual activity. Of the athletes, 45.5% stated that they had never had sexual intercourse, compared to 50.0% of the nonathletes. Of the sexually active athletes, 81.9% had their first intercourse at between 13 and 15 years of age, whereas only 67.8% of the nonathlete control group had done so. This difference diminished significantly at age 16 and above. The results of this study suggest that participation in athletics by male athletes may lead to a significant decrease in drug and alcohol use and abuse but, also may increase early sexual contact. These trends were seen throughout all 4 years of high school in the athletes studied.

Gender differences in patterns of alcohol consumption in Spain

Gender differences in alcohol consumption components, hazardous alcohol consumption, and drinking patterns among Spaniards were analyzed. The study was conducted in the fall of 1992 on 2,500 individuals, aged 14-70 years, who lived in the region of Castile and Leon (Spain). Males drank more frequently (with a high intake of alcohol), were more likely to be hazardous drinkers, and started drinking earlier than females. Both sexes drank beer in a similar way, but not wine and spirits. Males and females gave similar reasons for drinking and showed similar patterns of "family" drinking, although sex differences in other patterns of alcohol consumption were found. The relevance of results was discussed.

How much can data on days with heavy drinking decrease the underestimation of true alcohol consumption?

An adjusted quantity-frequency method, with questions on occasions with heavy drinking, was used to estimate the consumption of alcohol during the last 30 days. The purpose was to analyze if it was possible to decrease the underestimation of true alcohol consumption. The questionnaire was mailed to a randomized sample of 1,500 individuals, 20-75 years of age, living in the city of Malmö, Sweden; 930 persons (64.3%) participated. Data on alcohol consumption were validated by comparison to sales of alcohol for the city of Malmö. The estimated per capita consumption of alcohol in the population was equivalent to 77.0% of the registered sale of alcohol in Malmö. By adding days with heavy drinking, the estimated weekly per capita consumption of alcohol among the alcohol consumers increased from 74.5 grams to 77.1 grams (+3.5%; p < .001). Of the alcohol consumers, 15.1% increased their reported consumption. In order to decrease even more the underestimation of the true alcohol consumption, we suggest the use of questions about any alcohol consumption that deviates from the typical consumption of each individual.

Smoking, alcohol consumption and the risk of cancer of the biliary tract; a population-based case-control study in The Netherlands

Although cancer of the biliary tract is a highly fatal disease, the relationship with modifiable, life style-related factors is hardly studied. Between 1984 and 1987 we conducted a case-control study of 114 patients and 487 controls from the general population. An interviewer-administered questionnaire was used to collect information on life-time smoking habits and life-time alcohol consumption. The information was obtained either from the subjects themselves (direct response) of from relatives (indirect response). Results show that neither smoking at the time of interview (odds ratio (OR) 1.5; 95% confidence interval (CI) 0.9-2.4) nor smoking 2, 5 or 10 years before were associated significantly with the cancer. Alcohol consumption at the time of interview (OR 1.0; 95% CI 0.6-1.5) or drinking 2, 5 or 10 years before were not significantly associated either. Among current alcohol drinkers, long-term consumers had a reduced risk (duration of use > 38 years vs < 25 years: OR 0.4; 95% CI 0.1-0.9) and late starters an elevated risk (starting age > 38 years vs < 21 years: OR 2.7, 95% CI 1.0-7.5). A modifying effect of alcohol consumption on the smoking-cancer relationship was observed: the risk for current smokers was increased only when they did not drink alcohol at that point in time (OR 3.4, 95% CI 1.3-8.5). Our results indicate that long-term moderate alcohol use might be protective against cancer of the biliary tract, whereas smoking might be a risk factor for this cancer.

Adenocarcinoma of the esophagus and esophagogastric junction in white men in the United States: alcohol, tobacco, and socioeconomic factors

In the United States, the incidence of adenocarcinoma of the esophagus, including the esophagogastric (EG) junction, has been increasing rapidly over the past two decades. Except for an association with Barrett's esophagus, little is known about the etiology of these cancers. A population-based case-control interview study of 174 White men with adenocarcinoma of the esophagus and 750 controls living in three areas of the United States offered the opportunity to investigate the relationship of these cancers with smoking, alcohol drinking, socioeconomic factors, and history of ulcer. There were significantly elevated risks for men who smoked cigarettes (odds ratio [OR] = 2.1) or drank liquor (OR = 1.6). For both cigarette smoking and liquor drinking, there were significant dose gradients with amount consumed. No reduction in risk was observed following smoking cessation. Subjects who switched from nonfilter to filter cigarettes experienced half the risk of those who only smoked nonfilter cigarettes. Inverse risk gradients were seen with increasing recent annual income, with the highest risk (OR = 3.4) for the lowest category. The risk for a history of ulcer (OR = 1.7), especially of the duodenum (OR = 2.2), was also significantly elevated. These data suggest that tobacco and alcohol may be etiologic factors for adenocarcinoma of the esophagus and EG junction, but these factors do not appear to explain the rapid rise in incidence of these tumors. The associations with low social class and history of ulcer need to be explored in greater detail along with other factors that may account for the temporal trends in esophageal adenocarcinomas.

Risk factors for esophageal cancer in lifelong nonsmokers

Information on the etiology of esophageal cancer in lifelong nonsmokers is of interest to understand and quantify risk factors for the disease in the absence of the residual confounding by tobacco. Of a total of 316 cases with histologically confirmed incident cancers of the esophagus, 46 (17 males and 29 females) who described themselves as lifelong nonsmokers were selected to assess esophageal cancer risk in the absence of potential confounding and interactive effects of smoking. These patients were compared to 230 lifelong nonsmoker controls (85 males and 145 females) admitted to hospital for acute, nonneoplastic, non-alcohol-related conditions. The major risk factor for cancer of the esophagus in lifelong nonsmokers was elevated alcohol consumption: compared to drinkers of fewer than 4 drinks per day the relative risk (RR) was 2.7 (95% confidence interval, 1.1-6.8) for 4 to fewer than 8 drinks, and 5.4 (95% confidence interval, 1.4-21.0) for 8 or more drinks, with a significant trend in risk. Among selected indicator foods considered, significant protective effects were observed for fish (RR = 0.5 for the highest consumption tertile), green vegetables (RR = 0.6), and fresh fruit intake (RR = 0.3). Consequently, there was a significant inverse relationship with an estimate of beta-carotene intake (RR = 0.5 and 0.4, respectively, for the middle and highest tertiles of intake versus the lowest), with a significant trend in risk. The estimated RR for the highest alcohol consumption and lowest beta-carotene intake category was 8.6, and these two factors together explained over 45% of cases. Gastrectomy and family history of cancer of the esophagus were also associated with increased risk (RR = 4.6 and 4.3, respectively).

Correlations of choriocarcinoma mortality with alcohol drinking and reproductive factors in China

This country-based correlation study examined associations of choriocarcinoma mortality with reproductive characteristics and lifestyle factors using data from an ecological survey in 49 Chinese rural counties. Univariate correlation and multivariate regression analyses showed that choriocarcinoma mortality rates among Chinese women were significantly related to alcohol consumption, number of pregnancies and age at menopause, and inversely associated with age at first birth. No clear association was seen between choriocarcinoma mortality and smoking, body mass index, dietary factors and levels of serum nutrients, sex hormones, and antibodies to herpes simplex virus. Limitations of these ecological data preclude causal inferences, but the findings add to the limited evidence of the role of reproductive characteristics in choriocarcinoma risk and provide additional clues to other risk factors for this rare and seldom examined cancer.

Risk factors for renal cell carcinoma in Denmark. I. Role of socioeconomic status, tobacco use, beverages, and family history

Risk factors for renal cell carcinoma were examined in a population based case-control study in Denmark. A total of 368 cases and 396 age- and gender-matched controls were interviewed in their homes. Increased risk was associated with low socioeconomic status. For men, an increasing risk with decreasing socioeconomic status was seen (odds ratio [OR] = 2.2, 95 percent confidence interval [CI] = 1.0-4.6 for men in the lowest socioeconomic stratum cf the highest). For women, the risk was lower in the highest socioeconomic stratum compared with the rest (OR = 2.4, CI = 0.9-5.9 for the lowest strata cf the highest). Cigarette smoking was a risk factor in men with an OR = 2.3 (CI = 1.1-5.1) for cigarette smokers with a total consumption of more than 40 pack-years compared with nonsmokers. Family history of kidney cancer was associated with an increased risk in both genders (for men, OR = 4.1, CI = 1.1-14.9; for women, OR = 4.8, CI = 1.0-23). Observations were inconsistent regarding coffee and alcohol consumption, and we found no association with tea drinking. The association with socioeconomic status remained after adjustment for other factors.

Consumption indicators of alcohol dependence

This Data Note evaluates various dichotomous measures of alcohol consumption as screeners for past-year alcohol dependence. The analysis is based on data from 22,102 current drinkers interviewed in the 1988 US National Health Interview Survey. The consumption indicators include measures of average daily intake, frequency of heavy drinking, usual quantity and frequency of drinking and various combinations of these measures. The measures based on frequency of heavy drinking are the most strongly correlated with dependence, but none of the consumption indicators have the sensitivity or specificity of screeners based on alcohol-related problems. Most of the consumption items considered in this analysis screen for dependence more successfully among men than among women.

Prospective study on alcohol consumption and the risk of cancer of the colon and rectum in the Netherlands

The association between alcohol consumption and cancer of the colon and rectum was investigated in a prospective cohort study, conducted in the Netherlands from 1986 onwards among 120,852 men and women, aged 55 to 69 years. During 3.3 years of follow-up, 312 and 166 cases of colon and rectal cancer had accumulated, respectively. After exclusion of cases diagnosed in the first year of follow-up, the analysis was based on 217 incident cases of colon cancer (107 men and 110 women) and 113 cases of rectal cancer (75 men and 38 women). For colon cancer, no association with total intake of alcohol nor with the consumption of beer and wine, specifically, could be demonstrated; for liquor intake, a significant (P = 0.04) decreasing risk with increasing consumption was observed. For rectal cancer in men, positive trends were observed for total alcohol intake (P = 0.04), beer (P = 0.05), and liquor (P = 0.06). Results for rectal cancer in women were consistent with those in men, but data were too sparse to provide stable estimates. Simultaneous adjustment for beverage type and quantity appeared to strengthen the association of rectal cancer with drinking beer (relative rate (yes/no) = 2.0, 95 percent confidence interval = 1.1-3.9), although a dose-response effect was not observed. When alcohol intake from beer, wine, and liquor were included as continuous variables, the association was somewhat stronger for liquor than for beer, but none of the associations were statistically significant. It is concluded that consumption of alcoholic beverages (beer, in particular) is associated with an increased risk for rectal but not colon cancer.

The sale of alcoholic beverages to minors

This study reports the findings of a field trial designed to assess the extent of alcohol sales to minors in one county in northwest New Jersey. Two 19-year-old males were successful in purchasing alcoholic beverages in 27 of 46 (58.7 percent) establishments visited. On the following day, 23 of the establishments that sold the alcohol were visited again and, on this occasion, 18 (78.3 percent) sold alcohol to the minor. This study supports the findings from surveys that show that underage drinkers can obtain alcohol with ease. Many community groups are now taking action to rectify this situation, and data of the type reported in this paper can be used to assess the effectiveness of their actions.

Alcohol consumption among junior high school students in the community of Litija, Slovenia

Alcohol drinking causes numerous problems to individuals, families and to society. Most people begin to drink alcohol in childhood. This study shows drinking habits of junior high school students at schools in the community of Litija, Slovenia. The data were collected with anonymous questionnaires that were completed by 941 students aged 12-15 years. There were 6.5% students who never drank alcohol (such a low percent of teetotallers among children aged 12-15 years has not yet been published); 18% drank alcohol several times a week. The frequency was higher if students lived in the country, if their parents as well as peers were frequent drinkers and if their parents produced alcohol at home themselves. There were no significant differences between girls and boys in frequency of drinking, nor differences with age. The author suggests some possible measures to be taken with individuals, families and society in order to diminish the prevalence of alcohol use among schoolchildren.

Recall and selection bias in reporting past alcohol consumption among breast cancer cases

Recall and selection bias are well-recognized potential problems in case-control studies of alcohol and cancer, but few analyses have attempted to assess the direction and the magnitude of these potential biases. We thus examined alcohol consumption in relation to risk of breast cancer using dietary questionnaires administered both before and after the diagnosis of breast cancer in the Nurses' Health Study (United States). Among cohort members who completed a dietary questionnaire in 1986 and who were free of cancer, 616 were diagnosed with breast cancer during follow-up to December 1989. These cases and 1,277 controls (a random sample of cohort members who did not develop cancer up to 1990) then were sent another questionnaire inquiring about their diet in 1985. Four hundred and ninety-four cases (80.2 percent) and 999 controls (78.2 percent) responded to the second questionnaire. The analysis based on the prospective (1986) questionnaire demonstrated an elevated risk of breast cancer among women who drank 30 or more g of alcohol daily (about two drinks) relative to nondrinkers (odds ratio [OR] = 1.55, 95 percent confidence interval [CI] = 1.01-2.39). The analysis based on the retrospective questionnaire also indicated a similar but slightly attenuated elevation of risk of breast cancer among women who drank at least 30 g daily (OR = 1.42, CI = 0.85-2.40). In these data, bias due to selection and recall had only minor effects on reported intake of alcohol consumption.

Cancer of the large bowel in women in relation to alcohol consumption: a case-control study in Wisconsin (United States)

Age-specific consumption of beer, wine, and liquor was ascertained by telephone interview from 779 women in Wisconsin (United States) with newly reported diagnosis of carcinoma of the colon and rectum. Population controls (n = 2,315) interviewed for this case-control study were randomly selected from Wisconsin driver's license files and Health Care Financing Administration files. Overall, there was a modest indication that high levels of alcohol consumption (11 or more drinks per week) were associated with increased risk of large bowel cancer (adjusted odds ratio [OR] = 1.47, 95 percent confidence interval [CI] = 1.0-2.22). In site-specific analyses, only rectal cancer demonstrated a significant linear trend (P = 0.01) with increasing consumption. Significant beverage-specific effects were observed for liquor and colon cancer: the adjusted ORs for 1-2, 3-5, and 6+ drinks per week were 1.12, 1.68, 1.51, respectively (P trend = 0.01). Beer was associated significantly with rectal cancer: the adjusted ORs for 1-2, 3-5, 6-10, and 11+ drinks per week were 1.25, 1.25, 1.58, 2.42, respectively (P trend = 0.02). Wine consumption was associated inversely with these cancers. These relationships appeared to be consistent for recent, past, and total lifetime consumption, and were not attributable to differences in dietary habits.

A cohort study of smoking, alcohol consumption, and dietary factors for pancreatic cancer (United States)

Risk factors for pancreatic cancer were evaluated in a cohort study of 17,633 White men in the United States who responded to a mailed questionnaire in 1966 and were followed-up through 1986 for mortality. Cigarette smoking and alcohol consumption were found to be important risk factors for pancreatic cancer. Risks increased significantly with number of cigarettes smoked, reaching fourfold for smokers of 25 or more cigarettes per day relative to nonsmokers. Alcohol intake also was related significantly to risk, with consumers of 10 or more drinks per month having three times the risk of nondrinkers, but dose-response trends among drinkers were not smooth. Coffee consumption was unrelated to risk. Dietary analyses revealed a rising rate of pancreatic cancer mortality with increasing consumption of meat after adjustment for other risk factors. Men in the highest quartile of meat intake had about three times the risk of those in the lowest quartile. No consistent association, however, was observed for consumption of fruits, vegetables, or grains. This study confirms cigarette smoking as an important risk factor for pancreatic cancer, and provides evidence that elevated intake of alcohol and meat may increase the risk of this fatal malignancy.

Alcohol and cancer of the colon and rectum

The association between alcohol intake and colorectal cancer was examined in a population-based case-control study performed in Stockholm in 1986-88. The study included 352 cases of colon cancer, 217 cases of rectal cancer, and 512 controls. Relative risks, with 95% confidence intervals, were calculated for total alcohol intake and for different alcoholic beverages. Total alcohol intake (> or = 30 g 100% ethanol per day) was not associated with colon cancer (relative risk = 0.9, confidence intervals = 0.4-1.8) or rectal cancer (1.0, 0.4-2.1). There was no evidence supporting beverage specificity (for colorectal cancer and > or = 10 g 100% ethanol per day: beer 1.1, 0.6-2.0, wine 1.0, 0.4-2.7, spirits 1.0, 0.6-1.6). The associations did not vary according to gender or site within the large bowel. These analyses were adjusted for year of birth and gender (when appropriate). Further adjustments for diet, body mass or physical activity had little or no influence on the results. The present study does not support the hypothesis that alcohol plays an important role in the aetiology of cancer of the colon and rectum in a population with a relatively low alcohol intake.

Alcoholic beverage consumption and risk of breast cancer in Spain

The relation between alcoholic beverage consumption and risk of breast cancer was examined. We used data from a population-based, case-control study that included almost all incident cases occurring in five Spanish regions from February 1990 to July 1991. A total of 762 women between 18 and 75 years of age, with a histologically confirmed, first diagnosis of breast cancer, were compared with 988 control women. Alcoholic beverage intake was measured by an interviewer-administered, semiquantitative food-frequency questionnaire. We used 'nondrinkers' as the reference category and divided the remainder into four categories according to alcohol intake. The multiple logistic analyses included not only alcohol intake but also possible confounding factors such as total caloric intake, age, socioeconomic status, and reproductive and medical histories. Even at moderate levels of alcohol intake (less than 8 g/day), a 50 percent increase in risk of breast cancer was found. The trend across categories of intake was statistically significant for wine and distilled drinks, as well as total alcohol intake. Consumption of 20 g or more of alcohol per day was associated with a 70 percent elevation in breast cancer risk compared with that of nondrinkers (adjusted relative risk (RR) = 1.7, 95 percent confidence interval = 1.3-2.3). Although the magnitude of the RR observed in our study was modest, our findings provide further support for a positive association between alcohol consumption and risk of breast cancer.

Alcohol advertising bans and alcohol abuse: reply

Young reexamines the work first presented in Saffer (1991) on the relationship between alcohol advertising bans and alcohol use. While there are several interesting possibilities for extending Saffer (1991), Young fails to provide any new insights. Most of his paper is devoted to recreating my data and results. He tries to extend my work with three new specifications. Each of these new specifications is flawed. His errors include a inappropriate application of fixed effects models, inappropriate dependent variables, and incorrect serial correlation computations. The results of these errors are a series of inconsistent advertising ban coefficients. He concludes that these inconsistent results are evidence that advertising bans have no effect of alcohol abuse. It might be better to at least provide a series of consistent regression models before coming to any conclusions.

Alcohol advertising bans and alcohol abuse

Henry Saffer [Saffer (1991) Journal of Health Economics 10, 65-79] concludes that bans on broadcast advertising for alcoholic beverages reduce total alcohol consumption, motor vehicle fatalities, and cirrhosis deaths. A reexamination of his data and procedures reveals a number of flaws. First, there is evidence of reverse causation: countries with low consumption/death rates tend to adopt advertising bans, creating a (spurious) negative correlation between bans and consumption/death rates. Second, even this correlation largely disappears when the estimates are corrected for serial correlation. Third, estimates based on the components of consumption--spirits, beer and wine--mostly indicate that bans are associated with increased consumption.

From beer to crack: developmental patterns of drug involvement

OBJECTIVES

Prior research has identified developmental stages in drug use in adolescence, from substances that are legal for adults to illicit drugs. The position of crack in patterns of drug involvement remains to be established.

METHODS

The analyses are based on a sample (n = 1108) representative of 12th graders attending New York State public and private schools. From reported ages of first use of five classes of drugs (alcoholic beverages, cigarettes, marijuana, cocaine but not crack, crack), alternate models of progression were tested for their goodness of fit through log-linear models.

RESULTS

The sequence involves at the earliest stage the use of at least one licit drug, alcohol or cigarettes. Subsequent stages involve marijuana and cocaine; crack is the last drug in the sequence. The results confirm the more important role of alcohol among males and cigarettes among females in the progression into various drug classes. Age of first drug use at a lower stage is a strong predictor of further progression.

CONCLUSIONS

The developmental pattern of drug involvement identified in the early 1970s still characterizes adolescent pathways of drug involvement in the late 1980s.

[The alcohol problem in former East Germany--suggestions for necessary discussion]

Based on publications from the GDR about alcohol-problems and respecting experiences of medical and psychological examinations alcoholism, the abuse of alcohol and its effects will be analysed and discussed. The following aspects will have main attention: meaning of alcohol as a drug, consumption of alcohol and its conditions, alcohol and its consequences in traffic, employment, criminal law and leisure time. Finally open questions will be discussed and recommendation for further research work will be explained.

[Change in the drinking behavior in Central Switzerland over two decades]

Based on the medical recordings registered during blood sampling of drunken drivers of the years 1971 and 1989 the changes of drinking behaviour in Switzerland was examined. An increase of female drivers under the influence of alcohol was noted. The younger drivers under 30, which were the most represented in all the age groups, showed a decrease in the average blood alcohol value. Due to the facts, the most blood samples were taken by forensic physicians rather than private physicians a much better information was gained concerning the substances drunken and the times of drinking. The evaluation of final drinking hours, critical incidents and time of blood sampling showed a tendency to post-midnight hours.

Seasonal variation in survey and sales estimates of alcohol consumption

Time variation of drinking is substantial and has an effect on aggregate estimates of consumption. In this article it is shown that because of a considerable seasonal variation in consumption (+/- 20%) a serious bias in annual consumption estimates can be expected in surveys with a limited time frame. The present study analyzes drinking data collected in the general population of the Netherlands from March 1985 through December 1985 (including Christmas and New Year's Eve). Since it was expected that sensitivity to temporal fluctuations might not be equal for different methods of measurement, several indices of consumption were compared. Although the assessed seasonal effect varies indeed across types of measurement, across male and female subsample and across types of alcoholic beverage, the general tendency is for consumption to be highest in the spring season and lowest in the autumn. Sales figures fluctuate accordingly. It is evident that the risk of biased estimates is larger the shorter the time frame of the survey. Seasonal variation was highest in the frequency domain. Furthermore, exclusion from the time frame of collective holidays, during which people drink more often and more per occasion (viz., Christmas), increases the risk of biased estimates. Even estimates of abstention, but also regular heavy drinking among women, appear to vary considerably over the three seasons in this study. The main conclusion is that results of comparisons of survey data on drinking, particularly those over time, are more or less invalid if the respective time frames of the surveys do not correspond.

Patterns of alcohol consumption: beverage effects on gender differences

This Data Note reports findings from 22,102 current drinkers who responded in the US National Interview Survey in 1988. Mean estimated alcohol intake of males exceeded that of females by a factor of two. Males drank more per occasion (ratio 1.45) and drank on more occasion (1.41). Mean ethanol content per drink was slightly less for males (ratio 0.95) attributable to a decreased proportion of drinks being wine and liquor. When beverage preferences were taken into account, the drinking patterns of males and females showed no meaningful differences among persons with similar levels of overall ethanol intake. The results do not support the view that the difference between ethanol consumption of males and females are due primarily to males drinking more per occasion. Apparent differences in drinking patterns are attributable to differences in preferred beverage.

Patterns of alcohol consumption among the general population of Castile and Leon (Spain)

A total of 2500 individuals, aged 14-70, who live in Castile and Leon (Spain), were surveyed in the spring of 1989 with regard to their alcohol consumption and its patterns. Among those surveyed 26.2% were 'daily' drinkers and 66.0% 'weekly' drinkers. Differences of alcohol use (frequency) and intake were reviewed with regard to sociodemographic factors such as gender, age, and marital status. Beer (52.6%) was the favourite drink, with wine (20.6%) the second most commonly consumed alcohol beverage. Most of those surveyed (54.6%) were 'light' drinkers (1-39 g/day of pure alcohol), while 3.0% had an intake of over 80 g/day ('heavy' drinkers). The average age at which they started drinking was 16.2 years. The results allow a better understanding of the pattern of alcohol consumption in Spain.

Measuring alcohol abuse in the community: consumption, binge-drinking, and alcohol-related consequences ("alcoholism")

This study reported and compared community health indicators for the measurement of alcohol abuse. Using data from the 1989 Hamilton-Wentworth Health Survey, similar rates were found for four differing definitions of alcohol abuse: 1) drinking everyday (5.7%, 95% confidence limit (CL) = 3.8-7.7%), 2) drinking at least 14 drinks in the past seven days (12.1%, 95% CL = 9.2-15.1%), 3) frequent binging on 10 drinks or more (9.4%, 95% CL = 6.9-11.8%), and 4) "alcoholism" as defined by the Michigan Alcoholism Screening Test (MAST) (7.4%, 95% CL = 5.1-9.7%). Binging on five drinks or more occurred frequently (37.0, 95% CL = 32.8-41.1%). All indicators of alcohol abuse from the survey were significantly higher for males as compared to females (p < 0.05), and demonstrated varying distributions by age. Estimates of drinking consumption based on the sale of alcoholic beverages in the community were also examined and found to estimate consumption levels nearly double that of the self-reported survey data. Relevance to public health planning and monitoring is discussed.

Changing the legal minimum drinking age: results of a longitudinal study

Alcohol consumption patterns of samples of college students were examined before and after legislation to raise the minimum drinking age for "weak" beer (3.2% or less alcohol content by weight). Sampling was completed just before and immediately after inception of the law, and then each semester for a total of 4 years. These samples were compared with baseline data obtained 2 years before the legislative action. Quantity and frequency of consumption showed an increase in the sampling period just before the law change and a decrease immediately following. Overall, the quantity-frequency index remained constant, and reports of problem drinking changed very little. Some adjustments were found in drinking locations with students reporting less drinking in public places, such as bars or restaurants, and more drinking in private places, such as residence halls or homes. Policy implications of legislation designed to control drinking are discussed.

Alcohol consumption regression models for distinguishing between beverage type effects and beverage preference effects

In relating health outcomes to alcohol consumption, several investigators have evaluated differences among beverage types, but there is no consistency with respect to models used for this purpose. Furthermore, beverage type effects and beverage preference effects have not been evaluated simultaneously. In this report, the authors propose regression models which permit the simultaneous evaluation of beverage type (congener dose response) effects and beverage preference (sociobehavioral) effects. The presence of sociobehavioral effects can be established even if the variables responsible for them have not been measured or identified. The models are applied to a data set from 589 women who participated in an oral contraceptive study at the Johns Hopkins University (Baltimore, Maryland) in 1988-1989.

Nonlinear modeling of alcohol consumption for analysis of beverage type effects and beverage preference effects

In a previous report (Kimball and Friedman, Am J Epidemiol, 1992;135:1279-86), linear models for relating health outcomes to alcohol consumption were proposed for differentiating between beverage type effects and beverage preference effects. The models were applied to data relating serum high density lipoprotein cholesterol to alcohol consumption. In this report, those models are extended to the nonlinear case and are applied to data from the 1982 Maryland Hypertension Survey relating systolic blood pressure to alcohol consumption.

Reductions in cirrhosis deaths in the United States: associations with per capita consumption and AA membership

Cirrhosis mortality and morbidity rates have declined in many jurisdictions, including the U.S., in recent years. Previous research in Canada and Europe suggests that these declines are linked to changes in per capita consumption of alcohol and changes in the availability and/or utilization of services to reduce abusive drinking (e.g., treatment, Alcoholics Anonymous). In this study, changes in cirrhosis death rates in the 50 U.S. states and the District of Columbia between 1974 and 1983 were regressed onto changes in per capita consumption (1974-83). AA membership (1974-83) and alcoholism treatment (1979-82). No significant relationship between treatment and cirrhosis changes was observed; however, the measure of change in treatment may not reflect the full extent of changes that occurred in the 1974-83 period. As predicted, decreases in per capita consumption and increases in AA membership were significantly associated with decreases in cirrhosis rates.

Alcohol advertising bans and alcohol abuse: an international perspective

This paper examines the effect of banning broadcast advertising of alcoholic beverages. The data used in this study are a pooled time series from 17 countries for the period 1970 to 1983. The empirical results show that countries with bans on spirits advertising have about 16% lower alcohol consumption than countries with no bans and that countries with bans on beer and wine advertising have about 11% lower alcohol consumption than countries with bans only on spirits advertising.

Quantity-frequency measures of alcohol consumption: beverage-specific vs global questions

Estimates of alcohol consumption (ounces of absolute alcohol per day, AA) based on beverage-specific and global quantity-frequency (QF) questions were compared in a survey representative of the adult drinking population in New York State. Beverage-specific AA estimates were higher than global (0.72, 95% confidence intervals = 0.68, 0.76) compared to 0.49 (95% confidence intervals = 0.47, 0.51), although estimates were highly correlated (r = 0.75). Discrepancies between beverage specific and global AA estimates increased as the number of beverages and the amount drunk increased. Sociodemographic characteristics were not significantly related to differences between beverage-specific and global AA estimates after adjusting for the amount drunk; however, drinking patterns did influence the differences. It was concluded that beverage-specific QF questions are probably more valid measures of alcohol consumption than global QF questions, but that the global questions provide useful information. Parallel analyses of variant global QF questions employed in the first US Health and Nutrition Examination Survey obtained similar results.

Relationship between alcohol consumption and attempted suicide morbidity rates in Perth, Western Australia, 1968-1984

Per adult (greater than or equal to 15 years) consumption of beer, wine, spirits, and absolute alcohol for a 17-year period (1968-1984) was related to the attempted suicide morbidity rates in the Perth urban area of Western Australia. For both males and females aged 15-39 years, Mann-Whitney U tests showed that during the years of highest spirits consumption, the highest rates for attempted suicide occurred. A similar finding also applied to 15-39-year-old males for wine. The effect of a rapidly rising blood alcohol level, together with a preselection factor as to the personal characteristics of persons who consumed the higher alcohol content drinks, may explain the results, which need to be confirmed by clinical studies of the type of alcoholic beverage consumed by persons prior to attempting suicide.

Estimating the effect of native Indian population on county alcohol consumption: the example of Ontario

Multiple regression analysis of cross-sectional 1985-1986 Ontario county data indicated that the presence of Native Indians on reserves is a significant factor in explaining differences in county alcohol consumption levels. Consumption in counties with reserves was higher than in those without reserves by roughly 1.48 liters of absolute alcohol per adult; consumption increased as the Native reserve population increased (p less than 0.05). When income, employment, household crowding, type of industrial activity, northern isolation, and tourism were included, we could account for over 60% of the variation in alcohol consumption between Ontario counties (p less than 0.01). Every extra $1,000 in income per tax return was associated with a 0.297-liter reduction in absolute alcohol consumption. Efforts to reduce alcohol consumption in the Native population would have their greatest impact when associated with improved economic conditions.

Are women drinking more like men? An empirical examination of the convergence hypothesis

The convergence hypothesis predicts that women's drinking levels are increasing and are approaching those observed in men. To test this hypothesis, drinking practices of women and men were assessed at a large urban university at two points in time, 1977 (n = 1711) and 1985 (n = 1045). Although women's ethanol intake remained the same, significant changes in patterns of drinking were seen. The mean annual volume of beer consumed by females in 1985 showed a 33.9% increase over the mean annual volume in 1977. "Binge" drinking increased for both sexes from 1977 to 1985. A decrease in women's rate of abstention was also observed. Convergence with male drinking patterns was noted for several drinking parameters. This convergence was demonstrated by decreases in the ratios of men's drinking to women's drinking for these measures. Women consumed more wine per occasion than men in 1985. When corrections were made for differences in body fluid, the data suggested that convergence was not a trend, but had in fact occurred. The findings have serious implications, particularly in the light of recent findings that women are at greater health risk than men when they imbibe ethanol.