Patterns of alcohol consumption among African Americans are more deadly

January 14, 2003

Many people have heard about the protective health effects of moderate alcohol consumption, usually in relation to red wine. This association is part of what researchers call a "J-shaped" relationship: moderate drinkers show a lower mortality risk than lifetime abstainers, and heavy drinkers show a higher mortality risk than both of the other groups. A study in the January issue of Alcoholism: Clinical & Experimental Research finds that alcohol consumption does not seem to have protective effects for African Americans, and its authors suggest this may be due to different drinking patterns, specifically, binge drinking.

"One of the most discussed findings in alcohol epidemiology is the J-shaped curve," said Christopher T. Sempos, professor and director of graduate studies in the department of social and preventive medicine at the University of Buffalo, and corresponding author for the study. "Essentially, what it tells us is that some kind of drinking is beneficial to health. In our study, however, this beneficial effect could not be found in African Americans, even when using the same study where the beneficial effect had been found for whites. We believe that patterns of drinking - that is, the style of how alcohol is consumed - explain the differences between African Americans and whites. For example, somebody can have an average moderate volume by drinking heavily once or twice a week."

From 1971 to 1975, the first National Health and Nutrition Examination Survey (NHANES I) collected data on 14,407 adults who were 25 to 75 years of age during this time. Follow-up surveys were conducted in four waves: 1982 to 1984, 1986, 1987 and 1992. Data for this study - the NHANES Epidemiologic Follow-up Study (NHEFS) - were collected as part of the 1992 wave, and comprise approximately 20 years of follow-up data. Researchers focused in particular on data collected for 2,054 African Americans (768 men, 1,286 women).

"This study clearly demonstrates an absence of a protective effect at lower volumes of consumption in a large sample of African Americans followed over a long period of longitudinal follow up," said Tom Greenfield, center director at the Alcohol Research Group. "Given that the protective effect of the J-shaped mortality curve is seen in the same large NHANES/NHEFS study for white respondents, the absence of this effect in the African Americans is striking. The study also confirms earlier findings that African Americans evidenced drinking less often but in larger amounts than the white respondents - a biologically less protective pattern."

"Basically, all alcohol has the same risk associated with it," added Sempos, "with no differences between beverage types, once alcohol content is the same. There are, however, cultural differences in consumption. For example, grape wine is most often consumed moderately and regularly with meals. If consumed in irregular binges outside meals, however, the same amount of alcohol may be much more detrimental. In fact, such a drinking style has no beneficial health outcomes. We know that African Americans have more binge drinking than whites or Hispanics. In addition, in some subgroups, such as those that are socioeconomically disadvantaged, special kinds of drinks like Malt Liquor that come in large serving sizes prevail."

Approximately two decades ago, Greenfield explained, the major ethnic groups in the United States consumed alcohol at comparable levels. However, "during the late 1980s and early 1990s, as the country experienced a 'drying' trend, there is good evidence that frequent heavy drinking fell among white men and women but not so among African American and Hispanic individuals," he said. In addition, other researchers have found evidence that because of larger containers and higher alcohol content products marketed to African Americans, these surveys may even underestimate the heavy quantities consumed by ethnic minorities. These factors are just some of those that help explain the higher risks of liver cirrhosis, for example, among African American and Hispanic populations compared to whites."

Both Sempos and Greenfield recommend that alcohol policy, which currently focuses on reducing average volume of drinking, instead should focus on drinking patterns (such as intermittently heavy drinking) among certain populations.

"For African Americans in particular," said Greenfield, "we need to develop evidence-based interventions, health messages and other prevention programs that will reinforce the acceptability of drinking in smaller amounts while emphasizing the health and social harms of drinking larger amounts.
Co-authors of the Alcoholism: Clinical & Experimental Research paper included: Jürgen Rehm of the Centre for Addiction and Mental Health in Toronto, and the Addiction Research Institute in Zurich; and Tiejian Wu, Carlos J. Crespo, and Maurizio Trevisan of the Department of Social and Preventive Medicine at the University of Buffalo (Dr. Wu is currently at the Department of Public Health at East Tennessee State University). The study was funded by funded by the University of Buffalo in New York state, the Centre for Addiction and Mental Health in Toronto, and the Addiction Research Institute in Zurich.

Alcoholism: Clinical & Experimental Research

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