Age, period and cohort influences on beer, wine and spirits consumption trends in the US National Alcohol Surveys

AIMS

To estimate the separate influences of age, period and cohort on the consumption of beer wine and spirits in the United States.

DESIGN

Linear age-period-cohort models controlling for demographic change with extensive specification testing. Setting US general population 1979-2000.

MEASUREMENTS

Monthly average of past-year consumption of beer, wine and spirits in five National Alcohol Surveys. Findings The strongest cohort effects are found for spirits; cohorts born before 1940 are found to have significantly higher consumption than those born after 1946, with especially high spirits consumption for men in the pre-1930s cohorts. Significant cohort effects are also found for beer with elevated consumption in the 1946-65 cohorts for men but in the pre-1940 cohorts for women. Significant negative effects of age are found for beer and spirits consumption, although not for wine. Significant period effects are found for men's beer and wine consumption and for women's spirits consumption. Increased educational attainment in the population over time is associated with reduced beer consumption and increased wine consumption.

CONCLUSIONS

Changing cohort demographics are found to have significant effects on beverage-specific consumption, indicating the importance of controlling for these effects in the evaluation of alcohol policy effectiveness and the potential for substantial improvement in the forecasting of future beverage-specific consumption trends, alcohol dependence treatment demand and morbidity and mortality outcomes.

Changes in drinking status, serious illness and mortality

OBJECTIVE

We studied the relationship of drinking and abstaining with all-cause mortality in a two-measurement-point prospective study to assess the importance of drinking change versus stability among the healthy and seriously ill.

METHOD

The National Health and Nutrition Examination Survey I (NHANES I) and follow-up of men and women (age 22-49 and 50+) at first measurement (1971-74) who survived until second measurement (1982-84) were followed in death records for 10 years (1993). Cox proportional hazards models evaluated those with and without serious illness.

RESULTS

We found no elevated mortality risk for consistent never drinkers, but consistent heavier drinkers were at higher all-cause risk among men. Groups of abstainers significantly differed for mortality risk, and illness was implicated in these differences. New drinkers who formerly abstained did not improve their chances for longevity. Heavier drinking men who decreased consumption increased their chances for survival.

CONCLUSIONS

Abstinence per se is not a risk factor for all-cause mortality, but heavier drinking is a risk factor among men. Adoption of drinking among former abstainers does not improve chances for survival. Reduction in consumption among heavier drinking men improves chances for survival.

Tracking alcohol consumption over time

Researchers are tracking long-term changes in alcohol consumption and related behaviors or outcomes in order to detect trends in the entire population or certain subgroups, test models of alcohol-related outcomes, and understand the consequences of interventions. Such analyses must consider the complexity of typical lifetime consumption patterns. Major approaches to measuring alcohol consumption over time include aggregate measures of consumption (e.g., sales data), cross-sectional surveys, and longitudinal or panel surveys. When analyzing the data, researchers must try to ensure the comparability of measurements over time. The stability of various measures and the potential for combining different types of data are also important considerations when tracking alcohol consumption over time. If these requirements are met, the regular collection of data on aspects of alcohol consumption will greatly increase researchers' understanding of the forces influencing a population's alcohol consumption and its consequences.

The average ethanol content of beer in the U.S. and individual states: estimates for use in aggregate consumption statistics

OBJECTIVE

The purpose of this study is to describe the variation in the ethanol content of beer and specific categories of beer, and to illustrate the importance of accurate assessment of ethanol conversion factors for the calculation of apparent ethanol consumption from beer at the state and national levels in the U.S.

METHOD

Published sources of brand-level ethanol content, national brand share of beer categories and state beer category market shares are utilized to (1) estimate the mean ethanol content of each beer category in the U.S. for 1995 and 2000, (2) calculate per capita apparent consumption of ethanol from beer for 1995 and 2000 and for each state in 2000 and (3) describe trends in ethanol content for specific beer brands during the 1990s.

RESULTS

The mean ethanol content of beer in the U.S. is found to increase from 4.33% (by volume) in 1995 to 4.66% in 2000. Using these estimates, per capita ethanol from beer is found to increase from 1.386 gallons in 1995 to 1.468 gallons in 2000. Use of a constant ethanol conversion, however, indicates a decrease. Application of ethanol content estimates to state-level per capita consumption for 2000 changes the relative rankings of 28 states, compared to the use of a constant 4.5% ethanol conversion.

CONCLUSIONS

Improved ethanol conversion factor estimates are found to influence both time trends and the cross-sectional ranking of states, suggesting that analyses of both cross-sectional and time series aggregate ethanol consumption data that fail to consider variation in the ethanol content of beer may be biased.

Stability of alcohol consumption over time: evidence from three longitudinal surveys from the United States

OBJECTIVE

To assess the stability of individual monthly alcohol consumption volume in three studies from the United States: The first National Health and Nutrition Examination Survey with three measurements, The Framingham Offspring and Spouse Cohort with four measurements, and the National Longitudinal Survey of Youth with six measurements. The results will aid in the interpretation of studies that assess consumption at one point only.

METHOD

Five analyses measure (1) the amount of change between measurements, (2) the correlation between reported consumption, (3) patterns of later drinking by the baseline group, (4) mean consumption of abstainers when they drink and heavy drinkers when not drinking heavily and (5) the strength of past consumption in predicting present consumption.

RESULTS

Correlations between measurements are high for adult samples 5 years apart or less but low for longer follow-ups and younger samples. Heavy drinkers are much less stable than abstainers or moderate drinkers. Abstainers at one time who drink at another drink much less than the mean. One time heavy drinkers are close to the consumption mean of the entire sample when not heavy but two or more time heavy drinkers drink more than the mean when not heavy. An autoregressive, rather than Markov, model of consumption change is supported.

CONCLUSIONS

Aspects of both stability and change are found. Baseline measures of drinking groups are especially unreliable for younger samples, longer follow-ups and heavier drinkers. There appear to be important subgroups moving between abstention and light drinking and moderate and heavy drinking that can be identified only by multiple measurements or retrospective measures.

Solution of Kramers' problem for a moderately to heavily damped elastic string

We obtain the nucleation rate of critical droplets for an elastic string moving in a double-well potential and subject to noise and damping forces. We obtain this rate for a class of potentials that includes both the asymmetric straight phi(4) and the straight phi(6) potentials. The frequencies of small oscillations about the critical droplet are obtained from a Heun equation. We solve the Fokker-Planck equation for the phase-space probability density by projecting onto the eigenfunction basis. We present a comparison with simulations for the case of the asymmetric straight phi(4) potential.

Beverage-specific alcohol consumption and cirrhosis mortality in a group of English-speaking beer-drinking countries

AIMS

To compare beverage-specific per capita consumption and total alcohol consumption's associations with cirrhosis mortality rates in multiple countries.

DESIGN

Pooled cross-sectional time-series analysis.

SETTING

Australia, Canada, New Zealand, the United Kingdom and the United States during the years 1953-1993.

MEASUREMENTS

National level data on per capita total alcohol, beer, wine and spirits consumption and standardized all-cause cirrhosis mortality rates.

FINDINGS

Significant associations with cirrhosis mortality are found for both total ethanol and spirits. Spirits consumption is found to make up the majority of the effect of alcoholic beverage consumption on cirrhosis mortality and the model including only spirits is found to fit the data at least as well as the model including only total ethanol consumption. The lag relationship between all alcohol types and cirrhosis is found to be short with only present and 1 year's lagged consumption having significant associations.

CONCLUSIONS

Spirits consumption rather than beer or wine is associated with cirrhosis mortality in this group of primarily beer-drinking countries. This finding offers important clues to understanding the drinking behaviors associated with cirrhosis mortality on the individual level.

Cirrhosis mortality and per capita consumption of distilled spirits, United States, 1949-94: trend analysis

OBJECTIVE

To describe, evaluate, and suggest interpretations for an observed aggregate level relation between trends in mortality from cirrhosis and per capita consumption of distilled spirits in the United States.

DESIGN

Trend analysis using data on US cirrhosis mortality and per capita alcohol consumption.

RESULTS

There is a consistent long term trend relation between mortality from cirrhosis and per capita consumption of distilled spirits in the United States from 1949 to 1994. Two instances of comparatively sharp drops in the consumption of spirits earlier in the 1940s generated mixed results in predicting changes in cirrhosis mortality.

CONCLUSIONS

An aggregate level relation between trends in long term cirrhosis mortality and the consumption of spirits falls considerably short of establishing a direct causal link between the two for individuals. Moreover, two sharp drops in the consumption of spirits generated only mixed results with respect to the short term trend in cirrhosis. Nevertheless, the observed relation between the consumption of spirits and cirrhosis mortality merits further investigation.

Cirrhosis mortality and per capita consumption of distilled spirits, United States, 1949-1994: trend analysis

OBJECTIVE

To describe, evaluate, and suggest interpretations for an observed aggregate-level relation between trends in mortality from cirrhosis and per capita consumption of distilled spirits in the United States.

DESIGN

Trend analysis using data on US cirrhosis mortality and per capita alcohol consumption.

RESULTS

There is a consistent long-term trend relation between mortality from cirrhosis and per capita consumption of distilled spirits in the United States from 1949 to 1994. Two instances of comparatively sharp drops in the consumption of spirits in the 1940s generated mixed results in predicting changes in cirrhosis mortality.

CONCLUSIONS

An aggregate-level relation between trends in long-term cirrhosis mortality and the consumption of spirits falls considerably short of establishing a direct causal link between the two for individuals. Moreover, two sharp drops in the consumption of spirits generated only mixed results with respect to the short-term trend in cirrhosis. Nevertheless, the observed relation between the consumption of spirits and cirrhosis mortality merits further investigation.

Temperature and domain size dependence of sickle cell hemoglobin polymer melting in high concentration phosphate buffer

Deoxygenated sickle cell hemoglobin (Hb S) in 1.8 M phosphate buffer, and carbon monoxide (CO) saturated buffer were rapidly mixed using a stopped-flow apparatus. The binding of the CO to the Hb S polymers and the polymer melting was measured by time resolved optical spectroscopy. Polymer melting was associated with decreased turbidity, and CO binding to deoxy-Hb S was monitored by observation of changes in the absorption profile. The reaction temperature was varied from 20 degrees C to 35 degrees C. Polymer domain size at 20 degrees C was also varied. The data for mixtures involving normal adult hemoglobin (Hb A) fit well to a single exponential process whereas it was necessary to include a second process when fitting data involving Hb S. The overall Hb S-CO reaction rate decreased with increasing temperature from 20 degrees C to 35 degrees C, and increased with decreasing domain size. In comparison, Hb A-CO reaction rates increased uniformly with increasing temperature. Two competing reaction channels in the Hb S-CO reaction are proposed, one involving CO binding directly to the polymer and the other involving CO only binding to Hb molecules in the solution phase. The temperature dependence of the contribution of each pathway is discussed.

Increased ventilation in runners during running as compared to walking at similar metabolic rates

At similar levels of carbon dioxide production (VCO2) and oxygen consumption (VO2), runners have been shown to have a greater minute ventilation (VE) during running as compared to walking. The mechanism responsible for these differences has yet to be identified. To determine if these differences are a result of differences in acid-base status, potassium (K+), norepinephrine and/or epinephrine levels, seven well-trained runners completed walk and run tests at similar VO2 and VCO2 levels. The occurrence of entrainment of the breathing and stride frequencies during both walking and running was also determined. VE was significantly greater during the run as compared to the walk, 73.7 (2.2) versus 68.6 (2.0) l.min-1, respectively, despite the similarity in VO2 and VCO2 levels. Alveolar ventilation was not significantly different between the run and the walk, 60.4 (4.7) versus 59.6 (4.4) l.min-1, respectively. Dead space ventilation was found to be significantly greater during running as compared to walking, 13.3 (3.2) versus 9.0 (4.7) l.min-1, respectively. The increases in VE were due to increases in breathing frequency and decreases in tidal volume during the run as compared to the walk. Arterial partial pressures of CO2 (PaCO2) were not significantly different when comparing walking and running to rest values nor when comparing walking and running. Arterial pH was significantly lower during walking as compared to rest and running. Bicarbonate levels were significantly lower during walking as compared to rest. Lactate was significantly greater during walking as compared to rest and to running. K+ levels were significantly higher during walking and running as compared to rest. Epinephrine and norepinephrine levels were not significantly different between running and walking. During the walk, six of the seven subjects entrained their breathing frequency to the stride frequency, and during the run three of the seven subjects demonstrated entrainment. Results from this investigation do not support mediation of VE under the present experimental conditions by changes in arterial levels of humoral factors previously shown to influence VE.

The importance of physical illness in psychiatric breakdown

This paper gives an indication of the importance of physical disease in contributing to psychiatric admission. The study was conducted in a situation in which the psychiatric unit dealt with all the psychiatric referrals and admissions for a fairly circumscribed population. Most admissions were made at the request of general practitioners who had equally easy access to either psychiatric or medical beds. The figures suggest that undervalued or unsuspected physical illness is particularly important in the apparent psychiatric breakdown of middle aged men.