Perspectives in Disease Prevention and Health Promotion Sex- and Age-Specific Prevalence of Heavier Drinking in Selected States in 1985 -- The Behavioral Risk Factor Surveys

Since 1984, several states have been collecting risk factor data from adults ( 18 years of age) on a monthly basis as part of the Behavioral Risk Factor Surveillance System (1). The following analysis was based on the 22 states (including the District of Columbia) that collected data on alcohol consumption during 1985.

In this analysis, the prevalence of heavier drinking* was based on the percentage of persons who reported regularly having an average of two or more drinks (beer, wine, liquor) every day. This cut-off is not intended to identify alcohol abusers, but rather individuals who were consuming alcohol with regularity at the time of the surveys. Extensive epidemiologic research has indicated that those chronically exposed to alcohol intakes at or above this cut-off level contribute a disproportionate share of alcohol-related morbidity and mortality (2).

Table 3 presents the sex-specific prevalence of heavier drinking in the 22 states. The distribution of these prevalences is summarized in the "box-plots" (2) in Figure 1. These plots show the location of the median (50th percentile) of the distribution of state-specific prevalences, the upper and lower quartiles, and the extreme highest and lowest prevalence estimates observed among the 22 states. Figure 1 indicates that the median state-specific prevalence of heavier drinking is several fold higher in men than in women and that the large majority of state-specific prevalence estimates for men do not overlap the distribution of estimates for women. This figure also shows that the variation in state-specific prevalence estimates of heavier drinking is much greater for men than for women.

Table 4 presents the age-specific prevalence of heavier drinking among men in the 22 states. (The number of women reporting heavier drinking in the three age groups in these states was too low to allow reliable age-specific prevalence estimates for women to be produced.) In most of the states, the prevalence of heavier drinking among men declined with increasing age. The distribution of these prevalences is summarized in Figure 2, which also indicates that there is considerable overlap in the age-specific prevalence distributions of heavier drinking among men in these states. Reported by T Hughes, Office of Health Education, Arizona Dept of Health Svcs; F Capwell, Health Education-Risk Reduction Program, California Dept of Health Svcs; R Conn, EdD, Preventive Health Svcs Admin, District of Columbia Dept of Human Svcs; WW Mahoney, Health Promotion Program, Florida Dept of Health and Rehabilitative Svcs; JD Smith, Div of Public Health, Georgia Dept of Human Resources; S Jain, Div of Health Education, Indiana State Board of Health; K Bramblett, Dept of Health Svcs, Kentucky Cabinet for Human Resources; R Moon, Health Education and Promotion Program, Montana Dept of Health and Environmental Sciences; C Washington, Health Promotion Br, Div of Health Svcs, North Carolina Dept of Human Resources; E Capwell, Bur of Preventive Medicine, Ohio Dept of Health; J Fortune, Div of Health Promotion, Tennessee Dept of Health and Environment; R Anderson, Health Education Dept, West Virginia Dept of Health; DR Murray, Wisconsin Center for Health Statistics; Div of Nutrition, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: A total of 25,221 persons were interviewed by telephone in the 22 states in 1985. In this group only 7% reported regularly having two or more drinks per day. Hence, the cut-off defined by "two or more drinks per day" appears to identify a level of alcohol exposure higher than that experienced by the large majority of adults living in these states. Similar estimates of the prevalence of heavier drinking have been reported from a recent, nationally representative survey based on household-interviews (4).

Although a variety of epidemiological studies indicate that there may be some health benefits associated with moderate drinking (5), such a level of drinking is difficult to quantify for the purpose of prudent health recommendations. In addition, given the known health effects and current estimated costs of alcohol abuse in the United States, it is not possible to justify any recommendations that imply that individuals should increase their current level of alcohol consumption (5).

This report and another recent study (4) show that women have a lower prevalence of heavier drinking than men. However, recent clinical and epidemiological studies suggest that, even when women consume less alcohol than men, they experience a more rapid and severe onset of alcohol-related disease than men (6). Hence the control of heavier drinking among women should remain a priority in state-based disease prevention programs.

This report demonstrates that there is a trend among men toward lower prevalence of heavier drinking with increasing age. However, this analysis was based on cross-sectional data. Hence, the observed trend could be influenced by differential mortality of heavier drinkers as well as by differences in drinking habits related to the age cohorts chosen. It is also interesting to note that in some states the observed prevalence of heavier drinking among older men is similar to that among younger men.

The large variation in heavier drinking prevalences among men across states suggests that a single public health intervention approach may be less appropriate for men than for women. This heterogeneity may be due to differences across states in socioeconomic and cultural determinants of drinking among men, such as levels of unemployment, urbanization, or dominant social mores.

Because of the small age-specific sample sizes in the individual state's surveys, it is difficult to show the statistical significance of differences in prevalence estimates among states. However, this should not limit examination of the public health significance of marked differences in prevalence among states. For example, one-quarter of the states now report the prevalence of heavier drinking to be below 12% among men 18-34 years of age (lower quartile; Figure 2). States in the upper quartile have prevalences of heavier drinking that are half again or more in excess of this achievable level (17+%). With the establishment of the state-based Behavioral Risk Factor Surveillance System, states can now monitor changes over time in the prevalence of heavier drinking in their total populations as well as in relevant age- and sex-specific subgroups. Regular surveillance of heavier drinking allows policy makers at the state level to evaluate the progress of efforts in meeting acceptable prevalence targets.

References

1. CDC. Smoking prevalence and cessation in selected states, 1981-83 and 1985. MMWR 1986;35:740.

2. National Institute on Alcohol Abuse and Alcoholism. Fifth special report to the Congress on alcohol and health from the Secretary of Health and Human Services. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1983.

3. Velleman PF, Hoaglin DC. Applications, basics, and computing of exploratory data analysis. Boston: Duxbury Press, 1981.

4. Williams GD, Dufour M, Bertolucci D. Drinking levels, knowledge, and associated characteristics, 1985 NHIS findings. Public Health Rep 1986;101:593-8.

5. Blume S, Levy RI, Kannel WB, Takamine J. The risks of moderate drinking (Letter). JAMA 1986;256:3213-4.

6. Blume SB. Women and alcohol: a review. JAMA 1986;256:1467-70. *The category "heavier drinking" and its definition are taken from the National Institute on Alcohol Abuse and Alcoholism, which, for study purposes, classifies individuals as "abstainers" or "lighter", "moderate", or "heavier drinkers" (1).

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