Kerr William C, Lui Camillia K, Williams Edwina, Ye Yu, Greenfield Thomas K, Lown E Anne
Alcohol Research Group, Public Health Institute, Emeryville, California.
School of Nursing, University of California, San Francisco, California.
Alcohol Clin Exp Res. 2017 Feb;41(2):388-398. doi: 10.1111/acer.13302. Epub 2017 Jan 7.
The choice and definition of a comparison group in alcohol-related health studies remains a prominent issue in alcohol epidemiology due to potential biases in the risk estimates. The most commonly used comparison group has been current abstainers; however, this includes former drinkers who may have quit drinking due to health problems. Lifetime abstention could be the best option, but measurement issues, selection biases due to health and other risk factors, and small numbers in populations are important concerns. This study examines characteristics of lifetime abstention and occasional drinking that are relevant for alcohol-related health studies.
This study used data from the National Longitudinal Survey of Youth 1979 cohort of 14 to 21 year olds followed through 2012 (n = 7,515). Definitions of abstinence and occasional drinking were constructed based on multiple measurements. Descriptive analyses were used to compare the definitions, and in further analysis, lifetime abstainers (n = 718) and lifetime minimal drinkers (n = 1,027) were compared with drinkers across demographics and early-life characteristics (i.e., religion, poverty, parental education, and family alcohol problems) in logistic regression models.
Using a strict measurement of zero drinks from adolescence to the 50s, only 1.7% of the sample was defined as lifetime abstainer compared to a broader definition allowing a total of 1 drink over the lifetime that included 9.5% and to lifetime minimal drinking (a total of 3 drinks or less a month), which accounted for 13.7%. Factors significantly associated with lifetime abstention and lifetime minimal drinking included religion, poverty, having no family alcohol problems, Hispanic ethnicity, foreign-born, and female gender. Importantly, work-related health limitations in early life were significantly associated, but not childhood physical and mental health problems.
Alcohol-related health studies should utilize lifetime classifications of drinkers and abstainers, and, in doing so, should account for early-life socioeconomic adversity and childhood health factors or consider these as unmeasured confounders.
在酒精相关健康研究中，由于风险估计存在潜在偏差，比较组的选择和定义仍是酒精流行病学中的一个突出问题。最常用的比较组是当前戒酒者；然而，这包括了可能因健康问题而戒酒的既往饮酒者。终生不饮酒可能是最佳选择，但测量问题、因健康和其他风险因素导致的选择偏差以及人群数量较少都是重要的问题。本研究考察了与酒精相关健康研究相关的终生不饮酒和偶尔饮酒的特征。
本研究使用了1979年全国青年纵向调查队列中14至21岁人群的数据，随访至2012年（n = 7515）。基于多次测量构建了戒酒和偶尔饮酒的定义。使用描述性分析来比较这些定义，在进一步分析中，在逻辑回归模型中比较了终生不饮酒者（n = 718）和终生少量饮酒者（n = 1027）与不同人口统计学和早期生活特征（即宗教、贫困、父母教育程度和家庭酒精问题）的饮酒者。
采用从青春期到50多岁零饮酒的严格测量标准，只有1.7%的样本被定义为终生不饮酒者，相比之下，更宽泛的定义允许终生总共饮用1杯酒，这一比例为9.5%，而终生少量饮酒（每月总共3杯或更少）的比例为13.7%。与终生不饮酒和终生少量饮酒显著相关的因素包括宗教、贫困、没有家庭酒精问题、西班牙裔、外国出生和女性性别。重要的是，早期与工作相关的健康限制与之显著相关，但童年时期的身心健康问题则不然。
酒精相关健康研究应采用饮酒者和不饮酒者的终生分类，这样做时应考虑早期社会经济逆境和童年健康因素，或将其视为未测量的混杂因素。
