Mary C. Dufour

The motivational correlates of drinking, smoking, and illicit drug use during pregnancy

Despite attempts to eliminate the consumption of alcohol, tobacco, and other substances of abuse by women of childbearing age, especially during gestation, apparently many do not curtail these negative lifestyle behaviors, as evidenced by the number of poor birth outcomes and developmentally disabled children born each year. This study examined the relationship of depression, attitude toward pregnancy, a number of sociodemographic variables, and substance use by women of child-bearing age prior to and after learning of their pregnancies. Results indicated that attitude independently, and depression independently and in interaction with socio-demographic factors are associated with substance use at both time points. From this we conclude that preventive efforts should be designed and targeted at those women who are depressed, especially those who have the sociodemographic characteristics associated with heavier substance use.

If You Drink Alcoholic Beverages Do So in Moderation: What Does This Mean?

The changes in content of the alcohol guideline of the various editions of the Dietary Guidelines for Americans from 1980 to 2000 are discussed. This is followed by a capsule summary of the history and evolution of the discipline of alcohol epidemiology compared with that of nutrition epidemiology. Methods of assessment are discussed, and issues surrounding the validity and reliability of self-report of alcohol consumption are then outlined. Relevant objectives from Healthy People 2010 are discussed. Surveillance of the alcohol guideline discloses that, at present, very few American drinkers follow the recommendations of the alcohol guideline. Indications for future research needs to address this issue conclude the discussion.

The effects of substance use during gestation on birth outcome, infant and maternal health

This study examines the relationship of substance use to birth outcome, infant, and maternal health in a large, nationally representative sample. Multiple regression analyses, accommodating the nature of the survey data using the SUDAAN software package, indicated that drinking and smoking independently and/or interactively with depression account for poor health and serious medical conditions among pregnant women as well as negative birth outcomes or adverse health consequences in those infants who are live births. In addition, African American women and their infants are more likely than those of other racial groups to suffer these adverse outcomes. Given the risk profiles of individual illnesses, this study suggests the need for developing and targeting health education and preventive efforts specific to those groups that are clearly at greater risk.

Alcohol consumption and the risk of developing liver cirrhosis: implications for future research.

Studies of the association of alcohol consumption and liver cirrhosis were reviewed, focusing on possible biases of study design. Daily alcohol consumption (as opposed to intermittent binge drinking), amount of alcohol consumed, longer duration of alcohol abuse, and being female were associated with the increased risk of cirrhosis. Follow-up studies reviewed failed to take full advantage of the study design and added little information to existing literature. Retrospective studies were relatively free of bias and are valuable tools in estimating the risk of cirrhosis. Future research needs to take the following variables into consideration: better ascertainment of alcohol consumption, consumption patterns, changes in alcohol consumption, gender, and body weight.

Genetic or cultural determinants of drinking: A study of embarrassment at facial flushing among Japanese and Japanese-Americans

Facial flushing after the ingestion of alcohol is common among Asians. Flushers are genetically less able to tolerate alcohol than nonflushers and are less likely to become alcoholics. This study examined whether lower consumption of alcohol among flushers was correlated with cultural factors such as embarrassment over flushing as well as with biological factors among Japanese in Japan and Japanese-Americans using data from a joint Japan-U.S. collaborative survey. Eight hundred forty-six Japanese and 737 Japanese-American current drinkers with known flushing status were studied. The mean alcohol intake differed significantly between groups: (1) habitat--Japanese versus Japanese-Americans, (2) flushing status--flushers versus nonflushers, and (3) embarrassment about flushing. Among men, ethnicity was the major determinant of alcohol consumption, followed by flushing status and embarrassment about flushing. Among women, differences were not significant. Lower alcohol consumption by flushers than by nonflushers has been attributed to differences in physiological reactions to alcohol. However, this study demonstrated that cultural factors such as embarrassment also contribute to lower alcohol consumption by flushers. The lack of interaction between habitat and flushing status and between habitat and embarrassment status suggests that flushing status and embarrassment status associated with drinking levels are independent of habitat.

Alcohol consumption, gender and self-reported hypertension

This study examines the relationship of alcohol consumption and self-reported lifetime prevalence of hypertension among 19,284 non-institutionalized civilians in the United States. Cross-sectional data from the 1983 National Health Interview Survey, a national probability sample, were examined for each sex separately. Women who report hypertension consumed significantly less alcohol than women who did not report hypertension. Self-reported hypertensive men consumed equal or greater amounts of alcohol than self-reported normotensive men. Alcohol consumption was significantly associated with greater risk of hypertension among men, but not among women. After controlling for other risk factors significant effects for hypertension were found among males who on average consumed more than one drink/day. Beer consumption and spirits consumption above three drinks/day were significant predictors of male hypertension after adjustment for the confounding effects of other alcoholic beverage consumption and other risk factors. This study suggests that alcohol consumption by men who know that they are hypertensive is an important public health concern, with policy implications for targeting prevention efforts.

Differential alcohol-related mortality among American Indian tribes in Oklahoma, 1968-1978

Tribal differences in alcohol-related mortality were examined among 11 Indian tribes living in Oklahoma. Data on alcohol-related deaths from 1968 to 1978 were compiled and assigned to various tribes on the basis of population distributions by county. Results showed significant differences in alcohol-related mortality among the various tribes. Of the 267,238 total deaths in Oklahoma during the study period, 9.3% of Indian deaths were alcohol-related while only 3.2% of those among blacks and 2.4% of those among whites were classified as such. Indian males and females are far more likely to die of alcohol-related deaths than their black and white counterparts. Cheyenne-Arapaho, Comanche and Kiowa areas (located in the western++ part of the state) have higher alcohol-related deaths than Cherokee, Choctaw, Creek, Seminole and Pawnee areas (located in eastern Oklahoma). Indian residents of the Seminole area have the lowest percentage of deaths identified as alcohol-related. The patterns which emerge may be due to different cultural and historical factors among the Indian tribes.

The association of drinking levels and drinking attitudes among Japanese in Japan and Japanese-Americans in Hawaii and California

This study examined cross-cultural differences in drinking attitudes and drinking levels and their correlation among Japanese in Japan and Japanese-Americans in Hawaii or California. In most situations, an increase in drinking levels was associated with more tolerant drinking attitudes in all three groups. Abstainers were less likely to say that getting drunk is sometimes all right, whereas the reverse was true for heavier drinkers. Drinking levels among Japanese, especially among Japanese women, were not highly associated with how much drinking was perceived as acceptable in each situation, whereas among Japanese-Americans, drinking levels were highly associated with drinking attitudes. Although the Japanese had generally tolerant attitudes toward drinking, they indicated higher abstention rates before driving than Japanese-Americans regardless of their drinking levels. This may reflect the impact of public education on drunken driving in Japan.